Placenta - Abnormalities

From Embryology

Introduction

--Mark Hill 22:31, 26 May 2010 (EST) Currently Template page only.

The placenta is a mateno-fetal organ which begins developing at implantation of the blastocyst and is delivered with the fetus at birth. As the fetus relies on the placenta for not only nutrition, but many other developmentally essential functions, the correct development of the placenta is important to correct embryonic and fetal development.

Abnormalities can range from anatomical associated with degree or site of inplantation, structure (as with twinning), to placental function, placento-maternal effects (pre-eclampsia, fetal erythroblastosis) and finally mechanical abnormalities associated with the placental (umbilical) cord.

This current page lists some abnormalities associated with the placenta and also provides links to other resources. (See also Week 2 Abnormalities Hydatidiform mole)

Placenta Links: placenta | Lecture - Placenta | Lecture Movie | Practical - Placenta | implantation | placental villi | trophoblast | maternal decidua | uterus | endocrine placenta | placental cord | placental membranes | placenta abnormalities | ectopic pregnancy | Stage 13 | Stage 22 | placenta histology | placenta vascular | blood vessel | cord stem cells | 2013 Meeting Presentation | Placenta Terms | Category:Placenta
Historic Embryology - Placenta 
1883 Embryonic Membranes | 1907 Development Atlas | 1909 | 1910 Textbook | 1917 Textbook | 1921 Textbook | 1921 Foetal Membranes |1921 human | 1921 Pig implantation | 1922 Single placental artery | 1923 Placenta Review | 1939 umbilical cord | 1943 human and monkey | 1944 chorionic villus and decidua parietalis | 1946 placenta ageing | 1960 first trimester placenta | 1960 monkey | 1972 Placental circulation | Historic Disclaimer


Placenta abnormalities.jpg

Placenta Accreta

Abnormal adherence, with absence of decidua basalis. The incidence of placenta accreta also significantly increases in women with previous cesarean section compared to those without a prior surgical delivery.

See WebPath images: Placenta accreta, microscopic

References: Zaideh SM, Abu-Heija AT, El-Jallad MF. [See Related Articles] Placenta praevia and accreta: analysis of a two-year experience. Gynecol Obstet Invest. 1998 Aug;46(2):96-8.

Placenta Increta

Placenta Increta occurs when the placenta attaches deep into the uterine wall and penetrates into the uterine muscle, but does not penetrate the uterine serosa. Placenta increta accounts for approximately 15-17% of all cases.

Placenta Percreta

Placental villi penetrate myometrium and through to uterine serosa. See clinical article on the laparoscopic management of placenta percreta. [1]

Placenta Previa

Model of Placenta Previa (Italian terracotta from 1770)


In this placenatal abnormality, the placenta overlies internal os of uterus, essentially covering the birth canal. This condition occurs in approximately 1 in 200 to 250 pregnancies.

In the third trimester and at term, abnormal bleeding can require cesarian delivery and can also lead to Abruptio Placenta (More? Abruptio Placenta)

Ultrasound screening programs during 1st and early 2nd trimester pregnancies now include placental localization. Diagnosis can also be made by transvaginal ultrasound.

See also recent advances in the management of placenta previa. [2]

Vasa Previa

Vasa previa (vasa praevia) placental abnormality where the fetal vessels lie within the membranes close too or crossing the inner cervical os (opening). This occurs normally in 1:2500-5000 pregnancies and leads to complications similar too those for placenta previa.[3]

Type II is defined as the condition where the fetal vessels are found crossing over the internal os connecting either a bilobed placenta or a succenturiate lobe with the main placental mass.[4]

Some recent evidence of successful in utero laser ablation of type II vasa previa at 22.5 weeks of gestation. See also the Canadian guidelines for the management of vasa previa.[5]

Abruptio Placenta

Retroplacental blood clot formation, abnormal hemorrhage prior to delivery.

References

Salihu HM, Bekan B, Aliyu MH, Rouse DJ, Kirby RS, Alexander GR. [See Related Articles] Perinatal mortality associated with abruptio placenta in singletons and multiples. Am J Obstet Gynecol. 2005 Jul;193(1):198-203.


Chronic Intervillositis

(massive chronicintervillositis, chronic histiocytic intervillositis) Rare placental abnormality and pathology defined by inflammatory placental lesions, mainly in the intervillous space (IVS), with a maternal infiltrate of mononuclear cells (monocytes, lymphocytes, histiocytes) and intervillous fibrinoid deposition.

References

Chronic intervillositis of the placenta. Jacques SM, Qureshi F. Arch Pathol Lab Med. 1993 Oct;117(10):1032-5.

Pre-eclampsia

This condition is also known as gestational proteinuric hypertension and occurs in occurs in approximately 2 to 4% of all pregnancies. The pathogenesis of eclamptic convulsions remains unknown and women with a history of eclampsia are at increased risk of eclampsia (1-2%) and preeclampsia (22-35%) in subsequent pregnancies. "Magnesium sulfate is the drug of choice for reducing the rate of eclampsia developing intrapartum and immediately postpartum."(see Sibai BM. 2005).

Recent research using a large population study in Norway has shown a strong generational association such that daughters of women who had pre-eclampsia during pregnancy had more than twice the risk of pre-eclampsia themselves. The paper concludes "Maternal genes and fetal genes from either the mother or father may trigger pre-eclampsia. The maternal association is stronger than the fetal association. The familial association predicts more severe pre-eclampsia." (see Skjaerven R. 2005)

References

Sibai BM. [See Related Articles] Diagnosis, prevention, and management of eclampsia. Obstet Gynecol. 2005 Feb;105(2):402-10. Skjaerven R, Vatten LJ, Wilcox AJ, Ronning T, Irgens LM, Lie RT. [See Related Articles] Recurrence of pre-eclampsia across generations: exploring fetal and maternal genetic components in a population based cohort. BMJ. 2005 Sep 16 Links: Australia Australian Action on Pre-eclampsia (voluntary organisation providing support and information to families who have suffered from pre-eclampsia)

Placental Mesenchymal Dysplasia Due to a similar "grape-like" placental appearance, this rare disorder placental mesenchymal dysplasia has been mistaken both clinically and macroscopically for a partial hydatidiform molar pregnancy. (More? Week 2 - Hydatidiform mole) The disorder also has a high incidence of both intrauterine growth restriction (IUGR) and fetal death.

(More? Parveen Z, Tongson-Ignacio JE, Fraser CR, Killeen JL, Thompson KS. Placental mesenchymal dysplasia. Arch Pathol Lab Med. 2007 Jan;131(1):131-7.)

Cord Abnormalities

There are few abnormalities associated with umbilical cord development, other that abnormally short or long cords, which in most cases do not cause difficulties.

In some cases though, long cords can wrap around limbs or the fetus neck, which can then restrict blood flow or lead to tissue or nerve damage, and therefore effect develoment.

Cord knotting can also occur (1%) in most cases these knots have no effect, in some cases of severe knotting this can prevents the passage of placental blood.

Rare umbilical cord torsion, even without knot formation can also affect placental blood flow, even leading to fetal demise.

See WebPath images: umbilical cord knot 1 | umbilical cord knot 2 | Pseudoknot of umbilical cord, gross | Torsion of umbilical cord, gross | Torsion of umbilical cord, with fetal demise, gross |

References

Umbilical cord torsion

Hallak M, Pryde PG, Qureshi F, Johnson MP, Jacques SM, Evans MI. Constriction of the umbilical cord leading to fetal death. A report of three cases. J Reprod Med. 1994 Jul;39(7):561-5. Review.


Fetal Erythroblastosis

This disease is also called Haemolytic Disease of the Newborn, an immune problem from fetus Rh+ /maternal Rh-, leakage from fetus causes anti-Rh antibodies, which is then dangerous for a 2nd child.

RHESUS BLOOD GROUP

Placental Infections

Listeria maternal-fetal barrier

Several infective agents may cross into the placenta from the maternal circulation, as well as enter the embry/fetal circulation. The variety of bacterial infections that can occur during pregnancy is as variable as the potential developmental effects, from virtually insignificant to a major developmental, abortive or fatal in outcome.

Placental Malaria

Pregnant women have an increased susceptibility to malaria infection. Malarial infection of the placenta by sequestration of the infected red blood cells leading to low birth weight and other effects. There are four types of malaria caused by the protozoan parasite Plasmodium falciparum (main), Plasmodium vivax, Plasmodium ovale, Plasmodium malariae). This condition is common in regions where malaria is endemic with women carrying their first pregnancy (primigravida).


Plasmodium falciparum

(More? Abnormal Development - Malaria Infection)

References: Beeson JG, Duffy PE. The immunology and pathogenesis of malaria during pregnancy. Curr Top Microbiol Immunol. 2005;297:187-227. | Brabin BJ, Romagosa C, Abdelgalil S, Menendez C, Verhoeff FH, McGready R, Fletcher KA, Owens S, D'Alessandro U, Nosten F, Fischer PR, Ordi J. The sick placenta-the role of malaria. Placenta. 2004 May;25(5):359-78.

Links: Brown University - Maternal Malaria | CDC - Malaria

Placental Membranes

There are few documented abnormalities associated with fetal membranes. Ultrasound measurement of abnormal yolk sac size/shape in early embryonic development has been suggested as an indicator of early gestational loss. The most common literature described abnormalities are those associated with abnormal vasularization of the chorion.

Placental Pathology

  • Chronic Villitis - can occur following placental infection leading to maternal inflammation of the villous stroma, often with associated intervillositis. The inflammation can lead to disruption of blood flow and necrotic cell death.
  • Massive Chronic Intervillositis (MCI) - maternal blood-filled space is filled with CD68-positive histiocytes and an increase in fibrin, occuring more commonly in the first trimester.
  • Meconium Myonecrosis - prolonged meconium exposure leads to toxic death of myocytes of placental vessels (umbilical cord or chorionic plate).
  • Neuroblastoma - a fetal malignancy that leads to an enlarged placenta, with tumor cells in the fetal circulation and rarely in the chorionic villi.
  • Thrombophilias - (protein C or S deficiency, factor V Leiden, sickle cell disease, antiphospholipid antibody) can generate an increased fibrin/fibrinoid deposition in the maternal or intervillous space, this can trap and kill villi. (Data from:

Roberts DJ. Placental pathology, a survival guide. Arch Pathol Lab Med. 2008 Apr;132(4):641-51.)

International Classification of Diseases

Ninth Revision, Clinical Modification16 codes for 5 selected complications of pregnancy

  • Preeclampsia (642.4, 642.5)
  • Eclampsia (642.6, 642.7)
  • Abruptio placentae (641.2)
  • Placenta previa (641.0, 641.1)
  • Postpartum hemorrhage (666.0–666.2)

References

  1. <pubmed>20129349</pubmed>
  2. <pubmed>15534438</pubmed>
  3. <pubmed>16582134</pubmed>
  4. <pubmed>18050017</pubmed>
  5. <pubmed>19772710</pubmed>

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Cite this page: Hill, M.A. (2024, March 28) Embryology Placenta - Abnormalities. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Placenta_-_Abnormalities

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