Difference between revisions of "Placenta"

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Placenta (view source)

Revision as of 12:00, 27 September 2013

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→‎Chorioamnionitis: split-out
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==Chorioamnionitis==
==Chorioamnionitis==
===General===
{{Main|Chorioamnionitis}}
*Associated with pre-term labour.<ref name=pmid22958008>{{Cite journal  | last1 = Martinelli | first1 = P. | last2 = Sarno | first2 = L. | last3 = Maruotti | first3 = GM. | last4 = Paludetto | first4 = R. | title = Chorioamnionitis and prematurity: a critical review. | journal = J Matern Fetal Neonatal Med | volume = 25 Suppl 4 | issue =  | pages = 29-31 | month = Oct | year = 2012 | doi = 10.3109/14767058.2012.714981 | PMID = 22958008 }}</ref>
**Classically described as due to an ascending infection.
*At term usually non-infectious.<ref name=pmid22412842>{{Cite journal  | last1 = Roberts | first1 = DJ. | last2 = Celi | first2 = AC. | last3 = Riley | first3 = LE. | last4 = Onderdonk | first4 = AB. | last5 = Boyd | first5 = TK. | last6 = Johnson | first6 = LC. | last7 = Lieberman | first7 = E. | title = Acute histologic chorioamnionitis at term: nearly always noninfectious. | journal = PLoS One | volume = 7 | issue = 3 | pages = e31819 | month =  | year = 2012 | doi = 10.1371/journal.pone.0031819 | PMID = 22412842 }}</ref>
 
Clinical features:
*Maternal fever.
*Premature rupture of membranes (PROM).
*Non-reassuring fetal heart rate (NRFHR).
 
Management:
*Antibiotics - usually ampicillin and gentamicin.<ref name=pmid20569811>{{Cite journal  | last1 = Tita | first1 = AT. | last2 = Andrews | first2 = WW. | title = Diagnosis and management of clinical chorioamnionitis. | journal = Clin Perinatol | volume = 37 | issue = 2 | pages = 339-54 | month = Jun | year = 2010 | doi = 10.1016/j.clp.2010.02.003 | PMID = 20569811 | PMC = 3008318 }}</ref>
 
===Gross===
*Fetal membranes dull/opaque.
 
===Microscopic===
Features:
*Neutrophils in the amnion.
**Amnion:
***The simple cuboidal epithelium and the paucicellular underlying connective tissue
***Separated from the chorion by an artefactual cleft.
*+/-Microorganisms (e.g. cocci<ref>{{Cite journal  | last1 = Murdoch | first1 = DA. | title = Gram-positive anaerobic cocci. | journal = Clin Microbiol Rev | volume = 11 | issue = 1 | pages = 81-120 | month = Jan | year = 1998 | doi =  | PMID = 9457430 | PMC = 121377}}
</ref>) - very uncommon to see.
 
Note:
*Severe cases may have umbilical cord vasculitis or [[funisitis]].
 
====Images====
<gallery>
Image:Chorioamnionitis_-_low_mag.jpg | Chorioamnionitis - low mag. (WC)
Image:Chorioamnionitis_-_high_mag.jpg | Chorioamnionitis - high mag. (WC)
Image:Chorioamnionitis_-2-_very_high_mag.jpg | Chorioamnionitis - very high mag. (WC)
</gallery>
====Grading chorioamnionitis====
Chorioamnionitis:<ref name=Ref_Sternberg4_2311>{{Ref Sternberg4|2311}}</ref>
# placental chorionic plate only.
# 1 + subamniotic tissue.
# 1 or 2 + necrosis ''or'' abscess.
 
===Sign out===
<pre>
PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, CESAREAN SECTION:
- CHORIOAMNIONITIS.
- FETAL MEMBRANES NEGATIVE FOR MECONIUM.
- THREE VESSEL UMBILICAL CORD WITHIN NORMAL LIMITS.
- PLACENTAL DISC WITH THIRD TRIMESTER VILLI.
- THROMBUS OF THE PLACENTAL DISC (1.3 CM - MAXIMAL DIMENSION).
</pre>
 
====Chorioamnionitis and funisitis====
<pre>
PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, CESAERIAN SECTION:
- CHORIOAMNIONITIS, MODERATE.
- THREE VESSEL UMBILICAL CORD WITH FUNISITIS, MILD.
- FETAL MEMBRANES NEGATIVE FOR MECONIUM.
- PLACENTAL DISC WITH THIRD TRIMESTER VILLI.
- THROMBUS OF THE PLACENTAL DISC (1.3 CM - MAXIMAL DIMENSION).
</pre>


==Umbilical cord vasculitis==
==Umbilical cord vasculitis==
Michael
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