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OB-GYN > Placenta & Immunology > Flashcards

Placenta & Immunology Flashcards

1
Q

The infant is dependent on the placenta for what functions?

A

Pulmonary, Hepatic, Renal

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2
Q

Maternal blood spurts from the __________ into the placental intervillous space and bathes the outer syncytiotrophoblasts

A

uteroplacental vessels

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3
Q

True or False: Fetal and maternal blood are not mixed in this hemochorial placenta

A

True

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4
Q

Where does the human placental formation begin?

A

Trophectoderm aka Morula

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5
Q

What is the invasive fxn of the trophoblast?

A

promotes implantation

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6
Q

What is the endocrine fxn of the trophoblast?

A

Endocrine function: maternal physiological adaptations, pregnancy maintenance

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7
Q

8th day after fertilization, what cells are formed on the outside. These are multinucleated

A

Syncitiotrophoblast

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8
Q

8th day after fertilization, what cells are formed on the inside. These are Germinal cells for syncytium and there is a well-demarcated cell border, single nucleus, undergoes DNA synthesis and mitosis

A

Cytotrophoblast

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9
Q

After implantation, trophoblasts differentiate further along two main pathways. What are these 2?

A

Villous Trophoblast & Exravillous Trophoblast

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10
Q

What is the function of Villous trophoblast?

A

It gives rise to CHORIONIC VILLI, which primarily transports oxgen, nutrients and other compounds bet mother and baby

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11
Q

The extravillous trophoblast is further differentiated into what? (2)?

A

Interstitial Trophoblast & Endovascular Trophoblast

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12
Q

Fxn of Interstitial Trophoblast

A

invade decidua and penetrate myometrium to form PLACENTAL BED GIANT CELLS. They also surround spiral arteries

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13
Q

Fxn of Endovascual Trophoblast

A

penetrate spiral artery LUMEN. Converts it from narrow-lumen, muscular spiral arteries into DILATED, LOW-RESISTANCE UTEROPLACENTAL VESSELS

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14
Q

by the 10th day… Blastocyst becomes totally encased within the _________

A

Endometrium.

Embryo enlarges -> more maternal decidua basalis is invaded by syncytiotrophoblast

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15
Q

by the 12th day… syncitiotrophoblast is permeated by a system of intercommunicatiing channels called ______

A

Trophoblastic Lacunae

It is filled with Maternal Blood

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16
Q

What does the extravillous cytotrophoblast give rise to?

A

Solid Primary Villi = Cytotrophoblast (Langhan’s Cell) Core + Syncitiotrophoblast Cover

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17
Q

Trophoblast-lined labyrinthine channels form….

A

Intervillous space

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18
Q

the solid cellular columns form the…

A

Primary Villous Stalks

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19
Q

At 8-10 weeks, this is formed via fusion of amnionic and primary chorionic plate mesenchyme

A

chorionic plate formed

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20
Q

Once angiogenesis begins in the mesenchymal cores, what are formed?

A

Tertiary Villi

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21
Q

At what day does the maternal blood enter the intervillous space?

A

day 15

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22
Q

At the 17th day, fetal blood vessels are _____ & placental circulation is _________

A

Functional & established

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23
Q

What is the contact between the trophoblast & maternal blood

A

Hemochorial Placenta

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24
Q

Hemochorial Placenta can be subdivided into:

A

Hemodichorial and Hemomonochorial.

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25
Q

In early pregnancy,villi are distributed _______ of the chorionic membrane

A

over the entire PERIPHERY

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26
Q

What is the fetal component of the placenta?

A

Chorion Frondosum or Leafy Chorion

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27
Q

Which part of the chorion becomes the avascular fetal membrane that abuts the decidua parietalis?

A

Chorion Laeve or Smooth Chorion

28
Q

This is composed of cytotrophoblasts and fetal mesodermal mesenchyme that survives in a relatively low-oxygen atmosphere

A

Smooth Chorion

29
Q

During first half of pregnancy, these accumulate in the decidua and are found in direct contact w/ trophoblasts. They lack cytotoxic fxns and are able to dampen inflammatory TH17 cells

A

Decidual Natural Killer Cells

30
Q

These cells play a regulatory role in inhibiting NK cell killing during pregnancy

A

Decidual Macrophages

31
Q

These promote decidual invasion toward spiral arteries

A

IL-8 & interferon-inducible protein 10

32
Q

When is the trophoblast highly invasive?

A

First trimester

33
Q

Invasive trophoblasts secrete _______ that digest ECM and activate proteinases already present in the endometrium

A

Proteolytic enzymes

34
Q

This appears to be critical for human trophoblst invasion

A

MMP-9

35
Q

During this time, there is limited invasiveness of trophoblasts

A

Late Pregnancy

36
Q

This promotes invasion into the endometrium

A

Insulin-like growth factor II

37
Q

secreted by decidual cells which blocks the autocrine loop

A

Insulin-like factor binding protein type 4

38
Q

Truncal/main stem villi = lobule/cotyledon

A

Functional Unit

39
Q 
The ff are functions of this type of cell found during placental maturation:
Phagocytic
Immunosuppressive
Produces cytokines
Regulates trophoblast function
A

Hofbauer cells

40
Q

Which MHC/s are absent from villous trophoblasts?

A

I & II

41
Q

Normal implantation depends on….

A

controlled trophoblastic invasion of maternal EM-decidua and spiral arteries

42
Q

This regulate trophoblast invasion

A

Uterine Natural Killer Cells

43
Q

Tough, pliable, tenacious membrane

Provides tensile strength of fetal membranes

A

Amnion

44
Q

Amnion is first identified during…

A

7th or 8th day

45
Q

the tensile strength of the amnion is due to….

A

Cross-linked interstitial collagens I (tensile strength) & III (+ tissue extensibility)

46
Q

Until when does the amniotic fluid increase?

A

increases until 34 weeks, then declines

47
Q

True or false:
As pregnancy advances:
Yolk sac becomesl larger
Pedicle grows shorter
Expanding amnion fuses with chorion laeve
Covers the placental disc and lateral surface of the body stalk  UMBILICAL CORD/FUNIS

A

FALSE
As pregnancy advances:
Yolk sac becomesl SMALLER
Pedicle grows LONGER
Expanding amnion fuses with chorion laeve
Covers the placental disc and lateral surface of the body stalk  UMBILICAL CORD/FUNIS

48
Q

most common vascular anomaly in the absence of 1 artery

A

Meckel Diverticulum

49
Q

2 routes of blood flow

A

Ductus venosus

Hepatic circulation

50
Q

Umbilical arteries are obliterated and become….

A

Medial umbilical ligaments

51
Q

This hormone is almost exclusively synthesized in the placenta. May be elevated in fetal kidney & malignant tumors

A

HCG

52
Q

Peak of HCG

A

Complete molecule peaks at 8-10 weeks

53
Q

Give the fxns of HCG

A

Rescue & maintenance of corpus luteum
Stimulation of fetal testicular testosterone secretion
Leydig cell replication: sexual differentiation
Stimulate maternal thyroid gland
Promotion of relaxin
Regulates expansion of uterine NK cells

54
Q

low plasma HCG indicates…

A

Early pregnancy wastage (abortion), ectopic pregnancy

55
Q

elevated plasma HCG indicates…

A

Multifetal pregnancy, erythroblastosis fetalis, GTD

56
Q

Proportional to placental mass
Synthesis is stimulated by insulin and insulin-like growth factor-1
Inhibition is by PGE2 and PGF2a

A

Human Placental Lactogen

57
Q

Actions of hPL

A

Promotes maternal lipolysis
Inhibits leptin secretion by term trophoblasts
Inc maternal β-cell proliferation
Potent angiogenic hormone

58
Q

This persists after fetal demise

A

Placental Progesterone

59
Q

principal precursor for placental estradiol synthesis

A

DHEA-S

60
Q

most impt source of placental estrogen precursors

A

Fetal Adrenal Glands

61
Q

source of 90% of placental estriol precursors

A

fetus

62
Q

85-90% of progesterone and estrogen formed in

A

Syncitiotrophoblast

63
Q

Fetal glands take up lipoproteins as a source of cholesterol.

A

(LDL>HDL>VLDL)

64
Q

in Anencephaly there is high levels of

A

Fetal Adrenal Steroid Precursor

65
Q

Used to assess level of serum estriol

A

maternal serum triple or quadruple screening test

66
Q

what do you check in triple screen

A

alpha-fetoprotein (AFP),human chorionic gonadotropin(hCG), unconjugated estriol

67
Q

what is added to the triple screen to be quad?

A

Inhibin A

OB-GYN (4 decks)

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