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ER Exam 2 > Placenta and Fetal Membranes > Flashcards

Placenta and Fetal Membranes Flashcards

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
What are the functions of the amniotic fluid?
Cushions against injury Maintains temperature Ease of movement Diagnostic information
26
Renal agenesis in the developing embryo can cause what to happen during pregnancy?
Oligohydramnios (no kidneys to produce fetal urine)
27
What are the common causes of oligohydramnios?
Renal agenesis Placental insufficiency Premature rupture of membranes
28
Polyhydramnios during pregnancy can result from failure of what?
Fetal swallowing
29
What are the common causes of polyhydramnios?
Anencephaly Esophageal atresia Maternal diabetes Multifetal gestations Hypoplastic lungs (can be for both oligo and poly)
30
What occurs during amniotic band syndrome?
Portions of amnion are sloughed off and wrap around extremities to cause amputation
31
What is an exogenous cause of amniotic band syndrome?
Trauma to amnion =\> delamination
32
What is an endogenous cause of amniotic band syndrome?
Poor vascular supply causes necrosis of amnion =\> delamination
33
When are primary chorionic villi formed?
Days 13-14
34
When are secondary chorionic villi formed?
Day 15-18
35
What is the difference between a primary and secondary chorionic villus?
Secondary have all 3 layers (Extraembryonic mesoderm, cytotrophoblast, and syncytiotrophoblast), primary only has trophoblastic layers
36
What does the trophoblast lacuna give rise to?
Intervillous space filled with maternal blood
37
What is the significance of the cytotrophoblastic shell?
Serves as interface between mom and fetus
38
When are tertiary chorionic villi formed?
Days 19-21 (End of week 3)
39
What does the extraembryonic mesoderm give rise to in a tertiary chorionic villus?
Villous capillaries
40
What do the stem/anchoring villi connect to in the intervillous space?
Cytotrophoblastic shell (at the apex of the villus, towards maternal side)
41
What is the purpose of the chorionic villi?
Nutrient and gas exchange between mother and fetus
42
In what week does the chorionic villi cover the chorionic sac?
Week 8
43
Where is the decidua basalis in the endometrium?
Deep to the conceptus (embryo)
44
Where is the decidua capsularis in the endometrium?
Superficial part of decidua overlying conceptus (its coat)
45
Where is the decidua parietalis in the endometrium?
Walls of uterus, everywhere that is not part of the basalis and capsularis
46
What is the smooth chorion formed from?
Decidua capsularis that has been flattened by the growing embryo
47
After formation of the smooth chorion, what is the fate of the decidua capsularis?
Fuses with the decidua parietalis and degenerates from lack of blood supply
48
After degeneration of the decidua capsularis, what is the fate of the smooth chorion?
Fuses with decidua parietalis
49
After fusion of the smooth chorion with the decidua basalis, what space is obliterated?
Uterine cavity (now filled with embryo)
50
What is the dividing line between early placental layers and late placental layers?
Week 20
51
What placental layers must gas and nutrients travel through prior to week 20?
Syncytiotrophoblast Cytotrophoblast Villi connective tissue Endothelium of fetal capillaries
52
What are the placental layers gas and nutrients must travel through after week 20?
Syncytiotrophoblast Vasculosyncytial basement membrane Endothelium of fetal capillaries
53
DC: Decidual cells DB: Decidual Basalis AV: Anchoring chorionic villi IS: Intervillous space N: Nuclei TV: Terminal Villi
54
Me: Mesoderm ST: Syncytial trophoblasts TV: Terminal Villi SK: Syncytial Knots Ca: Capillaries IS: Intervillous space
55
When was this slide taken? What are the numbers labelled?
Midterm placenta 10: Intervillous space 11: Syncytiotrophoblast 12: Trophoblastic bud 13: Cytotrophoblast 14: Hofbauer cells
56
When was this slide taken? What are the labelled numbers?
3rd week - secondary villus 7: Mesodermal core 8: Cytotrophoblast cells 9: Syncytiotrophoblast
57
When was this slide taken? What is labelled?
Full term placenta 1: Chorionic villi 2: Intervillous space 3: Umbilical V. 4: Syncytiotrophoblast 5: Cytotrophoblast (remnant cells) 6: Placental macrophages (Hofbauer cells)
58
What are Hofbauer cells and where are they found?
Placental macrophages Found in the terminal/branching villi, found between syncytiotrophoblast and cytotrophoblast
59
What are cotyledon?
Main stem villi and all branches that appear as lobules on the maternal side of the placenta
60
What is this? What is labelled?
Amniotic placental surface A: Amnion CP: Chorionic plate CV: Chorionic villi
61
What is this? What is labelled?
Maternal placental surface DC: Decidual cells, only if decidua basalis present (not on the amniotic side)
62
What is placenta accreta?
Abnormal adherence of chorionic villi to myometrium
63
What is Placenta Increta?
Chorionic villi penetrate into the myometrium More severe than placenta
64
What is placenta percreta?
Chorionic villi penetrate through the myometrium to uterine serosa or adjacent organs Most severe - placenta will not release during childbirth =\> hemorrhage
65
What is the typical treatment for placenta percreta?
Hysterectomy, partial removal of uterus
66
How does placenta previa prevent?
Vaginal bleeding beyond 20 weeks gestation
67
How should antepartum bleeding be evaluated?
Ultrasound BEFORE digital vaginal exam (can cause hemorrhage)
68
What can cross the placenta?
Nutrients (water, clucose, AAs, vitamins) Hormones (steroid and thyroid hormones) Ab (IgG, urea/uric acid, conjugated bilirubin) Most drugs Infectious agents (viruses)
69
What cannot cross the placenta?
Protein hormones (insulin, pituitary hormone) Ab (IgD, IgM, IgA, IgE) Heparin Bacteria
70
How does hemolytic disease of the newborn develop?
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
Which maternal Ab are attacking the Rh+ fetus?
IgG
72
What is a mild presentation of hemolytic disease of the newborn?
Hyperbilirubinemia in first 24 hours of life Symptomatic anemia (lethargy or tachycardia) but without signs of circulatory collapse
73
What is a severe presentation of hemolytic disease of the newborn?
Hydrops fetalis Skin edema Pleural or pericardial effusion Ascites
74
What layer does the allantois arise from?
Endoderm
75
What is the function of the allantois?
Provide template for umbilical arteries and vein Becomes urachus
76
What makes up the core of the umbilical cord?
Extraembryonic mesoderm
77
How many arteries/veins in the umbilical cord?
2 Umbilical As. 1 Umbilical V.
78
What is the outer covering of the umbilical cord?
Amnion
79
What travels through the umbilical cord?
2x Umbilical As. Umbilical V. Allantois Vitello-intestinal duct Extraembryonic coelom
80
What is a consequence of a true umbilical knot?
Prevents blood flow to the fetus =\> fatal
81
What is the clinical significance of an absent umbilical A.?
15-20% incidence of CV defects Chromosoma/fetal abnormalities
82
In MZ twins, if the fertilized egg split at Day 2, what layers surround the resulting twins? How frequently does this occur?
2x amnion 2x Chorion 2x Placenta 25% of cases
83
In MZ twins, if the fertilized egg split at 4 days, what are the layers surrounding the twins? How frequently does this occur?
2x Amnion 1 Chorion 1 Placenta 75% of cases
84
In MZ twins, if the fertilized egg split in week 2, what are the layers surrounding the twins?
1 amnion 1 chorion 1 placenta
85
When is the embryo thought to have split in the case of conjoined twins?
In week 3, after formation of the primitive streak

ER Exam 2 (16 decks)

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