Placental Pathology - The role of the placenta in... · Placental Pathology Mirthe Schoots Perinatal Pathologist UMCG Groningen, ... •Clotting disorders like thrombophilia •Could

Pathology & Medical Biology UNIVERSITY MEDICAL CENTER GRONINGEN

Placental Pathology

Mirthe SchootsPerinatal Pathologist UMCG Groningen, the Netherlands

11-10-2019


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Contents

• Placental examination

• Fetal hypoxia

• Placental lesions associated with fetal hypoxia

– Maternal vascular malperfusion

– Fetal vascular malperfusion

– Chronic villitis

– Chorioamnionitis


Placental examination

• Macroscopy

• Microscopy

• Based on Amsterdam Placental Consensus Statement 2016


Normal placenta

Color Atlas of Fetal and Neonatal Histology, LM Ernst ea, 2011


Color Atlas of Fetal and Neonatal Histology, LM Ernst ea, 2011


Normal histology


Villous development

3e trimester

Distal villous immaturity, RW Redline, Diagnostic Histopathology 18:5, 2012

20-24 weeks

32-38 weeks

Term


Gas and nutrient exchange

M.H. Schoots, et al., Oxidative stress in placental pathology, Placenta (2018), https://doi.org/10.1016/j.placenta.2018.03.003


Normal spiral artery remodeling at implantation

Brosens ea. AJOG 2010Espinoza ea. J. Perinat 2006


Fetal hypoxia

• Due to malperfusion of the parenchyma of the placenta

• Due to malperfusion of the umbilical cord

• Leading to fetal growth restricion


Placental lesions

• Maternal vascular malperfusion

• Fetal vascular malperfusion

• Chronic villitis

• Chorioamnionitis


Maternal vascular malperfusion

• Pre-eclampsia

• Hypertension during pregnancy

• HELLP-syndrome


Burton ea. Placenta 2009


Maternal Vascular Malperfusion

• Placental hypoplasia

– Weight <10th centile

– Thin umbilical cord (<10th centile / <8 mm diameter at term)

• Infarction

– Any preterm

– >5% of nonperipheral parenchyma at term


Infarction


Distal villous hypoplasia


Increased perivillous fibrin deposition


Retroplacental hemorrhage

Sampling and Definitions of Placental Lesions, TY Khong ea, Arch Pathol Lab Med, published online 2016


Fetal vascular malperfusion

• Compromised fetal blood suply in the umbilical cord

• Severe chorioamnionitis

• Clotting disorders like thrombophilia

• Could lead to neonatal thrombosis of CNS, lungs and kidneys


Thrombosis chorionic plate


Thrombosis of stemvillus


Avascular villi


Chronic villitis of unknown etiology

• 5-10% placentas in uncomplicated pregnancy

• 34% complicated pregnancy (FGR)

• No infectious agent

• Maternal reaction to fetal antigens

• Recurrence risk to 20%



Chorioamnionitis

• 20-24% of life birth and 67% of preterm birth

• Ascending intra-uterine infection

• Via maternal blood (sepsis)

• Premature rupture of membranes / premature birth

• Meconium release

• Sepsis of mother and or child


Maternal respons


Fetal respons


Placental pathology and neonatal PH

• Possibly MVM associated with BPD

• Angiogenic factors in cord blood associated with BPD

• No studies yet to compare single placental lesions to BPD and PH


Questions?


Literature

• Hampl V, Bibova J, ea: ‘Hypoxic fetoplacental vasocontstriction in humans is mediated by potassium channel inhibition’. Am J Physiol Heart Circ Physiol 283: H2240-H2249, 2002

• Yang WC, Chen CY, ea: ‘Angiogenic factors in cord blood of preterm infants predicts subsequently developing bronchopulmonary dysplasia’. Pediatrics and Neonatology (2015) 56, 382-385

• Yallapragada SG, Mestan KK, ea: ‘Placental villous vascularity is decreased in premature infants with bronchopulmonary dysplasia-associated pulmonary hypertension’. Pediatric and Developmental Pathology 19, 101-107, 2016

• Mestan KK, Gotteiner N, ea: ‘Cord blood biomarkers of placental maternal vascular underperfusion predict bronchopulmonary dysplasia-associated pulmonary hypertension’. The Journal of Pediatrics 2017;185:33-41

Documents

Placental Pathology - The role of the placenta in... · Placental Pathology Mirthe Schoots Perinatal Pathologist UMCG Groningen, ... •Clotting disorders like thrombophilia •Could