Placental Pathology

Question 1

What cells are the source of hCG?

Answer 1

Trophophoblasts are the source of hCG

Question 2

What are the normal vessels in the umbilical cord?

Answer 2

Two arteries and one vein surrounded by Wharton Jelly

Question 3

Preeclampsia

Answer 3

preeclampsia: hypertension and proteinuria after the 20th week of gestation

Question 4

eclampsia

Answer 4

eclampsia: seizures and eventual coma- really high blood pressure

Question 5

what enzyme degrades the basement membrane?

Answer 5

matrix metaloprotenase is the enzyme that degrades the basement membrane. it is responsible for abnormal decidualization

Question 6

acute atherosis

Answer 6

Acute Atherosis is characterized by fibrinoid necrosis of vessel walls, perivascular lymphocytic infiltrates, and subendothelial macrophages

Question 7

Abruptio Placenta

-risk factors?

Answer 7

when the placenta detataches during pregnancy- premature separation from the uterine wall

Risk factors include previous abruptio placenta, maternal hypertensive disease, cocaine and vasoconstrictive drugs, cigarette smoking, multiple pregnancies, chorioamnionitis, abdominal trauma or uterine manipulation

Question 8

Trophoblasts are on the fetal/maternal side of the placenta?

Answer 8

trophoblasts are on the fetal side of the placenta

Question 9

a pregnant woman comes into your officce with vaginal bleeding (dark blood) abdominal pain, and uterine contractions. The contractions have a sawtooth pattern (High frequency, low amplitude). What is one dx for this patient?

Answer 9

Abruptio Placenta is characterized by having:
-vaginal bleeding (dark blood)
-abdominal pain
-sawtooth pattern contractions
the bleeding may or may not be apparent because the hemorrhage may trap the blood between the placent and the uterus

Question 10

Placenta Accreta

• three classifications
• pathology

Answer 10

Placenta Accreta is when the placenta invades the myometrium.  
The three classificcations are"
-Accreta-superficial myometrium
-Increta- into myometrium
-Percreta- through myometrium to serosa

caused by an over invasiveness of the trophoblast and a deficiency of decidualisation (progesterone is the hormone responsible for decidualisation)

Question 11

Clinical outcomes of placenta Accreta

Answer 11

Clinical outcomes for Placenta Accreta

• hysterectomy
• associated with increased incidence of preterm delivery and SGA infants because there is inadequate exchange of blood… the vessels in the myometrium do not have maternal blood surrounding them so no exchange can happen

Question 12

Placenta Previa-
presentation
three classifications

Answer 12

Low lying placenta
Placenta previa presents with PAINLESS vaginal bleeding towards the end of the second trimester to the third trimester
Complete- covers the ox
Partial-part of the placenta is in the os
Marginal-on the edge of the ox

Question 13

Twin-Twin transfusion syndrome

Answer 13

a vascular anasomosis between the two fetal circulations in a monochorionic twin placenta leads to diminished blood flow to one twin. Increased mortality to both twins

Question 14

Which type of moalr pregnancy has a higher risk for developing choriocarcinoma?

Answer 14

complete hydatidiform moles have an increased risk for developing into choriocarcinoma

Question 15

What blood test can serve as a marker for trophoblastic disease?

Answer 15

hCG- produced by the trophoblasts

Question 16

On histology you notice:

marked villous enlargement, edema, and circumferential trophoblastic proliferation.

Answer 16

complete hydatidiform mole

Question 17

on histology you notice:

scalloping of some villi and the presence of normal appearing villi

Answer 17

partial mole

Question 18

how are levels of hCG affected with a hyditidiform mole?

What are other clinical features?

Answer 18

HCG levels will be way way higher (3x or 30x… i didn’t hear what she said and i’m too lazy to relisten to it or look it up) when compared to a pregnancy of similar gestational age.
-MONITOR the HCG levels until they fall and remain to 0 to make sure the mole isn’t invasive
women will present with a spontaneous pregnancy loss or undergo curettage because of abnormalities in ultrasound showing diffuse villous enlargement.

Question 19

Invasive Mole

• manifestations?
• morphology?
• treatment

Answer 19

Invasive Moles manifest as vagional bleeding and irregular uterine enlargement.
Invasive moles are H. moles that penetrate or even perforate the uterine wall. They are locally destructive and may invade parametrial tissue and blood vessels.
Treatment: chemotherapy or hysterectomy if the uterus is ruptured

Question 20

Gestational choriocarcinoma
manifestations:
treatment:

Answer 20

Gestational choriocarinoma is a malignant neoplasm of trophoblastic cells derived from a previous pregnancy

• can arise from h. mole (50%), previous abortions, some normal pregnancies, and ecotopic pregnancies.
• they can present as irregular vaginal spotting. they re highly metatsatic (lungs, vagina, brain, liver, kidney) and are very necrotic (you’ll see areas of necrosis on gross morphology)
• treatment: very sensitive to chemotherapy. evacuation of uterine content, surgery, and chemo
• YOU MUST HAVE A HISTORY OF PREGNANCY TO HAVE THIS TYPE OF CARCINOMA!*

Question 21

Pt presents with a uterine mass, accompanied by either abnormal uterine bleeding or amenorrhea with a moderate increase of beta HCG
-what is it?
-what is her prognosis?
-

Answer 21

This patient has placental-site trophoblastic tumor
this is a neoplastic proliferation of extra villous trophoblast
this pts prognosis is excellent if localized or has a <2 year interval from pregnancy to diagnosis.. otherwise the prognosis is poor (10-15% die)