Pregnancy/Placental pathology Flashcards
Describe fetal and maternal placenta
Fetal: cord enters, arborizes and dives into placental parenchyma
Maternal has nodular condylemoas; make sure NONE left behind in uterus
Understand fetal gas exchange
Veins take blood away, arteries towards
braching continues till single cell barrier or capillary for gas exchange
Mom pumps blood to intervillinous space and gas exchange occurs here
What makes up umbilical cord?
Two arteries, one vein, surrounded by Whartons jelly
Cord abnormalities; four types
Marginal insertion–into edge of disk
Velamentous insterion–into membranes
Knots
psuedoknots
cord inserted into edge of disk
marginal insertion
Cord inseted into membranes
Velamentous insertion
Neutrophils present in wall of vessels; Neutrophils from BABY and seen in association with infection from mom that baby is defending against
Funisitis: cord inflammation
What are the 3 membrane layers in placenta?
Amnion
Chorion laeve
Decidua capsularis
You see the picture of a placenta, what happened to baby?
Meconium staining located in the chorion level
What is going on in this placenta? Where is inflammation coming from?
Chrioamnionitis: LOTS of neutrophils that are maternal coming from mom’s decidua; mom is sick and working from deciduca–> chorion–> amnion
Tx is delivery
What do we see in this image?
Disk with amnion to the right
have chorionic plate and chorion frondosum (chorionic villi)
fetal vessesls to the left
What do we see in this image?
Trophoblast
Notice all these bumps on placneta and you attending says its squamous metaplasia, what was the likely cause?
Result of oligohydramnios; low fluid, less protection
All the whorls are vessels in the fetus, whats wrong with this?
Fetal vasculopathy, should all be open, now we have low blood flow with tiny lumen
You notice some lymphocytes in the maternal decidua, is this normal?
yes, she has larger decidual cells with some lymphocytes
What happens in placental abruption
Maternal surface gets blood clot the arteries from mom in that area aren’t feeding blood to fetus
Implantaiton into the myometrium
accreta
Implantation over the cervix
Previa
Implantation deeper into the myometrium
Increta
Implantation through the uterine wall
Percreta
What do we see on histology of villous parenchyma
see chorionic villi, fetal stem vessles and villous capillaries with fetal blood and intervillous space with maternal blood
What is a concern with distal villous HYPOplasia?
many end up being avascular leading to low intrauterine growth, baby not getting enough blood supply
What are all these white spots on placenta?
Parenchymal infarct: dead spots on placenta with no gas exchange you can see on histology the area to right with white space where there was infarct
Two sources of placental infection
ascending from GI/GU tract
Hematogenous: via maternal blood to placenta (evidence in villi)
What is the fetal response to placental infection?
leukocytes form fetal blood vessels go into cord and chorionic plate
Maternal repsosne to placental infection
leukocytes from decidual vessels into membranes and from intervillous space into villi
Implantation of a fertilized ovum anywhere other than the uterine cavity (1% of all pregnancies)
Ectopic: 90% are tubal
risk: anything obstructing tubes like PID, ligation
Can we detect ectopic pregnancy early?
nope, normal rise in hCG and menstartion stops
–> eventually embryo dies from inadequate attachment or placental invasion causes rupture with massive hemorrhage and shock
• Hydatidiform mole (complete and partial)
- Invasive mole
- Choriocarcinoma
**Gestational Trophoblastic Disease **
Arises from two sperm fertilizing an empty or normal egg.
Chorionic villi are swollen, edematous, and grape-like
Produce b-hCG
Molar pregnancy
Complete mole
karyotype:
villous edema:
trophoblast proliferation:
atypia:
46 XX or 46 XY (2 sperm, anucelate egg)
diffuse villous edema
atypia is common
What is teh difference btwn hCG in complete and parital mole
Really high hCG in complete vs partial
Which has more potential for developing choriocarcinoma: complete or partial mole
2% for complete mole and rare in partial
There is p57 staining present, what type of pregnancy?
Partial mole = +p57
Partial mole:
Karotype:
Villous edema:
Trophoblast proliferation:
atypia
69 XXY
patchy villous edema
focal or absent trophoblast poliferation
no atypea
fetus present
Invasive moles (10%) see in_____ mole with invasive behavior with___ metastatic potential
Complete
No met potential!
Very aggressive, malignant neoplasm
Half occur in the setting of complete mole, others after SAB or normal pregnancy
Highly chemosensitive
Choriocarcinoma (2-3%)
Hypertension, edema, and proteinuria in the third trimester of pregnancy
Pre-eclampsia / eclampsia
Describe eclampsia
w/seizures = eclampsia
• Can be accompanied by DIC and multisystem organ failure • Treated symptomatically, but need to deliver baby
Pathophysiology of preeclampisa
• Inadequate maternal blood flow to the placenta due to incomplete remodeling of the spiral arteries
two examples of Primary placental tumors
- Hydatidiform moles
- Choriocarcinoma
Metestatic disease from mom to baby is rare but seen in what malignancies?
breast and melanoma
