Repro Zaman - Placenta; Kct

Front 1

Describe the normal anatomy/findings of a placenta.

Back 1

-Placenta disk shaped, fetal side bluish, smooth & shiny.
-Maternal side cortelydons (bults of tissue adjacent to uterine wall) intact;
-Cord 55-60 cm, 3 vessels (can have 2 but one is really bad!)
-Membranes shiny, no foul smell, no meconium (secretions of intestines of fetus, from trauma/injury to fetus), membranes intact

Front 2

What are situations in which you would get abnormal implantation of placenta?

Back 2

1. Ectopic pregnancy
2. Placenta previa (placenta attaches to inferior segment of uterus-->not much blood supply in lower levels, so placenta detaches, so has poor growth & hypoxia). Get hemorrhage & need cesearian section.
3. Placenta accreta/increta/perceta (placenta implants on myometrium, deeply into myometrium, or thru uterine wall respectivally.) Results in retained placenta, hemorrhage, may lead to uterine rupture w/ placenta percreta. Causes: mutliple curettages, previous c-section, severe endometritis, or closely spaced pregnancies.

Front 3

Describe 2 types of abnormalities in placental morphology.

Back 3

1. Circumvallate/marginate (cord is inverted into edge of disc membrane): complications-marginal sinus hematoma & hemorrhage during labor;
2. Placenta succenturiate: have 1+ lobes separated from main placenta. Complications-extra separated tissue remains behind post delivery, get retained placenta, postpartum hemorrhage, & potential for infection.

Front 4

Describe the abnormal cord condition of having 2 umbilical vessels. What complications is it associated w/?

Back 4

1. 2 umbilical vessels (1 artery--we usually have 2 arteries & one vein!)-->in 1% of all cords, assoc w/ congenital defects in 30%: cardiac, renal, skeletal,etc; assoc w/ prematurity & small for dates. Observe grossly, must be confirmed microscopically. May need to deliver fetus is blood supply is cut off.

Front 5

What can happen w/ the umbilical cords of identical twins?

Back 5

They can become interlaced.

Front 6

What is the difference b/w an umbilical true knot vs a false knot?

Back 6

True knots: knots of umbilical cord from fetal movement, usually from early pregnancy when baby moves the most.
False knots: kinks in vessels enabling umbilical vein, which is longer than umbilical artery, to fit w/in length of cord. More common than true.

Front 7

What is velamentous insertion of the cord & what can it result in?

Back 7

Abnl conditions where umbilical cord doesn't insert into placenta but rather goes thru fetal membranes. May result in massive hemorrhage if located & cervical opening.

Front 8

What are some causes of prolapse of the cord? What is prolapse of the cord? Is it common?

Back 8

-1/100-150 deliveries;
-Cord prolapse: cord falls into birth canal ahead of baby-->can be dangerous if this is compression of this cord b/c can cut off oxygen & blood supply to baby.
-Causes: too much amniotic fluid, abnormal presentation, delay in engagement of head b/c cord was pushed out.

Front 9

Torsion of the umbilical cord is an effect of what?

Back 9

Associated w/ fetal distress b/c cord is now twisted around fetus--can effect blood supply to baby;
Effect of poor cord perfusion;

Front 10

What is meconium? When is it released?

Back 10

-Meconium is content of fetal bowel.
-Its released during fetal stress/stressful delivery; -Stains placenta & amnionic ;
fluid.
(FYI: it normally stays in baby's intestines until after birth but can come out into amniotic fluid; if it gets thick & congested in ileum its meconium ileus like in CF pts)

Front 11

What is chorioamnionitis?

Back 11

-Inflammation of chorion & amnio.
-Its the result of intrauterine infection.
-Most commonly seen w/ rupture of membranes & delayed delivery.
-In severe dz w/ infection of fetus, will see inflammatory cells around vessels of cord (funisitis)

Front 12

What are the complications of premature separation of the placenta (abruptio placentae; basal decidual hematoma)? What is it associated w/?

Back 12

-Assoc w/ cocaine use;
-Complications: Hemorrhage, fetal death, amniotic fluid embolism, bleeding diathesis (DIC) (FYI bleedig diathesis is unusual susceptibility to bleeding b/c of coagulation defect)
-Couvelaire uterus (utero-placental apoplexy) 5-20% of cases of abruptio placentae. Blood extravasates thru myometrium & uterus fails to contract forcefully.

Front 13

True infarcts of the placenta are associated w/ what conditions and what are the complications?

Back 13

-well-defined lesions assoc w/ pre-eclampsia, HTN, chronic glomerulonephritis.
-Complications: fetal death, premature delivery, retarded fetal development.

Front 14

What is feto-placental hydrops and what diseases it is associated w/?

Back 14

-Voluminous placentas & edematous infants.
-Assoc w/ hemolytic dz of newborn (HDN) due to maternal-fetal red cell antigen incompatibility, & some congenital anemias. Similar pic in DM & syphilis.

Front 15

What is amnion nodosum?

Back 15

Plaques on amnion which are assoc w/ oligohydramnios (dec amniotic fluid) of any etiology. (granulomatous cell debris)

Front 16

What is a chorioangioma? When is it symptomatic?

Back 16

-Hemangioma of placenta (1% of births) assoc w/ L to R shunting.
-Symptmatic when >5 m in size: fetal distress/death, premature delivery, placental separation, placental previa (usually do c-sction)
(FYI: A benign vascular (blood vessel) tumor of the placenta)

Front 17

What are the characteristics of a hydatiform mole? Where is it most common?

Back 17

-placental neoplasm, grape-like appearance w/ massively swollen villi; common in SE Asia & Indian, teens, women >45.

Front 18

What are the sx's of a hydatiform mole?

Back 18

-Rapidly inc uterine size, vaginal bleeding, sometimes toxemia (1st trimester).
-Vomiting common.
-Uterus is larger & hCG levels inc more than expected for date of pregnancy.
-can progress to more malignant neoplasm or abortion
-expelled spontaneously or delivered.

Front 19

What is the difference b/w a complete & partial hydatiform mole?

Back 19

Both from abnl fertilization.
1. Complete: more common. All placental villi are abnl & NO fetus. Usually 46XX. All from dad. Duplicated 23x sperm believed to fertilize defective ovum lacking mom's chromosomes. 2% chance of developing into choriocarcinoma.
2. Partial: only pt of placenta is involved & there IS fetus present; Most are triploid (69XXY), sometimes tetraploid. Rarely develop choriocarcinoma.

Front 20

What is an invasive mole (aka chorioadenoma destruens)?

Back 20

-usually benign local lesion of placenta; Usually complete, sometimes partial.
-Villi penetrate deeply into myometrium &/or its bv's, exaggeration of trophoblastic invasion.
-may get uterine perforation

Front 21

What are the manifestations of invasive moles?

Back 21

-placenta accreta
-microscopic trophoblastic emboli in lungs post nl pregnancy
-w/ vascular invasion-->implants in lungs (X-ray appearance, hemorrhagic complications, make HcG, may regress spontaneously), brain (may get fatal hemorrage-->doesn't regress), & spinal cord.

Front 22

What key pt do invasive moles tells us about normal cells and neoplasia?

Back 22

Invasive moles tell us that nl cells have programming necessary for neoplasia (invasion & mets) already present.

Front 23

How do you differentiate an invasive mole from choriocarcinoma?

Back 23

presence of villi (chorio has no villi)

Front 24

What is the tx for pt w/ invasive mole?

Back 24

Chemo &/or hysterectomy

Front 25

What is a choriocarcinoma? Is it benign of malignant?

Back 25

-MALIGNANT neoplasm of placenta composed of trophoblast w/o any histo tendency to mimic villi.
-Always fatal before chemo, now lots of cures. -Gestational choriocarcinoma (from pregnancy)better prognosis than chorio from gonads (b/c of foreign paternal antigens it carries);
-Tumor produces HcG, so can use this as just of if chemo is working;
-1/40,000 preg. (1/2 post molar, other 1/2 from nl preg or abortion)