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Difference between revisions of "Placenta"
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→Inflammatory pathologies: subdivide/rework
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=Inflammatory pathologies= | =Inflammatory pathologies= | ||
== | ===Overview of infections=== | ||
General:<ref name=Ref_PBoD1106>{{Ref PBoD|1106}}</ref> | General:<ref name=Ref_PBoD1106>{{Ref PBoD|1106}}</ref> | ||
*Infection usually ascending, i.e. from vagina up through cervix. | *Infection usually ascending, i.e. from vagina up through cervix. | ||
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**Inflammatory cells in umbilical cord are fetal (trivia). | **Inflammatory cells in umbilical cord are fetal (trivia). | ||
===Types | ====Types==== | ||
By site:<ref name=Ref_PBoD1106>{{Ref PBoD|1106}}</ref> | |||
*Fetal membranes: chorioamnionitis, membranitis.<ref name=Ref_Sternberg4_2311>{{Ref Sternberg4|2311}}</ref> | *Fetal membranes: chorioamnionitis, membranitis.<ref name=Ref_Sternberg4_2311>{{Ref Sternberg4|2311}}</ref> | ||
*Umbilical cord: funisitis. | *Umbilical cord: funisitis. | ||
*Placenta: placentitis, villitis. | *Placenta: placentitis, villitis. | ||
==Grading | ==Membranitis== | ||
===General=== | |||
*Controversial. (???) | |||
===Microscopic=== | |||
Features: | |||
*[[PMN]]s in the decidua. | |||
*+/-PMNs in subamniotic tissue. | |||
*+/-Necrosis in decidua or chorion/subamniotic tissue. | |||
====Grading membranitis==== | |||
''Sternberg'':<ref name=Ref_Sternberg4_2311>{{Ref Sternberg4|2311}}</ref> | |||
# PMNs - decidua only. | # PMNs - decidua only. | ||
# PMNs - in subamniotic tissue. | # PMNs - in subamniotic tissue. | ||
# 1 or 2 + [[necrosis]] in decidua or chorion/subamniotic tissue. | # 1 or 2 + [[necrosis]] in decidua or chorion/subamniotic tissue. | ||
==Chorioamnionitis== | |||
===General=== | |||
Clinical: | |||
*Maternal fever. | |||
*Premature rupture of membranes (PROM). | |||
*Non-reassuring fetal heart rate (NRFHR). | |||
===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. | |||
Note: | |||
*Severe cases may have umbilical cord vasculitis or [[funisitis]]. | |||
Images: | |||
*[[WC]]: | |||
**[http://commons.wikimedia.org/wiki/File:Chorioamnionitis_-_low_mag.jpg Chorioamnionitis - low mag. (WC)]. | |||
**[http://commons.wikimedia.org/wiki/File:Chorioamnionitis_-_high_mag.jpg Chorioamnionitis - high mag. (WC)]. | |||
**[http://commons.wikimedia.org/wiki/File:Chorioamnionitis_-2-_very_high_mag.jpg Chorioamnionitis - very high mag. (WC)]. | |||
====Grading chorioamnionitis==== | |||
Chorioamnionitis:<ref name=Ref_Sternberg4_2311>{{Ref Sternberg4|2311}}</ref> | Chorioamnionitis:<ref name=Ref_Sternberg4_2311>{{Ref Sternberg4|2311}}</ref> | ||
# placental chorionic plate only. | # placental chorionic plate only. | ||
# 1 + subamniotic tissue. | # 1 + subamniotic tissue. | ||
# 1 or 2 + necrosis or abscess. | # 1 or 2 + necrosis ''or'' abscess. | ||
==Umbilical cord vasculitis== | |||
===General=== | |||
*Usu. seen together with [[chorioamnionitis]]. | |||
===Microscopic=== | |||
Features: | |||
*Neutrophils in the vessels of the umbilical cord. | |||
====Grading==== | |||
Umbilical cord vasculitis:<ref name=Ref_Sternberg4_2311>{{Ref Sternberg4|2311}}</ref> | Umbilical cord vasculitis:<ref name=Ref_Sternberg4_2311>{{Ref Sternberg4|2311}}</ref> | ||
* +0.5 for each vessel. | * +0.5 for each vessel. | ||
* +0.5 for each vessel with severe involvement. | * +0.5 for each vessel with severe involvement. | ||
==Funisitis== | |||
===General=== | |||
*Usu. seen together with [[chorioamnionitis]]. | |||
===Microscopic=== | |||
Features: | |||
*Neutrophils in the vessels of the umbilical cord and Wharton's jelly. | |||
Note: | |||
*Wharton's jelly = connective tissue of the umbilical cord. | |||
====Grading funisitis==== | |||
Funisitis:<ref name=Ref_Sternberg4_2311>{{Ref Sternberg4|2311}}</ref> | |||
# Focal inflammation. | # Focal inflammation. | ||
# Diffuse inflammation. | # Diffuse inflammation. | ||
# Necrosis - in vessels or Wharton jelly. | # Necrosis - in umbilical vessels or Wharton jelly. | ||
==Villitis of unknown etiology== | ==Villitis of unknown etiology== | ||
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*'''No''' plasma cells - this suggests an infectious etiology.<ref>CS. 7 February 2011.</ref> | *'''No''' plasma cells - this suggests an infectious etiology.<ref>CS. 7 February 2011.</ref> | ||
**Plasma cells may be seen in the decidua -- these can be ignored. | **Plasma cells may be seen in the decidua -- these can be ignored. | ||
Images: | Images: | ||