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Histopathological Approach to Villous Alterations

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Pathology of the Human Placenta

Abstract

Evaluation of the placental villous tissue during the routine evaluation of the placenta is important to gain an overall understanding of the normalcy of the placenta and to ascertain possible disorders. If the villous structure is abnormal, this helps to direct one’s attention to certain pregnancy disturbances that may require further study.

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References

  • Altshuler, G.: Chorangiosis: an important placental sign of neonatal morbidity and mortality. Arch. Pathol. Lab. Med. 108: 71–74, 1984.

    PubMed  CAS  Google Scholar 

  • Altshuler, G.: Some placental considerations related to neurodevelopmental and other disorders. J. Child Neurol. 8: 78–94, 1993.

    Article  PubMed  CAS  Google Scholar 

  • Altshuler, G. and Herman, A.A.: The medicolegal imperative: placental pathology and epidemiology. In, Fetal and Neonatal Brain Injury: Mechanisms, Management and the Risk of Malpractice. D.K. Stevenson and P. Sunshine, eds., pp. 250–263. Decker, Toronto, 1989.

    Google Scholar 

  • Alvarez, H., Morel, R.L., Benedetti, W.L. and Scavarelli, M.: Trophoblast hyperplasia and maternal arterial pressure at term. Am. J. Obstet. Gynecol. 105: 1015–1021, 1969.

    PubMed  CAS  Google Scholar 

  • Alvarez, H., Benedetti, W.L., Morel, R.L. and Scavarelli, M.: Trophoblast development gradient and its relationship to placental hemodynamics. Am. J. Obstet. Gynecol. 106: 416–420, 1970.

    PubMed  CAS  Google Scholar 

  • Alvarez, H., Medrano, C.V., Sala, M.A. and Benedetti, W.L.:Trophoblast development gradient and its relationship to placental hemodynamics. II. Study of fetal cotyledons from the toxemic placenta. Am. J. Obstet. Gynecol. 114: 873–878, 1972.

    PubMed  CAS  Google Scholar 

  • Bacon, B.J., Gilbert, R.D., Kaufmann, P., Smith, A.D., Trevino, F.T. and Longo, L.D.: Placental anatomy and diffusing capacity in guinea pigs following long-term maternal hypoxia. Placenta 5: 475–487, 1984.

    Article  PubMed  CAS  Google Scholar 

  • Becker, V.: Über maturitas praecox placentae. Verh. Deutsche Gesellsch. Pathol. 44: 256–260, 1960.

    CAS  Google Scholar 

  • Becker, V.: Pathologie der Ausreifung der Plazenta. In, Die Plazenta des Menschen. V. Becker, T.H. Schiebler and F. Kubli, eds., pp. 266–281. Thieme, Stuttgart, 1981a.

    Google Scholar 

  • Becker, V.: Plazenta bei Totgeburt. In, Die Plazenta des Menschen. V. Becker, T.H. Schiebler and F. Kubli, eds., pp. 305–308. Thieme, Stuttgart, 1981b.

    Google Scholar 

  • Becker, V. and Röckelein, G.: Pathologie der weiblichen Genitalorgane I. Pathologie der Plazenta und des Abortes. Springer-Verlag, Heidelberg, 1989.

    Google Scholar 

  • Beischer, N.A., Sivasamboo, R., Vohra, S., Silpisornkosal, S. and Reid, S.: Placental hypertrophy in severe pregnancy anaemia. J. Obstet. Gynaecol. Br. Commonw. 77: 398–409, 1970.

    Article  PubMed  CAS  Google Scholar 

  • Benirschke, K. and Gille, J.: Placental pathology and asphyxia. In, Intrauterine Asphyxia and the Developing Fetal Brain. L. Gluck, ed. Year Book, Chicago, 1977.

    Google Scholar 

  • Bernstein, P.S., Minior, V.K. and Divon, M.Y.: Neonatal nucleated red blood cell counts in small-for-gestational age fetuses with abnormal umbilical artery Doppler studies. Am. J. Obstet. Gynecol. 177: 1079–1084, 1997.

    Article  PubMed  CAS  Google Scholar 

  • Bouw, G.M., Stolte, L.A.M., Baak, J.P.A. and Oort, J.: Quantitative morphology of the placenta. 1. Standardization of sampling. Europ. J. Obstet. Gynecol. Reprod. Biol. 6: 325–331, 1976.

    Article  Google Scholar 

  • Burstein, R., Frankel, S., Soule, S.D. and Blumenthal, H.T.: Aging of the placenta: autoimmune theory of senescence. Am. J. Obstet. Gynecol. 116: 271–276, 1973.

    PubMed  CAS  Google Scholar 

  • Burton, G.J.: Intervillous connections in the mature human placenta: Instances of syncytial fusion or section artifacts? J. Anat. 145: 13–23, 1986a.

    PubMed  CAS  Google Scholar 

  • Burton, G.J.: Scanning electron microscopy of intervillous connections in the mature human placenta. J. Anat. 147: 245–254, 1986b.

    PubMed  CAS  Google Scholar 

  • Cantle, S.J., Kaufmann, P., Luckhardt, M. and Schweikhart, G.: Interpretation of syncytial sprouts and bridges in the human placenta. Placenta 8: 221–234, 1987.

    Article  PubMed  CAS  Google Scholar 

  • Clifford, S.H.: Postmaturity—with placental dysfunction. Am. J. Obstet. Gynecol. 44: 1–13, 1954.

    CAS  Google Scholar 

  • de Sa, D.J.: Intimai cushions in foetal placental veins. J. Pathol. 110: 347–352, 1973.

    Article  Google Scholar 

  • Emmrich, P.: Pathologie der Plazenta. VII. Asphyxieinfiltrate der Plazenta. Zentralbl. Pathol. 137: 479–485, 1991.

    PubMed  CAS  Google Scholar 

  • Emmrich, P. and Mälzer, G.: Zur Morphologie der Plazenta bei Übertragung. Pathol. Microbiol. 32: 285–302, 1968.

    CAS  Google Scholar 

  • Emmrich, P., Dalitz, H. and Rother, P.: Genesis and significance of so-called asphyxial infiltrates of the placenta. I. Histological findings. Ann. Anat. 180: 123–130, 1998a.

    Article  PubMed  CAS  Google Scholar 

  • Emmrich, P., Friedrich, T. and Dalitz, H.: Genesis and significance of so-called asphyxial infiltrates of the placenta. I. Immunohistochemical findings. Ann. Anat. 180: 203–209, 1998b.

    Article  PubMed  CAS  Google Scholar 

  • Essbach, H. and Röse, I.: Plazenta and Eihäute. Fischer, Jena, 1966.

    Google Scholar 

  • Fejgin, M.D., Amiel, A., Goldberger, S., Barnes, I., Zer, T. and Kohn, G.: Placental insufficiency as a possible cause of low maternal serum human gonadotropin and low maternal serum unconjugated estriol levels in triploidy. Am. J. Obstet. Gynecol. 167: 766–767, 1993.

    Google Scholar 

  • Fok, R.Y., Pavlova, Z., Benirschke, K., Paul, R.H. and Platt, L.D.: The correlation of arterial lesions with umbilical artery Doppler velocimetry in the placentas of small-for-dates pregnancies. Obstet. Gynecol. 75: 578–583, 1990.

    PubMed  CAS  Google Scholar 

  • Fox, H.: Perivillous fibrin deposition in the human placenta. Am. J. Obstet. Gynecol. 98: 245–251, 1967.

    PubMed  CAS  Google Scholar 

  • Fox, H.: Fibrinoid necrosis of placental villi. J. Obstet. Gynaecol. Br. Commonw. 75: 448–452, 1968a.

    Article  PubMed  CAS  Google Scholar 

  • Fox, H.: Fibrosis of placental villi. J. Pathol. Bacteriol. 95: 573–579, 1968b.

    Article  PubMed  CAS  Google Scholar 

  • Fox, H.: Basement membrane changes in the villi of the human placenta. J. Obstet. Gynaecol. Br. Commonw. 75: 302–306, 1968c.

    Article  PubMed  CAS  Google Scholar 

  • Fox, H.: Villous immaturity in the term placenta. Obstet. Gynecol. 31: 9–12, 1968d.

    Article  PubMed  CAS  Google Scholar 

  • Fox, H.: Pathology of the Placenta. 2nd Ed. Saunders, London, 1997.

    Google Scholar 

  • Gagnon, R., Johnston, L. and Murotsuki, J.: Fetal placental embolization in the late-gestation ovine fetus: alterations in umbilical blood flow and fetal heart rate patterns. Am. J. Obstet. Gynecol. 175: 63–72, 1996.

    Article  PubMed  CAS  Google Scholar 

  • Garrow, J.S. and Hawes, S.F.: The relationship of the size and composition of the human placenta to its functional capacity. J. Obstet. Gynaecol. Br. Commonw. 78: 22–28, 1971.

    Article  PubMed  CAS  Google Scholar 

  • Giles, W.B., Trudinger, B.J. and Baird, P.J.: Fetal umbilical artery flow velocity waveforms and placental resistance: pathological correlation. Br. J. Obstet. Gynaecol. 92: 31–38, 1985.

    Article  PubMed  CAS  Google Scholar 

  • Gille, J.: Kritische Gedanken zur “Plazentainsuffizienz”. Med. Klin. 80: 148–152, 1985.

    Google Scholar 

  • Goshen, R. and Hochberg, A.A.: The genomic basis of the ß-subunit of human chorionic gonadotropin diversity in triploidy. Am. J. Obstet. Gynecol. 170: 700–701, 1994.

    PubMed  CAS  Google Scholar 

  • Harvey-Wilkes, K., Nielsen, H.C. and D’Alton, M.E.: Elevated endothelin levels are associated with increased placental resistance. Am. J. Obstet. Gynecol. 174: 1599–1604, 1996.

    Article  PubMed  CAS  Google Scholar 

  • Jackson, M.R., Joy, C.F., Mayhew, T.M. and Haas, J.D.: Stereo-logical studies on the true thickness of the villous membrane in human term placentae: a study of placentae from high altitude pregnancies. Placenta 6: 249–258, 1985.

    Article  PubMed  CAS  Google Scholar 

  • Jackson, M.R., Mayhew, T.M. and Haas, J.D.: Morphometric studies on villi in human term placentae and the effects of altitude, ethnic grouping and sex of newborn. Placenta 8: 487–495, 1987.

    Article  PubMed  CAS  Google Scholar 

  • Jackson, M.R., Mayhew, T.M. and Haas, J.D.: On the factors which contribute to thinning of the villous membrane in human placentae at high altitude. II. An increase in the degree of peripheralization of fetal capillaries. Placenta 9: 9–18, 1988.

    Article  PubMed  CAS  Google Scholar 

  • Jackson, M.R., Walsh, A.J., Morrow, R.J., Mullen, J.B.M., Lye, S.J. and Ritchie, J.W.K.: Reduced placental villous tree elaboration in small-for-gestational-age pregnancies: relationship with umbilical artery Doppler waveforms. Am. J. Obstet. Gynecol. 172: 518–525, 1995.

    Article  PubMed  CAS  Google Scholar 

  • Jauniaux, E., Ramsay, B. and Campbell, S.: Ultrasonographic investigation of placental morphologic characteristics and size during the second trimester of pregnancy. Am. J. Obstet. Gynecol. 170: 130–137, 1994.

    PubMed  CAS  Google Scholar 

  • Kadyrov, M., Kosanke, G., Kingdom, J. and Kaufmann, P.: Increased fetoplacental angiogenesis during first trimester in anaemic women. Lancet 352 (9142): 1747–1749, 1998.

    Article  PubMed  CAS  Google Scholar 

  • Kaufmann, R: Influence of ischemia and artificial perfusion on placental ultrastructure and morphometry. Contrib. Gynecol. Obstet. 13: 18–26, 1985.

    PubMed  CAS  Google Scholar 

  • Kaufmann, R, Luckhardt, M., Schweikhart, G. and Cantle, S.J.: Cross-sectional features and three-dimensional structure of human placental villi. Placenta 8: 235–247, 1987.

    Article  PubMed  CAS  Google Scholar 

  • Kaufmann, R, Kohnen, G. and Kosanke, G.: Wechselwirkungen zwischen Plazentamorphologie and fetaler Sauerstoffversorgung. Versuch einer zellbiologischen Interpretation pathohistologischer and experimenteller Befunde. Gynäkologe 26: 16–23, 1993.

    PubMed  CAS  Google Scholar 

  • Kemnitz, P. and Theuring, F.: Makroskopische, licht-and elektronenmikroskopische Plazentabefunde bei Uebertragung. Zentralbl. Allg. Pathol. 118: 43–54, 1974.

    PubMed  CAS  Google Scholar 

  • Kingdom, J.C.P. and Kaufmann, R: Oxygen and placental villous development: origins of fetal hypoxia. Placenta 18: 613–621, 1997.

    Article  PubMed  CAS  Google Scholar 

  • Kingdom, J.C.P, Macara, L.M., Krebs, C., Leiser, R. and Kaufmann, R: Pathological basis for abnormal umbilical artery Doppler waveforms in pregnancies complicated by intrauterine growth restriction. Trophoblast Res. 10: 291–309, 1997.

    Google Scholar 

  • Kloos, K. and Vogel, M.: Pathologie der Perinatalperiode. Thieme, Stuttgart, 1974.

    Google Scholar 

  • Kosanke, G., Kadyrov, M., Korr, H. and Kaufmann, R: Maternal anemia results in increased proliferation in human placental villi. Trophoblast Res. 11: 339–357, 1998.

    Google Scholar 

  • Krebs, C., Macara, L.M., Leiser, R., Bowman, A.W., Greer, I.A. and Kingdom, J C.P.: Intrauterine growth restriction with absent end-diastolic flow velocity in the umbilical artery is associated with maldevelopment of the placental terminal villous tree. Am. J. Obstet. Gynecol. 175: 1534–1542, 1996.

    Article  PubMed  CAS  Google Scholar 

  • Küstermann, W.: Über “Proliferationsknoten” and ÜSyncytialknoten” der menschlichen Placenta. Anat. Anz. 150: 144–157, 1981.

    PubMed  Google Scholar 

  • Kuss, E.: Was ist “Das Plazentainsuffizienzsyndrom”? Geburtsh. Frauenheilkd. 47: 664–670, 1987.

    Article  CAS  Google Scholar 

  • Liebhart, M.: The electron microscopic pattern of placental villi in diabetes of the mother. Acta Med. Pol. 12: 133–137, 1971.

    PubMed  CAS  Google Scholar 

  • Liebhart, M.: Ultrastructure of the stromal connective tissue of normal placenta and of placenta in diabetes mellitus of mother. Pathol. Eur. 9: 177–184, 1974.

    PubMed  CAS  Google Scholar 

  • Macara, L.M., Kingdom, J.C.P., Kohnen, G., Bowman, A.W., Greer, I.A. and Kaufmann, P.: Elaboration of stem villous vessels in growth restricted pregnancies with abnormal artery Doppler waveforms. Br. J. Obstet. Gynaecol. 102: 807–812, 1995.

    Article  PubMed  CAS  Google Scholar 

  • Macara, L.M., Kingdom, J.C.P., Kaufmann, E, Kohnen, G., Hair, J., More, I.A.R., Lyall, F. and Greer, I.A.: Structural analysis of placental terminal villi from growth-restricted pregnancies with abnormal umbilical artery Doppler waveforms. Placenta 17: 37–48, 1996.

    Article  PubMed  CAS  Google Scholar 

  • Mayhew, T.M., Wadrop, E. and Simpson, R.A.: The proliferative versus hypertrophic growth in tissue subcompartments of human placental villi during gestation. J. Anat. 184: 535–543, 1994.

    PubMed  Google Scholar 

  • McDermott, M. and Gillan, J.E.: Chronic reduction of fetal blood flow is associated with placental infarction. Placenta 16: 165–170, 1995.

    Article  PubMed  CAS  Google Scholar 

  • Mikolajczak, J., Ruhrberg, A., Fetzer, M., Kaufmann, P. and Goecke, C.: Irreguläre Zottenreifung bei Frühgeburtichkeit and Übertragung, and ihre Darstellbarkeit im Ultraschall. Gynaekol. Rundsch. 27: 145–146, 1987.

    Article  Google Scholar 

  • Naeye, R.L.: Disorders of the Placenta, Fetus, and Neonate. Diagnosis and Clinical Significance. Mosby Year Book, St. Louis, 1992.

    Google Scholar 

  • Naeye, R.L., Maisels, J., Lorenz, R.P. and Botti, J.J.: The clinical significance of placental villous edema. Pediatrics 71: 588–594, 1983.

    PubMed  CAS  Google Scholar 

  • Pilz, I., Schweikhart, G. and Kaufmann, P.: Zur Abgrenzung normaler, artefizieller and pathologischer Strukturen in reifen menschlichen Plazentazotten. III. Morphometrische Untersuchungen bei Rh-Inkompatibilität. Arch. Gynecol. Obstet. 229: 137–154, 1980.

    CAS  Google Scholar 

  • Piotrowicz, B., Niebroj, T.K. and Sieron, G.: The morphology and histochemistry of the full term placenta in anaemic patients. Folia Histochem. Cytochem. 7: 436–444, 1969.

    Google Scholar 

  • Reshetnikova, O.S., Burton, G.J. and Milovanov, A.P.: Effects of hypobaric hypoxia on the fetoplacental unit: The morpho-metric diffusing capacity of the villous membrane at high altitude. Am. J. Obstet. Gynecol. 171: 1560–1565, 1994.

    PubMed  CAS  Google Scholar 

  • Salafia, C.M., Vintzileos, A.M., Silberman, L., Bantham, K.F. and Vogel, C.A.: Placental pathology of idiopathic intrauterine growth retardation at term. Am. J. Perinatol. 9: 179–184, 1992.

    Article  PubMed  CAS  Google Scholar 

  • Sander, C.H.: Hemorrhagic endovasculitis and hemorrhagic villitis of the placenta. Arch. Pathol. Lab. Med. 104: 371–373, 1980.

    PubMed  CAS  Google Scholar 

  • Scheffen, I., Kaufmann, E, Philippens, L., Leiser, R., Geisen, C. and Mottaghy, K.: Alterations of the fetal capillary bed in the guinea pig placenta following long-term hypoxia. Adv. Exp. Med. Biol. 277: 779–790, 1990.

    Article  PubMed  CAS  Google Scholar 

  • Schuhmann, R.: Plazenton: Begriff, Entstehung, funktionelle Anatomie. In, Die Plazenta des Menschen. V. Becker, T.H. Schiebler and E Kubli, eds., pp. 192–207. Thieme, Stuttgart, 1981.

    Google Scholar 

  • Schweikhart, G.: Morphologie des Zottenbaumes der menschlichen Plazenta—Orthologische und pathologische Entwicklung und ihre klinische Relevanz. Thesis, Medical Faculty of University Mainz, 1985.

    Google Scholar 

  • Schweikhart, G., Kaufmann, P. and Beck, T.: Morphology of placental villi after premature delivery and its clinical relevance. Arch. Gynecol. 239: 101–114, 1986.

    Article  PubMed  CAS  Google Scholar 

  • Shen-Schwarz, S., Ruchelli, E. and Brown, D.: Villous oedema of the placenta: a clinicopathological study. Placenta 10: 297–307, 1989.

    Article  PubMed  CAS  Google Scholar 

  • Sinclair, J.G.: Significance of placental and birthweight ratios. Anat. Rec. 102: 245–258, 1948.

    Article  PubMed  CAS  Google Scholar 

  • Tenney, B. and Parker, E: The placenta in toxemia of pregnancy. Am. J. Obstet. Gynecol. 39: 1000–1005, 1940.

    Google Scholar 

  • Todros, T., Sciarrone, A., Piccoli, E., Guiot, C., Kaufmann, P. and Kingdom, J.: Umbilical Doppler waveforms and placental villous angiogenesis in pregnancies complicated by fetal growth restriction. Obstet. Gynecol. 93: 499–503, 1999.

    Article  PubMed  CAS  Google Scholar 

  • Veen, F., Walker, S. and Fox, H.: Endarteritis obliterans of the fetal stem arteries of the human placenta: an electron microscopic study. Placenta 3: 181–190, 1982.

    Article  PubMed  Google Scholar 

  • Vogel, M.: Pathologie der Schwangerschaft, der Plazenta und des Neugeborenen. In, Pathologie, Vol. 3. Remmele, W. ed. Springer-Verlag, Heidelberg, 1984.

    Google Scholar 

  • Vogel, M.: Atlas der Morphologischen Plazentadiagnostik. 2nd Ed. Springer-Verlag, Heidelberg, 1996.

    Google Scholar 

  • Voigt, S., Kaufmann, P. and Schweikhart, G.: Zur Abgrenzung normaler, artefizieller und pathologischer Strukturen in reifen menschlichen Plazentazotten. II. Morphometrische Untersuchungen zum Einfluß des Fixationsmodus. Arch. Gynäkol. 226: 347–362, 1978.

    CAS  Google Scholar 

  • Wentworth, P.: The placenta in cases of hemolytic disease of the newborn. Am. J. Obstet. Gynecol. 98: 283–289, 1967.

    PubMed  CAS  Google Scholar 

  • Werner, C. and Schneiderhan, W: Plazentamorphologie und Plazentafunktion in Abhaengigkeit von der diabetischen Stoffwechselfuehrung. Geburtsh. Frauenheilkd. 32: 959–966, 1972.

    CAS  Google Scholar 

  • Wong, T.-C. and Latour, J.P.A.: Microscopic measurement of the placental components in an attempt to assess the malnourished newborn infant. Am. J. Obstet. Gynecol. 94: 942–950, 1966.

    PubMed  CAS  Google Scholar 

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Benirschke, K., Kaufmann, P. (2000). Histopathological Approach to Villous Alterations. In: Pathology of the Human Placenta. Springer, New York, NY. https://doi.org/10.1007/978-1-4757-4199-5_14

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  • DOI: https://doi.org/10.1007/978-1-4757-4199-5_14

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