Placental Pathology I Flashcards
placental delivery
third stage of delivery
looking at placenta during delivery
child surface
maternal surface
all placental vessels - are childs
trapped placenta
cannot deliver
dislodged from wall - but abnormal contraction of lower uterus stops expulsion
placental delivery steps
uterus contract - except what is connected to placenta
uterus relaxation - except connected to placenta - dislodge with shear force
global contraction - expels placenta
important to look at with cord
count vessels**
if 2 - structural and chromosomal abnormalities - 35% of time
progesterone
following ovulation increase
-prepares endometrium for implantation - secretory and blood vessel rich
placental implantation
week 1-2
produce HCG - prevents loss of CL
trophoectoderm
2 layers - of chorionic villi
-synctiotrophoblast
cytotrophoblast
spiral arteries
from endometrium - go up into placental tissue
smooth muscle cells invaded by cytotrophoblasts
- high pressure system to low resistance system
- allows pooling of blood
abnormalities - lead to preeclampsia
eclampsia pathology
placental factors to the mother
neutrophils on amniotic membrane
always abnormal
first trimester chorionic villi
have syncytiotrophoblast (outer) and cytotrophoblasts (inner)
50% of fertilizations
spontaneous abortion
metabolic transfer in chorionic villi
most syncytiotrophiblast
third trimester chorionic villi
stroma with dense network of dilated capillaries surrounding thinned syncytiotrophoblasts and cytotrophoblasts
pregnancy lost <20 weeks
spontaneous abortion
1st trimester abortion
chromosomal problem
50% of spontaneous abortions
2nd trimester abortion
mechanical problem
3rd trimester abortion
fetoplacental unit problem
risk factors for spontaneous abortion
increased age
history of prior
maternal smoking
ectopic pregnancy location
90% fallopian tubes
predispose to ectopic
PID - 35-50%
diagnosis of ectopic
beta-HCG
ultrasound
laparoscopy
most important predisposing condition for ectopic?
hx of PID
highest relative risk for ectopic?
smoking
dichorionic
fraternal twins
monochorionic
identical twins
twins get unequal blood supply
monochorionic placenta
disproportionate circulation
AV shunt
can cuse death of both
twin twin transfusion syndrome
two chorions between amnion
dichorion
-fraternal twins
one chorion between amnion
monochorion
-identical twins
implantation of placenta in lower uterus
placenta previa
retroplacental hemorrhage
abruptio placenta
placenta into myometrum
placenta accreta
due to lack of intervening decidua
painful vaginal bleeding
abruptio placenta
painful**
fetal death
with abruptio placenta of 1-3 or more of placenta
painless vaginal bleeding in 3rd trimester
placenta previa
most common cause of antepartum bleeding
placenta previa
tx for placenta previa
C-section
loss of decidual basalis
with placenta accreta
uterine rupture
15% of placenta accreta
depth of placent accreta
accreta - little invasion
increta - partway though
percreta - through to outside
cause of placenta accreta
endometrial scarring
-previous C section**
tx of placenta accreta
hysterectomy
placental infection
ascending - from vagina
hematogenous - TORCH
TORCH
toxoplasmosis other rubella CMV HSV
ascending infection
group B strep
acute chorioamnionitis
placenta - greenish membrane - pus and or meconium
baby stressed in uteru
vaginal flora ASCENDS through cervix - after loss of mucous plug**
neutros in membrane
villitis
inflammation of chorionic villi
-typical of TORCH organisms - from maternal infection
proteinuria and edema
preeclampsia
-HTN in pregnancy
path of preeclampsia
maternal endothelial dysfunction
underperfusion of placenta - abnormal adaptation of spiral arteries
maternal complications of eclampsia
hypercoagulable
DIC
kidney damage
preeclampsia vs. eclampsia
eclampsia - is final condition
seizure, hyperreflex
complication of severe preeclampsia
hemolysis, elevated liver enzymes, low platelets
HELLP
associated with severe preeclampsia
atherosis
can occur in preeclampsia
hydatidiform mole
Hydatidiform mole is a rare mass or growth that forms inside the womb (uterus) at the beginning of a pregnancy.
complete and partial
all elaborate HCG
invasive mole
perforates uterine wall
partial mole
fetus parts present**
triploid - ovum and two sperm
complete mole
no fetus**
diploid - empty ovum
high risk of choriocarcinoma
complete mole
low risk of choriocarcinoma
partial mole
edematous villi with diffuse trophoblastic proliferation
complete mole
non-edematous villi with slight trophoblastic proliferation
partial mole
uterus too large for date and no fetal heart sounds
gestational trophoblastic disease - moles
also see painless vaginal bleeding during 4th month
grape like clusters
partial mole
snowstorm appearance on US
partial mole
choriocarcinoma
markedly elevated beta-hCG
lack villous structures
mets to lungs (cannon ball), vagina, brain, liver
bloody brown vaginal spotting
choriocarcinoma
tx of choriocarcinoma
chemotherapy - 100% cure or remossion
DOC - methotrexate
