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64 Cards in this Set

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Fetal surface of a normal Placenta
What is this showing?
Maternal surface of a normal Placenta
What is this showing?
What are the predisposing factors to Placental Inflammation and Infection?

Which is most common?
1. Premature rupture of membranes ****
2. Induced abortion
3. Hematogenous spread
4. Sex in the 3rd trimester
What microbes are responsible for Ascending infection of the Placenta?
1. Group B Streptococci
2. Anaerobic Strep
3. Staph
4. Coliforms and Bacteroides
5. Clostridium Welchii
What microbes are responsible for hematogenous spread causing Placental infection?
1. Treponema Pallidum
2. Listeria Monocytogenes
3. Candida
4. Toxoplasma
5. CMV
-Inflammation of the placental villi = 1

-Inflammation of fetal membranes = 2

-Inflammation of the umbilical cord = 3
1. Placentitis

2. Chorioamnionitis

3. Funisitis
Chorioamnionitis = inflammation of the fetal membranes = amnion, chorion, allantois, and yolk sac
What is this showing?
Term for accessory lobes of the placenta along the margin
- risk for hemorrhage if the accessory lobes are detached
Placenta Succenturiata
Accessory lobe = Succenturiate
What are these showing?
Succenturiate lobe

If it ruptures there can be massive bleeding
What is this showing?

What is the risk?
Marginal (peripheral)insertion of the umbilical cord
Battledore placenta
Battledore placenta = marginal placement of the placenta
What are these showing?
Placenta circumvallata = membranes double back for a short distance over the fetal surface when the chorionic plate is too small
What is this showing?
Diamnionic + Dichorionic
- could be monozygotic or dizygotic
What is this picture showing?
What is this picture showing?
Diamnionic + Monochorionic = Monozygotic
Could be either, but most likely Dizygotic
Is this Di- or Monozygotic?
Stealing Syndrome

One placenta with 2 babies, one baby is stealing blood from the other
What is the name for this syndrome?

What causes it?
What is "Velamentous insertion of the Umbilical Cord"?
When the major umbilical vessels separate in the fetal membranes before reaching the placental disk
-is of no major consequence in utero
-could lead to greater chances for cord trauma with bleeding during delivery
Abnormal penetration of the placenta into the uterine wall in which the Villi reach the Myometrium but do not invade it
Placenta Accreta
Abnormal penetration of the placenta into the uterine wall in which the Villi invade beyond the Endometrium into the Myometrium
Placenta Increta
Abnormal penetration of the placenta into the uterine wall in which the Villi penetrate through the entire Myometrium and may reach the serosal surface
Placenta Percreta
What is the pathophysiology of Placenta Accreta, Increta, Percreta?
Defective decidual layer
Placenta accreta, percreta
What is shown here?
What is the clinical manifestation of Placental Accreta?
Massive hemorrhage after delivery -> requires hysterctomy
What predisposes to Placenta Accreta?
1. Endometrial inflammation

2. prior C-section scars
What is Placenta Praevia?
Attachment of the placenta over the Cervical Os
What is Placenta Praevia associated with?
Placenta Accreta
How may Placenta Previa present clinically?
repeated bouts of bleeding during the entire pregnancy
What are Spontaneous abortions associated with in 50% of the cases?
Chromosomal abnormalities -> Trisomy 16
Implantation of the conceptus at some other site than the Endometrial lining of the uterus
Ectopic pregnancy
How common is Ectopic Pregnancy?
1 in 100 pregnancies
What are 4 causes of Ectopic pregnancy?

Which is most common?
1. Chronic Salpingitis (PID) ***
2. Congenital abnormalities of the Salpinx
3. Extrinsic compression of Salpinx (tumors, adhesions)
4. Transmigration of the ovum
What is the most common cause of Hematosalpinx?
Ectopic pregnancy
What are the most common sites of Ectopic pregnancy?
-
Ectopic Tubal pregnancy
What are these showing?
Late Ectopic Tubal pregnancy
What is this showing?
A woman with previous history of Pelvic Inflammatory Disease presents with sudden onset of lower abdominal pain and is in hypovolemic shock. Her last menstruation was 6 weeks ago and she has elevated hCG but not as high as normal pregnancies.

What is the cause?
Ruptured Fallopian Tube Ectopic pregnancy
Ectopic tubal pregnancy
- hemorrhage
-decidua
-chorionic villi
What are these showing?
What is the triad of Toxemia of Pregnancy?
1. Hypertension
2. Proteinuria
3. Edema
When does Toxemia of Pregnancy usually occur?
3rd trimester of a woman's first pregnancy
What are the 2 forms of Toxemia of Pregnancy?
1. Preeclampsia

2. Eclampsia
What differentiates Preeclampsia from Eclampsia?
Eclampsia includes seizures
Describe the pathogenesis of Toxemia of Pregnancy
1. Abnormal placentation -> obstruction of Spiral arteris
2. Normal vasodilator are decreased
3. Vasoconstrictors are increased
4. Net effect = Placental hypoperfusion
Toxemia of Pregnancy
-placenta with infarcts = lighter parts
What is this showing?
Toxemia of Pregnancy
- chorionic villi with coagulative necrosis and infarction of the placenta
What has happened here?
What are the 3 sequelae of Toxemia of Pregnancy?
1. Complete recovery
2. Persistent HTN
3. Persistent Renal Damage
What is the treatment for Eclampsia?
Magnesium sulfate

Diazepam
What are the 4 Gestational Trophoblastic Diseases?
1. Hydatidiform mole
2. Chorioadenoma destruens
3. Choriocarcinoma
4. Placental site trophoblastic tumor
Cystic, hydropic swelling of the Chorionic Villi with variable hyperplastic and anaplastic changes in the chorionic epithelium
Hydatidiform mole
Where is Hydatidiform Mole somewhat common?
Asian countries = Taiwan, Phillipines, India
Complete Molar Pregnancy
What is this?
Hydatidiform mole
-no blood vessels within Villi
-proliferation of trophoblast with some atypia
What is this?
An 18 year old woman in hter 16 week of pregnancy presents with excessive vomiting (10/day for 3 days) and vaginal bleeding. Labs show beta-hCG. Ultrasound shows "snow-storm" appearance

What is the diagnosis?
Hydatidiform Mole
What is the most common cause of Choriocarcinoma?
Complete Mole
What is the genotype of complete mole?
46 XX with both sets of chromosomes coming from the father
What is the genotype of Partial Mole?
69 XXY usually due to fertilization of egg by 2 sperm
Edematous changes of Villi with the presence of Fetal Parts
Partial Mole
What is Chorioadenoma Destruens?
Invasive mole
-vaginal bleeding
-elevated hCG in serum and urine
-rupture of uterus with hemorrhage, sepsis, and death
Invasive Mole = Chorioadenoma Destruens
What are these showing?
What are the 3 most common causes of Choriocarcinoma?
1. Complete Hydatidiform mole
2. Previous abortion = originates from residual chorionic villi
3. Normal pregnancies
This is proliferation of Malignant Syncytial and Cytotrophoblastic cells...chorionic villi are not present
Choriocarcinoma
Choriocarcinoma
What is this?
An Asian woman with a previous history of Hydatidiform Mole and abortion presents with excessive vaginal bleeding. Lab results confirm elevated hCG in serum and urine. She has also been coughing up blood.

1. What is the diagnosis?
2. Why does she have elevated hCG?
3. Why the hemoptysis?
1. Gestational Choriocarcinoma
2. Syncytiotrophoblasts secrete hCG
3. Metastasis to the lungs
What are common sites of Metastasis of Gestational Choriocarcinoma?
Lungs

Brain

Liver