Reproduction L05 Placental Dev & Path

Front 1

What is the fate of the inner cell mass?

Back 1

becomes the embryo

Front 2

What are the 3 components of the blasotcyst?

Back 2

inner cell mass, blastocyst cavity, trophoblast

Front 3

After implantation what sort of differentiation occurs to the trophoblast?

Back 3

trophoblastic cells --> (a) i. Cytotrophoblast (inner layer of cuboidal cells)… (b) Syncytiotrophoblast (outer layer of muntinucleanated synctial cells)

Front 4

What happens to the blastocyst after implantation?

Back 4

the blastocyst is completely embedded:

Front 5

With respect to the blastocyst, what part of the endometrium is the DECIDUA CAPSULARIS? Is it fetally or maternally derived?

Back 5

Decidua capsularis superficial portion of endometrium overlying the blastocyst… fetally derived

Front 6

With respect to the blastocyst, what part of the endometrium is the DECIDUA BASALIS? Is it fetally or maternally derived?

Back 6

Deciudua Basalis: the endometrium underlying the blastocyst (maternally derived)

Front 7

Which is maternally derived, the decidua capsularis or basalis?

Back 7

Basalis is maternally derived

Front 8

When do you see the chorion and connecting stalk form?

Back 8

2nd week

Front 9

In the second week the amnionic cavity forms… what is it?

Back 9

amnioinic cavity is the the slit-like space between the inner cell mass and the trophoblast

Front 10

In the second week what happens to the inner cell mass?

Back 10

it becomes the bilaminar embryonic disk

Front 11

What forms the primary yolk sak?

Back 11

blastocyst cavity lined with the exocoelomic membrane --> primary yolk sak

Front 12

Where does the extra embryonic mesoderm grow?

Back 12

Extra-embryonic mesoderm grows under trophoblast

Front 13

What is the primative chorion made of?

Back 13

Mesoderm + trophoblast → primitive chorion

Front 14

What is the Chorionic cavity?

Back 14

Chorionic Cavity (fused spaces in the mesoderm)

Front 15

What eventually develops into the UMBILICAL CORD?

Back 15

[Embryonic disk + amnion + yolk sac + alantois] – attach to chorion – suspended by connecting stalk → Umbilical Cord

Front 16

What structure grows and surrounds the embryo?

Back 16

the amnion grows and surrounds the embryo

Front 17

What is the primordial villi composed of?

Back 17

Mesodermal tissue beneath the trophoblast → trophoblastic cell mass → primordial villi (each villus = mesoderm core surrounded by inner cytotophoblast and outer synctiotrohoblast cells.

Front 18

What is the placenta derived from?

Back 18

Primordial villi branch over bloastocyst → primordial frondosum… (The primordial frondosum over the deciduas capsularis atrophies → chorion laeve [smooth chorion])… 3. The part that does not atrophy and invades deciduas basalis→ placenta… SHORT ANSWER: the PRIMORDIAL VILLI --> PRIMORDIAL FRONDOSUM --> PLACENTA

Front 19

Before the third week, where does the embryo collects its nutrition?

Back 19

Lacunae (blood lakes) form in synctiotrophoblast (day 9.. maternal blood) → this serves as Nutrition: Until 3rd week

Front 20

When do fetal blood cells and vessels form?

Back 20

3rd week

Front 21

When does fetal circulation start?

Back 21

4th week

Front 22

What supplies maternal blood to the intervillous spaces?

Back 22

Sprial arterioles supply maternal blood to the intervillous spaces

Front 23

What converts Spiral arterioles? And what is the effect of this conversion?

Back 23

Syncytotrophoblasts & intermediate trophoblasts cause PHYSIOLOGIC CONVERSION of spiral arterioles → specialized blood vessels that nurish growing fetus.

Front 24

Why are chorionic villi so important?

Back 24

1) Chorionic villi must be bathed by maternal blood for normal growth & dev… 2) Exhange occurs in elaborate capillary of the chorionic villi: nutrients, gas exhange, waste excretion.

Front 25

What vessels feed the umbilical vein and what fx does the umbilical vein serve?

Back 25

Chorionic vessel → form umbilical vein: carry oxygenated blood.

Front 26

What do umbilical arteries carrie and where do they lead to?

Back 26

deoxygenated blood… Two – Umbilical arteries carry deoxygenated blood → to chorionic villi → waste products enter intervillous space → exit maternal endometrial veins.

Front 27

What function does the Placental membrane serve… (2) what three structures is it composed from?

Back 27

Placental Barrier: fetal tissue separating fetal and maternal blood: components: trophoblast, connective tissue core of the villi, endothelium of the fetal capillaries

Front 28

What are the two components of the placenta?

Back 28

1) Maternal surface separate from deciduas basalis when expelled… 2) Fetal surface: direct toward amnionic cavity → attached to umbilical cord

Front 29

Where are the fetal membranes? What are it's components?

Back 29

1. Extend from margins of placenta. 2. Amnion, Chorion, Thin layer of decidua

Front 30

Where does the umbilical cord connect, 2) what are its 3 contents?

Back 30

1) two ends: fetal skin & amnion… 2) two umbilical arteries, 1 umbilical vein, Stroma (Whartons Jelly)

Front 31

Which twins come from 1 fertilized and and which come from 2 fertilized eggs?

Back 31

Monzygotic: 1 fertilized egg… Dizygotic: 2 fertilzed eggs

Front 32

What type of twin will result from monchorionic/monoamnionic combination?

Back 32

monchorionic/monoamnionic --> always monzygotic tiwns

Front 33

What type of twin will result from monchorionic/diamnionic combination?

Back 33

monchorionic/diamnionic --> always monozygotic twins

Front 34

What type of twin will result from dichorionic/diamnionic combination?

Back 34

either monozygotic or dizygotic twins

Front 35

What type of twin will result from dichorionic/monoamnionic combination?

Back 35

Can't happen has to be diamnionic

Front 36

Which twins result from two morulas --> two blastocysts?

Back 36

dizygotic twins

Front 37

You're looking at a sample from the membrane dividing one fetus from the other: you see no dividing membrane. What types of twins are these and how do you know?

Back 37

No dividing membrane --> single amnionic cavity --> monochorioinic/monoamnionic --> monozygotic twins

Front 38

You're looking at a sample from the membrane dividing one fetus from the other: you see a dividing membrane, with two amnions. What types of twins are these and how do you know?

Back 38

Not enough information…

Front 39

You're looking at a sample from the membrane dividing one fetus from the other: you see a dividing membrane, with two amnions and chorion in the dividing membrane. What types of twins are these and how do you know?

Back 39

dizygotic twins or monozygotic twins… dividning membrane --> two amnions --> 2 chorion in dividing membrane --> two chorions --> could be either

Front 40

If there is no dividing membrane can you rule a twin type out?

Back 40

yes… no dividing membrane --> monozygotic

Front 41

If there is a dividing membrane, when can you rule out dizygotic twins: w/ chorion in dividing membrane or w/o chorion in the divding membrane?

Back 41

dividing membran without chorion in the dividing membrane --> monozygotic only

Front 42

What is a Placental Vascular Anastomosis? What are it's complications?

Back 42

1) shunting of blood between fetuses… 2) Donor twin: hypovolemic and poorly developed… Recipient twin: hypervolemic and hydramniotic

Front 43

Where does the blastocyst normally implant/

Back 43

lateral wall of the uterine fundus

Front 44

Match the following to either Placenta Previa, Placenta Accreta, or Abruptio Placenta: Caused by insufficient deciduas → leading trophoblast invastion of myometrium

Back 44

PLACENTA ACCRETA: Caused by insufficient deciduas → leading trophoblast invastion of myometrium

Front 45

Match the following to either Placenta Previa, Placenta Accreta, or Abruptio Placenta: complete ________ _________ --> Placental destruction → fetal exsanguinations… require cesarean section

Back 45

complete PLACENTA PREVIA--> Placental destruction → fetal exsanguinations… require cesarean section

Front 46

Match the following to either Placenta Previa, Placenta Accreta, or Abruptio Placenta: bordering or covering os (in the lower part of the uterus)

Back 46

PLACENTA PREVIA: bordering or covering os (in the lower part of the uterus)

Front 47

Match the following to either Placenta Previa, Placenta Accreta, or Abruptio Placenta: Premature separation of normally implanted placenta

Back 47

ABRUPTIO PLACENTA: Premature separation of normally implanted placenta

Front 48

Match the following to either Placenta Previa, Placenta Accreta, or Abruptio Placenta: has 3 different types of trophoblast penetration… (2) Which type is the worst? Why?

Back 48

PLACENTA PERCRETA-TROPHOBLAST: has 3 different types of trophoblast penetration… (2) penetrates entire thickness --> leads to uterine rupture

Front 49

Which type of placenta accreta invades the deep myometrium?

Back 49

PLACENTA INCRETA: Trophoblast penetrates deep myometrium

Front 50

Where does the trohoblast penetrate in Placenta Accreta?

Back 50

the Trophoblast penetrates the superficial myometrium in placenta accreta

Front 51

Match the following to either Placenta Previa, Placenta Accreta, or Abruptio Placenta: 3x Increased risk with pre-eclampsia

Back 51

ABRUPTIO PLACENTA: Pre-eclampsia → 3x as likely to have abruptio placenta

Front 52

Match the following to either Placenta Previa, Placenta Accreta, or Abruptio Placenta: Etiology: Previous surgery OR curettage (D&C) OR infection i. →Thin endometrium → thin deciduas → ?

Back 52

Etiology: Previous surgery OR curettage (D&C) OR infection→Thin endometrium → thin deciduas → PLACENTA ACCRETA

Front 53

Match the following to either Placenta Previa, Placenta Accreta, or Abruptio Placenta: Premature separation of the placenta caused by degeneration of deciduas w/ damage of decidual vessels

Back 53

ABRUPTIO PLACENTA : Premature separation of normally implanted placenta… CAUSED BY degeneration of deciduas w/ damage of decidual vessels

Front 54

Match the following to either Placenta Previa, Placenta Accreta, or Abruptio Placenta: Retroplacental hematoma → ischemia of placenta… associated with Couvellairs Uterus (extreme form of concealed type with symptoms of excessive bleeding and uterine rupture)

Back 54

ABRUPTIO PLACENTA: Retroplacental hematoma → ischemia of placenta… associated with Couvellairs Uterus (extreme form of concealed type with symptoms of excessive bleeding and uterine rupture)

Front 55

Match the following to either Placenta Previa, Placenta Accreta, or Abruptio Placenta: Placenta cannot separate normally after delivery → hemorrhage

Back 55

PLACENTA PREVIA: Placenta cannot separate normally after delivery → hemorrhage

Front 56

Match the following to eitherPlacenta Previa, Placenta Accreta, or Abruptio Placenta: Placental tissue remains postpartum --> leading to bleeding and infection

Back 56

PLACENTA ACCRETA: Placental tissue remains postpartum --> leading to bleeding and infection

Front 57

Match the following to eitherPlacenta Previa, Placenta Accreta, or Abruptio Placenta: Complications of excessive bleeding --> Associated with Maternal shock, fetal distress (or death), and DIC

Back 57

APBRUPTIO PLACENTA: Complications of excessive bleeding --> Associated with Maternal shock, fetal distress (or death), and DIC

Front 58

Match the following to eitherPlacenta Previa, Placenta Accreta, or Abruptio Placenta: Post partum bleeding because uterine contraction insufficient to cause tamponade (Normally minimal bleeding due to uterine contraction → tamponade)

Back 58

ABRUPTIO PLACENTA: Post partum bleeding because uterine contraction insufficient to cause tamponade (Normally minimal bleeding due to uterine contraction → tamponade)

Front 59

Match the following to eitherPlacenta Previa, Placenta Accreta, or Abruptio Placenta: Placenta penetrates myometrium

Back 59

PLACENTA ACCRETA: Placenta penetrates myometrium

Front 60

Match the following to eitherPlacenta Previa, Placenta Accreta, or Abruptio Placenta: Sheehan's syndrome and intraglomerular thrombi associated with kidney cortical necrosis (Irreversible lesion → death 95% of cases)

Back 60

ABRUPTIO PLACENTA: (1) Sheehan's syndrome and (2) intraglomerular thrombi associated with kidney cortical necrosis (Irreversible lesion → death 95% of cases)

Front 61

Which causes bleeding PLACENTA PREVIA, ACCRETA, or ABRUPTIO at the placental margin or distal to the placental margin?

Back 61

In ABRUPTIO PLACENTA separation at the margin is associated with bleeding.

Front 62

Match the following to eitherPlacenta Previa, Placenta Accreta, or Abruptio Placenta: Blastocyst implants in lateral wall of uterine fundus.

Back 62

None: NORMAL PLACENTA:: Has blastocyst implants in lateral wall of uterine fundus

Front 63

Match the following to eitherPlacenta Previa, Placenta Accreta, or Abruptio Placenta: Symptoms associated with bleeding after 7 months (due to placental separation)

Back 63

PLACENTA PREVIA: Symptoms associated with bleeding after 7 months (due to placental separation)

Front 64

Match the following to eitherPlacenta Previa, Placenta Accreta, or Abruptio Placenta: Premature separation of normally implanted placenta after 20th week, where the fetal blood supply decreases proportionally to the size of the separation

Back 64

ABRUPTIO PLACENTA: Premature separation of normally implanted placenta after 20th week, where the fetal blood supply decreases proportionally to the size of the separation

Front 65

Which type of cord knot is caused by the umbilical vein being longer than the umbilical artery? False or true

Back 65

False knots are caused by the umbilical vein being longer than the umbilical artery

Front 66

Which type of cord knot causes entanglements and impede blood flow in the umbilical vein? False or True?

Back 66

TRUE KNOTS cause entanglements and impede blood flow in the umbilical vein… FALSE KNOTS have no clinical significance.

Front 67

What type of umbilical cord abnormality is assoicated with Insertion of cord into membrane NOT Whartons Jelly (unprotected)? Velamentous, single umbilical or True knots?

Back 67

Velamentous cord inserts into membrane, not Whartons jelly

Front 68

What type of umbilical cord abnormality is assoicated with increased risk of fetal morbidity and mortality during labor (arteries are unprotected: Velamentous, Single umbilical artery, or True knots?

Back 68

Velmentous insertion is associate with increased risk of fetal morbidity and mortality during labor (arteries are unprotected

Front 69

What type of umbilical cord abnormality is assoicated with gestational diabetes: Velamentous, Single umbilical artery, or True knots?

Back 69

Single umbilical artery is associated with gestational diabetes

Front 70

What type of umbilical cord abnormality is 7x more common in twin pregnancy: Velamentous, Single umbilical artery, or True knots?

Back 70

Velementous insertion are 7x more common in twin pregnancies

Front 71

What type of umbilical cord abnormality is associate with congenital malformations: Velamentous, Single umbilical artery, or True knots?

Back 71

Both Single Umbilical artery and Velamentous are associated with congenital malformations

Front 72

What type of umbilical cord abnormality is associate with perinatal mortality and infants being small for delivery date: Velamentous, Single umbilical artery, or True knots?

Back 72

Small size and increased perinatal mortality is associated with single umbilical artery.

Front 73

What type of umbilical cord abnormality is associate with single umbilical artery: Velamentous or True knots?

Back 73

Velamentous insertion is associated with single umbilical artery

Front 74

What type of infection is ectopic pregnancy related to?

Back 74

chronic tubal infection (especially gonococcus infection) is associated with ectopic pregnancy

Front 75

What happens if an ectopic pregnancy is not diagnosed by the 4-5th week?

Back 75

tubal rupture if ectopic pregnancy is not diagnosed by 4-5th week.

Front 76

What are the two types of placental infection?

Back 76

the two types of placental infection are chorioamniontitis and transplacental-Villitis

Front 77

Which placental infection is associated with viral infections: Ascending Infection-chorioamniontitis or transplacental-Villitis

Back 77

Viral infection is associated with transplacental-Villitis

Front 78

Which placental infection is a major cause of premature births: Ascending Infection-chorioamniontitis or transplacental-Villitis

Back 78

Ascending Infection-chorioamniontitis --> major cause of premature births

Front 79

Which placental infection is associated with congenital abnormalities: Ascending Infection-chorioamniontitis or transplacental-Villitis

Back 79

transplacental-Villitis associate with congenital abnormalities

Front 80

Which placental infection is secondary to vaginal or cevix infection: Ascending Infection-chorioamniontitis or transplacental-Villitis

Back 80

Is secondary to vaginal or cevix infection -->Ascending Infection-chorioamniontitis

Front 81

Which placental infection is associated with Hx of reproductive failure: Ascending Infection-chorioamniontitis or transplacental-Villitis

Back 81

Hx of reproductive failure: transplacental-Villitis

Front 82

Which placental infection is secondary to hematogenous spread or extension from endometrium: Ascending Infection-chorioamniontitis or transplacental-Villitis

Back 82

Which placental infection is secondary to hematogenous spread or extension from endometrium: transplacental-Villitis

Front 83

Which placental infection is associated with intrauterine growth restriction: Ascending Infection-chorioamniontitis or transplacental-Villitis

Back 83

Which placental infection is associated with intrauterine growth restriction -->transplacental-Villitis

Front 84

Placenta Accreta:

Placenta penetrates myometrium
a. Caused by insufficient deciduas
→ leading to trophoblast invastion of myometrium

b. Etiology: Previous surgery OR curettage (D&C) OR infection
→Thin endometrium → thin deciduas → placenta accreta

Back 84

Which placenta pathology is seen in this image?

Front 85

Abruptio Placenta:

1. Premature separation of normally implanted placenta
a. Cause: degeneration of deciduas w/ damage of decidual vessels

2. Retroplacental hematoma → ischemia of placenta
a. Couvellairs Uterus: extreme form of concealed type
i. Excessive bleeding
ii. Uterine rupture

Back 85

Name the placental abnormality associated with these two images

Front 86

There is chorion in the center... thus its dichorionic... since there is no such thing as dichorionic monochorionic, this is DICHORIONIC-DIAMNIONIC

(2) Could be Faternal twins or Identical twins

Back 86

(1) Which type of twining is indictated by this image? Monochorionic-Monoamnioinic, Monochorionic-Diamnionic, Dichorionic-Monochorionic, or Dichorionic-Diamnionic

(2) Faternal twins or Identical twins?

Front 87

Since there is no chorion between the amnions, this is MONOCHORIONIC... since there are two amnioins this is DIAMNIONIC... thus MONOCHORIONIC-DIAMNIONIC

Back 87

(1) Which type of twining is indictated by this image? Monochorionic-Monoamnioinic, Monochorionic-Diamnionic, Dichorionic-Monochorionic, or Dichorionic-Diamnionic

(2) Faternal twins or Identical twins?