Abstract
The pathology of the placenta and the conception has interested scientists and physicians for centuries. In this chapter, the pathology of the placenta is illustrated according to pathophysiology emphasizing the role of implantation, formation, maturation, and vascularization of the placenta in the early pregnancy. The pathology of the late pregnancy is grouped according to the timing of the events that can be considered catastrophic for a pregnancy. Thus, acute diseases are placental abruption, fetal bleeding, and injury or damages to the integrity of the umbilical cord (“ABC”). In the late pregnancy, subacute diseases include amniotic fluid infection, meconium staining of the membranes, fetomaternal hemorrhages, and the appearance of nucleated erythrocytes as the status of prolonged hypoxia. Chronic conditions include vasculopathies that render the intervillous space unpracticable for the exchange between mother and fetus. Preneoplastic and neoplastic lesions may complicate a pregnancy and trouble the postpartum period in case of follow-up and chemotherapy are required. A number of nonscientific literature have accompanied the description of several congenital disabilities, and historiography found how much progress and evolution was present in the Byzantine society long before the brothers Chang and Eng Bunker were known as Siamese twins. The description of the surgical separation performed by Byzantine surgeons is adamantine as described by Leon Grammatikos and Theodoros Daphnopates, two major Byzantine authorities, in Constantinople during the second half of the tenth century. In this chapter, the congenital disabilities are grouped according to the etiopathogenesis during missteps of embryology. Finally, infection in pregnancy and fetal growth restriction are reviewed according to the eyes of the fetal medicine, and a step-by-step approach to the handling and examination of the placenta is provided.
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Multiple Choice Questions and Answers
Multiple Choice Questions and Answers
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PLA-1 Some viruses have cytoplasmic replication, while others have nuclear replication. In which of the following viruses is the replication not in the cytoplasm?
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(a)
Herpes simplex virus
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(b)
Paramyxovirus
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(c)
Picornavirus
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(d)
Poxvirus
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(e)
Reovirus
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(a)
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PLA-2 Rubella is a usually mild viral disease that typically occurs in childhood in children who did not get vaccines against this virus. Rubella virus crosses the placenta of infected women during pregnancy. In the first trimester, the rubella virus causes miscarriage, or congenital rubella syndrome can develop. Typically, congenital rubella syndrome includes cardiac, auditory, sensorineural, and ocular abnormalities. What is the best method to diagnose congenital rubella?
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(a)
Detection of rubella virus IgM in fetal blood or viral genome in amniotic fluid, fetal blood, or chorionic villus biopsies
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(b)
Detection of rubella virus IgG in fetal blood or viral genome in amniotic fluid, fetal blood, or chorionic villus biopsies
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(c)
Detection of rubella virus IgG in fetal blood of the newborn
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(d)
Detection of rubella virus in the urine of the mother
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(a)
-
PLA-3 Congenital syphilis became a rare disease in Western countries, but it became more often discussed in the differential diagnosis following the recent increased migratory flows. Infected infants may harbor severe sequelae, including hydrocephalus, cerebral palsy, musculoskeletal deformity, and sensorineural hearing loss. What is the best method to diagnose congenital syphilis?
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(a)
Dark-field microscopy examination of desquamative or ulcerative skin lesions, nasal discharge (“snuffles”), and placenta
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(b)
FTA-ABS IgM test (fluorescent treponemal antibody absorption immunoglobulin M test)
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(c)
AgNO3 staining of spirochetal bacteria
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(d)
Long bone radiography
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(e)
Updated Wassermann reaction of antiphospholipid antibodies including the introduction of a sample of blood to the antigen of cardiolipin extracted from the bovine muscle or heart
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(a)
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PLA-4 What is the best presumptive procedure in case of a suspect of congenital syphilis?
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(a)
An infant’s nontreponemal titer (VDRL or RPR) is twofold higher than that of the mother when both blood samples are drawn at the time of delivery.
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(b)
An infant’s nontreponemal titer (VDRL or RPR) persists or increases after birth.
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(c)
An infant’s treponemal antibody titer (FTA-ABS or MHA-TP) remains positive at 6 to 9 months of age.
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(d)
An infant’s treponemal antibody titer (FTA-ABS and MHA-TP) remains positive at 6 to 9 months of age.
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(a)
-
PLA-5 Schwalbe’s and Goerttler’s deterministic periods indicate which period is more susceptible to give rise to congenital defects by environmental factors. Which period is most vulnerable for the human embryo (postfertilization day (PFD))?
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(a)
PFD 1–14
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(b)
PFD 15–60
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(c)
The early second trimester
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(d)
The late second trimester
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(e)
Between the 22nd week and the 32nd week of pregnancy
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(a)
-
PLA-6 Which of the following viruses/bacteria are associated with intranuclear inclusions in precursors of the red blood cells?
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(a)
Fusobacterium nucleatum
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(b)
Cytomegalovirus
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(c)
Parvovirus B19
-
(d)
Herpes simplex virus
-
(e)
Varicella-zoster virus
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(a)
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PLA-7 Placenta thrombi may be particularly damaging for the correct hemodynamics of the placenta and determine the death of the fetus if they are compromising the nutritional function of the placenta. An intravascular thrombus can occur in a series of conditions. Which one of the following states is unlikely to start an intravascular thrombogenesis and form a thrombus?
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(a)
Hyperviscosity syndromes
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(b)
Hypercoagulable states
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(c)
Endothelial damage
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(d)
Blood stasis
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(e)
Warfarin therapy
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(a)
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PLA-8 Which of the following statements is NOT correct regarding the massive perivillous fibrin deposition (MPVFD)?
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(a)
MPVFD is defined as excessive fibrin deposition ensnaring villi and entirely obliterating the intervillous space.
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(b)
When the fibrin deposition mainly involves the basal plate, it is often referred to as maternal floor infarct.
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(c)
MPVFD has a chance of recurrence in future pregnancies.
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(d)
MPVFD is associated with decreased alpha-fetoprotein in the maternal serum.
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(e)
The differential diagnosis includes chronic villitis of unknown etiology and chronic histiocytic villitis.
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(a)
-
PLA-9 Twin-reversal arterial perfusion sequence (TRAP) or acardia is defined by which of the following definition?
-
(a)
Arterial-arterial (A-A) anastomosis, with retrograde perfusion of poorly oxygenated blood from the healthy twin or pump twin to the acardiac twin
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(b)
Arterial-venous (A-V) anastomosis, with retrograde perfusion of poorly oxygenated blood from the healthy twin or pump twin to the acardiac twin, and venous-arterial (V-A) anastomosis is carrying blood back from the acardiac to the donor twin
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(c)
Arterial-arterial (A-A) anastomosis, with retrograde perfusion of poorly oxygenated blood from the healthy twin or pump twin to the acardiac twin, venous-venous (V-V) anastomosis carrying blood back from the acardiac to the donor twin, and circulatory failure of the acardiac twin
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(d)
Venous-venous (V-V) anastomosis carrying blood back from the acardiac to the donor twin, and circulatory failure of the acardiac twin
-
(a)
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PLA-10 Which of the following statements on choriocarcinoma of the placenta is TRUE?
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(a)
Gestational choriocarcinoma occurs in 1 in 40,000 pregnancies.
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(b)
It is a highly aggressive malignant tumor of the amnion epithelium in association with any form of gestation.
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(c)
Of all forms of choriocarcinoma, placental choriocarcinoma is the most frequent.
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(d)
Gestational choriocarcinoma is rarely diagnosed in symptomatic patients with metastases.
-
(e)
Metastases to the lung and brain usually are seen in both fetus and mother.
-
(a)
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Sergi, C.M. (2020). Placenta, Abnormal Conception, and Prematurity. In: Pathology of Childhood and Adolescence. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-59169-7_18
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