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Placental Shape Aberrations

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Benirschke's Pathology of the Human Placenta

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Abstract

The factors that determine the site of nidation of the human blastocyst are not fully understood. The human blastocyst implants normally in the upper portion of the uterus; nevertheless, abnormal implantation is frequent and can lead to pregnancy complications, such as placenta previa. There are three theories regarding the etiology of abnormal placental shape. The first theory is “trophotropism” in which it is suggested that the placenta grows in areas of well-vascularized decidual tissue and atrophies in areas of less vascularized endometrium. This is supported by the description of “dynamic placentation” where the original location of the implanting blastocyst may be modified during development and the placenta appears to migrate throughout gestation [7]. This often is seen when implantation occurs over leiomyomas or scars, as well as in implantation in the lower uterine segment. The second theory is that the fetal pole of the blastocyst may be eccentric at implantation such that the placenta does not develop uniformly [26]. The third theory is that there is defective branching of the chorionic plate vessels in the first trimester creating areas deficient in vascularization which persist into the third trimester [57, 58]. This latter theory attributes shape aberrations (and abnormal cord insertions; see Chap. 16) to early influences on placental growth including the shape of the vasculogenic zone and position of the placenta in the uterus [57] and is supported by mathematical modeling of chorionic plate vasculature.

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Authors and Affiliations

  1. Professor of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA

    Rebecca N. Baergen

  2. New York Presbyterian Hospital - Weill Cornell Medicine, Department of Pathology and Laboratory Medicine, New York, NY, USA

    Cathleen Matrai

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Editors and Affiliations

  1. Professor of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA

    Rebecca N. Baergen

  2. Centre for Trophoblast Research, University of Cambridge, Cambridge, UK

    Graham J. Burton

  3. Professor Emeritus of Pathology, State University of New York, Stony Brook, NY, USA

    Cynthia G. Kaplan

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Baergen, R.N., Matrai, C. (2022). Placental Shape Aberrations. In: Baergen, R.N., Burton, G.J., Kaplan, C.G. (eds) Benirschke's Pathology of the Human Placenta. Springer, Cham. https://doi.org/10.1007/978-3-030-84725-8_17

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