Placenta Pathology Flashcards
Endometrium of the pregnant uterus
Decidua
Innermost lining of the membranous sac enclosing the embryo
Amnion
Outermost lining of the membranous sac enclosing the embryo
Chorion
Placental structure where nutrient and gas exchange occurs; core is composed of loose mesenchyme, fetal blood vessels and vill
Chorionic Villus
Part of the VILLOUS trophoblast; the INNER single layer of the trophobast on the surface of the villus
Cytotrophoblast
Part of the VILLOUS trophoblast; the OUTER layer of syncytium; make hCG to maintain the Corpus Luteum
Syncytiotrophoblast
Extra lobe of placental tissue; membranous (velamentous) vessels connect each lobe; risk of fetal bleeding and may result in retained placental tissue after birth
Accessory or Succenturiate Lobe
Condition in which the placenta crosses the internal os of the uterus; at risk of rupture when the supporting membranes rupture, as they are unsupported by the umbilical cord or placental tissue
Placenta Previa
Common Umbilical Cord abnormalities (3 total)
Common Umbilical Cord abnormalities (3 total)
(True/False) umbilical knots are when there is a varicosity with no clinical consequence
False
(True/False) umbilical knots are when there is a cord compression
True
An inflammation of the amnion and chorion due to a bacterial infection; typically results from bacteria ascending from the vagina into the uterus (usually Strep. agalactiae or E. coli; MOST often associated with prolonged labor; result in maternal fever, uterine tenderness, tachycardia and purulent/foul amniotic fluid; associated with Premature Labor or Rupture of Membranes (PROM)
Chorioamnionitis
Bacteria involved with Chorioamnionitis (3 total)
Strep. agalactiae
E. coli
Anaerobes
Signs/Symptoms of Chorioamnionitis
Maternal fever
Fetal/Maternal tachycardia
Foul smelling fluid
Uterine tenderness
Neutrophils in the umbilical cord; seen in Chorioamnionitis
Funisitis
Inflammation of the placenta’s chorionic villi surface; usually due to HEMATOGENOUS infection (TORCH infections) or immune-mediated; will see LYMPHOCYTES (not neutrophils); associated with Intrauterine Growth Restriction (IUGR)
Villitis
Infections associated with Villitis
TORCHES infections (Toxo, Rubella, CMV, Herpes, Syphilis)
(Chorioamnionitis/Villitis) is associated with premature labor or rupture of membranes (PROM)
Chorioamnionitis
(Chorioamnionitis/Villitis) is associated with Intrauterine Growth Restriction (IUGR)
Chronic Villitis
What is important to ascertain in a case of Chorioamnionitis?
Source of inflammation; if fetal (neutrophils in cord), greater risk of neurologic effects and may be marker for infection elsewhere in fetus
How can you tell between Maternal vs. Fetal immune response in Chorioamnionitis
Maternal: neutrophils in Amnion/Chorion
Fetal: neutrophils in Cord
Yellow discoloration of the Fetal membrane means what?
Infection
Green discoloration of the Fetal membrane means what?
Meconium
Brown discoloration of the Fetal membrane means what?
Hemosiderin (remote hemorrhage)
Bile-stained intestinal contents of the fetus; can stain placenta and baby green if discharge before birth; usually after 32 weeks gestation; slight risk of aspiration
Meconium
Risk factors for Abruptio Placenta
Abd TRAUMA Smoking Cocaine Multiple gestations Premature Rupture of Membranes (PROM) HTN Oligohydramnios Chorioamnionitis
Premature of separation of the placenta from the decidua before delivery; has pain, uterine bleeding, contractions and DIC; can result in fetal hypoxia, maternal blood loss and fetal death
Abruptio Placenta
Hematoma along the maternal surface of the placenta (between the basal plate and uterine wall); seen in correlation with Abruptio Placenta; can compress villous tissue and result in INFARCTION of the placenta
Retroplacental Hematoma
Necrosis of Chorionic Villi secondary to decreased or interrupted maternal blood supply; can be due to Maternal HTN, Thrombophilia, Abruption or smoking
Placental Infarct
Abnormal implantation of the placenta to the uterine wall; due to lack of maternal Decidua at implantation site; further subdivided based on depth of invasion; usually due to uterine scars; results in retained placenta and post-partum hemorrhage
Placenta Accreta
Placenta (accreta/increta/percreta) is when chorionic villi are implanted ON the myometrium WITHOUT intervening Decidua
Placenta accreta
“ACcreta ADheres”
Placenta (accreta/increta/percreta) is when the chorionic villi INVADE the myometrium
Placenta increta
“INcreta INvades”
Placenta (accreta/increta/percreta) is when the chorionic villi perforate the ENTIRE uterine wall
Placenta percreta
“PERcreta PERforates”
What problems can arise from Multiple Gestations
Prematurity
Cord problems (entanglements)
Maternal HTN
Twin-Twin transufion syndrome
