Rosanna G. Abellar, MD - Columbia University

2/12/09

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PLACENTAL PATHOPHYSIOLOGY

Rosanna G. Abellar, MD

2/12/09

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ANATOMICAL RELATIONS

Moore & Persaud: The developing human- Clinically oriented embryology

EMBRYOLOGY

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PLACENTAL CIRCULATION


FETAL SURFACE

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MATERNAL SURFACE

HISTOLOGY: UMBILICAL CORD

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Decidua

Chorion

Amnion

HISTOLOGY: MEMBRANES

HISTOLOGY: PLACENTAL DISC-FETAL SURFACE

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HISTOLOGY: PLACENTAL DISC- MATERNAL SURFACE


HISTOLOGY: VILLOUS ARCHITECTURE

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HISTOLOGY: VILLOUS ARCHITECTURE


FUNCTIONS OF THE PLACENTA

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PLACENTAL HORMONES

Human Chorionic Gonadotropin (HCG)

• Secreted by SyncytiotrophoblastS • Structurally similar to pituitary LH

• Prolongs survival of Corpus luteum, thus maintaining steroid hormone levels in pregnancy.

• Detectable in maternal plasma 7-10 days after implantation

• Levels peak at 8-10 weeks’ gestation

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Human Placental Lactogen (HPL)

• A.K.A Chorionic Somatomammotropin

• Secreted by Syncytiotrophoblasts

• Structurally similar to pituitary Growth Hormone and Prolactin

• Metabolic effects- Insulin antagonist

• Promotes breast development

PLACENTA IN STEROID HORMONE BIOSYNTHESIS

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PROGESTERONE

• Synthesized by the placenta using maternal cholesterol and LDL lipoprotein

• Serves as a substrate pool for fetal adrenal gland production of glucococorticoids and mineralocorticoids

• Acts to decrease myometrial activity, constrict myometrial vessels, inhibit prolactin secretion,help suppress maternal immunologic response to fetal antigens

Estrogen

• Estrone, estradiol, estriol

• DHEAS- estriol precursor derived from the fetus

• Acts to enhance myometrial activity, promote myometrial vasodilatation, increase pituitary secretion of prolactin

• Maternal serum levels of estriol are decreased in Trisomy 21

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OTHER PLACENTAL HORMONES

• Placental Prolactin

• Placental Thyrotropin

• Placental ACTH and CRF

• Placental growth hormone

• Other peptides- Activin, inhibin, follistatin, urocortin, leptin, IGF etc.

HCG Elevated in Tri 21 uE3 Decreased in Tri 21 AFP Decreased in Tri 21 Inhibin A Elevated in Tri 21

AFP is elevated in Neural Tube Defects

Fetoplacental hormones and peptides in prenatal screening

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DEVELOPMENTAL PATHOPHYSIOLOGY

ECTOPIC IMPLANTATION


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PLACENTA PREVIA & PLACENTA ACCRETA


MECHANICAL PROBLEMS MECHANICAL

PATHOPHYSIOLOGY

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CORD KNOTS & TWISTS

CORD: VELAMENTOUS INSERTION

Kaplan: Color atlas of gross placental pathology.

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Amnion Nodosum

Amniotic band sequence

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INFLAMMATORY PATHOPHYSIOLOGY

INFLAMMATION: CHORIOAMNIONITIS

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Acute Funisitis

Candida Funisitis

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Candida Funisitis

Normal membranes

Decidua

Chorion

Amnion

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Acute chorioamnionitis

Meconium

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Acute villitis

Acute intervillositis.

Placental infection: Listeria

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Listeriosis

Placental Microabscesses

Villous necrosis

Heavy growth of Listeria in postmortem cultures

TRANSPLACENTAL (TORCH) INFECTIONS

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Parvoviral inclusions in villi

Cytomegalovirus: Characteristic nuclear inclusions

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Chronic Villitis (non-specific)

VASCULAR

PATHOPHYSIOLOGY

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Maternal Vascular Pathology: Pre-eclampsia

Maternal vascular pathology: Placental Infarct

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Maternal vascular pathology: Placental Abruption

PROLIFERATIVE / NEOPLASTIC

PATHOPHYSIOLOGY

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Complete hydatidiform mole

HYDATIDIFORM MOLES- GENETICS

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VASCULAR TUMOR- CHORANGIOMA

MULTIPLE GESTATIONS

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Twin placenta- fused discs

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Dichorionic Diamnionic placenta

Monochorionic Diamnionic placenta

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VASCULAR ANASTOMOSES

TWIN-TWIN TRANSFUSION SYNDROME

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Twin placenta- Monoamnionic, with entangled cords

Twin placenta- fetus papyraceus

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ENJOY THE LAB!

Rosanna G. Abellar, MD - Columbia University

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