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placental pathology Flashcards

1
Q

compare hCG levels in nl pregnancy, ectopic pregnancy, trophoblastic disease and intrauterine fetal demise

A

nl pregnancy: rises from wk 0-4, then drops off and plataus. Ectopic: rises from wk 0-6 (lower levels than nl pregnancy) then stops. Trphoblastic: levels rise continuously. IUFD: levels rise initially but then drop back to 0 after fetal demise

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2
Q

ectopic pregnancy diagnosis

A

clincal, hCG levels, ultrasound.

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3
Q

Ectopic pregnancy treament

A

MTX (side effects, need for ongoing monitoring), Surgery (laparoscopic unless massive hemoperitoneum), Expectant (rarely, only if apparently aborting spontaneously)

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4
Q

gestational Trophoblastic Disease (GTD)

A

Group of rare tumors that involve abnormal growth of cells. . . Starting in the cells that would normally develop into the placenta” benign or malignant. Ie. Moles

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5
Q

complete vs partial mole

A

Need both maternal and paternal DNA for normal development. Mom : embryonic tissue. Dad: placental tissue. Complete mole is an empty ovum fertilized by two sperm or one sperm fertilizes anucleate agg and divides(46, XX or XY). Partial mole is a haploid ovum fertilized by 2 sperm (69, XXY)

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6
Q

partial vs complete hydatiform mole ultrasounds

A

partial: Large cystic spaces, +/- fetal tissue, Subtle. Complete: “snowstorm” appearance, cystically dilated spaces without fetal parts. Placental overgrowth.
partial: Large cystic spaces, +/- fetal tissue, Subtle. Complete: “snowstorm” appearance, cystically dilated spaces without fetal parts. Placental overgrowth.
partial: Large cystic spaces, +/- fetal tissue, Subtle. Complete: “snowstorm” appearance, cystically dilated spaces without fetal parts. Placental overgrowth.
partial: Large cystic spaces, +/- fetal tissue, Subtle. Complete: “snowstorm” appearance, cystically dilated spaces without fetal parts. Placental overgrowth.
partial: Large cystic spaces, +/- fetal tissue, Subtle. Complete: “snowstorm” appearance, cystically dilated spaces without fetal parts. Placental overgrowth.

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7
Q

partial mole histology

A

Admixture of hydropic and fibrotic villi: “Lacy” trophoblast hyperplasia, Villous inclusions, Association with fetal syndactyly (fusion of digits).
Virtually no partial moles recur/progressAdmixture of hydropic and fibrotic villi: “Lacy” trophoblast hyperplasia, Villous inclusions, Association with fetal syndactyly (fusion of digits).
Virtually no partial moles recur/progressAdmixture of hydropic and fibrotic villi: “Lacy” trophoblast hyperplasia, Villous inclusions, Association with fetal syndactyly (fusion of digits).
Virtually no partial moles recur/progressAdmixture of hydropic and fibrotic villi: “Lacy” trophoblast hyperplasia, Villous inclusions, Association with fetal syndactyly (fusion of digits).
Virtually no partial moles recur/progressAdmixture of hydropic and fibrotic villi: “Lacy” trophoblast hyperplasia, Villous inclusions, Association with fetal syndactyly (fusion of digits).
Virtually no partial moles recur/progress

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8
Q

Complete mole- which type is most common, gross appearance

A

85% are due to one sperm fertilizing anucleate egg and dividing. Grossly: abnormal placental tissue with NO fetal development

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9
Q

complete mole histology

A

scalloped shape, hydropic (water) villi, central cisterns, circumferential trophoblast proliferation and absent vessels

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10
Q

complete mole sx

A

Present with elevated β-hCG, uterine size greater than dates, hyperemesis gravidarum, vaginal bleeding, early pre-eclampsia, hyperthyroidism

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11
Q

Gene involved in abnormal conception

A

p57 (kip2) on chrom 11p15. Its expression is required from the female because the male gene is imprinted. In complete mole, expression of this gene is lost in cytotrophoblast and villous stromal cells, but retained in decidua. In partial mole, it is retained in all cell types.

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12
Q

risk factors for post-molar gestational trophoblastic neoplasia

A

Age >40 years. Uterine size, Theca lutein cysts (>6 cm), hCG >100,000 IU/mL, Medical complications:
ARDS (acute respiratory distress syndrome), pre-eclampsia, hyperthyroidismAge >40 years. Uterine size, Theca lutein cysts (>6 cm), hCG >100,000 IU/mL, Medical complications:
ARDS (acute respiratory distress syndrome), pre-eclampsia, hyperthyroidismAge >40 years. Uterine size, Theca lutein cysts (>6 cm), hCG >100,000 IU/mL, Medical complications:
ARDS (acute respiratory distress syndrome), pre-eclampsia, hyperthyroidismAge >40 years. Uterine size, Theca lutein cysts (>6 cm), hCG >100,000 IU/mL, Medical complications:
ARDS (acute respiratory distress syndrome), pre-eclampsia, hyperthyroidismAge >40 years. Uterine size, Theca lutein cysts (>6 cm), hCG >100,000 IU/mL, Medical complications:
ARDS (acute respiratory distress syndrome), pre-eclampsia, hyperthyroidism

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13
Q

gestational choriocarcinoma

A

preceeding lesions include complete mole, abortion, normal pregnancy

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14
Q

choriocarcinoma histology ans sx

A

Vaginal bleeding after pregnancy, High serum β-hCG. Single/multiple hemorrhagic well-circumscribed nodules in uterus. Biphasic pattern w hemorrhage and necrosis. Marked nuclear atypia and mitoses. Cytotrophoblasts (mononuclear) and syncytiotrophoblasts (multinuclear) present

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15
Q

Placental Site Trophoblastic Tumor (PSTT)

A

Neoplastic proliferation of extravillous trophoblast. 5-8 % develop after molar pregnancy. Hysterectomy is curative.

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16
Q

Placental Site Trophoblastic Tumor histology

A

Sheets and cords of trophoblast growing between muscle fibers. Implantation site-like extracellular fibrinoid in 90 %

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17
Q

fetal: placental weight ratio

A

Decreases as gestational age increases (slower placental growth and faster fetal growth)

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18
Q

fetal growth restriction

A

failure of a fetus to reach his/her biological growth potential and small for gestational age (SGA) is widely used as a statistical indicator of FGR. SGA is defined as birth weight<10th percentile for gestational age and sex based on a population standard

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19
Q

umbilical cord size

A

Long is >75cm: Associated with knots and fetal entanglement. May correspond to later hyperactivity. Short is 75cm: Associated with knots and fetal entanglement. May correspond to later hyperactivity. Short is 75cm: Associated with knots and fetal entanglement. May correspond to later hyperactivity. Short is 75cm: Associated with knots and fetal entanglement. May correspond to later hyperactivity. Short is <30cm: Pieces of cord may be left attached to baby or taken for blood gas
Associated with decreased fetal movement and neurodevelopmental problems.

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20
Q

placental weight and associated conditions

A

90th: Anemia, Diabetes, Infection (syphilis, toxo), Hydrops fetalis

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21
Q

components of umbilical cord

A

2 arteries (deoxygenated blood from fetus), 1 vein (oygenated blood to fetus), Whartons jelly (stroma), remnants

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22
Q

layers of the placenta

A

amnion (cuboidal/ columnar epithelium) > amniotic fluid > chorion (fibrous w/ fetal blood vessels) > extravillous trophoblast > decidua capsularis (macrophages, lymphocytes, stroma)

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23
Q

placental parenchyma histology

A

fetal compartment is intravillous. Maternal space is intervillous.

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24
Q

villi histology

A

stromal core with vessels. Cytotrophoblasts are inner and mononuclear. Syncytiotrophoblast are outer and multinucleated.

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25
syncytiotroph funcion
. Involved in maternofetal transfer mechanisms including catabolism and resynthesis of proteins and lipids, hormone synthesis, gas and small molecule exchange. Covered in microvilli which multiply villous surface area by >7X at term.
26
histology of basal (maternal) plate
extravillous trophoblast, decidual cells, uteroplacental vessels, and endometrial glands in abundant fibrinoid
27
nomenclature for pregnancies/ delivery
G: number of pregnancies. TPAL: term delivery, preterm delivery, abortion, living children. Often abbreviated to just include L (ie. G1P1)
28
List inflammatory conditions of placenta
Acute chorioamnionitis, chronic villitis or deciduitis
29
Acute chorioamnionitis
secondary infection with neutrophils in fetal membranes. Occurs in 24% live births, 67% preterm deliveries. Fever, leukocytosis, uterine tenderness, tachycardia.
30
causes of acute chorioamnionitis
Can be due to Group B strep (Streptococcus agalactiae- remember B for babies). Beta-hemolytic bacteria (catalase negative and bacitracin resistant) which colonizes vagina and can cause pneumonia, meningitis and sepsis. Screen pregnant women at 35-37 weeks; if positive should get intrapartum penicillin
31
fetal inflammatory responses
Umbilical Cord Vasculitis and Chorionic Plate Vasculitis
32
Routes of Infection of placenta
1. Ascending: Bacteria from cervico-vaginal flora. Maternal neutrophils in membranes. 2. Trans-placental (hematogenous): Premature labor, hydrops, IUGR, IUFD. Histopathology: Chronic villitis, Intervillositis, Lymphoplasmacytic deciduitis 1. Ascending: Bacteria from cervico-vaginal flora. Maternal neutrophils in membranes. 2. Trans-placental (hematogenous): Premature labor, hydrops, IUGR, IUFD. Histopathology: Chronic villitis, Intervillositis, Lymphoplasmacytic deciduitis 1. Ascending: Bacteria from cervico-vaginal flora. Maternal neutrophils in membranes. 2. Trans-placental (hematogenous): Premature labor, hydrops, IUGR, IUFD. Histopathology: Chronic villitis, Intervillositis, Lymphoplasmacytic deciduitis 1. Ascending: Bacteria from cervico-vaginal flora. Maternal neutrophils in membranes. 2. Trans-placental (hematogenous): Premature labor, hydrops, IUGR, IUFD. Histopathology: Chronic villitis, Intervillositis, Lymphoplasmacytic deciduitis
33
List the organisms that can cause trans pacental infection
ToRCHeS (Toxoplasma, Rubella, CMV, HIV, HSV, Syphilis)
34
fetal manifestations of toxoplasma gondii villitis
Chorioretinitis, Hydrocephalus, Intracranial Calcification
35
fetal manifestations of rubella placentitis
PDA, Cataracts, Deafness (+/- "blueberry muffin" rash)
36
fetal manifestations of CMV placentitis
Deafness, Seizures, Petechial rash. Also intrauterine demise, intrauterine growth restriction.
37
fetal manifestations of HIV placentitis
Recurrent infections, Chronic Diarrhea
38
fetal manifestations of HSV2 villitis
Temporal encephalitis, Herpetic lesions
39
fetal manifestations of syphilis villitis
Stillbirth, Hydrops, Fetal abnormalities
40
CMV placentitis histology
Intranuclear basophilic inclusion surrounded by clear halo- Owls eyes
41
histology of villitis of unknown etiology
Agglutination/clumping of villi, Maternal lymphocytes attacking & destroying villi
42
compare infectious villitis with villitis of unknown etiology
infectious: occurs during premature stage of pregnancy, causes maternal and fetal illness/ infection, all villi are abnormal, fibrosis and calcification occurs. VUE: occurs near term, no maternal illness, no fetal infection, focal/ patchy, fibrin and necrosis
43
When is it normal to have meconium in the amniotic fluid
NEVER normal before 36 weeks GA. 15% at 39 weeks, 32% by 42 weeks.
44
Meconium complications
Complications include aspiration (pneumonia) and myonecrosis. Meconium is highly toxic to vascular smooth muscle. Also associated with post-dates, low apgar scores, neuro developmental delay
45
Intervillous thrombi histology
laminated appearance- Lines of Zahn.
46
Kleihauer – Betke Test
test for hemoglobin F (fetal) in maternal circulation, due to fetomaternal hemorrhage. >20% of fetoplacental volume. Test when fetal demise occurs, nonimmune hydrops, neonatal anemia
47
placental infarct
Acute cessation of maternal flow with live fetus. Central more significant than peripheral. Red and firm, then white and hard. <10% parenchyma involved does not affect oxygenation
48
placental infarct associated conditions
IUGR, fetal hypoxia, IUFD
49
placenta accreta
placenta attaches to myometrium without penetrating it. Chorionic villi adhere to myometrium. Failure of decidual formation. Concern for postpartum hemorrhage. Predisposing factors: prior C-section, endometrial ablation, multiple D&C’s.
50
placenta increta
placental villi INVADE into myometrium.
51
Placenta Percreta
placental villi penetrate through myometrium and into serosa. Placenta can attach to rectum or bladder.
52
placenta previa
attachment of placenta to lower uterus, covering the internal os. Increased risk for abruption, postpartum hemorrhage, C-section
53
pre-eclampsia
Hypertension (>140/90)+ proteinuria (>300mg/ 24hr) after 20 weeks gestational age (clinical)-Abnormal placental spiral arteries causes maternal endothelial dysfunction, vasoconstriction or hyperreflexia.
54
pre-eclampsia risk factors
Family history, Pre-existing disease (HTN, DM, APA, autoimmune, renal), Pre-e in prior pregnancy Family history, Pre-existing disease (HTN, DM, APA, autoimmune, renal), Pre-e in prior pregnancy
55
eclampsia
pre-eclampsia plus seizures
56
pre-eclampsia treatment
antihypertensives, deliver at 34 weeks (severe) or 37 weeks (mild). IV magnesium sulfate to prevent seizures
57
pre-eclampsia histology
Deposition of dense pink fibrinoid around vessels causes high resistance. Atherosis (foamy macrophages). Small terminal villi, widely spaced villi, big syncytial knots
58
preeclampsia outcomes for baby and mom
fetal: risk of stillbirth, IUGR, preterm deliver, hypoxia, neuro injury, risk of stroke and CAD as adults. Maternal: abruption, DIC, stroke, organ failure (liver, kidney, pulm edema), risk for chronic HTN
59
Abruptio placentae
premature separation of placenta from uterine wall before delivery. Variable symptoms: vaginal bleeding, abdominal/back pain, rapid uterine contractions. Clot forms, then compresses underlying villous tissue. Hemosiderin appears after 4-5 days
60
risk factors for abruptio placentae
trauma, smoking, HTN, preeclampsia, cocaine abuse, older women, multiple pregancy, blood clotting disorder
61
placental abruption outcomes for mom and baby
fetal: deprivation of oxygen and nutrients, premature birth, stillbirth. Mom: shock (loss of blodd), DIC, ogran failure
62
risk factors for DIC during/after pregancy
Pregnancy is a inflammatory/prothrombotic state, Amniotic fluid embolus (anaphylactoid, complement), Fetal demise (retained >4 weeks, TF release), Placental abruption (TF release), Preeclampsia, eclampia, HELLP* (damaged endothelium), Massive hemorrhage
63
types of IUGR
symmetric: genetic. Asymmetric: placental/ maternal etiology, oligohydramnios
64
Pataus syndrome
trisomy 13: Small for gestational age, rocker bottom feed, Polydactyly and cleft lip/palate, holoprosencephaly, Cutis aplasia, heart and brain defects, pancreato-splenic fusion.
65
Edwards syndrome
trisomy 18: rocker bottom feet, micrognathia (small jaw), low set ears, heart anomalies, omphalocele (herniation of abd contents into umbilical cord)
66
fetal hydrops
Abnormal fluid collection (edema) under skin, within abdomen or chest cavity. Often polyhydramnios.
67
fetal hydrops causes
1. immune: Maternal antibodies against fetal RBC cross placenta > hemolyzed in fetal spleen > severe anemia. Usually Rh antigens. Diagnose with indirect coombs, prevent with RhoGAM. 2. Non-immune: infection, cardiac/ congenital anomalies, neoplasms, metabolic dz
68
neural tube defect labs
elevated maternal serum AFP.
69
anencephaly
a neural tube defect that occurs when the head end of the neural tube fails to close, usually during the 23rd and 26th days of pregnancy, resulting in a absence of a major portion of the brain and skull.
70
Rachischisis
In utero, the neural tube fails to close completely. The vertebrae overlying the open portion of the spinal cord do not fully form and remain unfused and open. Thus, the spinal cord is exposed.
71
Encephaloceles
neural tube defect that characterize by sac-like protrusion of the brain though through the opening in the skull. The defect is caused by the incomplete closure of the cranium during development.
72
Acardiac Twin
“Parasitic” twin fails to develop head, arms and heart; gets blood from host twin. Congestive heart failure (ascites, pleural effusion) in normal twin from perfusing both

life cycle II (12 decks)

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