Difference between revisions of "Placenta"

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The '''placenta''' feeds the developing baby, breathes for it and disposes of its waste.
The '''placenta''' feeds the developing baby, breathes for it and disposes of its waste.


==Normal==
=Clinical=
Amnion - next to fetus, surrounds amniotic fluid, avascular.
==Examination of the placenta==
*Most placentas are ''not'' examined by a pathologist.
 
Indications for exam by a pathologist:
*Abnormalities in the:
*#Fetus:
*#*Bad fetal outcome.
*#*Suspected or known congenital abnormalities ''or'' chromosomal abnormalities.
*#Mother:
*#*Infection/suspected infection.
*#*Pre-term labour.
*#*Maternal disease (e.g. SLE, coagulopathy).
*#*Complicated pregnancy (preclampsia, pregnancy induced hypertension, gestational diabetes).
*#Placenta:
*#*Unusual gross characteristics.
 
==Bleeding in late pregnancy==
DDx of bleeding in late pregnancy:
*Placental abruption (most common).
*Placenta previa.
*Vasa previa (fetus losing blood).
 
==Clinical screening tests==
*PAPP-A - low values seen in aneuploidy.<ref>URL: [http://www.ncbi.nlm.nih.gov/sites/entrez?Db=gene&Cmd=ShowDetailView&TermToSearch=5069 http://www.ncbi.nlm.nih.gov/sites/entrez?Db=gene&Cmd=ShowDetailView&TermToSearch=5069]. Accessed on: 7 July 2010.</ref>
 
{{main|Pregnancy}}
 
=Normal histology=
==Amnion==
General:
*Next to fetus, surrounds amniotic fluid, avascular.
 
Characteristics:
*Characterized by a single layer of cells.<ref name=Ref_H4P2_974>{{Ref H4P2|974}}</ref>
*Characterized by a single layer of cells.<ref name=Ref_H4P2_974>{{Ref H4P2|974}}</ref>
**Cuboidal/squamoid shape.
**Cuboidal/squamoid shape.
Line 12: Line 44:
*'Fibroblastic layer'.<ref name=Ref_H4P2_974>{{Ref H4P2|974}}</ref>
*'Fibroblastic layer'.<ref name=Ref_H4P2_974>{{Ref H4P2|974}}</ref>


Chorion - surrounds amnion
==Chorion==
General:
*Surrounds amnion.
 
Characteristics:
*Layers:<ref name=Ref_H4P2_977>{{Ref H4P2|977}}</ref>
*Layers:<ref name=Ref_H4P2_977>{{Ref H4P2|977}}</ref>
**'Reticular layer' - cellular (inner aspect).
**'Reticular layer' - cellular (inner aspect).
Line 21: Line 57:
**Beneath of the "trophoblastic X cells" is ''decidua'' (mnemonic ''NEW'' = nucleus central, eosinophilic, well-defined cell border), which is maternal tissue.  
**Beneath of the "trophoblastic X cells" is ''decidua'' (mnemonic ''NEW'' = nucleus central, eosinophilic, well-defined cell border), which is maternal tissue.  


===Additional terms===
==Common terms==
*Chorionic plate - fetal aspect of placenta.
*Chorionic plate - fetal aspect of placenta.
*Basal plate - maternal aspect of placenta.
*Basal plate - maternal aspect of placenta.
Line 27: Line 63:
**Place to look for maternal vessels.
**Place to look for maternal vessels.


==Grossing==
=Grossing=
This is often very quick.  The gross is quite important, as some things cannot be diagnosed microscopically.
==General==
*Dimensions:
*Dimensions:
**Disc.  
**Disc.  
Line 50: Line 88:
**Maternal surface - are the cotyledons intact?
**Maternal surface - are the cotyledons intact?


===Sections===
==Sections==
*Cord two sections.
*Cord two sections.
*Cord at insertion.
*Cord at insertion.
Line 56: Line 94:
*Placenta - full thickness (maternal and fetal surface).
*Placenta - full thickness (maternal and fetal surface).


===Placental membranes===
==Placental membranes==
Appearance:<ref name=Ref_Lester461>{{Ref Lester|461}}</ref>
Appearance:<ref name=Ref_Lester461>{{Ref Lester|461}}</ref>
*Normal - shiny.
*Normal - shiny.
Line 66: Line 104:
**Gross: - (single) yellow patch or yellow nodules .
**Gross: - (single) yellow patch or yellow nodules .


==Sign-out==
==Placental mass==
Placental mass by gestational age:<ref>AFIP Placental pathol. ISBN: 1-881041-89-1. P.312</ref>
{| class="wikitable"
|Gest. Age/Percentile ||'''25%''' ||'''50%''' ||'''75%'''
|-
|'''32 weeks''' ||275 g ||318 g ||377 g
|-
|'''36 weeks''' ||369 g ||440 g ||508 g
|-
|'''40 weeks''' ||440 g ||501 g ||572 g
|-
|}
 
===Linear regression - placental mass-gestational age===
Based on the table in the AFIP book<ref>AFIP Placental pathol. ISBN: 1-881041-89-1. P.312</ref> I generated the following regression lines:
{| class="wikitable"
| ||'''50%''' ||'''10%''' ||'''90%'''
|-
|slope (g/week) ||21.58088235 ||19.70588235 ||25.40196078
|-
|y-intercept (g) ||-357.4558824 ||-397.2352941 ||-366.7254902
|-
|Pearson (r) ||0.988670724 ||0.988268672 ||0.982206408
|-
|}
 
placental mass = slope x gestational age + intercept
 
===What to remember...===
Extrapolated from the linear regression (see above):
*50% at term = 500 grams.
*50% at 26 weeks = 200 grams.
*The change in mass/week is approximately linear and equal to 300 grams / 14 weeks ~ 20 grams/week.
*The spread in mass between 10% and 90%, crudely estimated, is 200 grams (for GA=26-40).
 
=Sign-out=
What should be commented on...
What should be commented on...


Line 86: Line 159:
Mnemonic: ''chorio, cord, vessels, villi (maturity, infarction)''.
Mnemonic: ''chorio, cord, vessels, villi (maturity, infarction)''.


==Twin placentas==
=Twin placentas=
These are often submitted... even if they are normal.
 
==General==
No membrane between fetuses.
No membrane between fetuses.
*Split at approx. 7th day.
*Split at approx. 7th day.
Line 99: Line 175:
*If monozygotic -- split before 3 days.
*If monozygotic -- split before 3 days.


==Bleeding in late pregnancy==
=Diseases of the placental attachment=
DDx of bleeding in late pregnancy:
==Placenta acreta/percreta/increta==
*Placental abruption (most common).
Placenta attaches to the uterus deeper than it should.
*Placenta previa.
*Vasa previa (fetus losing blood).


==Placental abruption==
==Placental abruption==
Line 120: Line 194:
*There are '''no''' good microscopic findings for placental abruption.
*There are '''no''' good microscopic findings for placental abruption.


==Infection==
=Infection=
===General<ref name=Ref_PBoD1106>{{Ref PBoD|1106}}</ref>===
==General<ref name=Ref_PBoD1106>{{Ref PBoD|1106}}</ref>==
*Infection usually ascending, i.e. from vagina up through cervix.
*Infection usually ascending, i.e. from vagina up through cervix.
**Assoc. with intercourse.
**Assoc. with intercourse.
Line 134: Line 208:
*Placenta: placentitis, villitis.
*Placenta: placentitis, villitis.


===Grading infection (chorioamnionitis, membranitis, funisitis)===
==Grading infection (chorioamnionitis, membranitis, funisitis)==
Membranitis:<ref name=Ref_Sternberg4_2311>{{Ref Sternberg4|2311}}</ref>
Membranitis:<ref name=Ref_Sternberg4_2311>{{Ref Sternberg4|2311}}</ref>
# PMNs - decidua only.
# PMNs - decidua only.
Line 160: Line 234:
Note: There is no such thing as ''chorionitis''.<ref>ALS. February 2009.</ref>
Note: There is no such thing as ''chorionitis''.<ref>ALS. February 2009.</ref>


==Infarction==
=Infarction=
==True infarcts==
===General===
===General===
*Associated with retroplacental hematoma.
*Associated with retroplacental hematoma.
Line 173: Line 248:
*[http://library.med.utah.edu/WebPath/PLACHTML/PLAC044.html Placental infarcts (med.utah.edu)].
*[http://library.med.utah.edu/WebPath/PLACHTML/PLAC044.html Placental infarcts (med.utah.edu)].


===Microscopy===
===Microscopic===
Features:
Features:
*Loss of intervillous space.<ref name=Ref_WMSP465>{{Ref WMSP|465}}</ref>
*Loss of intervillous space.<ref name=Ref_WMSP465>{{Ref WMSP|465}}</ref>
Line 191: Line 266:
*> 3cm --or-- central location --or-- in 1st or 2nd trimester.
*> 3cm --or-- central location --or-- in 1st or 2nd trimester.
**Small foci are accepted in term placentae - typically at periphery.
**Small foci are accepted in term placentae - typically at periphery.
==Chorangioma==
===General===
*[[Hamartoma]]-like growth in the placenta consisting of [[blood vessel]]s.<ref name=pmid20594143>{{cite journal |author=Amer HZ, Heller DS |title=Chorangioma and related vascular lesions of the placenta--a review |journal=Fetal Pediatr Pathol |volume=29 |issue=4 |pages=199–206 |year=2010 |pmid=20594143 |doi=10.3109/15513815.2010.487009 |url=}}</ref>
===Epidemiology===
*Often benign.
*May be association with:
**Fetal maternal haemorrhage.
**Hydrops.
**[[IUGR]].
===Microscopy===
Features:
*Mass of capillaries.
Image:
*[http://commons.wikimedia.org/wiki/File:Chorangioma_-_intermed_mag.jpg Chorangioma (WC)].


==Perivillous fibrin deposition==
==Perivillous fibrin deposition==
Line 224: Line 281:
**Obliteration of intervillous space.
**Obliteration of intervillous space.


 
=Other=
==Passage of meconium==
==Passage of meconium==
===General===
===General===
Line 262: Line 319:
*Meconium contains bile.<ref>{{cite journal |author=Sienko A, Altshuler G |title=Meconium-induced umbilical vascular necrosis in abortuses and fetuses: a histopathologic study for cytokines |journal=Obstet Gynecol |volume=94 |issue=3 |pages=415?0 |year=1999 |month=September |pmid=10472870 |doi= |url=}}</ref>
*Meconium contains bile.<ref>{{cite journal |author=Sienko A, Altshuler G |title=Meconium-induced umbilical vascular necrosis in abortuses and fetuses: a histopathologic study for cytokines |journal=Obstet Gynecol |volume=94 |issue=3 |pages=415?0 |year=1999 |month=September |pmid=10472870 |doi= |url=}}</ref>


==Placental mass==
=Maternal disease=
Placental mass by gestational age:<ref>AFIP Placental pathol. ISBN: 1-881041-89-1. P.312</ref>
{| class="wikitable"
|Gest. Age/Percentile ||'''25%''' ||'''50%''' ||'''75%'''
|-
|'''32 weeks''' ||275 g ||318 g ||377 g
|-
|'''36 weeks''' ||369 g ||440 g ||508 g
|-
|'''40 weeks''' ||440 g ||501 g ||572 g
|-
|}
 
===Linear regression - placental mass-gestational age===
Based on the table in the AFIP book<ref>AFIP Placental pathol. ISBN: 1-881041-89-1. P.312</ref> I generated the following regression lines:
{| class="wikitable"
| ||'''50%''' ||'''10%''' ||'''90%'''
|-
|slope (g/week) ||21.58088235 ||19.70588235 ||25.40196078
|-
|y-intercept (g) ||-357.4558824 ||-397.2352941 ||-366.7254902
|-
|Pearson (r) ||0.988670724 ||0.988268672 ||0.982206408
|-
|}
 
placental mass = slope x gestational age + intercept
 
===What to remember...===
Extrapolated from the linear regression (see above):
*50% at term = 500 grams.
*50% at 26 weeks = 200 grams.
*The change in mass/week is approximately linear and equal to 300 grams / 14 weeks ~ 20 grams/week.
*The spread in mass between 10% and 90%, crudely estimated, is 200 grams (for GA=26-40).
 
==Hypertensive changes==
==Hypertensive changes==
Features:<ref name=pmid6754249>{{cite journal |author=Soma H, Yoshida K, Mukaida T, Tabuchi Y |title=Morphologic changes in the hypertensive placenta |journal=Contrib Gynecol Obstet |volume=9 |issue= |pages=58–75 |year=1982 |pmid=6754249 |doi= |url=}}</ref>
Features:<ref name=pmid6754249>{{cite journal |author=Soma H, Yoshida K, Mukaida T, Tabuchi Y |title=Morphologic changes in the hypertensive placenta |journal=Contrib Gynecol Obstet |volume=9 |issue= |pages=58–75 |year=1982 |pmid=6754249 |doi= |url=}}</ref>
Line 344: Line 367:
**In essence: severe ''hypertrophic decidual vasculopathy''. (???)
**In essence: severe ''hypertrophic decidual vasculopathy''. (???)


==Tumours==
=Tumours=
{{main|Gestational trophoblastic disease}}
{{main|Gestational trophoblastic disease}}


==Clinical screening tests==
==Chorangioma==
*PAPP-A - low values seen in aneuploidy.<ref>URL: [http://www.ncbi.nlm.nih.gov/sites/entrez?Db=gene&Cmd=ShowDetailView&TermToSearch=5069 http://www.ncbi.nlm.nih.gov/sites/entrez?Db=gene&Cmd=ShowDetailView&TermToSearch=5069]. Accessed on: 7 July 2010.</ref>
===General===
*[[Hamartoma]]-like growth in the placenta consisting of [[blood vessel]]s.<ref name=pmid20594143>{{cite journal |author=Amer HZ, Heller DS |title=Chorangioma and related vascular lesions of the placenta--a review |journal=Fetal Pediatr Pathol |volume=29 |issue=4 |pages=199–206 |year=2010 |pmid=20594143 |doi=10.3109/15513815.2010.487009 |url=}}</ref>
 
===Epidemiology===
*Often benign.
*May be association with:
**Fetal maternal haemorrhage.
**Hydrops.
**[[IUGR]].
 
===Microscopy===
Features:
*Mass of capillaries.


{{main|Pregnancy}}
Image:
*[http://commons.wikimedia.org/wiki/File:Chorangioma_-_intermed_mag.jpg Chorangioma (WC)].


==See also==
=See also=
*[[Chorionic villi]].
*[[Chorionic villi]].
*[[Endometrium]].
*[[Endometrium]].
*[[Pregnancy]].
*[[Pregnancy]].


==References==
=References=
{{reflist|2}}
{{reflist|2}}


[[Category:Gynecology]]
[[Category:Gynecology]]

Revision as of 18:23, 8 January 2011

The placenta feeds the developing baby, breathes for it and disposes of its waste.

Clinical

Examination of the placenta

  • Most placentas are not examined by a pathologist.

Indications for exam by a pathologist:

  • Abnormalities in the:
    1. Fetus:
      • Bad fetal outcome.
      • Suspected or known congenital abnormalities or chromosomal abnormalities.
    2. Mother:
      • Infection/suspected infection.
      • Pre-term labour.
      • Maternal disease (e.g. SLE, coagulopathy).
      • Complicated pregnancy (preclampsia, pregnancy induced hypertension, gestational diabetes).
    3. Placenta:
      • Unusual gross characteristics.

Bleeding in late pregnancy

DDx of bleeding in late pregnancy:

  • Placental abruption (most common).
  • Placenta previa.
  • Vasa previa (fetus losing blood).

Clinical screening tests

  • PAPP-A - low values seen in aneuploidy.[1]
Main article: Pregnancy

Normal histology

Amnion

General:

  • Next to fetus, surrounds amniotic fluid, avascular.

Characteristics:

  • Characterized by a single layer of cells.[2]
    • Cuboidal/squamoid shape.
    • Eosinophilic cytoplasm.
    • Central nucleus.
  • Squamous metaplasia may be seen at cord insertion.
  • Basement membrane.
  • 'Compact layer'.[2]
  • 'Fibroblastic layer'.[2]

Chorion

General:

  • Surrounds amnion.

Characteristics:

  • Layers:[3]
    • 'Reticular layer' - cellular (inner aspect).
    • 'Pseudo-basemement membrane'.
    • 'Outer trophoblastic layer'.
  • Has blood vessels.
  • Opposed to "trophoblastic X cells" on side opposite of amnion.[2]
    • Beneath of the "trophoblastic X cells" is decidua (mnemonic NEW = nucleus central, eosinophilic, well-defined cell border), which is maternal tissue.

Common terms

  • Chorionic plate - fetal aspect of placenta.
  • Basal plate - maternal aspect of placenta.
    • Has extravillous trophoblast.
    • Place to look for maternal vessels.

Grossing

This is often very quick. The gross is quite important, as some things cannot be diagnosed microscopically.

General

  • Dimensions:
    • Disc.
    • Length of cord, diameter of cord.
  • Mass (weight) -- should be done 'trimmed' (cord cut-off, membrane cut-off).
  • Umbilical cord
    • Attachment.
      • Location: central, eccentric, marginal.
        • Marginal attachment assoc. with hypertension[4]
      • Membranous or velamentous (veil-like) insertion.
        • Vessels separate/branch prior to reaching placental disc.
      • Furcate insertion - vessel run on fetal surface (more exposed to trauma).
    • Knots (false vs. true).
      • False knots are nothing to worry about -- look like a knot but aren't really one.
    • Twisting/coiling.
    • Number of vessels.
      • Normal: 2 arteries, 1 vein.
  • Membranes - shiny, thin, translucent
    • Attachment: marginal (normal), circummarginate (inside edge), circumvallated (folding on self).
  • Placental disc.
    • Fetal surface - normal is shinny (dull in chorioamnionitis).
    • Maternal surface - are the cotyledons intact?

Sections

  • Cord two sections.
  • Cord at insertion.
  • Membranes (rolled).
  • Placenta - full thickness (maternal and fetal surface).

Placental membranes

Appearance:[5]

  • Normal - shiny.
  • Choriomnionitis - opaque/dull.
  • Meconium - green.
  • Amnion nodosum.
    • AKA squamous metaplasia of amnion.[6]
    • Assoc. with oligohydramnios.[7]
    • Gross: - (single) yellow patch or yellow nodules .

Placental mass

Placental mass by gestational age:[8]

Gest. Age/Percentile 25% 50% 75%
32 weeks 275 g 318 g 377 g
36 weeks 369 g 440 g 508 g
40 weeks 440 g 501 g 572 g

Linear regression - placental mass-gestational age

Based on the table in the AFIP book[9] I generated the following regression lines:

50% 10% 90%
slope (g/week) 21.58088235 19.70588235 25.40196078
y-intercept (g) -357.4558824 -397.2352941 -366.7254902
Pearson (r) 0.988670724 0.988268672 0.982206408

placental mass = slope x gestational age + intercept

What to remember...

Extrapolated from the linear regression (see above):

  • 50% at term = 500 grams.
  • 50% at 26 weeks = 200 grams.
  • The change in mass/week is approximately linear and equal to 300 grams / 14 weeks ~ 20 grams/week.
  • The spread in mass between 10% and 90%, crudely estimated, is 200 grams (for GA=26-40).

Sign-out

What should be commented on...

  • Placenta:
    • Maturity of villi (2nd or 3rd trimester).
    • Infarction?
      • Subchorionic less important than maternal aspect.
      • Peripheral aspect of placental disc less important than central region of disc.
    • Blood vessels.
      • Maternal.
      • Fetal.
  • Membranes.
    • Membranitis?
    • Chorioamnionitis?
  • Cord:
    • 3 vessel?
    • Vasculitis/inflammation?

Mnemonic: chorio, cord, vessels, villi (maturity, infarction).

Twin placentas

These are often submitted... even if they are normal.

General

No membrane between fetuses.

  • Split at approx. 7th day.

Diamnionic-monochorionic (DiMo)

  • No interposed chorion.[10]
  • Always monozygotic.
  • Highest risk of TTTS (twin-to-twin transfusion syndrome).

Diamnionic-dichorionic (DiDi)

  • Most dizygotic (70%), may be monozygotic (30%).
  • If monozygotic -- split before 3 days.

Diseases of the placental attachment

Placenta acreta/percreta/increta

Placenta attaches to the uterus deeper than it should.

Placental abruption

General

Classic clinical manifestations:[11]

  • Vaginal bleeding (~70%).
  • Abdominal pain (~50%).
  • Fetal heart rate abnormalities (~70%).

Pathologic findings

Features:

  • Gross pathology: depression on maternal side, large blood clot.
    • Central haemorrhage is the most worrisome.

Note:

  • There are no good microscopic findings for placental abruption.

Infection

General[12]

  • Infection usually ascending, i.e. from vagina up through cervix.
    • Assoc. with intercourse.
  • Hematogenous rare - manifest as villitis.
    • Think TORCH infections (toxoplasmosis, others (syphilis, TB, listeriosis), rubella, cytomegalovirus, herpes simplex virus).
  • Funisitis usually follows chorioamnionitis.
    • Inflammatory cells in umbilical cord are fetal (trivia).

Types (by site)[12]

  • Fetal membranes: chorioamnionitis, membranitis.[13]
  • Umbilical cord: funisitis.
  • Placenta: placentitis, villitis.

Grading infection (chorioamnionitis, membranitis, funisitis)

Membranitis:[13]

  1. PMNs - decidua only.
  2. PMNs - in subamniotic tissue.
  3. 1 or 2 + necrosis in decidua or chorion/subamniotic tissue.

Chorioamnionitis:[13]

  1. placental chorionic plate only.
  2. 1 + subamniotic tissue.
  3. 1 or 2 + necrosis or abscess.

Sternberg separates vasculitis and funisitis without really explaining the terms[13] -- I presume: vasculitis = inflammation of vessels in the umbilical cord. funisitis = inflammation of the cord (vessels and Wharton jelly).

Umbilical cord vasculitis:[13]

  • +0.5 for each vessel.
  • +0.5 for each vessel with severe involvement.

Umbilical funisitis:[13]

  1. focal inflammation.
  2. diffuse inflammation.
  3. necrosis - in vessels or Wharton jelly.

Note: There is no such thing as chorionitis.[14]

Infarction

True infarcts

General

  • Associated with retroplacental hematoma.

Gross

Features:[15]

  • Early - red.
  • Late - white/grey.

Images:

Microscopic

Features:

  • Loss of intervillous space.[15]
    • Villi appear to be crowded.[16]
  • Prominent syncytial knots.
  • Thickened trophoblastic basement membrance (below cytotrophoblasts).
  • +/-Acute atherosis (vaguely like atherosclerosis).
    • Fibrioid necrosis.
    • Vessel wall lipid deposition.

Images:

Significant infarcts

  • > 3cm --or-- central location --or-- in 1st or 2nd trimester.
    • Small foci are accepted in term placentae - typically at periphery.

Perivillous fibrin deposition

  • Massive perivillous fibrin deposition is assoc. with anti-phospholipid antibody (APLA) syndrome.[18]
    • APLA is assoc. with recurrent miscarriage - can be treated with heparin + ASA.[18]
  • Thought to be an immunologic problem - resulting in platelet activation and fibrin deposition.[18]

Gross

  • Pale (white).
  • Firm.
  • White fibrous sepatae.

Microscopy

  • Acellular eosinophilic material around formed villi.
    • Obliteration of intervillous space.

Other

Passage of meconium

General

  • Associated with fetal distress.

Gross

  • Green/green discolourization.

Microscopy

Features:[19]

  • Macrophages with brown fine granular pigment.
  • Columnar morphology (normally cuboidal).
  • "Drop-out" of individual cell -- the loss of individual cells.

Level of staining and time:[20]

  • <1 h - no staining of membranes.
  • 1-3 h - amnion is stained.
  • >3 h - chorion is stained.

DDx:

  • Hemosiderin-laden macrophages.

Images:

Special stains

  • Hemosiderin +ve in hemosiderin-laden macrophages.
  • PAS +ve in meconium-laden macrophages.[21]

Useful to differentiate hemosiderin-laden macrophages and meconium laden macrophages:

  • Hemosiderin stain -- +ve for old blood.
    • Prussian-blue stain = hemosiderin stain.[22]
  • PAS-D -- +ve in chorioamnionitis???

Note:

  • Meconium contains bile.[23]

Maternal disease

Hypertensive changes

Features:[24]

  • Enlarged endothelial cells - fetal capillaries.
  • Atherosis of the spiral arteries - placental bed (maternal).

Associated changes:[24]

  • Placental infarcts.
  • Increased syncytial knots.
  • Hypovascularity of the villi.
  • Cytotrophoblastic proliferation.
  • Thickening of the trophoblastic basement membrane.

Hypertrophic decidual vasculopathy

Features:[25]

  • Mild or moderate:
    1. Perivascular inflammatory cells.
    2. +/-Vascular thrombosis.
    3. Smooth muscle hypertrophy.
    4. Endothelial hyperplasia.
      • Above two lead to narrowing of the decidual spiral arteries[26] -- key feature.
  • Severe:[25]
    1. Atherosis of maternal blood vessels.
      • Foamy macrophages within vascular wall.
    2. Fibrinoid necrosis of vessel wall (amorphous eosinophilic material vessel wall).

General:

  • Seen in intrauterine growth restriction (IUGR).

Images:

HELLP syndrome

General

  • Diagnosed clinically.
  • Pathologically not the same as severe preclampsia.[27]

Definition:

  • H = hemolysis.
  • EL = elevated liver enzymes.
  • LP = low platelets.

Microscopic

Features:[28]

  • Thrombotic microangiopathic vasculopathy.
    • In essence: severe hypertrophic decidual vasculopathy. (???)

Tumours

Main article: Gestational trophoblastic disease

Chorangioma

General

Epidemiology

  • Often benign.
  • May be association with:
    • Fetal maternal haemorrhage.
    • Hydrops.
    • IUGR.

Microscopy

Features:

  • Mass of capillaries.

Image:

See also

References

  1. ↑ URL: http://www.ncbi.nlm.nih.gov/sites/entrez?Db=gene&Cmd=ShowDetailView&TermToSearch=5069. Accessed on: 7 July 2010.
  2. ↑ 2.0 2.1 2.2 2.3 Sternberg, Stephen S. (1997). Histology for Pathologists (2nd ed.). Lippincott Williams & Wilkins. pp. 974. ISBN 978-0397517183.
  3. ↑ Sternberg, Stephen S. (1997). Histology for Pathologists (2nd ed.). Lippincott Williams & Wilkins. pp. 977. ISBN 978-0397517183.
  4. ↑ J Anat. Soc. India 49(2) 149-152 (2000). Available at: http://www.indmedica.com/anatomy/aindex1.cfm?anid=41. Accessed on: January 21, 2009.
  5. ↑ Lester, Susan Carole (2005). Manual of Surgical Pathology (2nd ed.). Saunders. pp. 461. ISBN 978-0443066450.
  6. ↑ URL: http://medical-dictionary.thefreedictionary.com/amnion+nodosum. Accessed on: 18 November 2010.
  7. ↑ http://library.med.utah.edu/WebPath/PLACHTML/PLAC042.html
  8. ↑ AFIP Placental pathol. ISBN: 1-881041-89-1. P.312
  9. ↑ AFIP Placental pathol. ISBN: 1-881041-89-1. P.312
  10. ↑ Sternberg, Stephen S. (1997). Histology for Pathologists (2nd ed.). Lippincott Williams & Wilkins. pp. 979. ISBN 978-0397517183.
  11. ↑ Tikkanen M, Nuutila M, Hiilesmaa V, Paavonen J, Ylikorkala O (2006). "Clinical presentation and risk factors of placental abruption". Acta Obstet Gynecol Scand 85 (6): 700–5. doi:10.1080/00016340500449915. PMID 16752262.
  12. ↑ 12.0 12.1 Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1106. ISBN 0-7216-0187-1.
  13. ↑ 13.0 13.1 13.2 13.3 13.4 13.5 Mills, Stacey E; Carter, Darryl; Greenson, Joel K; Oberman, Harold A; Reuter, Victor E (2004). Sternberg's Diagnostic Surgical Pathology (4th ed.). Lippincott Williams & Wilkins. pp. 2311. ISBN 978-0781740517.
  14. ↑ ALS. February 2009.
  15. ↑ 15.0 15.1 Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 465. ISBN 978-0781765275.
  16. ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1109. ISBN 0-7216-0187-1.
  17. ↑ URL: http://path.upmc.edu/cases/case75/micro.html. Accessed on: 6 January 2011.
  18. ↑ 18.0 18.1 18.2 Sebire NJ, Backos M, Goldin RD, Regan L (May 2002). "Placental massive perivillous fibrin deposition associated with antiphospholipid antibody syndrome". BJOG 109 (5): 570–3. PMID 12066949. http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1470-0328&date=2002&volume=109&issue=5&spage=570.
  19. ↑ ALS. 6 Feb 2009.
  20. ↑ 3 Apr 2009.
  21. ↑ Povýsil C, Bennett R, Povýsilová V (January 2001). "CD 68 positivity of the so-called meconium corpuscles in human foetal intestine". Cesk Patol 37 (1): 7–9. PMID 11268705.
  22. ↑ Sienko A, Altshuler G (September 1999). "Meconium-induced umbilical vascular necrosis in abortuses and fetuses: a histopathologic study for cytokines". Obstet Gynecol 94 (3): 415?0. PMID 10472870.
  23. ↑ Sienko A, Altshuler G (September 1999). "Meconium-induced umbilical vascular necrosis in abortuses and fetuses: a histopathologic study for cytokines". Obstet Gynecol 94 (3): 415?0. PMID 10472870.
  24. ↑ 24.0 24.1 Soma H, Yoshida K, Mukaida T, Tabuchi Y (1982). "Morphologic changes in the hypertensive placenta". Contrib Gynecol Obstet 9: 58–75. PMID 6754249.
  25. ↑ 25.0 25.1 Roberts, DJ.; Post, MD. (Dec 2008). "The placenta in pre-eclampsia and intrauterine growth restriction.". J Clin Pathol 61 (12): 1254-60. doi:10.1136/jcp.2008.055236. PMID 18641412.
  26. ↑ AFIP - Placental Pathology. P.122. ISBN: 1-881041-89-1. 2004.
  27. ↑ Vinnars MT, Wijnaendts LC, Westgren M, Bolte AC, Papadogiannakis N, Nasiell J (May 2008). "Severe preeclampsia with and without HELLP differ with regard to placental pathology". Hypertension 51 (5): 1295–9. doi:10.1161/HYPERTENSIONAHA.107.104844. PMID 18362224.
  28. ↑ Ornstein MH, Rand JH (July 1994). "An association between refractory HELLP syndrome and antiphospholipid antibodies during pregnancy; a report of 2 cases". J. Rheumatol. 21 (7): 1360–4. PMID 7966086.
  29. ↑ Amer HZ, Heller DS (2010). "Chorangioma and related vascular lesions of the placenta--a review". Fetal Pediatr Pathol 29 (4): 199–206. doi:10.3109/15513815.2010.487009. PMID 20594143.
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