PLACENTAL PATHOPHYSIOLOGY

Harsh Thaker, MD, PhD ht89@columbia.edu

IMPLANTATION

TROPHOBLAST AND VILLI

ANATOMY

Moore & Persaud: The dev eloping human- Clinically oriented embryology

PLACENTAL CIRCULATION

Moore & Persaud: The developing human- Clinically oriented embryology

FETAL SURFACE

MATERNAL SURFACE

HISTOLOGY: UMBILICAL CORD

HISTOLOGY: MEMBRANES Decidua

Chorion Amnion

HISTOLOGY: PLACENTAL DISC

HISTOLOGY: PLACENTAL DISC-FETAL SURFACE

HISTOLOGY: PLACENTAL DISC- MATERNAL SURFACE

HISTOLOGY: VILLOUS ARCHITECTURE

Moore & Persaud: The dev eloping human- Clinically oriented embryology

HISTOLOGY: VILLOUS ARCHITECTURE

FUNCTIONS OF THE PLACENTA

Moore & Persaud: The dev eloping human- Clinically oriented embryology

PLACENTAL HORMONES

Human Chorionic Gonadotropin (HCG)

Secreted by Syncytiotrophoblast Cells 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

Human Placental Lactogen (HPL)

A.K.A Chorionic Somatomammotropin Secreted by Syncytiotrophoblast Cells Structurally similar to pituitary Growth Hormone and Prolactin Metabolic effects- Insulin antagonist Promotes breast development

PLACENTAPlacental Endocrine Functions : Steroid Hormones IN STEROID HORMONE BIOSYNTHESIS

MOTHER
LDL Cholesterol Cholesterol (Blood)

PLACENTA
LDL Cholesterol

FETUS
LDL (Blood)

Progesterone

DHEAS (Adrenal)

DHEAS Sulfatase 3 Beta OH steroid DH Aromatase

DHEAS (Adrenal)

Estrone Estradiol

Key: DHEAS 3 Beta OH steroid DH

: Dehydroepiandrosterone sulfate : 3 beta hydroxy steroid dehydrogenase

Figure modified from: Carr, BR , The maternal -fetal -placental unit. In: Becker KL, rd ed. Lippincott ed. Principles and Practice of Endocrinology and Metabolism, 3 Williams & Wilkins, Philadelphia. 2001: 1061.

Dehydroepiandrosterone
(C19) O
18 17

1 2 3

19

OH

3 beta-hydroxy steroid dehydrogenase

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Androstenedione
(C19) O Aromatase
1 2 3 19 18 17

Estrone
(C18) 17 beta-hydroxy steroid oxidoreductase O
18 17

1 2 3

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Estradiol
(C18) OH
18 17

1 2 3

OH

OTHER PLACENTAL HORMONES

Placental Prolactin Placental Thyrotropin Placental ACTH and CRF Placental growth hormone Other peptides- Activin, inhibin, follistatin, urocortin, leptin, IGF etc.

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Fetoplacental hormones and peptides in prenatal screening

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

AFP is elevated in Neural Tube Defects

DEVELOPMENTAL PATHOPHYSIOLOGY

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ECTOPIC IMPLANTATION

Moore & Persaud: The dev eloping human- Clinically oriented embryology

PLACENTA PREVIA & PLACENTA ACCRETA

Moore & Persaud: The dev eloping human- Clinically oriented embryology

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MECHANICAL PATHOPHYSIOLOGY
MECHANICAL PROBLEMS

CORD KNOTS & TWISTS

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CORD: VELAMENTOUS INSERTION

Kaplan: Color atlas of gross placental pathology.

ABNORMAL MEMBRANE ATTACHMENT

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MEMBRANE RUPTURE: AMPUTATIONS

INFLAMMATORY PATHOPHYSIOLOGY

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INFLAMMATION: CHORIOAMNIONITIS

Acute Funisitis

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Candida Funisitis

Candida Funisitis

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Normal membranes

Decidua

Chorion Amnion

Acute chorioamnionitis

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Meconium

Acute villitis Acute intervillositis.

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Placental infection: Listeria

Listeriosis

Placental Microabscesses Villous necrosis Heavy growth of Listeria in postmortem cultures

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TRANSPLACENTAL (TORCH) INFECTIONS

Parvoviral inclusions in villi

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Cytomegalovirus: Characteristic nuclear inclusions

Chronic Villitis (non-specific)

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VASCULCAR PATHOPHYSIOLOGY

FETAL VASCULAR PATHOLOGY

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Maternal Vascular Pathology: Pre-eclampsia

Maternal vascular pathology: Placental Infarct

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Maternal vascular pathology: Placental Abruption

NEOPLASTIC PATHOPHYSIOLOGY

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VASCULAR TUMOR- CHORANGIOMA

TROPHOBLASTIC TUMORS HYDATIDIFORM MOLES

COMPLETE = Diploid 2 Pat, 0 Mat. PARTIAL = Triploid 2 Pat, 1 Mat

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HYDATIDIFORM MOLES- GENETICS

MULTIPLE GESTATIONS

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TWINS- Dizygotic

TWO AMNIONS TWO CHORIONS (fused or separate)

TWINS- Monozygotic

TWO AMNIONS TWO CHORIONS (fused or separate)

ONE CHORION ONE OR TWO AMNIONS

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TWINS- Monozygotic

FORMATION OF MONOAMNIONIC TWINS (including conjoined twins)

TWIN ZYGOSITY AND CHORIONICITY

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Twin placenta- fused discs

Dichorionic Diamnionic placenta

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Monochorionic Diamnionic placenta

Monochorionic twins with Vascular anastomosis

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Twin-Twin transfusion syndrome

Twin placenta- Monoamnionic, with entangled cords

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Twin placenta- fetus papyraceus

ENJOY THE LAB!

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