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Placental Abnormalities
Placental Abnormalities
ABNORMALITIES
Normal Placenta
- Weight: 470g
- Shape and Size: round to oval with 22cm diameter
o Central thickness – 2.5cm
- Composition:
o Placental disc
o Extraplacental membranes
o Three-vessel umbilical cord
- Maternal Surface – basal plate
o Clefts
Divides the placenta into portions
(cotyledons)
Site of internal septa which extend into
the intervillous space
- Fetal Surface – chorionic plate
o Where the umbilical cord inserts (at the center)
o Covered by thin amnion
- Increases in thickness during pregnancy (1mm per week)
but does not exceed 40mm
Abnormalities of the Placenta
o Placentomegaly - >40mm thickness; secondary SHAPE AND SIZE
to: Complication
Maternal DM Bilobate - Placenta form as a
Severe maternal anemia Placenta/ separate, nearly
Fetal hydrops Bipartite equally sized disc
Infection (syphilis, toxoplasma, CMV) placenta/ - Cord inserts
Placenta Duplex between two
Collections of blood or fibrin
placental lobes
- Sonographic findings:
(either on a
o Homogenous and 2-4cm thick
connecting
o Lies against the myometrium and indents into the chorionic bridge or
amniotic sac intervening
o Retroplacental space (<1-2cm) is a hyperechoic membranes)
area that separates the myometrium from its
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Multilobate - Contains 3 or more -
basal plate placenta equally sized lobes
Succenturiate - Small accessory - Vasa previa
lobe lobes (if vessels
- Develops at a overlie the
distance from the cervix)
main placenta - Fetal
hemorrhage
- Postpartum
uterine atony
and
1
PLACENTAL CALCIFICATION
EXTRACHORIAL PLACENTATION - most commonly deposited on the basal plate
- Chorionic plate fails to extend to the periphery of the - grow with advancing gestation
placenta - Associated with:
- Chorionic plate smaller than the basal plate o Nulliparity
Circummarginate - Fibrin and old o Smoking
placenta hemorrhage lie o High socioeconomic status
between the placenta o Inc. maternal s. calcium
and the overlying PLACENTAL TUMORS
amniochorion Chorioangioma
Circumvallate - Peripheral chorion is a Increased - Benign
placenta thickened, opaque, risk of - Have components similar to blood vessels and stroma of
gray-white circular antepartum
the chorionic villi
ridge composed of bleeding
- Diagnostics:
double fold of chorion and
and amnion (appears preterm o MSAFP
as shelf on cross- birth o Sonogram: well circumscribed, rounded,
section) predominantly hypoechoic lesion near the
PLACENTA ACCRETA, INCRETA, AND PERCRETA chorionic surface
o Increased blood flow by color Doppler –
- Develops when trophoblast invades the myometrium to
varying depths causing abnormal adherence distinguishes other placental masses
- Factors that increases incidence: Placenta previa and Prior - Small: asymptomatic
uterine incision or prforation - Large (>5cm) associated with significant AV shunting that
can cause fetal anemia and hydrops
- Complication: torrential hemorrhage
Tumors metastatic to the Placenta
CIRCULATORY DISTURBANCES
- Rare but most commonly:
- 30% of placental villi can be lost without untoward fetal
o Melanoma***
effects
o Leukemia
Maternal Blood Flow Disruption
o Lymphoma
Subchorionic - Caused by slowing of
o Breast cancer
Fibrin maternal blood flow
- Tumor cells usually are confined within the intervillous
Deposition within the intervillous
space
space with subsequent
fibrin deposition Abnormalities of the Membranes
- Lesion: white or yellow Meconium Staining
firm plaques on the - Staining of the amnion obvious within 1-3hrs
fetal surface
- Passage of meconium cannot be timed or dated
Preivillous - Caused by maternal
accurately
Fibrin blood flow stasis around
Chorioamnionitis
Deposition individual villus
- d/t prolonged membrane rupture
Maternal Floor - Dense fibrinoid layer Miscarriage,
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Infarction within the placental fetal-growth - organisms initially infect the chorion and adjacent decidua
basal plate restriction, in the area overlying the internal os full thickness
- Associated with preterm del, involvement chorioamnionitis spread along the
thrombophillias stillbirths chorioamniotic plate inflammation of the chorionic
Intervillous - Collection of Elevated s. AFP plate and of umbilical cord funitis
thrombus coagulated maternal - fetal infection:
blood normally found in o Hematogenous spread maternal bacteremia
the intervillous space o Aspiration or swallowing of infected amniotic fluid
mixed with fetal blood o Direct contact wth infected amniotic fluid
from a break in a villus - Possible explanation for unexplained cases of:
Infarction - Associated with Placental Ruptured membranes
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o
o Abnormal cord length
Vessel Number
o Umbilical vessel aneurysm
- Most common abnormality: single umbilical artery
o Trauma; Entanglement
o When seen, aneuploidy risk is increased
o Umbilical vessel venipuncture; Funitis
o Most common anomalies associated:
- Usually the umbilical vein
CVS and Genitourinary
Cord Vessel thromboses
- Fused umbilical artery with a shared lumen
- 70% venous; 20% both; 10% arterial
o Associated with marginal or velamentous cord
- Arterial thromboses have higher perinatal morbidity and
insertion
mortality and associated with fetal-growth restrictions, fetal
Remnants and Cysts
acidosis, stillbirth
True Cyst – epithelium-lined remnants of the allantoic or vitelline