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Placental Pathology

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Title: Placental Pathology


1
Placental Pathology
  • AnS 536
  • Spring 2016

2
The Placenta
  • The placenta is an endocrine organ, a site of
    synthesis, and selective transport of hormones
    and neurotransmitters.
  • In addition, the placenta forms a barrier to
    toxins and infective organisms.
  • Most of the known cause cases of stillbirths are
    caused by placental lesions/ abnormalities, then
    infections, and then umbilical cord abnormalities.

3
Placental Pathology
  • There are some situations when pathologists are
    more inclined to interpret placental messages
  • Abortion
  • Fetal malformation
  • Intrapartum hypoxia
  • Placental Lesions
  • Complicated twin pregnancy
  • Prematurity
  • Intrauterine growth restrictions
  • Pre-eclampsia
  • Intrauterine death
  • Infection
  • Chorionic villous inflammation
  • Chorioamnionitis

4
Abortion
  • Estimated 50 of all conceptions are thought to
    end in abortion
  • This is the bodys corrective response to an
    embryonic defect
  • Defect in chorionic villi
  • Due to a genetic abnormality
  • Tetraploidy, triploidy, or trisomy

5
Chorionic Villi
6
Placental Lesions
  • Placental lesions are suggested to be associated
    with illness severity shortly after birth, and
    with a wide range of neonatal problems
  • Maternal vascular underperfusion
  • Inadequate spiral artery muscling
  • Fetal thrombotic vasculopathy
  • Thrombosis, recent or remote, in the umbilical
    cord, chorionic plate or stem villus vessels

7
  • Maternal Vascular Underperfusion
  • Fetal Thrombotic Vasculopathy

8
Twin Pregnancy
  • Very rarely a twin pregnancy identifies the
    newborns as identical
  • Chorionic tissue in the membrane means that the
    twins live in separate cavities.
  • Rate of complications is low
  • Lack of chorionic tissue in the dividing membrane
    signifies a monochorionic cavity which means
    fetal-fetal vascular connections are present.
  • Arteriovenous fistulas
  • Arterio-arterial anastomoses within the chorionic
    plate

9
Arterial-arterial anastomoses
Legend Arteries- blue and green Veins-red and
yellow White star- large arterio-arterial
anastomosis Blue stars-several arterio-venous
anastomoses Green stars- veno-arterial anastomoses
10
Infection
  • Ascending amniotic infection
  • Bacteria ascending from the vagina and infecting
    the fetal membranes specifically the amnion and
    chorion
  • Neutrophilic infiltrates in the membranes,
    chorionic plate, and umbilical cord
  • Increased hepatic granulopoiesis
  • Ingested and aspirated granulocytes
  • Formation of bronchus-associated lymphatic tissue
    in the lungs
  • Segmented neutrophilic granulocytes within the
    fetal alveoli

11
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12
Prematurity
  • Pre-eclampsia
  • Begins after 20 weeks of normal pregnancy
  • Terminated on the mothers side
  • Can lead to HELLP Syndrome
  • Destruction of red blood cells, elevated liver
    enzymes, and low platelet count
  • Placentae are below 5th percentile for weight,
    size, and display circulatory abnormalities
  • Reduces blood flow to the placenta
  • Amniotic infection

13
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14
Intrauterine Growth Restriction
  • Live-born severely growth-restricted children are
    occasionally observed with placentae containing
    barely 30 functional tissue
  • Causes
  • Malfunction in the nutritional supply line
  • A genetic condition
  • Toxins
  • Impaired maternal blood flow through the
    intervillous space
  • Impaired fetal blood flow through the cord and
    allantoic vessels or chorionic villi

15
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16
Intrauterine Death
  • 3-4 of 1000 pregnancies that have progressed to
    fetal viability will result in sudden infant
    death syndrome.
  • Fetus has died from hypoxia, as either a single
    or repeated event
  • Premature abruptio
  • At autopsy, hypoxic hemorrhages are seen in the
    pleura, pericardium, and meninges
  • Placental dysmaturity or placental maturation
    defect
  • Placentae are of normal size with a pale cut
    surface
  • This is due to defective formation of both the
    sinusoidal vessels in the terminal villi and the
    syncytiocapillary membranes

17
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18
Real Life Example
  • Pine Needle Abortion
  • Ponderosa pine needles
  • Diterpene abietane acids
  • Symptoms
  • Severe Illness after abortion
  • Weak calves and prone to respiratory problems
  • Retained placentae
  • Endometritis
  • Renal and neurological lesions

19
Decline in Perinatal Postmortem Examinations
  • Examination of the placenta should be done in
    every pregnancy failure, in children who survive
    birth but have an unexplained low Apgar score,
    infection, or growth retardation.
  • When babies enrolled in a trial do go on to die,
    parents are not always asked about doing a
    postmortem examination.
  • Reasons as to why a PM does not occur.
  • Prematurity
  • Lower birth weight
  • Specific diagnosis
  • ie. Birth asphyxia

20
Professional Views on PM
  • In general, the sample saw the importance of the
    PM as being strongly related to the cause of
    death whereas only 31 felt that they were very
    important when the cause of death was extreme
    prematurity, when the cause of death was
    congenital anomaly, 94, or an indeterminate
    cause only 91 felt they were very important.
  • 17 of the sample indicated that they do not
    approach families that are upset.

21
Parental Views on PM
  • 45 of parents who did not permit a PM stated
    that they had not been approached.
  • 81 of the responding parents had taken up the
    offer of a PM.
  • 24 of these did so to contribute to research
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