Placental Pathology

Dr William Robichaux December 9, 2011 wrobich@tulane.edu

PLACENTAL PATHOLOGY
ANATOMY INFLAMMATION TOXEMIA / ECLAMPSIA NEOPLASIA ECTOPIA APGAR

PLACENTAL PATHOLOGY

ANATOMY INFLAMMATION
Chorioamnionitis Villitis

TOXEMIA/ECLAMPSIA

Abruptio placenta

NEOPLASIA
Hydatidiform mole Choriocarcinoma

ECTOPIA

Placenta previa

Implants in cervix
3

Ectopic pregnancy

CHORIONIC PLATE

CHORIONIC VILLUS

MATURE CHORIONIC VILLI (3rd Trimester)

TROPHOBLASTS (HCG)

IMMATURE CHORIONIC VILLI

PLACENTA = cake

Placentophagy
All

mammals except man 12-18 hrs defenseless newborn

Provides nourishment
Labor

Hides evidence from predators

Succulent,

PLACENTA

Chorionic plate Chorionic villi Chorionic membrane Chorionic gonadotropin (HCG) Chorioamnionitis Choriocarcinoma

PLACENTA = cake

Spontaneous abortion

Pregnancy loss < 20 wks Chromosomal anomalies (50%) Maternal diabetes Uterine leiomyomas Coagulopathies Infections

10

INFLAMMATION

Chorioamnionitis
Ascending from vagina Bacteria

Group B Streptococcus Escherichia coli

Villitis

Hematogenous infection

= Blood borne

TORCH Organisms

Immunologic
11

TORCH Organisms

Toxoplasma gondii (parasite) Other

Syphilis

(Treponema pallidum) Parvovirus B19 (PVB-19) Tuberculosis, Listeriosis

Rubella CMV Herpes simplex

12

TOXEMIA of Pregnancy

aka Pre-ECLAMPSIA Hypertension Proteinuria Edema

13

TOXEMIA

Systemic endothelial dysfunction

Potentially

life-threatening

Incidence 3 to 5% 3rd trimester Primigravida (1st pregnancy)

14

TOXEMIA Pathogenesis

Normal Placenta
Villous

trophoblasts implant Replace maternal vascular media

Toxemia / Pre-eclampsia
Inadequate

blood flow Placental ischemia Leaky & thrombogenic vessels

16

TOXEMIA

Hypercoagulability Acute renal failure Pulmonary edema Seizures / Headaches

Eclampsia

H-EL-LP
Hemolysis Elevated

Liver enzymes Low Platelets

17

TOXEMIA Rx

Bed rest Anti-hypertensive Rx ***DELIVERY OF BABY Resolution = 1-2 weeks 20% develop chronic hypertension

18

ECTOPIC PREGNANCY

90% Fallopian tubes Ovary Abdominal cavity Prior pelvic inflammatory disease

19

Ectopic pregnancy in Fallopian Tube

20

Chorionic villi in fallopian tube

21

ECTOPIC PREGNANCY

Low level HCG urine/serum Hematosalpinx

Fallopian

tube hemorrhage

Tube rupture
Hemorrhagic

shock Life-threatening

22

NEOPLASIA

HYDATIDIFORM MOLE Risk of choriocarcinoma (1 in 40) Both ends of reproductive life

Teens Between

ages of 40 and 50 years

Incidence USA 1 in 1,000 to 2,000 Incidence Indonesia 1 in 100

23

HYDATIDIFORM MOLE (Complete)

aka Molar pregnancy Risk of uterine perforation

Burrows

through uterus (10%)

Risk of choriocarcinoma
2.5%

(1 in 40)

24

HYDATIDIFORM MOLE (Complete)

HCG level very high No fetus in complete mole Placental villi not finger-like
swollen

& grape like

Hydatidiform = Bunch of grapes Ultrasound = snow storm

25

HYDATIDIFORM MOLE IN UTERUS

MOLAR PREGNANCY

COMPLETE Mole
46

chromosomes BOTH SETS ARE PATERNAL Empty egg 2.5% risk of choriocarcinoma

27

MOLAR PREGNANCY

INCOMPLETE Mole
Fetus

usually present Mixture of normal & swollen villi NO RISK of Choriocarcinoma Triploid (or Tetraploid) 69,XXY (92,XXXY) TWO SETS ARE PATERNAL

28

CANCER of Placenta

Choriocarcinoma (gestational) HCG levels are VERY HIGH Responds well to chemotherapy

29

Non-Gestational Choriocarcinoma

Outside of the setting of pregnancy Very rare Ovary; mediastinal germ cells
rarely

seen in males

Poor response to chemotherapy

30

APGAR Score

devised by Dr. Virginia Apgar

Anesthesiologist

evaluates fetal condition 0 to 2 points on 5 parameters assessed at 1 and 5 minutes

31

APGAR Score

1) Color (Appearance) 2) Heart rate (Pulse) 3) Response (Grimace) 4) Tone (Activity) 5) Respiratory effort

32

APGAR Score

Predicts mortality in 1st month life 0 to 1 = 50% mortality 4 = 20% mortality 7-10 = 0% mortality

33

PLACENTAL PATHOLOGY
ANATOMY INFLAMMATION TOXEMIA / ECLAMPSIA NEOPLASIA ECTOPIA

34

What is placenta? A chorionic villus tree What is placenta? Syncytiotrophoblasts make HCG

35

Chorioamnionitis Infection of the babys nidus Light a TORCH, watch it sizzle Group B Strep, E. coli fizzle

36

What is placenta? A chorionic villus tree What is placenta? Syncytiotrophoblasts make HCG

37

Chorio-a-carcinoma In placenta or in ova Ask the mole about its recipe, Makin plenty, plenty HCG

38

What is placenta? A chorionic villus tree What is placenta? Syncytiotrophoblasts make HCG

39

E-C-L-A-M-P-S-I-A Hypertension, proteinuria E-D-E-M-A and seizures Gotta get the baby out To cure ya.

40

What is placenta? A chorionic villus tree What is placenta? Syncytiotrophoblasts make HCG

41

Placental Pathology
Dr William Robichaux December 9, 2011 wrobich@tulane.edu

42