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Repro / GU > SM_210b: Anatomy and Physiology of Implantation Placentation > Flashcards

SM_210b: Anatomy and Physiology of Implantation Placentation Flashcards

1
Q

Placenta has a ____ circulatory system

A

Placenta has a dual circulatory system (fetal and placental)

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2
Q

Placenta provides ____

A

Placenta provides fetal nourishment from maternal blood without allowing direct mixing with fetal blood

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3
Q

Describe three compartments of placenta

A

Three compartments of placenta

  • Membranes: maternal + fetal
  • Placental disc: maternal + fetal
  • Umbilical cord: fetal
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4
Q

Three compartments of placenta are ____, ____, and ____

A

Three compartments of placenta are membranes, placental disc, and umbilical cord

  • Membranes: maternal + fetal
  • Placental disc: maternal + fetal
  • Umbilical cord: fetal
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5
Q

Membranes of placenta have 3 layers: ____, ____, and ____

A

Membranes of placenta have 3 layers: amnion, chorion, and parietal decidua

  • Amnion: fetal epithelial layer
  • Chorion: fetal mesodermal layer
  • Parietal decidua: maternal layer containing remodeled maternal blood vessels
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6
Q

Umbilical cord is composed of ____ including ____ and ____ and is cushioned by ____

A

Umbilical cord is composed of 3 vessels including 1 vein and 2 arteries and is cushioned by Wharton’s jelly

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7
Q

Placental disc components of fetal origin are ____ and ____

A

Placental disc components of fetal origin are chorionic plate (fetal surface) and villous tree

  • Chorionic plate (fetal surface): arborizing fetal vessels
  • Villous tree: fetal vessels surrounded by trophoblasts
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8
Q

Placental disc components of maternal origin are ____ and ____

A

Placental disc components of maternal origin are basal plate (maternal surface) and intervillous space (maternal blood)

  • Basal plate (maternal surface): decidua (maternal), remodeled vessels (maternal), extravillous trophoblast (fetal), fibrinoid (fetal)
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9
Q

This is the ___

A

This is the chorionic plate (fetal surface)

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10
Q

Chorionic villi are ____

A

Chorionic villi are embryo derived structures containing fetal blood vessels and surrounded by trophoblast

  • As gestation progresses, villi branch like branches of a tree
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11
Q

Describe the syncytiotrophoblast

A

Syncytiotrophoblast

  • Outer layer
  • Multinucleated (syncytium)
  • Permeable to oxygen + nutrients
  • Not permeable to blood
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12
Q

Describe the cytotrophoblast

A

Cytotrophoblast

  • Inner layer
  • Stem cells
  • Continuous -> discontinuous
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13
Q

Describe the histology

A

Histology of placenta

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14
Q

Describe remodeled maternal vessels

A

Remodeled maternal vessels lose muscle and become lined by extravillous trophoblast cells to create low resistance vessels that supply blood to the intervillous space

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15
Q

Normal implantation is into ____

A

Normal implantation is into uterine wall

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16
Q

Ectopic pregnancy is ____

A

Ectopic pregnancy is implantation outside uterine wall, usually in fallopian tube

  • High risk of rupture and hemorrhage
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17
Q

Placenta previa is ____

A

Placenta previa is low implantation over the cervical internal os

  • Placenta blocks vaginal delivery
  • Risks: maternal hemorrhage, fetal hypoxic injury
  • Cesarean section
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18
Q

Normal implantation is into the ____ which separates at birth

A

Normal implantation is into the decidua which separates at birth

  • Without decidua, placenta on myometrium (adherent)
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19
Q

Placenta accreta is ____

A

Placenta accreta is implantation on myometrium

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20
Q

Placenta increta is ____

A

Placenta increta is invasion into myometrium

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21
Q

Placenta percreta is ____

A

Placenta percreta is invasion through uterine serosa into adjacent structures

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22
Q

Describe placenta increta

A

Placenta increta

  • Placenta invades myometrium
  • Often C-section
  • Hysterectomy
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23
Q

____ placental infections are most common

A

Ascending placental infections are most common

  • Vaginal canal -> amniotic fluid
  • Maternal inflammatory response: chorioamnionitis
  • Fetal inflammatory response: inflammation in umbilical cord and placental vessels
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24
Q

Hematogenous infection (maternal sepsis) infects ____ and is ____

A

Hematogenous infection (maternal sepsis) infects intervillous spaces and is villitis

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25
Ascending placental infections are usually ____ caused by ____ or \_\_\_\_
Ascending placental infections are usually bacterial caused by maternal genitourinary flora or maternal gastrointestinal flora * Maternal genitourinary flora: Mycoplasmas, Gardnerella * Maternal gastrointestinal flora: group B Strep, E. coli, Enterococcus * Occassionally: Candida spp, HSV
26
Maternal inflammatory response to ascending placental infections is ____ originating from \_\_\_\_
Maternal inflammatory response to ascending placental infections is maternal neutrophils (acute inflammatory cells) originating from decidual vessels membrane and basal plate
27
Three stages of maternal response to ascending placental infections are \_\_\_\_, \_\_\_\_, and \_\_\_\_
Three stages of maternal response to ascending placental infections * Subchorionitis * Chorioamnionitis * Necrotizing amnionitis
28
Fetal inflammatory response to ascending placental infections is ____ originating from \_\_\_\_
Fetal inflammatory response to ascending placental infections is fetal neutrophils originating from fetal vessels * Fetal vessels are in umbilical cord and on chorionic plate
29
Three stages of fetal response to ascending placental infections are \_\_\_\_, \_\_\_\_, and \_\_\_\_
Three stages of fetal response to ascending placental infections 1. Phlebitis (vein) 2. Arteritis (artery) 3. Necrotizing funisitis (necrosis in Wharton's jelly)
30
Hematogenous placental infections can be caused by \_\_\_\_, \_\_\_\_, or \_\_\_\_
Hematogenous placental infections can be caused by bacteria, viruses, or toxoplasmosis * Bacteria: syphilis, TB, Listeria * Viral: Cytomegalovirus, Rubella
31
Chronic villitis variant of hematogenous placental infection involves \_\_\_\_
Chronic villitis variant of hematogenous placental infection involves infiltration of villi by lymphocytes, plasma cells, and / or histiocytes * Cytomegalovirus, toxoplasmosis, syphilis
32
Acute villitis variant of hematogenous placental infection involves \_\_\_\_
Acute villitis variant of hematogenous placental infection involves infiltration of villi by neutrophils * Listeria (abscesses) * Sometimes E. coli, TB
33
Maternal vascular malperfusion is ____ that presents with ____ and \_\_\_\_
Maternal vascular malperfusion is pathologic changes associated with uteroplacental insufficiency that presents with HTN and preeclampsia
34
In normal placentas, maternal vessels are ____ so they have ____ resistance and ____ flow
In normal placentas, maternal vessels are remodeled by trophoblasts so they have low resistance and high flow
35
In maternal vascular malperfusion, maternal vessels ____ so they have ____ resistance and ____ flow
In maternal vascular malperfusion, maternal vessels retain their muscular walls so they have high resistance and low flow
36
In maternal vascular malperfusion, decreased maternal blood flow leads to \_\_\_
In maternal vascular malperfusion, decreased maternal blood flow leads to chronic hypoxia * Placenta adapts by increasing villous branching -\> smaller terminal villi -\> increased surface area for oxygen / nutrient exchange -\> accelerated villous maturation
37
In maternal vascular malperfusion, vessel injury consists of ____ and \_\_\_\_
In maternal vascular malperfusion, vessel injury consists of replacement of necrotic wall by fibrinoid necrosis and foamy macrophages (atherosis)
38
Damaged placental vessels \_\_\_\_, leading to \_\_\_\_
Damaged placental vessels thrombose, leading to placental infarction
39
When placenta infarcts, \_\_\_
When placenta infarcts, intervillous space collapses and villi die
40
Describe retroplacental hematoma / abruption
Retroplacental hematoma / abruption * Damaged vessels can rupture -\> large retroplacental hematomas -\> premature separation of placenta from uterus
41
Women with retroplacental hematoma / abruption usually present with \_\_\_\_
Women with retroplacental hematoma / abruption usually present with painful bleeding (can be life-threatening)
42
Retroplacental hematomas extend into and infarct the \_\_\_
Retroplacental hematomas extend into and infarct the disc
43
Fetal vascular malperfusion is ____ caused by \_\_\_\_
Fetal vascular malperfusion is pathologic changes associated with fetoplacental insufficiency caused by processes that obstruct / compromise blood flow from the fetus to the placenta
44
Fetal vessels are \_\_\_\_, \_\_\_\_, \_\_\_\_, and \_\_\_\_
Fetal vessels are umbilical cord, chorionic vessels, stem villous vessels, and villous capillaries
45
\_\_\_\_ is sole source of oxygenated / nutrient-rich blood to fetus
Umbilical cord is sole source of oxygenated / nutrient-rich blood to fetus * Abnormal cords compromise delivery of this blood
46
Normal umbilical cords are inserted ____ on the disc and have \_\_\_\_
Normal umbilical cords are inserted centrally / paracentrally on the disc and have loose twists
47
Abnormal cord insertion is ____ and risks \_\_\_\_
Abnormal cord insertion is cord inserted into membranes (velamentous insertion) and risks kinks / injury
48
Abnormal cord twisting can lead to \_\_\_, \_\_\_
Abnormal cord twisting can lead to strictures, constricting blood flow * Normal cords have 1-3 twists / 10 cm
49
Mechanical obstruction of umbilical cord can be ____ or \_\_\_\_
Mechanical obstruction of umbilical cord can be knots or entrapment * Neck entrapment (nuchal cord) * Body entrapment (body cord)
50
Thrombus formation is governed by ____ which consists of \_\_\_\_, \_\_\_\_, and \_\_\_\_
Thrombus formation is governed by Virchow's triad, which consists of stasis, hypercoagulability, and vascular damage * Stasis: cord compression / stricture, heart failure / anomalies, polcythemia * Hypercoagulability: thrombophilic disorders, acquired or gentic * Vascular damage: infection, meconium, mechanical
51
Pathologic findings of fetal vascular malperfusion are ____ and \_\_\_\_
Pathologic findings of fetal vascular malperfusion are thrombosed vessel and apoptosis of fetal vessels (avascular villi)
52
Describe consequences of fetal vascular malperfusion
Fetal vascular malperfusion consequences * High grade fetal vascular malperfusion can result in fetal neurologic damage (i.e. cerebral palsy) * In most severe cases, can result in intrauterine or neonatal fetal demise
53
Dizygous (fraternal) placentas are \_\_\_
Dizygous (fraternal) placentas are two eggs each fertilized by their own sperm
54
Monozygous (identical) placentas are \_\_\_\_
Monozygous (identical) placentas are 1 egg fertilized by 1 sperm
55
Describe chorions in twin placentas
Chorions in twin placentas * Most twins have 2 chorions (dichorionic): 1/3 monozygous, 2/3 dizygous * Monochorionic: nearly always monozygous
56
Describe amnions in twin placentas
Amnions in twin placentas * Dichorionic always has two amniotic sacs (diamniotic) * Monochorionic has one or two (monoamniotic): rarely monochorionic monoamniotic twins can be conjoined
57
All dizoygotic twins are ___ and placental discs can be \_\_\_
All dizoygotic twins are dichorionic diamniotic and placental discs can be either fused or separate
58
For monozygotic twins, chorionicity and amniocity are dependent on \_\_\_
For monozygotic twins, chorionicity and amniocity are dependent on when the ovum divides after fertilization * \< 2 days: dichorionic diamniotic * 2-8 days: monochorionic diamniotic * \> 8 days: monochorionic monoamniotic
59
Dichorionic placenta has a dividing membrane that is \_\_\_\_
Dichorionic placenta has a dividing membrane that is thick, obaque, and firmly adhered to the disc because of the intervening chorion * Could be either dizygotic or monozygotic
60
Monochorionic placenta has a dividing membrane that is \_\_\_\_
Monochorionic placenta has a dividing membrane that is thin, translucent, and not adhered to the disc because no intervening chorion * Almost always monzygotic
61
Twin pregnancies are at increased risk of \_\_\_\_
Twin pregnancies are at increased risk of developing preterm labor * Monochorionic placentas have additional risks: twin twin transfusion and twin reversed arterial perfusion, cord entanglement in monochorionic monoamniotic twins, more congenital malformations
62
Monochorionic twin placenta is almost always ____ and has \_\_\_\_
Monochorionic twin placenta is almost always monozygotic and has intertwin vascular connections
63
Problems of intertwin vascular connections are ____ and \_\_\_\_
Problems of intertwin vascular connections are twin twin transfusion and twin reversed arterial perfusion
64
Twin twin transfusion syndrome involves ____ and \_\_\_\_
Twin twin transfusion syndrome involves anemic donor twin and plethoric recipient twin
65
Twin reversed arterial perfusion involves a ____ and \_\_\_\_
Twin reversed arterial perfusion involves a pump twin (hydrops) and acardiac twin
66
Gestational trophoblastic disease involves \_\_\_\_
Gestational trophoblastic disease involves proliferative placental tissue tumors that develop from trophoblasts * Produce B-hCG (tumor marker)
67
B-hCG is a tumor marker for \_\_\_\_
B-hCG is a tumor marker for gestational trophoblastic disease * Gestational trophoblastic disease: proliferative placental tissue tumors
68
Gestational trophoblastic disease classificiation includes ____ and \_\_\_\_
Gestational trophoblastic disease classificiation includes hydatidiform mole (80%) or choriocarcinoma * Hyaditidiform mole: complete or partial
69
Molar pregnancies have \_\_\_\_
Molar pregnancies have overrepresentation of paternal chromosomes
70
Describe complete molar pregnancies
Complete molar pregnancies * Grape-like swollen villi * Diffuse trophoblast hyperplasia * Cystic swelling of all chorionic villi
71
Describe partial molar pregnancies
Partial molar pregnancies * Only some villi are edematous and trophoblast hyperplasia only focal * Embryo present but often abnormal and rarely visible
72
Compare complete and partial molar pregnancies
Complete and partial molar pregnancies
73
Choriocarcinoma is a \_\_\_\_
Choriocarcinoma is a pure trophoblast proliferation with NO chorionic villi * Highly malignant * Rapidly invasive and widely metastasizing (especially to lung, brain, and liver) * Responds well to chemotherapy
74
Choriocarcinoma appears as ____ on histology
Choriocarcinoma appears as poorly differentiated syncytiotrophoblasts on histology

Repro / GU (46 decks)

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