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Placenta

Placental findings in specific newborn/fetal or maternal conditions

Toxemia of pregnancy (preeclampsia and eclampsia)


Reviewers: Mandolin Ziadie, M.D. (see Reviewers page)
Revised: 17 November 2011, last major update November 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

Definition
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● Pre-eclampsia is a pregnancy-specific hypertensive disorder diagnosed by the presence of three main signs: hypertension, proteinuria and edema diagnosed after 20 weeks gestational age (usually begins at 32 weeks, but may present earlier in patients with pre-existing kidney disease or hypertension or hydatidiform moles)
● Diagnosed in 6% of pregnant women, usually primigravidas, in last trimester
● Eclampsia is pre-eclampsia complicated by convulsions, disseminated intravascular coagulation (DIC) affecting liver, kidney, brain, heart and placenta due to thrombosis of arterioles and capillaries

Treatment
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● Deliver baby

Etiology
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● Early-onset disease is attributed to abnormal superficial implantation resulting in diminished blood supply to the placenta
● Late-onset disease is attributed to excessive or ischemic trophoblasts in maternal circulation
● Maternal hypertension due to endothelial release of vasoactive substances that lead to endothelial damage

Gross description
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● Most placentas are smaller than expected, although a subset are larger than expected
● Infarcts and retroplacental hematomas are more common

Micro description
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● Placenta: villous ischemia (increased syncytial knots, thickening of trophoblastic basement membrane, villous hypovascularity, villous agglutination and infarction), fibrinoid necrosis of uterine vessels and acute atherosis; more tortuous or densely distributed spiral and basal arteries than normal (Hum Pathol 1997;28:353), inappropriate trophoblastic immaturity (Hum Pathol 1995;26:594)
● Brain: gross or microscopic hemorrhage; small vessel thrombi
● Kidneys: endothelial cell swelling, fibrinogen-derived amorphous dense deposits on endothelial side of glomerular basement membrane; severe disease may cause bilateral renal cortical necrosis
● Liver: hemorrhage, fibrin thrombi

Micro images
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Toxemia

End of Placenta > Placental findings in specific newborn/fetal or maternal conditions > Toxemia of pregnancy (preeclampsia and eclampsia)


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