Placenta and Umbilical Cord and the Immunology of Pregnancy

  • T. Yee Khong


The placenta and extraplacental membranes are an apposition of fetal and maternal tissues for the purposes of physiological exchange. The gestation sac has a finite lifespan and is the body’s largest biopsy, yet its examination is often neglected, even from fetal and neonatal deaths, sick and premature neonates and maternal complications of pregnancy. This is perplexing because its function is embodied in its definition. It may be that placental pathology is considered complex since the organ is evolving rapidly over a short period of time, or that lesions found may be quantitative rather than qualitative. The response of the placenta to injury is limited and there is a need to correlate the macroscopic and microscopic findings with clinical and laboratory investigations.


Proteinuria Hunt Excavation Candida Neuroblastoma 


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  1. Abramowsky CR, Vegas ME, Swinehart G, Gyves MT (1980) Decidual vasculopathy of the placenta in lupus erythematosus. N Engl J Med 303: 668–672PubMedCrossRefGoogle Scholar
  2. Aherne W, Dunnill MS (1982) Morphometry. Arnold, LondonGoogle Scholar
  3. Althabe Labarrere (1985) Chronic villitis of unknown aetiology and intrauterine growth-retarded infants of normal and low ponderal index. Placenta 6: 369–373PubMedCrossRefGoogle Scholar
  4. Althabe Labarrere C, Telenta M (1985) Maternal vascular lesions in placentae of small-for-gestational-age infants. Placenta 6: 265–276CrossRefGoogle Scholar
  5. Altshuler G (1984) Chorangiosis. An important sign of neonatal morbidity and mortality. Arch Pathol Lab Med 108: 71–74PubMedGoogle Scholar
  6. Altshuler G, Russell P (1975) The human villitides; a review of chronic intrauterine infection. Springer, Berlin, pp 63–112Google Scholar
  7. Andres RL, Kuyper W, Resnik R, Piacquadio KM, Benirschke K (1990) The association of maternal floor infarction of the placenta with adverse perinatal outcome. Am J Obstet Gynecol 163: 935–938PubMedGoogle Scholar
  8. Baill IC, Moore GW, Hendrick LA (1989) Abscess of allantoic duct remnant. Am J Obstet Gynecol 161: 334–336PubMedGoogle Scholar
  9. Baill IC, Witter FR (1990) Sickle trait and its association with birthweight and urinary tract infections in pregnancy. Int J Gynaecol Obstet 33: 19–21PubMedCrossRefGoogle Scholar
  10. Bain C, Elliot BW (1976) Fetal distress in the first stage of labour associated with early fetal heart decelerations and a short umbilical cord. Aust NZ J Obstet Gynaecol 16: 51–56CrossRefGoogle Scholar
  11. Batcup G, Holt P, Hambling MH, Gerlis LM, Glass MR (1985) Placental and fetal pathology in Coxsackie virus A9 infection: a case report. Histopathology 9: 1227–1235PubMedCrossRefGoogle Scholar
  12. Bendon RW, Ray MB (1986) The pathologic findings of the fetal membranes in very prolonged amniotic fluid leakage. Arch Pathol Lab Med 110: 47–50PubMedGoogle Scholar
  13. Benirschke K, Driscoll S (1976) The pathology of the human placenta. Springer, BerlinGoogle Scholar
  14. Birkenfeld A, Mordel N, (1989) Direct demonstration of iron in a placenta in a case of β-thalassemia major. Am J Obstet Gynecol 160: 562–563PubMedGoogle Scholar
  15. Björk Persson (1982) Placental changes in relation to the degree of metabolic control in diabetes mellitus. Placenta 3: 367–378PubMedCrossRefGoogle Scholar
  16. Björk Persson (1984) Villous structure in different parts of the cotyledon in placentas of insulin-dependent diabetic women. Acta Obstet Gynecol Scand 63: 37–43PubMedCrossRefGoogle Scholar
  17. Blanc WA (1981) Pathology of the placenta, membranes and umbilical cord in bacterial, fungal and viral infections in man. In: Naeye RL, Kissane JM, Kaufman N (eds) Perinatal disease. Williams and Wilkins, Baltimore, pp 67–132Google Scholar
  18. Bleker OP, Kloosterman GJ, Breur W, Mieras DJ (1977) The volumetric growth of the human placenta: a longitudinal ultrasonic study. Am J Obstet Gynecol 127: 657–661PubMedGoogle Scholar
  19. Blickstein I, Shoham-Schwartz Z, Lancet M (1987) Predisposing factors in the formation of true knots of the umbilical cord—analysis of morphometric and perinatal data. Int J Gynaecol Obstet 25: 395–398PubMedCrossRefGoogle Scholar
  20. Boyd JD, Hamilton WJ (1970) The human placenta. Heffer, CambridgeGoogle Scholar
  21. Boyd PA (1984) Quantitative structure of the normal human placenta from ten weeks of gestation to term. Early Hum Dev 9: 297–307PubMedCrossRefGoogle Scholar
  22. Boyd PA, Scott A (1985) Quantitative structural studies in human placentas associated with pre-eclampsia, essential hypertension and intrauterine growth retardation. Br J Obstet Gynaecol 92: 714–721PubMedCrossRefGoogle Scholar
  23. Boyd PA, Brown R, Stewart W (1980) Quantitative structural differences within the normal term human placenta: a pilot study. Placenta 1: 337–344PubMedCrossRefGoogle Scholar
  24. Boyd PA, Scott A, Keeling JW (1986) Quantitative structural studies on placentas from pregnancies complicated by diabetes mellitus. Br J Obstet Gynaecol 93: 31–35PubMedCrossRefGoogle Scholar
  25. Bryan EM (1986) The intrauterine hazards of twins. Arch Dis Child 61: 1044–1045PubMedCrossRefGoogle Scholar
  26. Bruyniks N, Khong TY, Leong R (1988) Relation of site of umbilical cord insertion and birth weight. J Obstet Gynaecol 9: 34–35CrossRefGoogle Scholar
  27. Bulmer JN, Johnson PM (1983) Antigen expression by trophoblast populations in the human placenta and their possible immunobiological relevance. Placenta 6: 127–140CrossRefGoogle Scholar
  28. Burton GJ, Palmer ME, Dalton KJ (1989) Morphometric differences between the placental vasculature of non-smokers, smokers and ex-smokers. Br J Obstet Gynaecol 96: 907–915PubMedCrossRefGoogle Scholar
  29. Carter J (1984) The maternal immunological response during pregnancy. In: Clarke JR (ed) Oxford reviews of reproductive biology, vol 6. Clarendon Press, Oxford, 47–128Google Scholar
  30. Christmas SE, Bulmer JN, Meager A, Johnson PM (1990) Phenotypic and functional analysis of human CD3-decidual leucocyte clones. Immunology 71: 182–189PubMedGoogle Scholar
  31. Clark DA, Mowbray J, Underwood J, Liddell H (1987) Histopathologic alteration in the decidua in human spontaneous abortion: loss of cells with large cytoplasmic granules. Am J Reprod Immunol 13: 19–22Google Scholar
  32. Clarson C, Tevaarwerk GJM, Harding PGR, Chance GW, Haust MD (1989) Placental weight in diabetic pregnancies. Placenta 10: 275–281PubMedCrossRefGoogle Scholar
  33. Clausen I (1989) Umbilical cord anomalies and antenatal fetal deaths. Obstet Gynecol Surv 44: 841–845PubMedCrossRefGoogle Scholar
  34. Clewell WH, Manchester DK (1983) Recurrent maternal floor infarction: a preventable cause of fetal death. Am J Obstet Gynecol 147: 346–347PubMedGoogle Scholar
  35. Coid CR, Fox H (1983) Short review: Campylobacters as placental pathogens. Placenta 4: 295–306PubMedCrossRefGoogle Scholar
  36. Costoya AL, Leontic EA, Rosenberg HG, Delgado MA (1980) Morphological study of placental terminal villi in intrahepatic cholestasis of pregnancy: histochemistry, light and electron microscopy. Placenta 1: 361–368PubMedCrossRefGoogle Scholar
  37. Danskin FH, Neilson JP (1989) Twin-to-twin transfusion syndrome: what are appropriate criteria? Am J Obstet Gynecol 161: 365–369PubMedGoogle Scholar
  38. Davey DA, MacGillivray I (1988) The classification and definition of the hypertensive disorders of pregnancy. Am J Obstet Gynecol 158: 892–898PubMedGoogle Scholar
  39. Denmead DT, Ariagno RL, Carson SH, Benirschke KB (1987) Placental pathology is not predictive for sudden infant death syndrome (SIDS). Am J Perinatol 4: 308–312PubMedCrossRefGoogle Scholar
  40. Dildy GA III, Moise KJ Jr, Carpenter RJ Jr, Klima T (1989) Maternal malignancy metastatic to the products of conception. Obstet Gynecol Surv 44: 535–540PubMedCrossRefGoogle Scholar
  41. Dougall A, Baird CH (1987) Vasa praevia—report of three cases and review of literature. Br J Obstet Gynaecol 94: 712–715PubMedCrossRefGoogle Scholar
  42. Edmonds DK, Lindsay KS, Miller JF, Williamson E, Wood PJ (1982) Early embryonic mortality in women. Fertil Steril 38: 447–453PubMedGoogle Scholar
  43. Ellis SA, Sargent IL, Redman CWG, McMichael AJ (1986) Evidence for a novel HLA antigen found on human extra villous trophoblast and a choriocarcinoma cell line. Immunology 59: 595–601PubMedGoogle Scholar
  44. Ellis SA, Palmer MS, McMichael AJ (1990) Human trophoblast and the choriocarcinoma cell line BeWo express a truncated HLA class I molecule. J Immunol 144: 731–735PubMedGoogle Scholar
  45. Faulk WP (1988) Haemostasis and fibrinolysis in human normal placentae: possible role in early pregnancy failure. In: Beard RW, Sharp F (eds) Early pregnancy loss. Mechanisms and treatment. Peacock Press, Ashton-under-Lyne, pp 193–198CrossRefGoogle Scholar
  46. Faulk WP, Temple A, Lovins R, Smith NC (1978) Antigens of human trophoblast: a working hypothesis for their role in normal and abnormal pregnancies. Proc Natl Acad Sci USA 75: 1947–1951PubMedCrossRefGoogle Scholar
  47. Ferry BL, Starkey PM, Sargent IL, Watt GMO, Jackson M, Redman CWG (1990) Cell populations in the human early pregnancy decidua: natural killer activity and response to interleukin-2 of CD56-positive large granular lymphocytes. Immunology 70: 446–452PubMedGoogle Scholar
  48. Fizet D, Bousquet J (1983) Absence of a factor blocking a cellular cytotoxicity reaction in the serum of women with recurrent abortions. Br J Obstet Gynaecol 90: 453–456PubMedCrossRefGoogle Scholar
  49. Fox H (1969) Pathology of the placenta in maternal diabetes mellitus. Obstet Gynecol 34: 792–798PubMedGoogle Scholar
  50. Fox H (1978) Pathology of the placenta. Saunders, LondonGoogle Scholar
  51. Fox H, Langley FA (1971) Leucocytic infiltration of the placenta and umbilical cord: a clinico-pathologic study. Obstet Gynecol 37: 451–458PubMedGoogle Scholar
  52. Fox H, Laurini RN (1988) Intraplacental choriocarcinoma: a report of 2 cases. J Clin Pathol 41: 1085–1088PubMedCrossRefGoogle Scholar
  53. Fox H, Sen DK (1972) Placenta extrachorialis: a clinico-pathological study. J Obstet Gynaecol Br Cmwlth 79: 32–35CrossRefGoogle Scholar
  54. Garcia AGP (1982) Placental morphology of low birth weight infants at term: gross and microscopic study of 50 cases. Contrib Gynecol Obstet 9: 100–112PubMedGoogle Scholar
  55. Garite TJ, Freeman RK (1982) Chorioamnionitis in the preterm gestation. Obstet Gynecol 59: 538–545Google Scholar
  56. Geirsson RT, Ogston SA, Patel NB, Christie AD (1985) Growth of total intrauterine, intra-amniotic and placental volume in normal singleton pregnancy measured by ultrasound. Br J Obstet Gynaecol 92: 46–53PubMedCrossRefGoogle Scholar
  57. Gough JD, Keeling JW, Castle B, Iliff PJ (1986) The obstetric management of non-immunological hydrops. Br J Obstet Gynaecol 93: 226–234PubMedCrossRefGoogle Scholar
  58. Gregory CD, Lee H, Rees GB, Scott IV, Shah LP, Golding PR (1985) Natural killer cells in normal pregnancy: analysis using monoclonal antibodies and single-cell cytotoxicity assays. Clin Exp Immunol 62: 121–127PubMedGoogle Scholar
  59. Gruenwald P (1975) The supply line of the fetus: definitions relating to fetal growth. In: Gruenwald P (ed) The placenta and its maternal supply line. MTP, Lancaster, pp 1–7Google Scholar
  60. Hallam LA, McLaren KM, El-Jabbour JN, Helm CW, Smart GE (1990) Intraplacental choriocarcinoma: a case report. Placenta 11: 247–251PubMedCrossRefGoogle Scholar
  61. Harris BA Jr, Gore H, Flowers CE (1985) Peripheral placental separation: a possible relationship to premature labour. Obstet Gynecol 66: 774–778PubMedGoogle Scholar
  62. Haust MD (1981) Maternal diabetes mellitus—effects of the fetus and placenta. Monogr Pathol 22: 201–285PubMedGoogle Scholar
  63. Head JR, Drake BL, Zuckermann FA (1987) Major histocompatibility antigens on trophoblast and their regulation: implications in the maternal-fetal relationship. Am J Reprod Immunol Microbiol 15: 12–18PubMedGoogle Scholar
  64. Heifetz SA (1984) Strangulation of the umbilical cord by amniotic bands: report of 6 cases and literature review. Pediatr Pathol 2: 285–304PubMedCrossRefGoogle Scholar
  65. Heifetz SA (1988) Thrombosis of the umbilical cord: analysis of 52 cases and literature review. Pediatr Pathol 8: 37–54PubMedCrossRefGoogle Scholar
  66. Herring AJ, Anderson IE, McClenaghan M et al. (1987) Restriction endonuclease analysis of DNA from two isolates of Chlamydia psittaci obtained from human abortion. Br Med J 295: 1239CrossRefGoogle Scholar
  67. Hill JA (1990) Immunological mechanisms of pregnancy maintenance and failure: a critique of theories and therapy. Am J Reprod Immunol 22: 33–41PubMedGoogle Scholar
  68. Ho PC, Haynes WDG, Ing RMY, Jones WR (1982) Histological, ultrastructural and immunofluorescence studies on the amniochorionic membrane. Placenta 3: 109–126PubMedCrossRefGoogle Scholar
  69. Hunt JS (1989) Macrophages in human uteroplacental tissues. A review. Am J Reprod Immunol 21: 119–122PubMedGoogle Scholar
  70. Hunt JS (1990) Current topic: the role of macrophages in the uterine response to pregnancy. Placenta 11: 467–475PubMedCrossRefGoogle Scholar
  71. Hurley VA, Beischer NA (1987) Placenta membranacea. Case reports. Br J Obstet Gynaecol 94: 798–802PubMedCrossRefGoogle Scholar
  72. Hustin J, Jauniaux E, Schaaps JP (1990) Histological study of the materno-embryonic interface in spontaneous abortion. Placenta 11: 477–486PubMedCrossRefGoogle Scholar
  73. Hyde S, Smotherman J, Moore JI, Altshuler G (1989) A model of bacterially induced umbilical vein spasm, relevant to fetal hypoperfusion. Obstet Gynecol 73: 966–970PubMedCrossRefGoogle Scholar
  74. Jauniaux E, Nessmann Imbert MC, Meuris S, Puissant F, Hustin J (1988) Morphological aspects of the placenta in HIV pregnancies. Placenta 9: 633–642PubMedCrossRefGoogle Scholar
  75. Jauniaux E, Zucker M, Meuris S, Verhest A, Wilkin P, Hustin J (1988) Chorangiocarcinoma: an unusual tumour of the placenta. The missing link? Placenta 9: 607–613PubMedCrossRefGoogle Scholar
  76. Jones CJP, Lendon M, Chawner LE, Jauniaux E (1990) Ultrastructure of the human placenta in metabolic storage disease. Placenta 11: 395–411PubMedCrossRefGoogle Scholar
  77. Jones KL (1988) Smith’s recognizable patterns of human malformation. Saunders, LondonGoogle Scholar
  78. Katz V, Blanchard G, Dingman Bowes WA, Cefalo RC (1987) Atenolol and short umbilical cords. Am J Obstet Gynecol 156: 1271–1272PubMedGoogle Scholar
  79. Kaufmann P (1982) Development and differentiation of the human placental villous tree. Bibl Anat 22: 29–39PubMedGoogle Scholar
  80. Khong TY (1987) Immunohistologic study of the leukocytic infiltrate in maternal uterine tissues in normal and preeclamptic pregnancies at term. Am J Reprod Immunol 15: 1–8Google Scholar
  81. Khong TY (1991) Acute atherosis in pregnancies complicated by hypertension, small-for-gestational-age infants, and diabetes mellitus. Arch Pathol Lab Med 115: 722–725PubMedGoogle Scholar
  82. Khong TY, Dilly SA (1989) Calcification of umbilical artery: two distinct lesions. J Clin Pathol 42: 931–934PubMedCrossRefGoogle Scholar
  83. Khong TY, George (1992) Chromosomal abnormalities associated with single umbilical artery. Prenat Diagn, (in press)Google Scholar
  84. Khong TY, Robertson WB (1987) Placenta creta and placenta praevia creta. Placenta 8: 399–409PubMedCrossRefGoogle Scholar
  85. Khong TY, De Wolf F, Robertson WB, Brosens I (1986) Inadequate maternal vascular response to placentation in pregnancies complicated by pre-eclampsia and by small-for-gestational-age infants. Br J Obstet Gynaecol 93: 1049–1059PubMedCrossRefGoogle Scholar
  86. Khong TY, Liddell HS, Robertson WB (1987a) Defective haemochorial placentation as a cause of spontaneous miscarriage: a preliminary study. Br J Obstet Gynaecol 94: 649–655PubMedCrossRefGoogle Scholar
  87. Khong TY, Pearce JM, Robertson WB (1987b) Acute atherosis in pre-eclampsia: maternal determinants and fetal outcomes in the presence of the lesion. Am J Obstet Gynecol 157: 360–363PubMedGoogle Scholar
  88. Khudr G, Benirschke K (1972) Placental lesions in viral hepatitis. Obstet Gynecol 40: 381–384PubMedGoogle Scholar
  89. King A, Birkby C, Loke YW (1989) Early human decidual cells exhibit NK activity against the K562 cell line but not against first trimester trophoblast. Cell Immunol 118: 337–344PubMedCrossRefGoogle Scholar
  90. Knowles S, Frost T (1989) Umbilical cord sclerosis as an indicator of congenital syphilis. J Clin Pathol 42: 1157–1159PubMedCrossRefGoogle Scholar
  91. Knox WF, Fox H (1984) Villitis of unknown aetiology: its incidence and significance in placentae from a British population. Placenta 5: 395–402PubMedCrossRefGoogle Scholar
  92. Koller BH, Geraghty DE, DeMars R, Duvick L, Rich SS, Orr HT (1989) Chromosomal organisation of the MHC class I gene family. J Exp Med 169: 469–480PubMedCrossRefGoogle Scholar
  93. Krohn M, Voigt L, McKnight Daling JR, Starzyk P, Benedetti TJ (1987) Correlates of placental abruption. Br J Obstet Gynaecol 94: 333–340PubMedCrossRefGoogle Scholar
  94. Kullander S, Kallen (1971) A prospective study of smoking and pregnancy. Acta Obstet Gynecol Scand 50: 83–94CrossRefGoogle Scholar
  95. Kundsin RB, Driscoll SG, Monson RR, Yeh C, Biano SA, Cochran WD (1984) Association of Ureaplasma urealyticum in the placenta with perinatal morbidity and mortality. N Engl J Med 310: 941–945PubMedCrossRefGoogle Scholar
  96. Labarrere CA (1988) Review article. Acute atherosis: a histopathological hallmark of immune aggression? Placenta 9: 95–108PubMedCrossRefGoogle Scholar
  97. Labarrere CA (1989) Allogeneic recognition and rejection reactions in the placenta. Am J Reprod Immunol 21: 94–99PubMedGoogle Scholar
  98. Labarrere C, Althabe O, Telenta M (1982) Chronic villitis of unknown aetiology in placentae of idiopathic small for gestational age infants. Placenta 3: 309–318PubMedCrossRefGoogle Scholar
  99. Labarrere C, Alonso J, Manni J, Domenichini E, Althabe Immunohistochemical findings in acute atherosis associated to intrauterine growth retardation. Am J Reprod Immunol Microbiol 7: 149–155Google Scholar
  100. Labarrere C, Sebastiani M, Siminovich M, Torassa E, Althabe O (1985b) Absence of Wharton’s jelly around the umbilical arteries: an unusual cause of perinatal mortality. Placenta 6: 555–559PubMedCrossRefGoogle Scholar
  101. Labarrere CA, McIntyre JA, Faulk WP (1990) Immunohistologic evidence that villitis in human normal term placentas is an immunologic lesion. Am J Obstet Gynecol 162: 515–522PubMedGoogle Scholar
  102. Lala PK, Kennedy TG, Parhar RS (1988) Suppression of lymphocyte alloreactivity by early gestational human decidua. II Characterization of the suppressor mechanisms. Cell Immunol 116: 411–422PubMedCrossRefGoogle Scholar
  103. Larsson S, Cronberg S, Winblad S (1979) Listeriosis during pregnancy and neonatal period in Sweden 1958-1984. Acta Paediatr Scand 68: 485–493CrossRefGoogle Scholar
  104. Lessin DL, Hunt JS, King CR, Wood GW (1988) Antigen expression by cells near the maternal-fetal interface. Am J Reprod Immunol Microbiol 16: 1–7PubMedGoogle Scholar
  105. Lewis SH, Reynolds-Kohler C, Fox HE, Nelson JA (1990) HIV-1 in trophoblastic and villous Hofbauer cells, and haematological precursors in eight-week fetuses. Lancet 335: 565–568PubMedCrossRefGoogle Scholar
  106. Lilja M (1991a) Infants with single umbilical artery studied in a national registry. General epidemiological characteristics. Paediatr Perinat Epidemiol 5: 27–36PubMedCrossRefGoogle Scholar
  107. Lilja M (1991b) Single umbilical artery and maternal smoking. Br Med J 302: 569–570CrossRefGoogle Scholar
  108. Lilja M (1991c) Infants with single umbilical artery studied in a national registry 2. Survival and malformations in infants with single umbilical artery. Paediatr Perinat EpidemiolGoogle Scholar
  109. Lowden JA, Cutz E, Conen PE, Rudd N, Doran TA (1973) Prenatal diagnosis of GM1 gangliosidosis. N Engl J Med 288: 225–228PubMedCrossRefGoogle Scholar
  110. MacGillivray I, Nylander PPS, Corney G (1975) Human multiple reproduction. Saunders, LondonGoogle Scholar
  111. Marzusch K, Dietl J, Horny H-P et al. (1991) Tolerance and the fetal graft. Lancet 337: 52PubMedCrossRefGoogle Scholar
  112. Matorras R, Diez J, Pereira JG (1990) True knots in the umbilical cord: clinical findings and fetal consequences. J Obstet Gynaecol 10: 383–386CrossRefGoogle Scholar
  113. Mayhew TM, Burton GJ (1988) Methodological problems in placental morphometry: apologia for the use of stereology based on sound sampling practice. Placenta 9: 565–581PubMedCrossRefGoogle Scholar
  114. Mclntyre JA, Faulk WP (1983) Recurrent spontaneous abortion in human pregnancy: results of immuno-genetical, cellular and humoral studies. Am J Reprod Immunol 4: 165–170Google Scholar
  115. Michel MZ, Khong TY, Clark DA, Beard RW (1990) A morphological and immunological study of human placental bed biopsies in miscarriage. Br J Obstet Gynaecol 97: 984–988PubMedCrossRefGoogle Scholar
  116. Mills JL, Harley EE, Moessinger AC (1983) Standards for measuring umbilical cord length. Placenta 4: 423–426PubMedCrossRefGoogle Scholar
  117. Minkoff H, Nanda D, Menez R, Fikrig S (1987) Pregnancies resulting in infants with acquired immunodeficiency syndrome or AIDS-related complex. Obstet Gynecol 69: 285–287PubMedGoogle Scholar
  118. Mochizuki M, Maruo T, Masuko K, Ohtsu T (1984) Effects of smoking on fetoplacental-maternal system during pregnancy. Am J Obstet Gynecol 149: 413–420PubMedGoogle Scholar
  119. Moessinger AC, Blanc WA, Marone PA, Polsen DC (1982) Umbilical cord length as an indicator of fetal activity: experimental study and clinical implications. Pediatr Res 16: 109–112PubMedCrossRefGoogle Scholar
  120. Moller D, Ipsen L, Asschenfeldt P (1986) Fatal course of malignant melanoma during pregnancy with dissemination to the products of conception. Acta Obstet Gynecol Scand 65: 501–502PubMedCrossRefGoogle Scholar
  121. Mortimer G, MacDonald DJ, Smeeth A (1985) A pilot study of the frequency and significance of placental villitis. Br J Obstet Gynaecol 92: 629–633PubMedCrossRefGoogle Scholar
  122. Moscuna M, Gross Z, Korenblum R, Volfson M, Oetinger M (1989) Septic abortion due to Campylobacter jejuni. Eur J Clin Microbiol Infect Dis 8: 800–801PubMedCrossRefGoogle Scholar
  123. Mossman HW (1974) Structural changes in vertebrate fetal membranes associated with the adoption of viviparity. Obstet Gynecol Annu 3: 7–32PubMedGoogle Scholar
  124. Mostofi-Zadeh M, Driscoll SG, Biano SA, Kundsin RB (1984) Placental evidence of cytomegalovirus infection of the fetus and neonate. Arch Pathol Lab Med 108: 403–406Google Scholar
  125. Mowbray JF, Underwood JL (1985) Immunology of abortion. Clin Exp Immunol 60: 1–7PubMedGoogle Scholar
  126. Naeye RL (1977) Placental abnormalities in victims of sudden infant death syndrome. Biol Neonate 32: 189–192PubMedCrossRefGoogle Scholar
  127. Naeye RL (1978) Effects of maternal cigarette smoking on the fetus and placenta. Br J Obstet Gynecol 85: 732–737CrossRefGoogle Scholar
  128. Naeye RL (1980) Placental disorders and smoking. Obstet Gynecol 55: 701–704PubMedGoogle Scholar
  129. Naeye RL (1985a) Maternal floor infarction. Hum Pathol 16: 823–828PubMedCrossRefGoogle Scholar
  130. Naeye RL (1985b) Umbilical cord length: clinical significance. J Pediatr 107: 278–281PubMedCrossRefGoogle Scholar
  131. Naeye RL, Blanc W (1970) Relation of poverty and race to antenatal infection. N Engl J Med 283: 558–560CrossRefGoogle Scholar
  132. Ogita S, Oka T, Imanaka M et al. (1989) Effect of amniotic fluid volume on umbilical cord length. Asia Oceania J Obstet Gynaecol 15: 203–208PubMedCrossRefGoogle Scholar
  133. O’Herlihy O’Driscoll (1987) Disease associated with abnormal placenta. In: The human placenta. Lavery JP (ed) Aspen Publishers, Rockville, pp 237-256Google Scholar
  134. Ollendorff DA, Goldberg JM, Abu-Jawdeh GM, Lurain JR (1990) Markedly elevated maternal serum alpha-fetoprotein associated with a normal fetus and choriocarcinoma of the placenta. Obstet Gynecol 76: 494–497PubMedGoogle Scholar
  135. Peckham CH, Yerulshamy J (1965) Aplasia of one umbilical artery: incidence by race and certain obstetric factors. Obstet Gynecol 26: 359–366PubMedGoogle Scholar
  136. Philippe E, Boué JG (1969) Le placenta dans les abérrations chromosomiques léthales. Ann Anat Pathol 14: 249–266Google Scholar
  137. Pijnenborg R, Bland JM, Robertson WB, Dixon G, Brosens I (1981) The pattern of interstitial trophoblast invasion of the myometrium in early human pregnancy. Placenta 2: 303–316PubMedCrossRefGoogle Scholar
  138. Popli S, Leehey DJ, Molnar ZV, Nawab ZM, Ing TS (1990) Demonstration of Fabry’s disease deposits in placenta. Am J Obstet Gynecol 162: 464–465PubMedGoogle Scholar
  139. Powell HC, Benirschke K, Favara BE, Pfluoger OH Jr (1976) Foamy changes of placental cells in fetal storage disorders. Virchows Arch [A] 369: 191–196CrossRefGoogle Scholar
  140. Redman CWG, McMichael AJ, Stirrat GM, Sunderland CA, Ting A (1984) Class I MHC complex antigens on human extravillous trophoblast. Immunology 52: 457–468PubMedGoogle Scholar
  141. Ritson A, Bulmer JN (1989) Isolation and functional studies of granulated lymphocytes in first trimester human decidua. Clin Exp Immunol 77: 263–268PubMedGoogle Scholar
  142. Roberts CJ, Lowe CR (1975) Where have all the conceptions gone? Lancet i: 498–499CrossRefGoogle Scholar
  143. Robinson LK, Jones KL, Benirschke K(1983) The nature of structural defects associated with velamentous and marginal insertion of the umbilical. Am J Obstet Gynecol 146: 191–193PubMedGoogle Scholar
  144. Rock JA, Shirey RS, Braine HG, Ness PM, Kickler TS, Niebyl JR (1985) Plasmapheresis for the treatment of repeated early pregnancy wastage associated with anti-P. Obstet Gynecol 66 suppl 3: 57S–60SPubMedGoogle Scholar
  145. Rocklin RE, Kitzmiller J, Carpenter B, Garovoy M, David JR (1976) Maternal-fetal reactions: absence of an immunologic blocking factor from the serum of women with chronic abortions. N Engl J Med 295: 1209–1213PubMedCrossRefGoogle Scholar
  146. Russell P (1980) Inflammatory lesions of the human placenta. III The histopathology of villitis of unknown aetiology. Placenta 1: 227–244PubMedCrossRefGoogle Scholar
  147. Russell P, Atkinson K, Krishnan L (1980) Recurrent reproductive failure due to severe placental villitis of unknown etiology. J Reprod Med 24: 93–98PubMedGoogle Scholar
  148. Salafia CM, Mangam HE, Weigl CA, Foye GJ, Silberman L (1989) Abnormal fetal heart rate patterns and placental inflammation. Am J Obstet Gynecol 160: 140–147PubMedGoogle Scholar
  149. Saller DN, Keene CL, Sun C-CJ, Schwartz S (1990) The association of single umbilical artery with cytogenetically abnormal pregnancies. Am J Obstet Gynecol 163:922–925PubMedGoogle Scholar
  150. Sander CH, Kinnane L, Stevens NG, Echt R (1986) Haemorrhagic endovasculitis of the placenta: a review with clinical correlation. Placenta 7: 551–574PubMedCrossRefGoogle Scholar
  151. Sands J, Dobbing J (1985) Continuing growth and development of the third trimester human placenta. Placenta 6: 13–22PubMedCrossRefGoogle Scholar
  152. Schoenfeld A, Abramovici A, Klibanski C, Ovadia J (1985) Placental, ultrasonographic, biochemical and histo-chemical studies in fetuses affected with Niemann—Pick disease type A. Placenta 6: 33–44PubMedCrossRefGoogle Scholar
  153. Schuhmann RA, Wynn RM (1980) Regional ultrastructural differences in placental villi in cotyledons of a mature human placenta. Placenta 1: 345–353PubMedCrossRefGoogle Scholar
  154. Shanklin DR, Scott JS (1975) Massive subchorial thrombo-haematoma (Breus’ mole). Br J Obstet Gynaecol 82: 476–487PubMedCrossRefGoogle Scholar
  155. Shen-Schwarz S, Ruchelli E, Brown D (1989) Villous oedema of the placenta: a clinicopathological study. Placenta 10: 297–307PubMedCrossRefGoogle Scholar
  156. Simor AE, Karmali MA, Jadaviji T, Roscoe M (1986) Abortion and perinatal sepsis associated with Campylobacter infection. Rev Infect Dis 8: 397–402PubMedCrossRefGoogle Scholar
  157. Soernes T, Bakke T (1987) The length of the human umbilical cord in twin pregnancies. Am J Obstet Gynecol 157: 1229–1230PubMedGoogle Scholar
  158. Sprecher S, Soumenkoff S, Puissant F, Degueldre M (1986) Vertical transmission of HIV in 15-week fetus. Lancet ii: 288–289CrossRefGoogle Scholar
  159. Strong SJ, Corney G (1967) The placenta in twin pregnancy. Pergamon, OxfordGoogle Scholar
  160. Teasdale F (1980) Gestational changes in the functional structural of the human placenta in relation to fetal growth. Am J Obstet Gynecol 137: 560–568PubMedGoogle Scholar
  161. Tuchmann-Duplessis H, David G, Haezel P (1971) Illustrated human embryology, vol 1. Springer, New York; Chapman and Hall, London; Masson et Cie, ParisGoogle Scholar
  162. Uyanwah-Akpom P, Fox H (1977) The clinical significance of marginal and velamentous insertion of the cord. Br J Obstet Gynaecol 84: 941–943PubMedCrossRefGoogle Scholar
  163. Van der Veen F, Fox H (1982) The effects of cigarette smoking on the human placenta: a light and electron microscopic study. Placenta 3: 243–256PubMedCrossRefGoogle Scholar
  164. Van der Veen F, Fox H (1983) The human placenta in idiopathic intrauterine growth retardation: a light and electron microscopic study. Placenta 4: 65–78PubMedCrossRefGoogle Scholar
  165. Van der Velde WJ, Peereboom-Stegeman JHJC, Treffers PE, James J (1983) Structural changes in the placenta of smoking mothers: a quantitative study. Placenta 4: 231–240PubMedCrossRefGoogle Scholar
  166. Wells M, Bennett J, Bulmer JN, Jackson P, Holgate CS (1987) Complement component deposition in uteroplacental (spiral) arteries in normal human pregnancy. J Reprod Immunol 12: 125–135PubMedCrossRefGoogle Scholar
  167. Wharton B, Edwards JH, Cameron AH (1968) Mono-amniotic twins. J Obstet Gynaecol Br Cmwlth 75: 158–163CrossRefGoogle Scholar
  168. Wigglesworth J (1964) Morphological variations in the insufficient placenta. J Obstet Gynaecol Br Cmwlth 71: 871–884CrossRefGoogle Scholar
  169. Wilkin P (1965) Pathologie du placenta. Masson et Cie, ParisGoogle Scholar
  170. Zaaijman J du T, Wilkinson AR, Keeling JW, Mitchell RG, Turnbull AC (1982) Spontaneous premature rupture of the membranes: bacteriology, histology and neonatal outcome. J Obstet Gynecol 2: 155–160CrossRefGoogle Scholar
  171. Zhang J, Kraus FT, Aquino TI (1985) Chorioamnionitis: a comparative histologic, bactériologic, and clinical study. Int J Gynecol Pathol 4: 1–10PubMedCrossRefGoogle Scholar

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© Springer-Verlag London 1993

Authors and Affiliations

  • T. Yee Khong

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