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25 Cards in this Set

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Describe the normal anatomy/findings of a placenta.
-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
What are situations in which you would get abnormal implantation of placenta?
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.
Describe 2 types of abnormalities in placental morphology.
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.
Describe the abnormal cord condition of having 2 umbilical vessels. What complications is it associated w/?
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.
What can happen w/ the umbilical cords of identical twins?
They can become interlaced.
What is the difference b/w an umbilical true knot vs a false knot?
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.
What is velamentous insertion of the cord & what can it result in?
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.
What are some causes of prolapse of the cord? What is prolapse of the cord? Is it common?
-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.
Torsion of the umbilical cord is an effect of what?
Associated w/ fetal distress b/c cord is now twisted around fetus--can effect blood supply to baby;
Effect of poor cord perfusion;
What is meconium? When is it released?
-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)
What is chorioamnionitis?
-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)
What are the complications of premature separation of the placenta (abruptio placentae; basal decidual hematoma)? What is it associated w/?
-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.
True infarcts of the placenta are associated w/ what conditions and what are the complications?
-well-defined lesions assoc w/ pre-eclampsia, HTN, chronic glomerulonephritis.
-Complications: fetal death, premature delivery, retarded fetal development.
What is feto-placental hydrops and what diseases it is associated w/?
-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.
What is amnion nodosum?
Plaques on amnion which are assoc w/ oligohydramnios (dec amniotic fluid) of any etiology. (granulomatous cell debris)
What is a chorioangioma? When is it symptomatic?
-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)
What are the characteristics of a hydatiform mole? Where is it most common?
-placental neoplasm, grape-like appearance w/ massively swollen villi; common in SE Asia & Indian, teens, women >45.
What are the sx's of a hydatiform mole?
-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.
What is the difference b/w a complete & partial hydatiform mole?
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.
What is an invasive mole (aka chorioadenoma destruens)?
-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
What are the manifestations of invasive moles?
-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.
What key pt do invasive moles tells us about normal cells and neoplasia?
Invasive moles tell us that nl cells have programming necessary for neoplasia (invasion & mets) already present.
How do you differentiate an invasive mole from choriocarcinoma?
presence of villi (chorio has no villi)
What is the tx for pt w/ invasive mole?
Chemo &/or hysterectomy
What is a choriocarcinoma? Is it benign of malignant?
-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)