Post on 29-May-2018
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PLACENTAL PATHOPHYSIOLOGY
Harsh Thaker, MD, PhD
ht89@columbia.edu
IMPLANTATION
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TROPHOBLAST AND VILLI
ANATOMY
Moore & Pers aud: The dev eloping human- Clinically oriented embryology
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PLACENTAL CIRCULATION
Moore & Persaud: The developing human- Clinically oriented embryology
FETAL SURFACE
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MATERNAL SURFACE
HISTOLOGY: UMBILICAL CORD
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Decidua
Chorion
Amnion
HISTOLOGY: MEMBRANES
HISTOLOGY: PLACENTAL DISC
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HISTOLOGY: PLACENTAL DISC-FETAL SURFACE
HISTOLOGY: PLACENTAL DISC- MATERNAL SURFACE
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Moore & Pers aud: The dev eloping human- Clinically oriented embryology
HISTOLOGY: VILLOUS ARCHITECTURE
HISTOLOGY: VILLOUS ARCHITECTURE
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Moore & Pers aud: The dev eloping human- Clinically oriented embryology
FUNCTIONS OF THE PLACENTA
PLACENTAL HORMONES
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Human Chorionic Gonadotropin
(HCG)
Secreted by Syncytiotrophoblast Cells
Structurally similar to pituitary LH
Prolongs survival of Corpus luteum,thus maintaining steroid hormonelevels 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
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MOTHER PLACENTA FETUS
LDL Cholesterol LDL Cholesterol LDLCholesterol
(Blood) (B lood)
Progesterone
DHEAS DHEAS DHEAS
(Adrenal) (Adrenal)Sulfatase
3 Beta OH steroid DH
Aromatase
Estrone
Estradiol
Key:DHEAS : Dehydroepiandrosterone sulfate
3 Beta OH steroid DH : 3 beta hydroxy steroid dehydrogenase
Figure modified from: Carr, BR , The maternal -fetal-placental unit. In: Becker KL,
ed. Principles and Practice of Endocrinology and Metabolism, 3 rd ed. Lippincott
Williams & Wilkins, Philadelphia. 2001: 1061.
PLACENTA IN STEROID HORMONE BIOSYNTHESIS
1
2
4
3
17
5
6
OH
O
Dehydroepiandrosterone(C19)
18
19
3 beta-hydroxy steroid dehydrogenase
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1
2
4
3
17
5
6O
O
Androstenedione(C19)
18
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Aromatase
1
2
4
3
17
5
6
O
Estrone(C18)
18
O
17 beta-hydroxy steroid oxidoreductase
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1
2
4
3
17
5
6OH
OH
Estradiol(C18)
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OTHER PLACENTALHORMONES
Placental Prolactin
Placental Thyrotropin
Placental ACTH and CRF
Placental growth hormone
Other peptides- Activin, inhibin,follistatin, urocortin, leptin, IGF etc.
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HCG Elevated in Tri 21
uE3 Decreased in Tri 21
AFP Decreased in Tri 21
Inhibin A Elevated in Tri 21
AFP is elevated in Neural Tube Defects
Fetoplacental hormones and
peptides in prenatal screening
DEVELOPMENTAL
PATHOPHYSIOLOGY
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ECTOPIC IMPLANTATION
Moore & Pers aud: The dev eloping human- Clinically oriented embryology
PLACENTA PREVIA & PLACENTA ACCRETA
Moore & Persaud: The developing human- Clinically oriented embryology
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MECHANICAL PROBLEMSMECHANICAL
PATHOPHYSIOLOGY
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!