Week 10: Placenta

Question 1

ID the structure

Answer 1

Umbilical Cord

2 umbilical arteries (yellow circle)
1 umbilical vein (cyan circle)
Wharton’s Jelly (green arrow)

Question 2

its job is to facilitate moving oxygen and nutrients from the mother to the fetus, and waste products from the fetus to the mother

Answer 2

Placenta

Question 3

What is the placenta disc composed of

Answer 3

Trophoblast and villi

Question 4

Is this on the fetal or maternal side?

Answer 4

Fetal side

Question 5

Is this on the fetal or maternal side?

Answer 5

Maternal side

Question 6

ID

Answer 6

Normal placenta with villi

Question 7

ID the structure

Answer 7

Normal placenta with villi

fetal blood in villi (cyan arrows)
maternal blood in intervillous space (yellow arrows)

Question 8

ID

Answer 8

Placenta Previa

Question 9

What are risk factors for placenta previa

Answer 9

• Previous C-section
• Advanced maternal age
• Multiparity
• Prior placenta previa

Question 10

ID

Answer 10

Placental Abruption

Premature separation of the placenta from the uterus

Question 11

ID

Answer 11

Placenta abruption

Question 12

What are risk factors for placental abruption?

Answer 12

• Tobacco smoking
• Hypertension
• Trauma

Question 13

abnormal placentation, attaches to myometrium instead of endometrium/decidua basalis

Answer 13

Placenta accreta

Question 14

ID

Answer 14

Placenta accreta

Question 15

What are risk factors for placenta accreta?

Answer 15

• Prior C-section (scar tissue in myometrium to attach to instead of endometrium)
• Placenta previa

Question 16

ID

Answer 16

Placenta accreta

Question 17

ID

Answer 17

Placenta accreta with previa

Question 18

ID the chorionicity and amnionicity of these twins

Answer 18

Monochorionic and Monoamniotic

Question 19

ID the chorionicity and amnionicity of these twins

Answer 19

Monochorionic and Diamniotic

Question 20

ID the chorionicity and amnionicity of these twins

Answer 20

Dichorionic and Diamniotic

Fused placenta

Question 21

ID the chorionicity and amnionicity of these twins

Answer 21

Dichorionic and Diamniotic

Separate/Unfused Placenta

Question 22

Which twin is the donor and recipient in this twin-twin transfusion syndrome?

Answer 22

Left - Recipient
Right - Donor

donor has anemia and recipient has polycythemia so by looking at their color you can tell

Question 23

Which twin is the donor and recipient in this twin-twin transfusion syndrome?

Answer 23

Left - Recipient
Right - Donor

see the recipient has more bloo in their villi and the donor is more pale in their villi

Question 24

What are congenital infections of the placenta?

Answer 24

Toxoplasma
Other (syphilis, Zika, VZV, parvo, and covid)
Rubella
CMV
HSV

“TORCH”

Question 25

ID

Answer 25

Placental Cytomegalovirus (CMV)

Question 26

ID

Answer 26

Placental Syphilis ## Footnote Treponema pallidum (yellow arrows)

Question 27

ID

Answer 27

Placental Parvovirus ## Footnote RBC nuclei are too perfectly circles - intranuclear inclusions in erythroid precursor cells (yellow arrows)

Question 28

ID

Answer 28

Placental COVID-19 ## Footnote reduced intervillous space in COVID-19 infection

Question 29

What are 4 maternal factors for fetal growth restriction (FGR)?

Answer 29

* Hypertension * Preeclampsia * Tobacco smoking * Malnutrition

Question 30

What are 3 fetal factors for fetal growth restriction (FGR)?

Answer 30

* Chromosomal anomalies * Congenital anomalies * Infection

Question 31

What are 4 placental factors for fetal growth restriction (FGR)?

Answer 31

* Umbilical cord anomalies * Chorionic abruption * Infection * Chronic Villitis of unknown origin

Question 32

ID

Answer 32

Decidua Vasculopathy ## Footnote In preeclampsia

Question 33

ID

Answer 33

Villous infarct ## Footnote In preeclampsia - note lake of purple staining cells. cell death occuring.

Question 34

ID

Answer 34

Chorangiosis ## Footnote a sign of chronic hypoxia, or low oxygen levels, in the placenta

Question 35

Who is at risk for chorangiosis?

Answer 35

* Maternal Tobacco smoking individuals * Air pollution areas * IVF babies - multiple pregnancies (twins, triplets, etc.)

Question 36

What is the normal number of capillary beds you should see in a villus?

Answer 36

~10 ## Footnote >10 is a sign of chorangiosis

Question 37

ID

Answer 37

Chorionic villitis of unknown etiology

Question 38

ID

Answer 38

True Knot of the Umbilical Cord (TKUC)

Question 39

A knot that forms in the umbilical cord during pregnancy

Answer 39

True Knot of the Umbilical Cord (TKUC)

Question 40

A bulge in the umbilical cord caused by excessive Wharton's jelly or looping of the cord vessels

Answer 40

False Knot of the Umbilical Cord (FKUC)

Question 41

The protective environment of the cord does not cover the vessels all the way to the disc. Occurs when the umbilical cord vessels insert into the membranes surrounding the placenta instead of directly into the placental mass.

Answer 41

Velamentous insertion

Question 42

If the membranes are ruptured at the cervical os for an extended period of time (hours to days to weeks), what are some of the risks?

Answer 42

Prolonged rupture of membranes increases the risk for an ascending infection from the vaginal canal, chorioamnionitis

Question 43

This is endometrium. What change has occurred? Why?

Answer 43

Decidualization is caused by progesterone from pregnancy or medication (i.e. oral contraceptives)

Question 44

ID

Answer 44

Question 45

ID

Answer 45

Question 46

ID

Answer 46

Normal placenta

Question 47

ID

Answer 47

Placenta accreta

Question 48

Where should the placenta normally attach?

Answer 48

Endometrium - decidua basalis

Question 49

What lab finding do you see in preeclampsia versus maternal/gestational hypertension?

Answer 49

Proteinuria (foamy urine) in preeclampsia

Question 50

ID: A

Answer 50

Normal Placenta

Question 51

ID: B

Answer 51

Placenta Previa

Question 52

ID: C

Answer 52

Placenta Accreta

Question 53

ID: D

Answer 53

Placental Abruption

Question 54

ID: E

Answer 54

Ectopic Pregnancy