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The '''placenta''' feeds the developing baby, breathes for it and disposes of its waste. | [[Image:Human_placenta.jpg|thumb|right|A placenta (fetal aspect) with attached umbilical cord. (WC/Asturnut)]] | ||
The '''placenta''' feeds the developing baby, breathes for it and disposes of its waste. | |||
=Clinical= | The organ is one that seems to be left behind; at least one review suggests it isn't done so well by general pathologists.<ref name=pmid12033960>{{Cite journal | last1 = Sun | first1 = CC. | last2 = Revell | first2 = VO. | last3 = Belli | first3 = AJ. | last4 = Viscardi | first4 = RM. | title = Discrepancy in pathologic diagnosis of placental lesions. | journal = Arch Pathol Lab Med | volume = 126 | issue = 6 | pages = 706-9 | month = Jun | year = 2002 | doi = 10.1043/0003-9985(2002)1260706:DIPDOP2.0.CO;2 | PMID = 12033960 }}</ref> | ||
''Placental pathology'' redirects to this article. | |||
=Clinical= | |||
==Examination of the placenta== | ==Examination of the placenta== | ||
*Most placentas are ''not'' examined by a pathologist. | *Most placentas are ''not'' examined by a pathologist. | ||
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====Most common==== | ====Most common==== | ||
Most common reasons for submitting a placenta to pathology:<ref> | Most common reasons for submitting a placenta to pathology:<ref>Sherman C. 8 February 2011.</ref> | ||
# Prematurity. | # Prematurity. | ||
# PROM / possible [[chorioamnionitis]]. | # PROM / possible [[chorioamnionitis]]. | ||
# Multiple gestation. | # Multiple gestation. | ||
==Bleeding in late pregnancy== | ==Bleeding in late pregnancy== | ||
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==Clinical screening tests== | ==Clinical screening tests== | ||
{{main|Pregnancy}} | |||
*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> | *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> | ||
==Abbreviations== | |||
*C/S = Caesarean section. | |||
*LSCS = lower segment C-section. | |||
*FTP = failure to progress. | |||
*PROM = premature rupture of membranes. | |||
*PPROM = preterm premature ruptures of membranes. | |||
*IUGR = [[intrauterine growth restriction]]. | |||
*IOL = induction of labour. | |||
=Normal histology= | =Normal histology= | ||
==Villi== | ==Villi== | ||
{{Main|Chorionic villi}} | {{Main|Chorionic villi}} | ||
This is dealt with in a separate article that also covers the types of trophoblast (cytotrophoblast, syncytiotrophoblast, intermediate trophoblast). | This is dealt with in a separate article that also covers the types of trophoblast ([[cytotrophoblast]], [[syncytiotrophoblast]], intermediate trophoblast). | ||
==Cord== | ==Cord== | ||
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*Opposed to "trophoblastic X cells" on side opposite of amnion.<ref name=Ref_H4P2_974>{{Ref H4P2|974}}</ref> | *Opposed to "trophoblastic X cells" on side opposite of amnion.<ref name=Ref_H4P2_974>{{Ref H4P2|974}}</ref> | ||
**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. | ||
Note: | |||
*Fibrin deposition may be found deep to the chorion - known as ''subchorionic fibrin deposition''. | |||
**Gross: subchorionic, white/yellow, laminated, classically has a triangular-shape with the base of triangle parallel to fetal aspect of disc. | |||
***Arises due to localized stasis of the inter-villous maternal blood. | |||
**Focal small deposits are considered to be a normal finding - seen in ~15% of cases.<ref name=pmid21393870>{{Cite journal | last1 = Narasimha | first1 = A. | last2 = Vasudeva | first2 = DS. | title = Spectrum of changes in placenta in toxemia of pregnancy. | journal = Indian J Pathol Microbiol | volume = 54 | issue = 1 | pages = 15-20 | month = | year = | doi = 10.4103/0377-4929.77317 | PMID = 21393870 |URL = http://www.ijpmonline.org/article.asp?issn=0377-4929;year=2011;volume=54;issue=1;spage=15;epage=20;aulast=Narasimha }}</ref><ref>URL: [http://zulekhahospitals.com/uploads/files/Sub-chorionic.pdf http://zulekhahospitals.com/uploads/files/Sub-chorionic.pdf]. Accessed on: 17 August 2012.</ref> | |||
***The pathologic counterpart of this is ''[[perivillous fibrin deposition]]''. | |||
Image: | |||
*[http://www.ijpmonline.org/viewimage.asp?img=IndianJPatholMicrobiol_2011_54_1_15_77317_u5.jpg Subchorionic fibrin deposition (ijpmonline.org)]. | |||
==Common terms== | ==Common terms== | ||
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***Membranous or velamentous (veil-like) insertion. | ***Membranous or velamentous (veil-like) insertion. | ||
****Vessels separate/branch prior to reaching placental disc. | ****Vessels separate/branch prior to reaching placental disc. | ||
***Furcate insertion - | ***Furcate insertion - blood vessels separate before reaching placenta disc/not surrounded by Wharton's jelly - vessels more exposed to trauma (risk for vasa previa). | ||
**Knots (false vs. true). | **Knots (false vs. true). | ||
***False knots are nothing to worry about -- look like a knot but aren't really one. | ***False knots are nothing to worry about -- look like a knot but aren't really one. | ||
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***Normal: 2 arteries, 1 vein. | ***Normal: 2 arteries, 1 vein. | ||
*Membranes - shiny & translucent - normal (green, opaque/dull - chorioamnionitis). | *Membranes - shiny & translucent - normal (green, opaque/dull - chorioamnionitis). | ||
**Attachment: marginal (normal), circummarginate (inside edge), | **Attachment (insertion): marginal (normal), circummarginate (inside edge), [[circumvallate placenta|circumvallate]] (folding on self). | ||
**Site of rupture - if obvious; low point of rupture suggests low-lying placenta. | **Site of rupture - if obvious; low point of rupture suggests low-lying placenta. | ||
*Placental disc. | *Placental disc. | ||
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Notes: | Notes: | ||
*Parenchymal nodules - a brief DDx: | *Parenchymal nodules - a brief DDx: | ||
**White: infarct (chronic), thrombi, chorangioma, perivillous fibrin deposition. | **White: [[placental infarct|infarct]] (chronic), thrombi, [[chorangioma]], [[perivillous fibrin deposition]]. | ||
**Red: infarct (acute), thrombi. | **Red: infarct (acute), thrombi. | ||
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===Linear regression - placental mass-gestational age=== | ===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> | Based on the table in the AFIP book<ref>AFIP Placental pathol. ISBN: 1-881041-89-1. P.312</ref> one can generate the following regression lines: | ||
{| class="wikitable" | {| class="wikitable" | ||
| ||'''50%''' ||'''10%''' ||'''90%''' | | ||'''50%''' ||'''10%''' ||'''90%''' | ||
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*Is it required? | *Is it required? | ||
**Sebire and Fox have advocated abandoning the practise of obtaining a placental mass, due to the large number of uncontrolled variables inherent in these measures. Instead, they have advocated using mushy descriptors such as "small", "average" and "large", which require experience in examining the organ.<ref>{{cite book |author= Fox, Harold; Sebire, Neil J. |title=[http://www.amazon.com/Pathology-Placenta-Major-Problems/dp/1416025928/ref=sr_1_fkmr0_1?ie=UTF8&qid=1297259619&sr=1-1-fkmr0 Pathology of the Placenta (Major Problems in Pathology)]|publisher=Saunders |location= |year=2007 |pages= 559-561 |edition=3rd |isbn=978-1416025924 |oclc= |doi= |accessdate=}}</ref> | **Sebire and Fox have advocated abandoning the practise of obtaining a placental mass, due to the large number of uncontrolled variables inherent in these measures. Instead, they have advocated using mushy descriptors such as "small", "average" and "large", which require experience in examining the organ.<ref>{{cite book |author= Fox, Harold; Sebire, Neil J. |title=[http://www.amazon.com/Pathology-Placenta-Major-Problems/dp/1416025928/ref=sr_1_fkmr0_1?ie=UTF8&qid=1297259619&sr=1-1-fkmr0 Pathology of the Placenta (Major Problems in Pathology)]|publisher=Saunders |location= |year=2007 |pages= 559-561 |edition=3rd |isbn=978-1416025924 |oclc= |doi= |accessdate=}}</ref> | ||
***In the context of quality, a measure (even if somewhat flawed) | ***In the context of quality, a measure (even if somewhat flawed) is probably more reproducible and objective than arbitrary descriptors which require experience and a continuing case volume to calibrate. | ||
===Placentomegaly=== | ===Placentomegaly=== | ||
*[[AKA]] ''large placenta''. | |||
Associations:<ref>URL: [http://quizlet.com/5793113/ob-flash-cards/ http://quizlet.com/5793113/ob-flash-cards/]. Accessed on: 13 January 2012.</ref> | Associations:<ref>URL: [http://quizlet.com/5793113/ob-flash-cards/ http://quizlet.com/5793113/ob-flash-cards/]. Accessed on: 13 January 2012.</ref> | ||
*Maternal diabetes. | *Maternal [[diabetes]] - esp. poorly controlled.<ref name=pmid2771897>{{Cite journal | last1 = Clarson | first1 = C. | last2 = Tevaarwerk | first2 = GJ. | last3 = Harding | first3 = PG. | last4 = Chance | first4 = GW. | last5 = Haust | first5 = MD. | title = Placental weight in diabetic pregnancies. | journal = Placenta | volume = 10 | issue = 3 | pages = 275-81 | month = | year = | doi = | PMID = 2771897 }}</ref> | ||
*Maternal [[anemia]]/low maternal iron stores.<ref>{{Cite journal | last1 = Hindmarsh | first1 = PC. | last2 = Geary | first2 = MP. | last3 = Rodeck | first3 = CH. | last4 = Jackson | first4 = MR. | last5 = Kingdom | first5 = JC. | title = Effect of early maternal iron stores on placental weight and structure. | journal = Lancet | volume = 356 | issue = 9231 | pages = 719-23 | month = Aug | year = 2000 | doi = | PMID = 11085691 }}</ref> | *Maternal [[anemia]]/low maternal iron stores.<ref>{{Cite journal | last1 = Hindmarsh | first1 = PC. | last2 = Geary | first2 = MP. | last3 = Rodeck | first3 = CH. | last4 = Jackson | first4 = MR. | last5 = Kingdom | first5 = JC. | title = Effect of early maternal iron stores on placental weight and structure. | journal = Lancet | volume = 356 | issue = 9231 | pages = 719-23 | month = Aug | year = 2000 | doi = | PMID = 11085691 }}</ref> | ||
*Fetal malformations. | *Fetal malformations. | ||
*Neoplasms of the placenta, e.g. [[chorangioma]]. | *Neoplasms of the placenta, e.g. [[chorangioma]]. | ||
*Twin-twin transfusion syndrome. | *Twin-twin transfusion syndrome. | ||
*Chronic intrauterine infections. | *Chronic intrauterine infections, e.g. [[syphilis]], [[toxoplasmosis]], [[cytomegalovirus]]. | ||
Lame causes of a heavy placenta: | Lame causes of a heavy placenta: | ||
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*Most of causes seem to have one thing in common: | *Most of causes seem to have one thing in common: | ||
**There is a decreased oxygen delivery to the fetus. | **There is a decreased oxygen delivery to the fetus. | ||
====Sign out==== | |||
<pre> | |||
PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, CESAERIAN SECTION: | |||
- LARGE PLACENTA (819 GRAMS -- TRIMMED, POST-FIXATION WEIGHT). | |||
- FETAL MEMBRANES WITHIN NORMAL LIMITS. | |||
- THREE VESSEL UMBILICAL CORD WITHIN NORMAL LIMITS. | |||
- PLACENTAL DISC WITH THIRD TRIMESTER VILLI. | |||
</pre> | |||
===Placental growth restriction=== | |||
*[[AKA]] ''placenta small for gestational age''. | |||
*''Small placenta'' redirects here. | |||
Associations: | |||
*Maternal vascular disease, e.g. [[hypertrophic decidual vasculopathy|hypertension]]. | |||
*Fetal malformations. | |||
====Sign out==== | |||
<pre> | |||
PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, BIRTH: | |||
- PLACENTA SMALL FOR GESTATIONAL AGE (160 GRAMS -- TRIMMED, POST-FIXATION WEIGHT). | |||
- THREE VESSEL UMBILICAL CORD WITHIN NORMAL LIMITS. | |||
- FETAL MEMBRANES WITHIN NORMAL LIMITS. | |||
- PLACENTAL DISC WITH THIRD TRIMESTER VILLI WITH: | |||
-- OLD CENTRAL TRANSMURAL INFARCT (1.7 CM MAXIMAL DIMENSION). | |||
COMMENT: | |||
The 10th percentile placental mass (pre-fixation) for 34 weeks and 2 days is approximately 390 grams. | |||
</pre> | |||
=Overview of placental pathology= | =Overview of placental pathology= | ||
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*Hypertensive changes. | *Hypertensive changes. | ||
=Sign | =Sign out= | ||
What should be commented on... | What should be commented on... | ||
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***Fetal. | ***Fetal. | ||
*Membranes. | *Membranes. | ||
**Membranitis? | **[[Membranitis]]? | ||
**Chorioamnionitis? | **[[Chorioamnionitis]]? | ||
*Cord: | *Cord: | ||
**3 vessel? | **3 vessel? | ||
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Mnemonic: ''chorio, cord, vessels, villi (maturity, infarction)''. | Mnemonic: ''chorio, cord, vessels, villi (maturity, infarction)''. | ||
==Normal placenta== | |||
<pre> | |||
PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, BIRTH: | |||
- THREE VESSEL UMBILICAL CORD WITHIN NORMAL LIMITS. | |||
- FETAL MEMBRANES WITHIN NORMAL LIMITS. | |||
- PLACENTAL DISC WITH THIRD TRIMESTER VILLI WITHIN NORMAL LIMITS. | |||
</pre> | |||
===C-section=== | |||
<pre> | |||
PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, CAESAREAN SECTION: | |||
- THREE VESSEL UMBILICAL CORD WITHIN NORMAL LIMITS. | |||
- FETAL MEMBRANES WITHIN NORMAL LIMITS. | |||
- PLACENTAL DISC WITH THIRD TRIMESTER VILLI WITHIN NORMAL LIMITS. | |||
</pre> | |||
=Cord pathology= | =Cord pathology= | ||
*Two vessel cord. | *[[Two vessel cord]]. | ||
*Hypercoiling/Hypocoiling. | *Hypercoiling/Hypocoiling. | ||
*Abnormal insertion. | *Abnormal insertion. | ||
*Cord | *[[Cord knot]]s (true vs. false). | ||
*Strictures. | *Strictures. | ||
*Hematoma. | *Hematoma. | ||
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*Benign cyst. | *Benign cyst. | ||
==Two vessel cord== | ==Two vessel umbilical cord== | ||
*[[AKA]] | *[[AKA]] ''two vessel cord''. | ||
*[[AKA]] ''single umbilical artery''. | |||
{{Main|Two vessel umbilical cord}} | |||
* | |||
==Insertion== | ==Insertion== | ||
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*Increased risk of vasa previa.<ref name=pmid20872421>{{cite journal |author=Hasegawa J, Farina A, Nakamura M, ''et al.'' |title=Analysis of the ultrasonographic findings predictive of vasa previa |journal=Prenat. Diagn. |volume=30 |issue=12-13 |pages=1121–5 |year=2010 |month=December |pmid=20872421 |doi=10.1002/pd.2618 |url=}}</ref> | *Increased risk of vasa previa.<ref name=pmid20872421>{{cite journal |author=Hasegawa J, Farina A, Nakamura M, ''et al.'' |title=Analysis of the ultrasonographic findings predictive of vasa previa |journal=Prenat. Diagn. |volume=30 |issue=12-13 |pages=1121–5 |year=2010 |month=December |pmid=20872421 |doi=10.1002/pd.2618 |url=}}</ref> | ||
== | ====Sign out==== | ||
<pre> | |||
PLACENTA, UMBILICAL CORDS AND FETAL MEMBRANES, BIRTH: | |||
- THREE VESSEL UMBILICAL CORD WITH A VELAMENTOUS INSERTION, OTHERWISE WITHIN NORMAL LIMITS. | |||
- FETAL MEMBRANES WITHIN NORMAL LIMITS. | |||
- PLACENTAL DISC WITH THIRD TRIMESTER VILLI WITHIN NORMAL LIMITS. | |||
</pre> | |||
==Umbilical knot== | |||
*[[AKA]] ''umbilical cord knot''. | |||
*[[AKA]] ''cord knot''. | |||
*[[AKA]] ''true knot''. | |||
===General=== | ===General=== | ||
*Prevalence ~1.25%.<ref name=pmid12012287>{{cite journal |author=Airas U, Heinonen S |title=Clinical significance of true umbilical knots: a population-based analysis |journal=Am J Perinatol |volume=19 |issue=3 |pages=127–32 |year=2002 |month=April |pmid=12012287 |doi=10.1055/s-2002-25311 |url=}}</ref><ref name=Ref_WMSP>{{Ref WMSP|464}}</ref> | *Prevalence ~1.25%.<ref name=pmid12012287>{{cite journal |author=Airas U, Heinonen S |title=Clinical significance of true umbilical knots: a population-based analysis |journal=Am J Perinatol |volume=19 |issue=3 |pages=127–32 |year=2002 |month=April |pmid=12012287 |doi=10.1055/s-2002-25311 |url=}}</ref><ref name=Ref_WMSP>{{Ref WMSP|464}}</ref> | ||
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*Rare ~ 1/5500. | *Rare ~ 1/5500. | ||
*Mortality ~50% is severe. | *Mortality ~50% is severe. | ||
=Membranes= | =Membranes= | ||
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==Amnion nodosum== | ==Amnion nodosum== | ||
{{Main|Amnion nodosum}} | |||
==Placental meconium== | |||
{{Main|Placental meconium}} | |||
==Squamous metaplasia of the amnion== | |||
===General=== | ===General=== | ||
* | *Benign common finding thought to be of no clinical significance.<ref name=Ref_WMSP463>{{Ref WMSP|463}}</ref> | ||
* | **One case report suggesting an association with [[chorioamnionitis]].<ref>{{Cite journal | last1 = Chew | first1 = RH. | last2 = Silberberg | first2 = BK. | title = Possible association of acute inflammatory exudate in chorioamnionitis and amniotic squamous metaplasia. | journal = Am J Clin Pathol | volume = 93 | issue = 4 | pages = 582-5 | month = Apr | year = 1990 | doi = | PMID = 2321592 }}</ref> | ||
*Needs to be separated from amnion nodosum - '''important'''.<ref>CS. 7 February 2011.</ref> | |||
===Gross=== | ===Gross=== | ||
Features:<ref name=pmid18081444>{{Cite journal | last1 = Adeniran | first1 = AJ. | last2 = Stanek | first2 = J. | title = Amnion nodosum revisited: clinicopathologic and placental correlations. | journal = Arch Pathol Lab Med | volume = 131 | issue = 12 | pages = 1829-33 | month = Dec | year = 2007 | doi = 10.1043/1543-2165(2007)131[1829:ANRCAP]2.0.CO;2 | PMID = 18081444 }}</ref> | |||
*White (or yellow) plaques - irregular outline. | |||
DDx: | |||
*[[Amnion nodosum]] - small (~1-5 mm), round, classically yellow. | |||
Images: | |||
*[http://www.archivesofpathology.org/action/showFullPopup?id=i1543-2165-131-12-1829-f01&doi=10.1043%2F1543-2165%282007%29131%5B1829%3AANRCAP%5D2.0.CO%3B2 Amnion nodosum & squamous metaplasia of the amnion (archivesofpathology.org)].<ref name=pmid18081444/> | |||
<!-- annoying use of '[' and ']' - had to go find escape characters here: http://www.w3schools.com/tags/ref_urlencode.asp --> | |||
===Microscopic=== | ===Microscopic=== | ||
Features: | Features:<ref name=pmid18081444/> | ||
* | *Dense, paucicellular (pink) compact keratin - '''key feature'''. | ||
Image: | Image: | ||
*[http:// | *[http://flylib.com/books/2/953/1/html/2/43%20-%20Placenta_files/DA10C43FF29.png Squmous metaplasia of the amnion (flylib.com)].<ref>URL: [http://flylib.com/books/en/2.953.1.49/1/ http://flylib.com/books/en/2.953.1.49/1/]. Accessed on: 10 January 2011.</ref> | ||
== | ==Circumvallate placenta== | ||
*[[AKA]] '' | *[[AKA]] ''circumvallate insertion of the membranes''. | ||
===General=== | ===General=== | ||
* | *May be associated with [[placental abruption]].<ref name=pmid18226129>{{Cite journal | last1 = Suzuki | first1 = S. | title = Clinical significance of pregnancies with circumvallate placenta. | journal = J Obstet Gynaecol Res | volume = 34 | issue = 1 | pages = 51-4 | month = Feb | year = 2008 | doi = 10.1111/j.1447-0756.2007.00682.x | PMID = 18226129 }}</ref> | ||
Note: | |||
* | *Membranes usually attach to the edge of the placenta. | ||
===Gross=== | ===Gross=== | ||
* | *Fetal membranes attach to the fetal surface of the placenta away from the margin of the placental disc. | ||
Classification: | |||
* | *Partial - not circumferential. | ||
* | *Complete. | ||
DDx: | DDx: | ||
* | *[[Circummarginate placenta]]. | ||
Images: | Images: | ||
*[http:// | *[http://library.med.utah.edu/nmw/mod2/Tutorial2/pics/circumvallate.jpg Circumvallate placenta - partial and complete (utah.edu)]. | ||
*[http://library.med.utah.edu/WebPath/jpeg2/PLAC027.jpg Circumvallate placenta (utah.edu)]. | |||
* | |||
=Twin placentas= | =Twin placentas= | ||
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===General=== | ===General=== | ||
*Non-specific finding. | *Non-specific finding. | ||
*Reported in associated with congenital adrenal hyperplasia for the stem villi.<ref name=pmid11045335>{{Cite journal | last1 = Furuhashi | first1 = M. | last2 = Oda | first2 = H. | last3 = Nakashima | first3 = T. | title = Hydrops of placental stem villi complicated with fetal congenital adrenal hyperplasia. | journal = Arch Gynecol Obstet | volume = 264 | issue = 2 | pages = 101-4 | month = Sep | year = 2000 | doi = | PMID = 11045335 }}</ref> | |||
===Microscopic=== | ===Microscopic=== | ||
Features: | Features: | ||
*"Swiss chesse-like" appearance / bubbly appearance. | *"Swiss chesse-like" appearance / bubbly appearance. | ||
* | *Usually patchy and focal. | ||
Note: | |||
*Cistern formation is reported in the stem villi in association with congenital adrenal hyperplasia.<ref name=pmid11045335/> | |||
DDx: | DDx: | ||
** | *[[Chorioamnionitis]]. | ||
*Fetal edema. | |||
*Idiopathic (no cause apparent). | |||
*[[Placental villous immaturity]]. | |||
Image: | Image: | ||
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==Placental villous immaturity== | ==Placental villous immaturity== | ||
{{Main|Placental villous immaturity}} | |||
== | ==Villous hypoplasia== | ||
*[[AKA]] ''terminal villus deficiency''.<ref name=Ref_Placenta346>{{Ref Placenta|346}}</ref> | |||
{{Main|Villous hypoplasia}} | |||
=Diseases of the placental attachment= | =Diseases of the placental attachment= | ||
==Placenta creta== | ==Placenta creta== | ||
Includes ''placenta accreta'', ''placenta increta'', and ''placenta percreta''. | |||
{{Main|Placenta creta}} | |||
==Placental abruption== | ==Placental abruption== | ||
{{Main|Placental abruption}} | |||
=Inflammatory pathologies= | =Inflammatory pathologies= | ||
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==Membranitis== | ==Membranitis== | ||
:''Chorionitis'' redirects here. | |||
===General=== | ===General=== | ||
*Controversial. | *Early [[chorioamnionitis]].<ref>{{Cite journal | last1 = Vedovato | first1 = S. | last2 = Zanardo | first2 = V. | title = [Chorioamnionitis and inflammatory disease in the premature newborn infant]. | journal = Minerva Pediatr | volume = 62 | issue = 3 Suppl 1 | pages = 155-6 | month = Jun | year = 2010 | doi = | PMID = 21090086 }}</ref> | ||
*Controversial.{{fact}} | |||
===Microscopic=== | ===Microscopic=== | ||
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*+/-PMNs in subamniotic tissue. | *+/-PMNs in subamniotic tissue. | ||
*+/-Necrosis in decidua or chorion/subamniotic tissue. | *+/-Necrosis in decidua or chorion/subamniotic tissue. | ||
Note: | |||
*Plasma cells in the decidua = [[chronic deciduitis]]. | |||
DDx: | |||
*[[Chorioamnionitis]]. | |||
====Grading membranitis==== | ====Grading membranitis==== | ||
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# 1 or 2 + [[necrosis]] in decidua or chorion/subamniotic tissue. | # 1 or 2 + [[necrosis]] in decidua or chorion/subamniotic tissue. | ||
== | ===Sign out=== | ||
<pre> | |||
PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, CESAERIAN SECTION: | |||
- FETAL MEMBRANES WITH CHORIONITIS. | |||
- THREE VESSEL UMBILICAL CORD WITH VASCULITIS. | |||
- PLACENTAL DISC WITH THIRD TRIMESTER VILLI. | |||
</pre> | |||
=== | ====Waffle==== | ||
<pre> | |||
PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, BIRTH: | |||
- FETAL MEMBRANES WITH MECONIUM-LADEN MACROPHAGES AND ABUNDANT DECIDUAL NEUTROPHILS | |||
SUSPICIOUS FOR EARLY CHORIONITIS. | |||
- PLACENTAL DISC WITH THIRD TRIMESTER VILLI. | |||
- THREE VESSEL UMBILICAL CORD WITHIN NORMAL LIMITS. | |||
</pre> | |||
==Chorioamnionitis== | |||
{{Main|Chorioamnionitis}} | |||
==Umbilical cord vasculitis== | ==Umbilical cord vasculitis== | ||
{{Main|Umbilical cord vasculitis}} | |||
Umbilical cord vasculitis | |||
==Funisitis== | ==Funisitis== | ||
{{Main|Funisitis}} | |||
* | *Inflammation of Wharton's jelly - the connective tissue of the umbilical cord. | ||
== | ==Acute villitis== | ||
{{main|Acute villitis}} | |||
==Villitis of unknown etiology== | ==Villitis of unknown etiology== | ||
{{Main|Villitis of unknown etiology}} | |||
==Chronic intervillitis== | |||
*[[AKA]] ''chronic intervillositis''.<ref name=pmid8215826>{{Cite journal | last1 = Jacques | first1 = SM. | last2 = Qureshi | first2 = F. | title = Chronic intervillositis of the placenta. | journal = Arch Pathol Lab Med | volume = 117 | issue = 10 | pages = 1032-5 | month = Oct | year = 1993 | doi = | PMID = 8215826 }}</ref> | |||
* | |||
===General=== | ===General=== | ||
Line 686: | Line 613: | ||
*Recurs. | *Recurs. | ||
===Microscopic=== | ===Microscopic=== | ||
Features:<ref name=pmid17088773/> | Features:<ref name=pmid8215826/><ref name=pmid17088773/> | ||
*Intervillous inflammatory cells: | *Intervillous inflammatory cells: | ||
**Lymphocytes. | **Lymphocytes. | ||
Line 692: | Line 619: | ||
*Fibrinoid deposition. | *Fibrinoid deposition. | ||
Images | ====Images==== | ||
<gallery> | |||
Image:Intervillitis_-_intermed_mag.jpg | Intervillitis - intermed. mag. (WC) | |||
Image:Intervillitis_-_very_high_mag.jpg | Intervillitis - very high mag. (WC) | |||
</gallery> | |||
==Chronic deciduitis== | ==Chronic deciduitis== | ||
*[[AKA]] plasma cell deciduitis. | *[[AKA]] plasma cell deciduitis. | ||
{{Main|Chronic deciduitis}} | |||
=Placental infarction= | =Placental infarction= | ||
==True infarcts== | ==True infarcts== | ||
{{Main|Placental infarct}} | |||
==Perivillous fibrin deposition== | ==Perivillous fibrin deposition== | ||
*Abbreviation ''PFD''. | |||
===General=== | ===General=== | ||
* | *Thought to be an immunologic problem - resulting in platelet activation and fibrin deposition.<ref name=pmid12066949>{{Cite journal | last1 = Sebire | first1 = NJ. | last2 = Backos | first2 = M. | last3 = Goldin | first3 = RD. | last4 = Regan | first4 = L. | title = Placental massive perivillous fibrin deposition associated with antiphospholipid antibody syndrome. | journal = BJOG | volume = 109 | issue = 5 | pages = 570-3 | month = May | year = 2002 | doi = | PMID = 12066949 }}</ref> | ||
* | *May be associated with [[diabetes mellitus]].<ref name=Ref_Placenta327>{{Ref Placenta|327}}</ref> | ||
===Gross=== | ===Gross=== | ||
Line 770: | Line 650: | ||
Notes: | Notes: | ||
*Nuclei of villi are | *Nuclei of villi are usually preserved. | ||
*Villi may have secondary infarction, i.e. there may be [[Basics#Nuclear destruction words|nuclear destruction]] (karyolysis, karyorrhexis, pyknosis). | *Villi may have secondary infarction, i.e. there may be [[Basics#Nuclear destruction words|nuclear destruction]] (karyolysis, karyorrhexis, pyknosis). | ||
DDx: | |||
*[[Placental infarction]] - loss of nuclei in the villi (below the edge of the lesion). | |||
*[[Massive perivillous fibrin deposition]] (maternal floor infarct). | |||
Images: | Images: | ||
*[http://path.upmc.edu/cases/case75.html APLA syndrome (upmc.edu)]. | *[http://path.upmc.edu/cases/case75.html APLA syndrome (upmc.edu)]. | ||
==Maternal floor | ===Sign out=== | ||
====Thrombi==== | |||
<pre> | |||
PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, BIRTH: | |||
- THREE VESSEL UMBILICAL CORD WITHIN NORMAL LIMITS. | |||
- FETAL MEMBRANES WITHIN NORMAL LIMITS. | |||
- PLACENTAL DISC WITH THIRD TRIMESTER VILLI AND THREE LARGE INTERVILLOUS | |||
THROMBI (BLOCKS A7-A9). | |||
</pre> | |||
==Maternal floor infarction== | |||
*Abbreviated ''MFI''. | |||
*Formally ''placental maternal floor infarction''. | *Formally ''placental maternal floor infarction''. | ||
*[[AKA]] ''massive perivillous fibrin deposition''.<ref name=Ref_Placenta367>{{Ref Placenta|367}}</ref> | |||
*'''' | {{Main|Maternal floor infarction}} | ||
=Fetal disease= | =Fetal disease= | ||
==Fetal thrombotic vasculopathy== | ==Fetal thrombotic vasculopathy== | ||
*Abbreviated ''FTV''. | |||
*A large number of terms are used for this including:<ref name=pmid19237859>{{Cite journal | last1 = Marchetti | first1 = D. | last2 = Belviso | first2 = M. | last3 = Fulcheri | first3 = E. | title = A case of stillbirth: the importance of placental investigation in medico-legal practice. | journal = Am J Forensic Med Pathol | volume = 30 | issue = 1 | pages = 64-8 | month = Mar | year = 2009 | doi = 10.1097/PAF.0b013e318187387e | PMID = 19237859 }}</ref> | *A large number of terms are used for this including:<ref name=pmid19237859>{{Cite journal | last1 = Marchetti | first1 = D. | last2 = Belviso | first2 = M. | last3 = Fulcheri | first3 = E. | title = A case of stillbirth: the importance of placental investigation in medico-legal practice. | journal = Am J Forensic Med Pathol | volume = 30 | issue = 1 | pages = 64-8 | month = Mar | year = 2009 | doi = 10.1097/PAF.0b013e318187387e | PMID = 19237859 }}</ref> | ||
**''Fibrinous vasculosis''. | **''Fibrinous vasculosis''. | ||
Line 798: | Line 684: | ||
**''Fetal artery stem thrombosis''. | **''Fetal artery stem thrombosis''. | ||
*The multitude of terms reflects the confusion about this finding and that it has numerous etiologies.<ref name=pmid19237859/> | *The multitude of terms reflects the confusion about this finding and that it has numerous etiologies.<ref name=pmid19237859/> | ||
{{Main|Fetal thrombotic vasculopathy}} | |||
==Hemorrhagic endovasculitis== | ==Hemorrhagic endovasculitis== | ||
Line 844: | Line 713: | ||
Notes: | Notes: | ||
*One should look for the changes in the membrane roll, not the maternal surface.<ref> | *One should look for the changes in the membrane roll, not the maternal surface.<ref>Sherman, C. 7 February 2011.</ref> | ||
Images: | |||
*[http://www.pathxchange.org/case/19711 Pregnancy-induced hypertension (pathxchange.org)]. | |||
==Hypertrophic decidual vasculopathy== | ==Hypertrophic decidual vasculopathy== | ||
:[[AKA]] ''decidual vasculopathy''. | |||
{{Main|Hypertrophic decidual vasculopathy}} | |||
==HELLP syndrome== | ==HELLP syndrome== | ||
{{Main|HELLP syndrome}} | |||
==Malaria== | ==Malaria== | ||
Line 899: | Line 735: | ||
*[[RBC]]s with basophilic dots ~1-2 micrometres. | *[[RBC]]s with basophilic dots ~1-2 micrometres. | ||
Image | ====Image==== | ||
<gallery> | |||
Image:Maternal_malaria_placenta_-_very_high_mag.jpg | Maternal malaria - very high mag. (WC) | |||
</gallery> | |||
=Tumours= | =Tumours= | ||
{{main|Gestational trophoblastic disease}} | {{main|Gestational trophoblastic disease}} | ||
==Chorangioma== | ==Chorangioma== | ||
{{Main|Chorangioma}} | |||
==Chorangiomatosis== | |||
===General=== | ===General=== | ||
Associated with: | |||
*Preeclampsia. | |||
*[[IUGR]]. | |||
* | |||
===Gross=== | ===Gross=== | ||
* | *Multiple tan nodules. | ||
===Microscopic=== | ===Microscopic=== | ||
Features:<ref | Features: | ||
*Multiple chorangiomas - the difference between chorangioma and chorangiomatosis is not well defined.<ref>URL: [http://path.upmc.edu/cases/case655/dx.html http://path.upmc.edu/cases/case655/dx.html]. Accessed on: 28 January 2012.</ref> | |||
Images: | Images: | ||
*[http:// | *[http://path.upmc.edu/cases/case655.html Chorangiomatosis - several images (upmc.edu)]. | ||
==Chorangiosis== | ==Chorangiosis== | ||
{{Main|Chorangiosis}} | |||
=Other= | =Other= | ||
==Fetus papyraceus== | ==Fetus papyraceus== | ||
*May be spelled ''foetus papyraceus''. | |||
*[[AKA]] ''fetus compressus''. | *[[AKA]] ''fetus compressus''. | ||
{{Main|Fetus papyraceus}} | |||
==Placental mesenchymal dysplasia== | |||
* | *Abbreviated ''PMD''. | ||
{{Main|Placental mesenchymal dysplasia}} | |||
=Placental cysts and pseudocysts= | |||
* | Types:<ref name=Ref_Placenta219-220>{{Ref Placenta|219-220}}</ref> | ||
*Amnionic epithelial inclusion cyst (amniotic cyst). | |||
*[[Epidermal inclusion cyst]] - lined by keratinized squamous epithelium. | |||
*Chorionic cyst ([[AKA]] chorionic pseudocyts). | |||
*Cell island cyst. | |||
=== | Other considerations:<ref name=pmid12054300>{{Cite journal | last1 = Brown | first1 = DL. | last2 = DiSalvo | first2 = DN. | last3 = Frates | first3 = MC. | last4 = Davidson | first4 = KM. | last5 = Genest | first5 = DR. | title = Placental surface cysts detected on sonography: histologic and clinical correlation. | journal = J Ultrasound Med | volume = 21 | issue = 6 | pages = 641-6; quiz 647-8 | month = Jun | year = 2002 | doi = | PMID = 12054300 }}</ref> | ||
*Hematoma. | |||
*Fibrin-lined pseudocyst. | |||
= | General:<ref name=pmid12054300/> | ||
*Usually good outcome. | |||
* | *Large cysts (>4.5 cm) or multiple cysts (>3) are associated with [[IUGR]]. | ||
* | |||
Images: | Images: | ||
*[http://www. | *[http://www.jultrasoundmed.org/content/21/6/641/F5.expansion.html Subchorionic cysts (jultrasoundmed.org)].<ref name=pmid12054300/> | ||
=See also= | =See also= | ||
Line 1,005: | Line 808: | ||
=External links= | =External links= | ||
*[http://emedicine.medscape.com/article/262470-overview Cord complications (emedicine.medscape.com)]. | *[http://emedicine.medscape.com/article/262470-overview Cord complications (emedicine.medscape.com)]. | ||
*[http://www.palpath.com/MedicalTestPages/placenta2.htm Placenta notes (palpath.com)]. | |||
[[Category:Placenta]] | [[Category:Placenta]] |
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