This document provides an overview of normal placenta anatomy and functions, as well as abnormalities in placenta shape, size, circulation, and tumors. A normal term placenta is round to oval shaped, weighs about 470g, and has a diameter of 22cm. Abnormal shapes include bipartite, multilobate, and succenturiate lobes. Increased size over 40mm thickness is considered placentomegaly. Circulatory disturbances disrupt maternal or fetal blood flow and can cause lesions like infarctions. Rare tumors like chorioangiomas may cause complications such as anemia or hydrops if large. Overall, this document covers the spectrum of normal and abnormal placenta features identified on gross and son
This document provides an overview of normal placenta anatomy and functions, as well as abnormalities in placenta shape, size, circulation, and tumors. A normal term placenta is round to oval shaped, weighs about 470g, and has a diameter of 22cm. Abnormal shapes include bipartite, multilobate, and succenturiate lobes. Increased size over 40mm thickness is considered placentomegaly. Circulatory disturbances disrupt maternal or fetal blood flow and can cause lesions like infarctions. Rare tumors like chorioangiomas may cause complications such as anemia or hydrops if large. Overall, this document covers the spectrum of normal and abnormal placenta features identified on gross and son
This document provides an overview of normal placenta anatomy and functions, as well as abnormalities in placenta shape, size, circulation, and tumors. A normal term placenta is round to oval shaped, weighs about 470g, and has a diameter of 22cm. Abnormal shapes include bipartite, multilobate, and succenturiate lobes. Increased size over 40mm thickness is considered placentomegaly. Circulatory disturbances disrupt maternal or fetal blood flow and can cause lesions like infarctions. Rare tumors like chorioangiomas may cause complications such as anemia or hydrops if large. Overall, this document covers the spectrum of normal and abnormal placenta features identified on gross and son
This document provides an overview of normal placenta anatomy and functions, as well as abnormalities in placenta shape, size, circulation, and tumors. A normal term placenta is round to oval shaped, weighs about 470g, and has a diameter of 22cm. Abnormal shapes include bipartite, multilobate, and succenturiate lobes. Increased size over 40mm thickness is considered placentomegaly. Circulatory disturbances disrupt maternal or fetal blood flow and can cause lesions like infarctions. Rare tumors like chorioangiomas may cause complications such as anemia or hydrops if large. Overall, this document covers the spectrum of normal and abnormal placenta features identified on gross and son
Normal Placenta Normal term placenta diameter: 22 cm thickness: 2.5 cm (central) weight: 470 g shape: round to oval Parts of Placenta placental disc extra placental membranes 3 vessel umbilical cord
Gross Description Maternal surface
Fetal surface
Basal plate Divided by cleft into portions (cotyledons) These clefts mark the site of internal septa, which extend into intervillous space
Chorionic plate In which the umbilical cord inserts , typically in the center Chorionic plate and its vessel are covered by thin amnions.
Normal Placenta Maternal side placenta
Fetal side
12-20 cotyledons
placenta
Sonographic description Homogeneous 2-4 cm thick
Retroplacental space hypoechoic area that separates the myometrium from the placental basal plate Measures less than 1-2 cm. Sonographic examinations include Placental location Relationship to the internal os Umbilical cord (fetal and maternal insertion) Vessels counted (2 A 1 V) AVA
Sonographic description Retroplacental hypoechoic zone
3 vessel cord Cord insertion-placental
omphalocoele
Cord insertion-fetal
cervix
Abnormalities Abnormality (shape) Multiple placentas with a single fetus
of
Definition
Placenta Clinical Significance
Bipartite placenta or placenta The cord inserts into two
placenta lobeseither in a duplex connecting bridge or into intervening membrane
Multilobate placenta
Placenta containing 3 or more
equally sized lobes.
Succenturiate lobe/ Accessory lobe
One or more accessory lobes.
May develop in the membranes at a distance from the main placenta.
Succenturiate lobe
Bipartite placenta
May be retained in the uterus
after delivery. May cause postpartum uterine atony or hemorrhage.
Abnormalities
of
Placenta
Abnormality(shape)
Definition
Clinical Significance
Placenta Membranacea
All of the fetal membranes
are covered by a functioning villi and the placenta develops as a thin membranous structure occupying the entire periphery of the chorion.
May be associated with
placenta previa or accreta
May be a variant of placenta
membranacea. Placenta is annular , and a partial or complete ring of placental tissue is present.
Associated with antepartum
and postpartum hemorrhage And IUGR.
Ring-shaped placenta
May give rise to serious
hemorrhage.
Abnormalities
of
Placenta
Abnormality(shape)
Definition
Clinical Significance
Placenta fenestrata
Central portion of a placental disc is missing.
It may erroneously prompt for a search for a retained placental cotyledon.
More of often, the defect
involves only villous tissue and the chorionic plate remains intact.
Placenta fenestrata
Abnormalities
of
Placenta
Normal placenta grows 1mm/week.
Thickness does not exceed 40 mm.
Abnormalities
of
Placenta
Abnormality(size)
Definition
Clinical Significance
Placentomegaly
a. Thicker than 40 mm Commonly results from striking villous enlargement.
Associated with maternal
diabetes, severe maternal anemia, fetal hydrops, Infection caused by syphilis, toxoplasmosis,cytomegalovirus.
b. Less commonly, villi are
enlarge and edematous and fetal parts are present Placenta mysenchymal dysplasia
Cystic vesicles are present,
unlike molar pregnancy , there is no excessive trophoblastic proliferation.
Placenta mysenchymal dysplasia
Ex. Partial mole or complete
mole that coexist with a normal twin.
Clinically mistaken as partial
H. Mole Associated with IUGR and fetal death.
Abnormalities The chorionic plate (fetal surface) normally extends to the periphery of the placenta and has a diameter similar to that of the basal plate (maternal surface. )
of
Placenta
normal
circummarginate
circumvalate
Abnormalities
of
Placenta
Abnormality(size)
Definition
Clinical Significance
Extrachondrial Placentation
The chorionic plate fails to extend to
its periphery and leads to a chorionic plate that is smaller than the basal plate.
Most pregnancies with extrachorial
placenta have normal outcomes.
Circummarginate placenta
Fibrin and old hemorrhage lie
between the placenta and the overlying amniochorion.
Circumvalate placenta
The peripheral chorion is a thickened,
opaque, gray white circular ridge composed of a double fold of chorion and amnion. Described as placental shelfin more than 10% of early 2nd trimester (Shen and collegues)
Increased risk for antepartum
bleeding and preterm birth.
Transient and benign
Abnormalities
of
Placenta
Placenta accreta, increta, percreta
trophoblastic invasion of the myometrium to varying depths to cause abnormal adherence. Torrential hemorrhage is a frequent complication.
Circulatory Disturbances - Frequently identified in normal placentas.
- Up to 30 % of the placental villi can be lost
without untowards fetal effect.
Placenta perfusion disorders can be grouped
into: (1) those in which there is disrupted maternal blood flow to or within the intervillous space. (2) those with disturbed fetal blood flow through the villi.
Circulatory Disturbances Placental lesions that cause abnormal perfusions are frequently seen grossly, sonographically , smaller lesions can be seen microscopically. Following lesions may appear focal sonolucencies within the placenta subchorionic fibrin depositions Perivillous fibrin depositions Intervillous thrombosis
blood flow within the intervillous space with subsequent fibrin deposition. Blood stasis occurs in the sunchorionic area, and lesions that develop are commonly seen as white or yellow firm plaques on the fetal surface.
Perivillous Fibrin Deposition
Maternal blood flow stasis around
an individual villus results in fibrin deposition and can lead to diminished villous oxygenation and syncitiotrophoblastic necrosis.
Clinical Significance
Within limits , these grossly
visible yellow white placental nodules are considered to be normal placental aging.
Exteme variant of perivillous fibrinoid layer within the placental basal plate. Erroneous termed as infarction. The lesion has a thick , white firm, corrugated surface that impedes normal maternal blood flow into the intervillous space.
Associated with miscarriage, IUGR, preterm delivery, and stillbirth. May be associated with maternal thrombophilias. Outcomes recur in subsequent pregnancies.
Collection of coagulated maternal blood normally found in the intervillous space mixed with fetal blood from a break in a villus. Red/White yellow if older.
Common
Any uteroplacental disease
that diminishes or obstruct the blood supply can result to infarction. Common in mature placenta. If numerousplacenta insufficiency can develop.
When thick, centrally
located, random distributed---may be associated with preeclampsia and lupus anticoagulant.
2 umbilical arteries carries May be clinically significant
deoxygenated blood, send if many villi become branches out across the infarcted. placental surface. Thrombosisobstruction necrosis
Subamnionic Hematoma
Hematomas between placenta and amnion. Most aften are acute events during 3rd stage of labor when cord traction ruptures a vessel near the cord insertion
Chronic lesions may cause
fetomaternal hemorrhage or IUGR. Maybe confused with chorioangioma, (-) color flow on UTZ.
Placental Calcifications Calcium salts deposited
throughout the placenta , but are
most common in the basal plate. Accrues with advancing gestation, and is associated with nulliparity, smoking, high socioeconomic status and increasing serum calcium levels. Grading Scale 0-3, but not useful to predict neonatal outcome.
Placental Tumors Chorioangioma
Diagnostics
Clinical Significance
benign tumor that have
component similar to blood vessels and stroma of the chorionic villus.
MSAFP may be elevated--an Small-asymptomatic
important diagnostic finding. Large (>5 cm)- maybe Ultrasound associated with arteriovenous shunting well-circumscribed , within the placenta . hypoechoic lesion near the chorionic surface and Can cause protruding into the amnionic fetal anemia cavity. Hydrops (+)increased color flow on Hemorrhage doppler Preterm delivery Amniotic fluid abnormality IUGR
Placental Tumors Metastatic Tumors Most common Melanoma Leukemia Lymphomas Breast cancer Metastasis to fetus is uncommon---most often seen in melanoma
Tumor cells usually are
confined within the intervillous space. Placental mets from breast cancer
Abnormalities of the Membranes
Abnormalities
Description
Clinical Significance
Meconium staining
Staining can be obvious
within 1-3 hrs.
(Inhalation) Meconium aspiration syndrome---airway obstruction, chemical pneumonitis, surfactant dysfunction or inactivation, pulmonary hypertension
Meconium passage cant be
timed accurately.
Severe hypoxemia neonatal death or long term neurological sequelae in surviving fetus.
Abnormalities of the Membranes
Abnormalities
Description
Clinical Significance
Chorioamnionitis
Secondary to ascending infection after PROM.
Fetal infection (hematogeneous spread)
(Normal genital tract flora
can coloniza and infect the membranes, umbilical cord, and eventually the fetus.)
Organisms usually infect the Associated with
chorion, and adjacent PROM and preterm birth. decidua in the area overlying the intenal os.
Chorioamnionitisfull thickness involvement of the membranes. Funisitismay follow
Abnormalities of the Membranes
Abnormalities
Description
Clinical Significance
Amnion Nodosum
Numerous small, light tan
nodules on the amnion overlying chorionic plate.
May be scraped off the fetal
surface and contain deposits of fetal squames and fibrin that may reflect prolonged and severe oligohydramnios.
Amniotic Band Sequence
Anatomic fetal disruption
sequence caused by bands of amnions that trap fetal structures and impair their growth and development.
entanglement or prolapse, fetal anomalies, acidemia and demise.
Abnormalities of Umbilical Cord
Coiling
Sinistral/Left twisting direction
Umbilical cord coiling index: # of complete cord coils per centimeter of a cord
length. N.V. (in utero: 0.4)(postpartum: 0.2) Hypocoiling
Hypercoiling
Associated with fetal demise
Associated with IUGR and fetal
acidosis.
Abnormalities of Umbilical Cord
Single Umbilical Artery
Fused Umbilical Artery
Most common. Can be isolated or associated with aneuploidy. Most common anomalies are genitourinary or cardiovascular. Also associated with IUGR.
F ailure of 2 arteries to split during
embryological development. Common lumen may extend through the entire cord or if partial, near the placental insertion.
Can be associated with marginal or
velamentous cord insertion but fetal congenital anomalies.
Abnormalities of Umbilical Cord Remnants
True Cyst
Maybe seen when mature Epithelium lined remnants
cord is viewed transversely. of the allantoic or vitelline ducts. Remnants of Vitelline duct, allantoic duct, and Tend to located closer to embryonic vessels. fetal insertion site. not associated with anomalies or perinatal complications.
Pseudocyst From local degeneration of the Whartons jelly. Occur anywhere along the cord. Both with similar sonologic appearance.
Abnormalities of Umbilical Cord Abnormalities Cord Insertion
Description
Clinical Significance
Marginal Insertion (Battledore Placenta)
Common variant Cord anchors at the placental margin.
Rarely causes problems.
Cord being pulled off during
cord traction. More frequent with multifetal pregnancy, assisted reproductive technology and weight discordance.
Abnormalities of Umbilical Cord Abnormalities Cord Insertion
Description
Clinical Significance
Velamentous Insertion
Umbilical vessels spread within
the membranes at a distance from the placental margins, w/c they are surrounded only by a fold of amnion.
Vessels are vulnerable to
compressions/twisting and thrombosis. Associated with placenta previa and multifetal gestation.
I %-incidence
Abnormalities of Umbilical Cord Abnormalities Cord Insertion
Description
Clinical Significance
Vasa Previa
Vessels within the
membranes overlie the cervical os. Vessels can be imposed between the cervix and the presenting part.
Vulnerable to compression, laceration, or avulsion with rapid fetal exsanguination.
dangerous variation of velamentous insertion Uncommon
Antepartum diagnosis is important by gray scale ultrasound or color doppler.
Mode of Delivery: CS
Risk factors include
bilobate/ssuccenturiate/2nd trimester placenta previa with or without later migration. Increased in IVF.
Abnormalities of Umbilical Cord Knots
Stricture
Loops
True knots are caused by fetal movements. Common in monomaniotic twinning. When seen in singleton pregnancy-Increase risk of stillbirth. fetal heart rate abnormalities are seen during labor. False knots Focal redunduncies of fetal vessels or Whartons jelly. No clinical significance
Cord stricture-focal narrowing of its diameter that develops near the fetal cord insertion.
Caused by coiling around
the fetal parts during the movements.
More common in longer
Due to absence of Whartons cords. jelly. Can result in FHT decelerations. Stenosis and obliteration of the vessels near the narrow segment. Less commonly caused by amniotic band.
trauma, entanglement, umbilical vessel venipuncture, and funisitis.
Umbilical Cord Vessel Thrombosis
Venous (70%) Arterial (10%) Arterial higher mobidity and mortality Associated with IUGR, fetal acidosis, and stillbirths
Umbilical Vein Varix
There is marked focal dilatation that can be within either the
amnionic or fetal abdominal portion of the umbilical vein.
Associated with fetal anomalies and aneuploidy. Complications: rupture or thrombosis, compression of umbilical artery, fetal cardiac failure due to increase preload.
Abnormalities of Umbilical Cord (Vascular)
Umbilical artery aneurysm near the insertion
Umbilical vein varix
Umbilical cord vessel
thrombosis
Abnormalities of Umbilical Cord
(Vascular) Umbilical Artery aneurysm caused by congenital thinning of the vessel wall with
dimininshed support from Whartons jelly.
Common site: At or near the cords placental insertion, where the support is absent. Associated with Single umbilical artery, Trisomy 18, Amniotic Fluid abnormality, IUGR, stillbirth. can cause fetal compromise or death by compression of umbilical vein. UTZ: cyst with hyperechoic rim, on Doppler: (+) low velocity or turbulent non pulsatile flow
