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life cycle II > placental pathology > Flashcards

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
Q

syncytiotroph funcion

A

. 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.

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26
Q

histology of basal (maternal) plate

A

extravillous trophoblast, decidual cells, uteroplacental vessels, and endometrial glands in abundant fibrinoid

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27
Q

nomenclature for pregnancies/ delivery

A

G: number of pregnancies. TPAL: term delivery, preterm delivery, abortion, living children. Often abbreviated to just include L (ie. G1P1)

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28
Q

List inflammatory conditions of placenta

A

Acute chorioamnionitis, chronic villitis or deciduitis

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29
Q

Acute chorioamnionitis

A

secondary infection with neutrophils in fetal membranes. Occurs in 24% live births, 67% preterm deliveries. Fever, leukocytosis, uterine tenderness, tachycardia.

30
Q

causes of acute chorioamnionitis

A

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
Q

fetal inflammatory responses

A

Umbilical Cord Vasculitis and Chorionic Plate Vasculitis

32
Q

Routes of Infection of placenta

A
  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
  2. 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
  3. 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
  4. 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
Q

List the organisms that can cause trans pacental infection

A

ToRCHeS (Toxoplasma, Rubella, CMV, HIV, HSV, Syphilis)

34
Q

fetal manifestations of toxoplasma gondii villitis

A

Chorioretinitis, Hydrocephalus, Intracranial Calcification

35
Q

fetal manifestations of rubella placentitis

A

PDA, Cataracts, Deafness (+/- “blueberry muffin” rash)

36
Q

fetal manifestations of CMV placentitis

A

Deafness, Seizures, Petechial rash. Also intrauterine demise, intrauterine growth restriction.

37
Q

fetal manifestations of HIV placentitis

A

Recurrent infections, Chronic Diarrhea

38
Q

fetal manifestations of HSV2 villitis

A

Temporal encephalitis, Herpetic lesions

39
Q

fetal manifestations of syphilis villitis

A

Stillbirth, Hydrops, Fetal abnormalities

40
Q

CMV placentitis histology

A

Intranuclear basophilic inclusion surrounded by clear halo- Owls eyes

41
Q

histology of villitis of unknown etiology

A

Agglutination/clumping of villi, Maternal lymphocytes attacking & destroying villi

42
Q

compare infectious villitis with villitis of unknown etiology

A

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
Q

When is it normal to have meconium in the amniotic fluid

A

NEVER normal before 36 weeks GA. 15% at 39 weeks, 32% by 42 weeks.

44
Q

Meconium complications

A

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
Q

Intervillous thrombi histology

A

laminated appearance- Lines of Zahn.

46
Q

Kleihauer – Betke Test

A

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
Q

placental infarct

A

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
Q

placental infarct associated conditions

A

IUGR, fetal hypoxia, IUFD

49
Q

placenta accreta

A

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
Q

placenta increta

A

placental villi INVADE into myometrium.

51
Q

Placenta Percreta

A

placental villi penetrate through myometrium and into serosa. Placenta can attach to rectum or bladder.

52
Q

placenta previa

A

attachment of placenta to lower uterus, covering the internal os. Increased risk for abruption, postpartum hemorrhage, C-section

53
Q

pre-eclampsia

A

Hypertension (>140/90)+ proteinuria (>300mg/ 24hr) after 20 weeks gestational age (clinical)-Abnormal placental spiral arteries causes maternal endothelial dysfunction, vasoconstriction or hyperreflexia.

54
Q

pre-eclampsia risk factors

A

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
Q

eclampsia

A

pre-eclampsia plus seizures

56
Q

pre-eclampsia treatment

A

antihypertensives, deliver at 34 weeks (severe) or 37 weeks (mild). IV magnesium sulfate to prevent seizures

57
Q

pre-eclampsia histology

A

Deposition of dense pink fibrinoid around vessels causes high resistance. Atherosis (foamy macrophages). Small terminal villi, widely spaced villi, big syncytial knots

58
Q

preeclampsia outcomes for baby and mom

A

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
Q

Abruptio placentae

A

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
Q

risk factors for abruptio placentae

A

trauma, smoking, HTN, preeclampsia, cocaine abuse, older women, multiple pregancy, blood clotting disorder

61
Q

placental abruption outcomes for mom and baby

A

fetal: deprivation of oxygen and nutrients, premature birth, stillbirth. Mom: shock (loss of blodd), DIC, ogran failure

62
Q

risk factors for DIC during/after pregancy

A

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
Q

types of IUGR

A

symmetric: genetic. Asymmetric: placental/ maternal etiology, oligohydramnios

64
Q

Pataus syndrome

A

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
Q

Edwards syndrome

A

trisomy 18: rocker bottom feet, micrognathia (small jaw), low set ears, heart anomalies, omphalocele (herniation of abd contents into umbilical cord)

66
Q

fetal hydrops

A

Abnormal fluid collection (edema) under skin, within abdomen or chest cavity. Often polyhydramnios.

67
Q

fetal hydrops causes

A
  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
Q

neural tube defect labs

A

elevated maternal serum AFP.

69
Q

anencephaly

A

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
Q

Rachischisis

A

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
Q

Encephaloceles

A

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
Q

Acardiac Twin

A

“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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