16-placenta pathophysiology lecture 2009-comp doc · functions of the placenta ... placenta previa...
TRANSCRIPT
PLACENTAL PATHOPHYSIOLOGY
Rosanna G. Abellar, MD
ANATOMICAL RELATIONS
Moore & Persaud: The developing human- Clinically oriented embryology
EMBRYOLOGYEMBRYOLOGY
PLACENTAL CIRCULATION
Moore & Persaud: The developing human- Clinically oriented embryology
FETAL SURFACE
MATERNAL SURFACE
HISTOLOGY: UMBILICAL CORD
HISTOLOGY: MEMBRANES
Decidua
Chorion
Amnion
HISTOLOGY: PLACENTAL DISC-FETAL SURFACE
HISTOLOGY: PLACENTAL DISC- MATERNAL SURFACE
HISTOLOGY: VILLOUS ARCHITECTURE
Moore & Persaud: The developing human- Clinically oriented embryology
HISTOLOGY: VILLOUS ARCHITECTURE
FUNCTIONS OF THE PLACENTA
Moore & Persaud: The developing human- Clinically oriented embryology
PLACENTAL HORMONESPLACENTAL HORMONES
Human Chorionic Gonadotropin Human Chorionic Gonadotropin (HCG)
• Secreted by SyncytiotrophoblastS• Structurally similar to pituitary LHy p y• Prolongs survival of Corpus luteum,
thus maintaining steroid hormone glevels in pregnancy.
• Detectable in maternal plasma 7-10 pdays after implantation
• Levels peak at 8-10 weeks’ gestationp g
Human Placental Lactogen Human Placental Lactogen (HPL)
• A.K.A Chorionic SomatomammotropinS d b S i h bl• Secreted by Syncytiotrophoblasts
• Structurally similar to pituitary y p yGrowth Hormone and Prolactin
• Metabolic effects- Insulin antagonistM ta o c ff cts nsu n antagon st• Promotes breast development
PLACENTA IN STEROID HORMONE BIOSYNTHESIS
MOTHER PLACENTA FETUS LDL Cholesterol LDL Cholesterol LDLLDL Cholesterol LDL Cholesterol LDL Cholesterol (Blood) (Blood) 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, 3rd ed. Lippincott Williams & Wilkins, Philadelphia. 2001: 1061.
PROGESTERONEPROGESTERONE
• Synthesized by the placenta using maternal cholesterol and LDL lipoprotein
• Serves as a substrate pool for fetal adrenal gland production of l ti id d i l ti idglucococorticoids and mineralocorticoids
• Acts to decrease myometrial activity, t i t t i l l i hibit constrict myometrial vessels, inhibit
prolactin secretion,help suppress maternal immunologic response to fetal antigensimmunologic response to fetal antigens
EEstrogen
• Estrone, estradiol, estriol• DHEAS- estriol precursor derived from p
the fetus• Acts to enhance myometrial activity,
promote myometrial vasodilatation, increase pituitary secretion of prolactin
• Maternal serum levels of estriol are decreased in Trisomy 21
OTHER PLACENTAL OTHER PLACENTAL HORMONES
• Placental ProlactinPl l Th i• Placental Thyrotropin
• Placental ACTH and CRF• Placental growth hormone• Other peptides- Activin inhibin Other peptides Activin, inhibin,
follistatin, urocortin, leptin, IGF etc.
Fetoplacental hormones and Fetoplacental hormones and peptides in prenatal screening
HCG Elevated in Tri 21uE3 Decreased in Tri 21uE3 Decreased in Tri 21AFP Decreased in Tri 21Inhibin A Elevated in Tri 21Inhibin A Elevated in Tri 21
AFP is elevated in Neural Tube AFP is elevated in Neural Tube Defects
DEVELOPMENTAL DEVELOPMENTAL PATHOPHYSIOLOGY
ECTOPIC IMPLANTATIONECTOPIC IMPLANTATION
Moore & Persaud: The developing human- Clinically oriented embryology
PLACENTA PREVIA & PLACENTA ACCRETA
Moore & Persaud: The developing human- Clinically oriented embryology
MECHANICAL MECHANICAL PROBLEMS
MECHANICAL PATHOPHYSIOLOGY
CORD KNOTS & TWISTS
CORD: VELAMENTOUS INSERTION
Kaplan: Color atlas of gross placental pathology.
Amnion Amnion Nodosum
A i i b d Amniotic band sequence
INFLAMMATORY INFLAMMATORY PATHOPHYSIOLOGY
INFLAMMATION: CHORIOAMNIONITISINFLAMMATION: CHORIOAMNIONITIS
Acute Funisitis
Candida FunisitisCandida Funisitis
Candida Funisitis
Normal membranes
Decidua
Chorion
Amnion
Acute chorioamnionitis
Meconium
Acute villitis Acute intervillositisAcute intervillositis.
Placental infection: Listeria
Listeriosis
Placental MicroabscessesVillous necrosisHeavy growth of Listeria in postmortem cultures
TRANSPLACENTAL (TORCH) INFECTIONS
Parvoviral inclusions in villi
Cytomegalovirus: Characteristic nuclear inclusions
Chronic Villitis (non-specific)
VASCULARVASCULAR PATHOPHYSIOLOGY
Maternal Vascular Pathology: Pre-eclampsia
Maternal vascular pathology: Placental Infarct
Maternal vascular pathology: Placental Abruption
PROLIFERATIVE / NEOPLASTIC
PATHOPHYSIOLOGYPATHOPHYSIOLOGY
Complete phydatidiform mole
HYDATIDIFORM MOLES- GENETICS
VASCULAR TUMOR- CHORANGIOMA
MULTIPLE GESTATIONS
Twin placenta- fused discs
Dichorionic Diamnionic placenta
Monochorionic Diamnionic placenta
VASCULAR ANASTOMOSES
TWIN-TWIN TRANSFUSION SYNDROME
Twin placenta- Monoamnionic, with entangled cords
Twin placenta- fetus papyraceus
ENJOY THE LAB!ENJOY THE LAB!