Repro - 18 - Pathology of Placenta

HCG

Growth Hormone Like Hormone

human placental lactogen

estrogen

progesterone

HCG

Growth Hormone Like Hormone

human placental lactogen

estrogen

progesterone

placenta that has implanted across the internal os of the cervix

causes 3rd trimester bleeding

placenta that has implanted across the internal os of the cervix

causes 3rd trimester bleeding

attachment of placenta directly to uterine muscle without decidua in between

makes it hard to seperate placenta from uterus after delivery

attachment of placenta directly to uterine muscle without decidua in between

makes it hard to seperate placenta from uterus after delivery

HCG

Growth Hormone Like Hormone

human placental lactogen

estrogen

progesterone

placenta that has implanted across the internal os of the cervix

causes 3rd trimester bleeding

attachment of placenta directly to uterine muscle without decidua in between

makes it hard to seperate placenta from uterus after delivery -> uterine inversion or massive hemorrhage

other types:
increta: placenta invades into uterine wall
percreta: invades through through the wall and can cause perforation of uterus

placenta previa

uterine scars

endometritis

submucosal leiomyoma

two seperate placental lobes connected by vessels through area without villi

can accidently leave one lobe in after delivery -> post partum hemorrhage

chorion is covered with villi -> thin placenta

can cause placenta previa

placenta with a rim of fibrotic tissue around

separation of placenta before delivery of the fetus

painful, bleeding

associated with DIC

a long cord can get knotted

a short cord can cause traction during labor

normally there are 2 arteries and 1 vein

1 artery is associated with increased infant mortality and congenital malformations

membrane isnt as strong as on placental disk - can get bleeding

baby can be small for getational age or abort

decreased amniotic fluid

associated with fetal renal abnormality - fetus can't pee

associated with nodules of fibrin and desquamated squamous cells on surface of amnion

fetus usually swollows the amniotic fluid

if fetus has swallowing problems -> too much amniotic fluid

can indicate fetal distress

if fetus aspirates meconium - lung problems

different sexes - only dizygotic

if same sex:
monochorionic -> monozygotic
dichorionic -> can be either monozygotic or dizygotic - do genetic test

ascending usually after rupture of membrane

staph, e-coli

clostridia from do-it-yourself abortions
Less common:
TB
Listeria
Syphilis

hemangioma of placenta

benign usually

can bleed, or cause heart problems in fetus

amenorrhea and enlarged uterus

patient throught to be preg

trophoblast infiltrates the uterus without syncytial or cytotrophoblast

currettage to cure, but watch for perforation

fertilization of empty egg - diploid DNA results from sperm deuplication

see first trimester bleeding

uterus is large

passage of grape like tissue

see very high HCG (than expected from getation)

snow storm pattern on pelvic ultra sound - no fetus seen

complete uterus is involved

fertilization of ovum with 2 sperm -> triploid DNA

uterus is small compared to normal gestation

HCG is lower than compared to gestation

often present as a missed abortion

fetus is present but is abnormal

only part of uterus involved

false - complete moles have increased risk of invasive moles or chriocarcinoma

most common form of persistent trophoblastic disease following hyatidaform mole

uterus is large for gestation

persistent bleeding

elevated HCG

hemorrhagic lesion invading the uterinine wall with enlarged dematous villi

can metastases, spread to broad lig

death not common

true

develop from mole

hemorrhagic mass in endomerium - lots of invasion of uterus wall

see mixture of malignant syncytiotrophoblast and cytotrophoblast

no villi

aggresive - mets via blood to lung, liver, brain, kidney

detect elevated HCG after molar preg, abortion, or post partum bleeding

actinomycin D

methotrexate

see small nodules of fibrin and desquamated cells on surface of amnion

abnormal placenta - oligohydramnios

increased risk of congenital malformation

associated with fetal renal problems