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ER Exam 2 > Placenta and Fetal Membranes > Flashcards

Placenta and Fetal Membranes Flashcards

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1
Q

In week 1, the formation of ___ gives rise to the embryo.

A

Inner Cell Mass

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2
Q

In week 2, formation of ____ gives rise to the placenta.

A

Trophoblast

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3
Q

What is the stem cell layer of week 1? What else is special about it?

A

Cytotrophoblast, mitotically active

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4
Q

What layer of the trophoblast releases hCG?

A

Syncytiotrophoblast

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5
Q

What does hCG signal?

A

Initial signal of pregnancy

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6
Q

What occurs on day 6 of fertilization?

A

Syncytiotrophoblast has released proteolytic enzymes for embryo to start to implant

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7
Q

Formation of the bilaminar disc occurs in what week?

A

Week 2

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8
Q

What layer of the bilaminar disc does the amnion and amniotic cavity derive from?

A

Epiblast

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9
Q

What does the decidua reaction occur in response to?

A

Syncytiotrophoblast burrowing into the endometrial lining

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10
Q

What occurs during the decidua reaction?

A

Endometrial changes to provide glycogen and nutrients as well as an immunologically privileged site for embryo (prevent rejection)

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11
Q

What does the extraembryonic somatic mesoderm line?

A

Trophoblast and covers amnion

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12
Q

What does the extraembryonic splanchnic mesoderm line?

A

Yolk sac/umbilical vesicle

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13
Q

What is the connecting stalk derived from?

A

Extraembryonic somatic mesoderm

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14
Q

What does the hypoblast give rise to?

A

Primary and secondary yolk sac

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15
Q

What are the three layers of the chorion?

A

Extraembryonic somatic mesoderm

Cytotrophoblast

Syncytiotrophoblast

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16
Q

What is produced in excessive amounts in a hydatidiform mole?

A

Abnormal trophoblastic proliferation => excess hCG

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17
Q

What does a complete hydatidiform mole result from?

A

Fertilization of empty oocyte by 1 sperm that duplicates or by 2 separate sperm => 46 chromosomes, all paternal

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18
Q

What does a partial hydatidiform mole result from?

A

Fertilization of normal oocyte by 2 sperm => 69 chromosomes, part mom part dad

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19
Q

What is the big symptom of a hydatidiform mole?

A

Hyperemesis gravidarum (morning sickness) from the excess hCG

(also present with vaginal bleeding, pelvic pain, enlarged uterus)

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20
Q

If a hydatidiform mole becomes malignant, what can result?

A

A choriocarcinoma - malignant

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21
Q

What makes up the fetal part of the placenta?

A

Chorionic sac

Amnion

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22
Q

What makes up the maternal part of the placenta?

A

Decidual basalis

Decidua Capsularis

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23
Q

What are the 3 sources of amniotic fluid?

A

Amnion

Fetal urine

Maternal circulation

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24
Q

What is the composition of amniotic fluid?

A

Ions and small molecules

Glycophospholipids

Steroids

Particulates/cells from embryo

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25
Q

What are the functions of the amniotic fluid?

A

Cushions against injury

Maintains temperature

Ease of movement

Diagnostic information

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26
Q

Renal agenesis in the developing embryo can cause what to happen during pregnancy?

A

Oligohydramnios (no kidneys to produce fetal urine)

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27
Q

What are the common causes of oligohydramnios?

A

Renal agenesis

Placental insufficiency

Premature rupture of membranes

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28
Q

Polyhydramnios during pregnancy can result from failure of what?

A

Fetal swallowing

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29
Q

What are the common causes of polyhydramnios?

A

Anencephaly

Esophageal atresia

Maternal diabetes

Multifetal gestations

Hypoplastic lungs (can be for both oligo and poly)

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30
Q

What occurs during amniotic band syndrome?

A

Portions of amnion are sloughed off and wrap around extremities to cause amputation

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31
Q

What is an exogenous cause of amniotic band syndrome?

A

Trauma to amnion => delamination

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32
Q

What is an endogenous cause of amniotic band syndrome?

A

Poor vascular supply causes necrosis of amnion => delamination

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33
Q

When are primary chorionic villi formed?

A

Days 13-14

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34
Q

When are secondary chorionic villi formed?

A

Day 15-18

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35
Q

What is the difference between a primary and secondary chorionic villus?

A

Secondary have all 3 layers (Extraembryonic mesoderm, cytotrophoblast, and syncytiotrophoblast), primary only has trophoblastic layers

36
Q

What does the trophoblast lacuna give rise to?

A

Intervillous space filled with maternal blood

37
Q

What is the significance of the cytotrophoblastic shell?

A

Serves as interface between mom and fetus

38
Q

When are tertiary chorionic villi formed?

A

Days 19-21 (End of week 3)

39
Q

What does the extraembryonic mesoderm give rise to in a tertiary chorionic villus?

A

Villous capillaries

40
Q

What do the stem/anchoring villi connect to in the intervillous space?

A

Cytotrophoblastic shell (at the apex of the villus, towards maternal side)

41
Q

What is the purpose of the chorionic villi?

A

Nutrient and gas exchange between mother and fetus

42
Q

In what week does the chorionic villi cover the chorionic sac?

A

Week 8

43
Q

Where is the decidua basalis in the endometrium?

A

Deep to the conceptus (embryo)

44
Q

Where is the decidua capsularis in the endometrium?

A

Superficial part of decidua overlying conceptus (its coat)

45
Q

Where is the decidua parietalis in the endometrium?

A

Walls of uterus, everywhere that is not part of the basalis and capsularis

46
Q

What is the smooth chorion formed from?

A

Decidua capsularis that has been flattened by the growing embryo

47
Q

After formation of the smooth chorion, what is the fate of the decidua capsularis?

A

Fuses with the decidua parietalis and degenerates from lack of blood supply

48
Q

After degeneration of the decidua capsularis, what is the fate of the smooth chorion?

A

Fuses with decidua parietalis

49
Q

After fusion of the smooth chorion with the decidua basalis, what space is obliterated?

A

Uterine cavity (now filled with embryo)

50
Q

What is the dividing line between early placental layers and late placental layers?

A

Week 20

51
Q

What placental layers must gas and nutrients travel through prior to week 20?

A

Syncytiotrophoblast

Cytotrophoblast

Villi connective tissue

Endothelium of fetal capillaries

52
Q

What are the placental layers gas and nutrients must travel through after week 20?

A

Syncytiotrophoblast

Vasculosyncytial basement membrane

Endothelium of fetal capillaries

53
Q
A

DC: Decidual cells

DB: Decidual Basalis

AV: Anchoring chorionic villi

IS: Intervillous space

N: Nuclei

TV: Terminal Villi

54
Q
A

Me: Mesoderm

ST: Syncytial trophoblasts

TV: Terminal Villi

SK: Syncytial Knots

Ca: Capillaries

IS: Intervillous space

55
Q

When was this slide taken? What are the numbers labelled?

A

Midterm placenta

10: Intervillous space
11: Syncytiotrophoblast
12: Trophoblastic bud
13: Cytotrophoblast
14: Hofbauer cells

56
Q

When was this slide taken? What are the labelled numbers?

A

3rd week - secondary villus

7: Mesodermal core
8: Cytotrophoblast cells
9: Syncytiotrophoblast

57
Q

When was this slide taken? What is labelled?

A

Full term placenta

1: Chorionic villi
2: Intervillous space
3: Umbilical V.
4: Syncytiotrophoblast
5: Cytotrophoblast (remnant cells)
6: Placental macrophages (Hofbauer cells)

58
Q

What are Hofbauer cells and where are they found?

A

Placental macrophages

Found in the terminal/branching villi, found between syncytiotrophoblast and cytotrophoblast

59
Q

What are cotyledon?

A

Main stem villi and all branches that appear as lobules on the maternal side of the placenta

60
Q

What is this? What is labelled?

A

Amniotic placental surface

A: Amnion

CP: Chorionic plate

CV: Chorionic villi

61
Q

What is this? What is labelled?

A

Maternal placental surface

DC: Decidual cells, only if decidua basalis present (not on the amniotic side)

62
Q

What is placenta accreta?

A

Abnormal adherence of chorionic villi to myometrium

63
Q

What is Placenta Increta?

A

Chorionic villi penetrate into the myometrium

More severe than placenta

64
Q

What is placenta percreta?

A

Chorionic villi penetrate through the myometrium to uterine serosa or adjacent organs

Most severe - placenta will not release during childbirth => hemorrhage

65
Q

What is the typical treatment for placenta percreta?

A

Hysterectomy, partial removal of uterus

66
Q

How does placenta previa prevent?

A

Vaginal bleeding beyond 20 weeks gestation

67
Q

How should antepartum bleeding be evaluated?

A

Ultrasound BEFORE digital vaginal exam (can cause hemorrhage)

68
Q

What can cross the placenta?

A

Nutrients (water, clucose, AAs, vitamins)

Hormones (steroid and thyroid hormones)

Ab (IgG, urea/uric acid, conjugated bilirubin)

Most drugs

Infectious agents (viruses)

69
Q

What cannot cross the placenta?

A

Protein hormones (insulin, pituitary hormone)

Ab (IgD, IgM, IgA, IgE)

Heparin

Bacteria

70
Q

How does hemolytic disease of the newborn develop?

A

Rh+ father and Rh- mother have a child => Rh+ baby’s blood enters mother’s bloodstream => mother develops Ab for the Rh+ baby => Rh Ab attack baby’s blood cells (Baby 2, not baby 1)

71
Q

Which maternal Ab are attacking the Rh+ fetus?

A

IgG

72
Q

What is a mild presentation of hemolytic disease of the newborn?

A

Hyperbilirubinemia in first 24 hours of life

Symptomatic anemia (lethargy or tachycardia) but without signs of circulatory collapse

73
Q

What is a severe presentation of hemolytic disease of the newborn?

A

Hydrops fetalis

Skin edema

Pleural or pericardial effusion

Ascites

74
Q

What layer does the allantois arise from?

A

Endoderm

75
Q

What is the function of the allantois?

A

Provide template for umbilical arteries and vein

Becomes urachus

76
Q

What makes up the core of the umbilical cord?

A

Extraembryonic mesoderm

77
Q

How many arteries/veins in the umbilical cord?

A

2 Umbilical As.

1 Umbilical V.

78
Q

What is the outer covering of the umbilical cord?

A

Amnion

79
Q

What travels through the umbilical cord?

A

2x Umbilical As.

Umbilical V.

Allantois

Vitello-intestinal duct

Extraembryonic coelom

80
Q

What is a consequence of a true umbilical knot?

A

Prevents blood flow to the fetus => fatal

81
Q

What is the clinical significance of an absent umbilical A.?

A

15-20% incidence of CV defects

Chromosoma/fetal abnormalities

82
Q

In MZ twins, if the fertilized egg split at Day 2, what layers surround the resulting twins? How frequently does this occur?

A

2x amnion

2x Chorion

2x Placenta

25% of cases

83
Q

In MZ twins, if the fertilized egg split at 4 days, what are the layers surrounding the twins? How frequently does this occur?

A

2x Amnion

1 Chorion

1 Placenta

75% of cases

84
Q

In MZ twins, if the fertilized egg split in week 2, what are the layers surrounding the twins?

A

1 amnion

1 chorion

1 placenta

85
Q

When is the embryo thought to have split in the case of conjoined twins?

A

In week 3, after formation of the primitive streak

ER Exam 2 (16 decks)

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