16-placenta pathophysiology lecture 2009-comp doc · functions of the placenta ... placenta previa...

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PLACENTAL PATHOPHYSIOLOGY Rosanna G. Abellar, MD

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Page 1: 16-Placenta pathophysiology lecture 2009-comp doc · FUNCTIONS OF THE PLACENTA ... PLACENTA PREVIA & PLACENTA ACCRETA ... 16-Placenta_pathophysiology_lecture 2009-comp doc [Compatibility

PLACENTAL PATHOPHYSIOLOGY

Rosanna G. Abellar, MD

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ANATOMICAL RELATIONS

Moore & Persaud: The developing human- Clinically oriented embryology

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EMBRYOLOGYEMBRYOLOGY

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PLACENTAL CIRCULATION

Moore & Persaud: The developing human- Clinically oriented embryology

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FETAL SURFACE

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MATERNAL SURFACE

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HISTOLOGY: UMBILICAL CORD

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HISTOLOGY: MEMBRANES

Decidua

Chorion

Amnion

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HISTOLOGY: PLACENTAL DISC-FETAL SURFACE

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HISTOLOGY: PLACENTAL DISC- MATERNAL SURFACE

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HISTOLOGY: VILLOUS ARCHITECTURE

Moore & Persaud: The developing human- Clinically oriented embryology

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HISTOLOGY: VILLOUS ARCHITECTURE

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FUNCTIONS OF THE PLACENTA

Moore & Persaud: The developing human- Clinically oriented embryology

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PLACENTAL HORMONESPLACENTAL HORMONES

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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

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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

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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.

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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

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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

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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.

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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

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DEVELOPMENTAL DEVELOPMENTAL PATHOPHYSIOLOGY

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ECTOPIC IMPLANTATIONECTOPIC IMPLANTATION

Moore & Persaud: The developing human- Clinically oriented embryology

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PLACENTA PREVIA & PLACENTA ACCRETA

Moore & Persaud: The developing human- Clinically oriented embryology

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MECHANICAL MECHANICAL PROBLEMS

MECHANICAL PATHOPHYSIOLOGY

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CORD KNOTS & TWISTS

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CORD: VELAMENTOUS INSERTION

Kaplan: Color atlas of gross placental pathology.

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Amnion Amnion Nodosum

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A i i b d Amniotic band sequence

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INFLAMMATORY INFLAMMATORY PATHOPHYSIOLOGY

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INFLAMMATION: CHORIOAMNIONITISINFLAMMATION: CHORIOAMNIONITIS

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Acute Funisitis

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Candida FunisitisCandida Funisitis

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Candida Funisitis

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Normal membranes

Decidua

Chorion

Amnion

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Acute chorioamnionitis

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Meconium

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Acute villitis Acute intervillositisAcute intervillositis.

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Placental infection: Listeria

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Listeriosis

Placental MicroabscessesVillous necrosisHeavy growth of Listeria in postmortem cultures

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TRANSPLACENTAL (TORCH) INFECTIONS

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Parvoviral inclusions in villi

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Cytomegalovirus: Characteristic nuclear inclusions

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Chronic Villitis (non-specific)

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VASCULARVASCULAR PATHOPHYSIOLOGY

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Maternal Vascular Pathology: Pre-eclampsia

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Maternal vascular pathology: Placental Infarct

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Maternal vascular pathology: Placental Abruption

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PROLIFERATIVE / NEOPLASTIC

PATHOPHYSIOLOGYPATHOPHYSIOLOGY

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Complete phydatidiform mole

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HYDATIDIFORM MOLES- GENETICS

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VASCULAR TUMOR- CHORANGIOMA

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MULTIPLE GESTATIONS

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Twin placenta- fused discs

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Dichorionic Diamnionic placenta

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Monochorionic Diamnionic placenta

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VASCULAR ANASTOMOSES

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TWIN-TWIN TRANSFUSION SYNDROME

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Twin placenta- Monoamnionic, with entangled cords

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Twin placenta- fetus papyraceus

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ENJOY THE LAB!ENJOY THE LAB!