Placental Color

8/8/2019 Placental Color

1/35

1

PLACENTAL PATHOPHYSIOLOGY

Harsh Thaker, MD, PhD

[email protected]

IMPLANTATION


2/35

2

TROPHOBLAST AND VILLI

ANATOMY

Moore & Pers aud: The dev eloping human- Clinically oriented embryology


3/35

3

PLACENTAL CIRCULATION

Moore & Persaud: The developing human- Clinically oriented embryology

FETAL SURFACE


4/35

4

MATERNAL SURFACE

HISTOLOGY: UMBILICAL CORD


5/35

5

Decidua

Chorion

Amnion

HISTOLOGY: MEMBRANES

HISTOLOGY: PLACENTAL DISC


6/35

6

HISTOLOGY: PLACENTAL DISC-FETAL SURFACE

HISTOLOGY: PLACENTAL DISC- MATERNAL SURFACE


7/35

7


HISTOLOGY: VILLOUS ARCHITECTURE

HISTOLOGY: VILLOUS ARCHITECTURE


8/35

8


FUNCTIONS OF THE PLACENTA

PLACENTAL HORMONES


9/35

9

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


10/35

10

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


11/35

11

1

2

4

3

17

5

6O

O

Androstenedione(C19)

18

19

Aromatase

1

2

4

3

17

5

6

O

Estrone(C18)

18

O

17 beta-hydroxy steroid oxidoreductase


12/35

12

1

2

4

3

17

5

6OH

OH

Estradiol(C18)

18

OTHER PLACENTALHORMONES

Placental Prolactin

Placental Thyrotropin

Placental ACTH and CRF

Placental growth hormone

Other peptides- Activin, inhibin,follistatin, urocortin, leptin, IGF etc.


13/35

13

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


14/35

14

ECTOPIC IMPLANTATION


PLACENTA PREVIA & PLACENTA ACCRETA

Moore & Persaud: The developing human- Clinically oriented embryology


15/35

15

MECHANICAL PROBLEMSMECHANICAL

PATHOPHYSIOLOGY

CORD KNOTS & TWISTS


16/35

16

CORD: VELAMENTOUS INSERTION

Kaplan: Color atlas of gross placental pathology.

ABNORMAL MEMBRANE ATTACHMENT


17/35

17

MEMBRANE RUPTURE: AMPUTATIONS

INFLAMMATORY

PATHOPHYSIOLOGY


18/35

18

INFLAMMATION: CHORIOAMNIONITIS

Acute Funisitis


19/35

19

Candida Funisitis

Candida Funisitis


20/35

20

Normal membranes

Decidua

Chorion

Amnion

Acute chorioamnionitis


21/35

21

Meconium

Acute villitis

Acute intervillositis.


22/35

22

Placental infection: Listeria

Listeriosis

Placental Microabscesses

Villous necrosis

Heavy growth of Listeria in postmortem cultures


23/35

23

TRANSPLACENTAL (TORCH) INFECTIONS

Parvoviral inclusions in villi


24/35

24

Cytomegalovirus: Characteristic nuclear inclusions

Chronic Villitis (non-specific)


25/35

25

VASCULCAR

PATHOPHYSIOLOGY

FETAL VASCULAR PATHOLOGY


26/35

26

Maternal Vascular Pathology: Pre-eclampsia

Maternal vascular pathology: Placental Infarct


27/35

27

Maternal vascular pathology: Placental Abruption

NEOPLASTIC

PATHOPHYSIOLOGY


28/35

28

VASCULAR TUMOR- CHORANGIOMA

TROPHOBLASTIC TUMORS HYDATIDIFORM MOLES

COMPLETE = Diploid

2 Pat, 0 Mat.

PARTIAL = Triploid

2 Pat, 1 Mat


29/35

29

HYDATIDIFORM MOLES- GENETICS

MULTIPLE GESTATIONS


30/35

30

TWINS- Dizygotic

TWO AMNIONS

TWO CHORIONS

(fused or separate)

TWINS- Monozygotic

TWO AMNIONS

TWO CHORIONS

(fused or separate)

ONE CHORION

ONE OR TWO AMNIONS


31/35

31

TWINS- Monozygotic

FORMATION OF

MONOAMNIONIC TWINS

(including conjoined twins)

TWIN ZYGOSITY AND CHORIONICITY


32/35

32

Twin placenta- fused discs

Dichorionic Diamnionic placenta


33/35

33

Monochorionic Diamnionic placenta

Monochorionic twins with Vascular anastomosis


34/35

34

Twin-Twin transfusion syndrome

Twin placenta- Monoamnionic, with entangled cords


35/35

Twin placenta- fetus papyraceus

ENJOY THE LAB!

Placental Color

Documents

Transcript of Placental Color