Pregnancy & Placental Pathology - Jarzembowski

Question 1

Describe the appearance of the fetal and maternal faces of the placenta.

Answer 1

Fetal: Smooth, with a vessel network that coalesces to form the umbilical cord.

Maternal: Rough and bumpy, divided into cotyledons.

Question 2

What fills the intervillous spaces?

What part of the chorion corresponds to the decidua basalis?

Answer 2

Intervillous spaces are filled with maternal blood

The decidua basalis corresponds with the chorion frondosum

Question 3

What are the contents of the umbilical cord?

Answer 3

Two arteries, one vein, and a lot of Wharton’s jelly (mucopolysaccharide matrix)

Question 4

Name 3-4 abnormalities that pertain to the umbilical cord.

Answer 4

Marginal insertion (cord should insert into center of disc)
Velamentous insertion
Knots (and pseudoknots)

Question 5

Distinguish between funisitis and chorioamnionitis.

Answer 5

Funisitis is inflammation of the CT of the cord by fetal neutrophils.

Chorioamnionitis is inflammation of the amnion and chorion by maternal neutrophils, indicating ascending infection (especially in prolonged labor)

Question 6

What decidual region corresponds to the chorion laeve?

Answer 6

The chorion laeve (smooth chorion) is met by decidua capsularis.

Question 7

When is meconium released?

How does it appear on histology?

Answer 7

During fetal stress (eg delivery)

Yellow-brown pigment laden macrophages.

Question 8

What are some gross hallmarks of oligohydramnios on the placenta?

Answer 8

Depletion of fluid means more physical damage to the placenta; white spots appear correlating to squamous metaplasia (normally columnar)

Question 9

Are the fetal vessels normally highly patent or narrow?

Answer 9

Highly patent; hypertrophy of the vessels indicates pathology.

Question 10

A placental section reveals abundant lymphocytes. Is this normal or abnormal?

Answer 10

Normal; lymphocytes in the decidua may play a role in triggering labor.

Question 11

How does placental abruption appear?

Answer 11

Abundant hemorrhage and clotting along the decidua basalis. The clotting process further facilitates detachment.

Question 12

What is the primary consequence of previas accreta/increta/percreta?

Answer 12

Implantation into the myometrium (without intervening endometrium) is hard to detach; hemorrhaging is common and may hysterectomy may be needed.

Question 13

What can be found in the villous parenchyma of the placenta?

Answer 13

Chorionic villi (fetal origin)
Fetal stem vessels
Intervillous space (filled with maternal blood)

Question 14

How does a parenchymal infarction appear histologically? How significant is it?

Answer 14

Coagulative necrosis without remodeling (placenta is short-lived, so why bother). If small and peripheral, infarctions are not very concerning.

Question 15

Name two routes by which the placenta may be infected.

Answer 15

Ascending (from GI/GU tract) or hematogenous.

Question 16

Ectopic pregnancies occur in __% of all pregnancies. They are usually located in _____. The main risk factor is ____. It is noticed when _____.

Answer 16

1% of pregnancies, usually tubal, risk factor being tubal obstruction (scarring, etc). Noticed when there is tissue rupture with massive hemorrhage and shock.

Question 17

How does a molar pregnancy appear grossly?

Answer 17

Chorionic villi that are swollen, edematous and grape-like (these may be passed vaginally). Fetal tissue may or not be present.

Question 18

Are complete or partial moles described by the following criteria?

1. Risk of choriocarcinoma
2. Focal regions of trophoblast proliferation
3. Diffuse villous edema
4. Snow-storm pattern
5. Positive p57 staining

Answer 18

1. Complete mole
2. Partial mole
3. Complete mole
4. Complete mole (see #3)
5. Partial mole (only expressed from maternal genome)

Question 19

What are the three signs of pre-eclampsia?
How common is it?
What, roughly, causes it?

Answer 19

Hypertension, edema, proteinuria (third-trimester!)
5-10% of all pregnancies, more with age
Malunion of the maternal and fetal arteries in the placenta.

Question 20

Name two maternal cancers that may metastasize to the placenta.

Where may a fetal neuroblastoma be found?

Name another fetal cancer.

Answer 20

Melanoma and breast

Found in stem and branch arteries.

Leukemia.