Placental disorders
Terms in this set (81)
basal plate The disc surface that lies against the uterine wall
the basal plate, which is divided by clefts into
cotyledons
portions—termed
chorionic plate The fetal surface
470 grams the typical placenta weighs
Abruption
Antepartum infection with fetal risks
Anti-CDE alloimmunization
Cesarean hysterectomy
Oligohydramnios or hydramnios
Peripartum fever or infection
Preterm (<32 wks) delivery
Maternal indications Postterm (>42 wks) delivery
Severe trauma
Suspected placental injury
Systemic disorders with known placental effects
Thick meconium
Unexplained late pregnancy bleeding
Unexplained or recurrent pregnancy
complications
Admission to an acute care nursery
Birth weight <10th or >95th percentile Fetal anemia
Fetal or neonatal compromise
Neonatal seizures
Fetal and Neonatal Hydrops fetalis
Indications Infection or sepsis
Major anomalies or abnormal karyotype Multifetal
gestation
Stillbirth or neonatal death
Vanishing twin beyond the first trimester
Gross lesions
Markedly abnormal placental shape or size
Markedly adhered placenta
Placental Indications
Term cord >32 cm or <100 cm
Umbilical cord lesions
Velamentous cord insertion
may also be called bipartite placenta or placenta
bilobate placenta duplexIn these, the cord inserts between the two
placental lobes
multilobate three or more equivalently sized lobes
succenturiate lobes smaller accessory lobes
vasa previa vessels overlie the cervix to create a
placenta membranacea, villi cover all or nearly all the uterine cavity.
variant of placenta membranacea.
ring-shaped placenta
This placenta is annular, and a partial or complete
ring of placental tissue is present.
placenta fenestrata the central portion of a placental disc is missing.
During pregnancy, the normal placenta increases
1 mm per week
its thickness at a rate ___
40 mm placental thickness does not exceed
defines those thicker than 40 mm and commonly
Placentomegaly
results from striking villous enlargement
placental mesenchymal Cystic vesicles also are seen with__
dysplasia
the chorionic plate fails to extend to this
extrachorial placentation
periphery
fibrin and old hemorrhage lie between the
circummarginate placenta placental disc and the overlying sheer
amniochorion.
the chorionic plate periphery is a thickened,
opaque, gray-white circular ridge composed of a
a circumvallate placenta, double fold of chorion and amnion.
On cross-section, however, it appears as two
"shelves,"
Crescent-shaped amnion mirrors the chorion's
Normal early chorioamnionic
curve; distinct from the fetus; fuses after 16 weeks'
separation
gestation
Echogenic blood lies between the myometrium
and chorioamnion, which appears as a thin band
Subchorionic hematoma
crossing the cavity. Hemorrhage and band resolve
over time
Uterine synechiae (Amnionic 2.5- to 4.0-mm-thick, broad-based band crosses
sheet) the cavity. Appears shelflike on cross section
Broad-based band extends from one placental
Circumvallate placenta edge to the other, just above the placental
surface. Appears shelflike on cross section
Amnionic band Thin strands cross and appear to tether fetal parts
Thin strands tether fetal parts and form after
Pseudoamnionic band
fetoscopic surgeries or amniocenteses that are
syndrome
complicated by membrane laceration
Chorioamnionic sac of an early pregnancy fills
one horn of a septate or partial bicornuate uterus.
Uterine septum
Thick band of echoes, which may be wedge-
shaped, extend from uterine fundus in midline
Membranes from vanishing Depending on chorionicity either a thin amnion or
twin thicker chorioamnion spans the cavity
Placental vessels supported With grayscale imaging, vessels appear as bands.
by membranes: velamentous Color Doppler will clarify
insertion, succenturiate lobe
caused by slowing of maternal blood flow within
the intervillous space.
Subchorionic Fibrin
Deposition
lesions are seen as white or yellow, firm, round,
elevated plaques just beneath the chorionic plate.
can lead to diminished villous oxygenation and
necrosis of syncytiotrophoblast
Perivillous Fibrin Deposition
small yellow-white placental nodules are grossly
visible within the parenchyma of a sectioned
placenta.
is a dense fibrinoid layer within the placental basal
plate and is erroneously termed an infarction
Maternal floor infarction
has a thick, yellow or white, firm corrugated
surface that impedes normal maternal blood flow
into the intervillous space
In specific cases that extend up and beyond the
massive perivillous fbrin
basal plate to entrap villi and obliterate the
deposition
intervillous space, the term ___ is used
This is a collection of coagulated maternal blood
normally found in the intervillous space mixed
Intervillous Thrombus
with fetal blood from a break in a villus.
appear red if recent or white-yellow if older,
Any uteroplacental disease that diminishes or
obstructs this supply can result in infarction of an
individual villus.
Infarction
associated with preeclampsia or lupus
anticoagulant
formed between the placenta and its adjacent
Retroplacental Hematoma
decidua;
formed between the chorion and decidua at the
Marginal hematoma placental periphery
known clinically as "chorionic hemorrhage"
—derived of fetal vessel origin and found beneath
subamnionic hematoma
the amnion but above the chorionic plate
also known as Breus moles.
massive subchorionic
hematomas subchorial thrombus along the roof of the
intervillous space and beneath the chorionic plate
with fetal vessel thrombosis, portions of the villus
Fetal Vascular Malperfusion
distal to the obstruction become nonfunctional.
describes an increased number o capillaries within
terminal villi.
Chorangiosis
long-standing hypoperfusion or hypoxia is
thought to be causative
increased capillary vascularity in a significant
Focal chorangiosis
portion of the placenta but not diffusely.
chorangiomatosis describes increased capillary number in stem villi
these hematomas lie between the chorionic plate
Subamnionic Hematoma
and amnion.
placental grade that is homogenous lacks
grade 0 placenta
calcification
has scattered echogenicities and subtle chorionic
A grade 1 placenta
plate undulations.
Grade 2 shows echogenic stippling at the basal plate
has echogenic indentations extending from the
grade 3 placenta chorionic plate to the basal plate, which create
discrete components that resemble cotyledons.
These benign tumors have components similar to
Chorioangioma the blood vessels and stroma of the chorionic
villus
True or False. maternal malignant tumors rarely
True
metastasize to the placenta
Bacteria most commonly ascend after prolonged
Chorioamnionitis membrane rupture and during labor to cause
infection
Infammation of the chorionic plate and of the
funisitis
umbilical cord
condition characterized by numerous small, light-
Amnion nodosum tan nodules affixed to the amnion that overlies the
chorionic plate.
is an anatomical disruption sequence in which
amnion bands tether, constrict, or amputate fetal
part
amnionic band sequence
cause limb-reduction defects, facial clefts, or
encephalocele
Severe defects of the spine or ventral wall that
limb-body wall complex
accompany amnionic bands suggest
contrast is formed by normal amniochorion
amnionic sheet
draped over a preexisting uterine synechia
40 to 70 cm lon Most umbilical cords at delivery measure
. The number of complete coils per centimeter o
umbilical coiling index—UCI
cord length i
hypocoiled, UCIs <10th percentile are considered
hypercoiled UCI those >90th percentile
is a standard component of anatomical evaluation
Counting cord vessel number during fetal sonographic examination and
immediately after delivery
connection between the two umbilical arteries,
Hyrtl anastomosis and it lies near the cord's insertion into the
placenta.
found along the course of the cord. They are
Cysts
designated according to their origin.
epithelium-lined remnants of the allantoic or
True cysts vitelline ducts and tend to be located closer to
the fetal insertion site.
Marginal insertion is a common variant—
battledore placenta sometimes referred to as a____in which the cord
anchors at the placental margin
the umbilical vessels characteristically travel within
velamentous insertion the membranes before reaching the placental
margin
vessels travel within the membranes and overlie
the cervical os. There, they can be torn with
Vasa previa
cervical dilation or membrane rupture, and
laceration can lead to rapid fetal exsanguination
in which vessels are part of a velamentous cord
Type 1 vasa previa
insertion,
involved vessels span between portions o a
type 2 vasa previa
bilobate or a succenturiate placenta
are found in approximately 1 percent o births.
true knots These form from fetal movement, and associated
risks include hydramnios and diabetes mellitus (
are especially common and dangerous in
Knots
monoamnionic twins
a focal narrowing o the diameter that usually
cord stricture
develops near the fetal cord insertion site
caused by coiling around various fetal parts
Cord loops
during movement
a nuchal cord A cord around the neck
the umbilical cord is the presenting part
funic presentation These are uncommon and most often are
associated with fetal malpresentation
rare and generally follow rupture of an umbilical
Cord hematomas vessel, usually the vein, and hemorrhage into the
Wharton jelly
Approximately 70 percent are venous, 20 percent
Umbilical cord vessel
are venous and arterial, and 10 percent are arterial
thromboses
thromboses
can complicate either the intraamnionic or fetal
intraabdominal portion o the umbilical vein.
umbilical vein varix
intraamnionic varices show cystic dilation o the
umbilical vein
is caused by congenital thinning o the vessel wall
ulbilical artery aneurysm
with diminished support rom Wharton jelly
aneurysms measuring -----, the blood reservoir
>5 cm within the aneurysm may pose a risk for high-
output heart failure
