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PLACENTAL PATHOPHYSIOLOGY

Harsh Thaker, MD, PhDht89@columbia.edu

IMPLANTATION

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TROPHOBLAST AND VILLI

ANATOMY

Moore & Persaud: The developing human- Clinically oriented embryology

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PLACENTAL CIRCULATION

Moore & Persaud: The developing human- Clinically oriented embryology

FETAL SURFACE

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MATERNAL SURFACE

HISTOLOGY: UMBILICAL CORD

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Decidua

Chorion

Amnion

HISTOLOGY: MEMBRANES

HISTOLOGY: PLACENTAL DISC

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HISTOLOGY: PLACENTAL DISC-FETAL SURFACE

HISTOLOGY: PLACENTAL DISC- MATERNAL SURFACE

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Moore & Persaud: The developing human- Clinically oriented embryology

HISTOLOGY: VILLOUS ARCHITECTURE

HISTOLOGY: VILLOUS ARCHITECTURE

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Moore & Persaud: The developing human- Clinically oriented embryology

FUNCTIONS OF THE PLACENTA

PLACENTAL HORMONES

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Human Chorionic Gonadotropin(HCG)

• Secreted by Syncytiotrophoblast Cells• Structurally similar to pituitary LH• Prolongs survival of Corpus luteum,

thus maintaining steroid hormonelevels in pregnancy.

• Detectable in maternal plasma 7-10days after implantation

• Levels peak at 8-10 weeks’ gestation

Human Placental Lactogen(HPL)

• A.K.A Chorionic Somatomammotropin• Secreted by Syncytiotrophoblast Cells• Structurally similar to pituitary Growth

Hormone and Prolactin• Metabolic effects- Insulin antagonist• Promotes breast development

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Placental Endocrine Functions : Steroid Hormones

MOTHER PLACENTA FETUS

LDL 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, 3 rd ed. Lippincott

Williams & Wilkins, Philadelphia. 2001: 1061.

PLACENTA IN STEROID HORMONE BIOSYNTHESIS

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4

3

17

56OH

O

Dehydroepiandrosterone(C19)

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3 beta-hydroxy steroid dehydrogenase

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12

4

3

17

56O

O

Androstenedione(C19)

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19

Aromatase

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4

3

17

56

O

Estrone(C18)

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O

17 beta-hydroxy steroid oxidoreductase

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12

4

3

17

56OH

OH

Estradiol(C18)

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OTHER PLACENTALHORMONES

• Placental Prolactin• Placental Thyrotropin• Placental ACTH and CRF• Placental growth hormone• Other peptides- Activin, inhibin,

follistatin, urocortin, leptin, IGF etc.

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HCG Elevated in Tri 21uE3 Decreased in Tri 21AFP Decreased in Tri 21Inhibin A Elevated in Tri 21

AFP is elevated in Neural Tube Defects

Fetoplacental hormones andpeptides in prenatal screening

DEVELOPMENTALPATHOPHYSIOLOGY

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ECTOPIC IMPLANTATION

Moore & Persaud: The developing human- Clinically oriented embryology

PLACENTA PREVIA & PLACENTA ACCRETA

Moore & Persaud: The developing human- Clinically oriented embryology

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MECHANICAL PROBLEMSMECHANICAL

PATHOPHYSIOLOGY

CORD KNOTS & TWISTS

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CORD: VELAMENTOUS INSERTION

Kaplan: Color atlas of gross placental pathology.

ABNORMAL MEMBRANE ATTACHMENT

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MEMBRANE RUPTURE: AMPUTATIONS

INFLAMMATORYPATHOPHYSIOLOGY

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INFLAMMATION: CHORIOAMNIONITIS

Acute Funisitis

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Candida Funisitis

Candida Funisitis

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Normal membranes

Decidua

Chorion

Amnion

Acute chorioamnionitis

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Meconium

Acute villitis Acute intervillositis.

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Placental infection: Listeria

Listeriosis

Placental MicroabscessesVillous necrosisHeavy growth of Listeria in postmortem cultures

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TRANSPLACENTAL (TORCH) INFECTIONS

Parvoviral inclusions in villi

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Cytomegalovirus: Characteristic nuclear inclusions

Chronic Villitis (non-specific)

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VASCULCARPATHOPHYSIOLOGY

FETAL VASCULAR PATHOLOGY

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Maternal Vascular Pathology: Pre-eclampsia

Maternal vascular pathology: Placental Infarct

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Maternal vascular pathology: Placental Abruption

NEOPLASTICPATHOPHYSIOLOGY

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VASCULAR TUMOR- CHORANGIOMA

TROPHOBLASTIC TUMORS HYDATIDIFORM MOLES

COMPLETE = Diploid 2 Pat, 0 Mat.

PARTIAL = Triploid2 Pat, 1 Mat

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HYDATIDIFORM MOLES- GENETICS

MULTIPLE GESTATIONS

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TWINS- Dizygotic

TWO AMNIONS

TWO CHORIONS

(fused or separate)

TWINS- Monozygotic

TWO AMNIONS

TWO CHORIONS

(fused or separate)

ONE CHORION

ONE OR TWO AMNIONS

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TWINS- Monozygotic

FORMATION OFMONOAMNIONIC TWINS

(including conjoined twins)

TWIN ZYGOSITY AND CHORIONICITY

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Twin placenta- fused discs

Dichorionic Diamnionic placenta

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Monochorionic Diamnionic placenta

Monochorionic twins with Vascular anastomosis

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Twin-Twin transfusion syndrome

Twin placenta- Monoamnionic, with entangled cords

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Twin placenta- fetus papyraceus

ENJOY THE LAB!