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

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!