Specimens

PLACENTA
• Develops from 2 components – fetal component(chorionic
frondosum)
Maternal component- decidua
basalis
• Development begins from 6 th week and completed bt 12 th week
• Human placenta is Discoid, hemochorial And deciduate
• Placenta at term
Diameter 15-20cm
Thickness abou 3cm in center
Weight 500gm(1/6th of fetus)
• 2surfaces
• A.fetal surface- covered by smooth, glistening amnionwith
umbilicus attached at center,. 4/5 th placenta is from fetal origin
• B.maternal surface-it has lobes and cotyledons
• Placental circulation
• A.uteroplacental B. Fetoplacental
• Uteroplacental circulation- it is concerned with circulation of
maternal blood in intervillous space.
A mature placenta has a volume of about 500ml, 350ml being
occupied in villi system and 150ml in intervillous space
At term blood flow through placenta is about 500-600ml per min.
• Fetoplacental circulation
• 2umbilical arteries carry impure blood from fetus.
• Placental barrier
Thickness- 0.025mm
Consists of syncYtiotrophoblasts, cytotrophoblasts,
basement membrane, stromal tissue and endothelium of
fetal cappilary wall
• Placental functions
1.Respiratory 4.endocrine.
2.Excretory 5.barrier
3.Nutritive 6.immunological function
FIBROID UTERUS
• Most common benign tumor in females
• About 20% have fibroid by 30yrs of age
Types
• Body-
1. Interstitial or intramural(75%)
2. Subperitoneal Or subserosal(15%)
3. Submucosal (5%)
• Cervical-
1. Anterior 3. Lateral
2. Posterior 4.central
• Naked eye appearance
• uterus enlarged
• Cut surface smooth, whitish, whorles appearance
• Has false capsule
• Microscopic appearance
• Consists of smooth musclea and fibrous connective tissue
• Types of degeneration s
• Hyaline
• Cystic
• Fatty
• Calcifiwd
• Red Degeneration
• Atrophy
• Necrosis
• Infection
• Vasular changes
• Sarcomatous changes
ANENCEPHALY
• The incidence of anencephaly is about 1 in 1,000 births.
• The anomaly results from deficient development of the vault of
the skull and brain tissue, but the facial portion is normal
• The pituitary gland is often absent or hypoplastic.
• About 70% of anencephalic fetuses are females.
It is more prevalent in first birth and in young and elderly
mothers.
• Genetic and environmental factors are probably involved
(multifactorial).
• Diagnosis: In the first half of pregnancy, the diagnosis is made
by elevated alpha-fetoprotein in amniotic fluid. confirmed by
sonography
• The findings around 10 weeks are: (a) absence of cranial vault,
(b) angiomatous, brain tissue.
• In the latter half of pregnancy, the diagnosis is difficult
especially when associated with hydramnios.
• Complications include: (1) Hydramnios (70%), (2)
Malpresentation—face or breech, (3) Premature labor, especially
when associated with hydramnios, (4) Tendency of postmaturity,
(5) Shoulder dystocia, (6) Obstructed labor if the head and
shoulders try to engage together because of short neck
• Management: If confirmed before 20 weeks, termi nation of
pregnancy is to be done. When diagnosed in late pregnancy,
termination is to be done. The couple is counseled in either
situation.
• The uterus is most often refractory to oxytocin because of low
level of estriol as a result of insufficient production of its
precursor cortisol from fetal adrenals. Use of prostaglandin
vaginal gel PGE2) has been proved to be effective in resistant
cases. During labor, there is tendency of delay. Shoulder
dystocia should be managed by cleidotomy.
• Prevention: Prepregnanc y counseling is essential.
• Folic acid supplementation Beginning 1 month before
conception to about 12 weeks of pregnancy has reduced the
incidence of NTD significantly (85%).
• A dose of 4 mg daily is recommended. Risk of recurrence is
about 2% in subsequent pregnancy.
Hydrocephalus
• Excessive accu mulation of cerebrospinal fluid (0.5–1.5 L) in the
ventricles with consequent thinning of the brain tissue and
enlargement of the cranium occurs in 1 in 2,000 deliveries.
• It is associated with other congenital malformations (aneuploidy)
in one-third of cases and neural tube defects.
• Recurrence rate is about 5%. Breech presentation occurs in
about 30% cases.
• Diagnosis:
• (1) The head is felt larger (head circumference > 50 cm),
globular and softer than the normal head.
• (2) The head is high-up and impossible to push down into the
pelvis.
• (3) FHS is situated high-up above the umbilicus.
• (4) Sonography: (a) Cranial shadow is globular rather than
normal ovoid, (b) Fontanels and sutures are wide, (c) Vault bones
thinner, (d) The lateral and third ventricles are dilated with
marked thinning of the cerebral cortex.
• (5) Often the dilatation is due to stenosis of the aqueduct of
Sylvius, agenesis of corpus callosum or fetal TORCH infections.
Isolated mild ventriculomegaly 10–12 mm) has a good prognosis.
• (6) Internal examination during labor reveals: (a) gaping sutures
and fontanels and (b) crackling sensation on pressing the head.
• Management:
• Principle is to decompress the hydrocephalic head in labor either
in vertex or in breech presentation. This is also done during
cesarean delivery before incising the uterus. Bladder is
evacuated before hand. Once the labor is established and the
cervix is 3–4 cm dilated, decompression of the head is done by a
sharp pointed scissors or with a wide bore (17 gauge) long
needle
IUFD(Intrauterine fetal death)
• Definition:
all fetal deaths weighing 500 g or more occurring both during
pregnancy (antepartum death) or during labor (intrapartum).
SYMPTOMS—
Absence of fetal movements which were previously noted
by the patient.
SIGNS: Retrogression of the positive breast changes that
occur during pregnancy is evident after variable period
following death of the fetus.
Per abdomen
 Gradual retrogression of the fundal height and it
becomes smaller than the period of gestation.
 Uterine tone is diminished and the uterus feels f accid.
Braxton-Hicks contraction is not easily
felt.
 Fetal heart sound is absent. Use of Doppler ultrasound is
better than the stethoscope.
 Cardiotocography (CTG): Flat trace
 Egg-shell crackling feel of the fetal head is a late feature.
Investigations:
Sonography- No cardiac activity and no movements of
fetus. Roberts sign present- gas in chambers of heart
Straight x-ray abdomen- Hyperflexion of spine and
hyperextension of neck. Overcrowded ribs, spalding sign
present
Blood fibrinogen levels elevated
RUPTURE UTERUS
• Scar Dehiscense
Serous layer remains intact
Scar rupture
All uterine layers are disrupted (endometrium,
myometrium, serosa)
Symptoms
Severe pain abdomin, feeling of giving way
Signs
Maternal tachycardia, fetal bradycardia
Fetal parts easily palpable,
DERMOID CYST
Origin:
Dermoid cyst arises from the germ cells arrested after the first
meiotic division.
Pathology:
Dermoid cyst constitutes about 97 percent of teratomata. Its
incidence is about 30–40percent amongst ovarian tumors. The
tumor is bilateral in about 15-20 percent. It constitutes about 20–
40percent of all ovarian tumors in pregnancy.
Torsion is the most common (15–20%) and rupture is an
uncommon (1%) complication. The chance of malignancy is about
1–2 percent.
Squamous cell carcinoma is the commonest.
Naked eye appearance:
The cyst is of moderate size.
The capsule is tense and Smooth.
On cut section, the content is a predominantly sebaceous material
with hair. There may be clear fluid (cerebrospinal fluid) derived
from the neural tissues (choroid plexus).
There is one area of solid projection called Rokitansky’s
protuberance which is covered by skin with sweat and sebaceous
glands. It is here that teeth and bones are found.
A rare one consists predominantly of thyroid tissue — called
struma ovarii, which may be associated with hyperthyroidism.
Microscopic examination
The wall is lined by stratified squamous epithelium; and at places
by granulation tissue. The epithelium may be transitional or
columnar. The most common tissue elements are ectodermal.
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MUCINOUS CYSTADENOMA
• 0rigin:
1. It arises from the totipotent surface epithelium of the ovary.
2. Its association with Brenner tumor suggests its origin as
mucinous metaplasia of the epithelioid cells.
• Pathology
1. about 20–25 percent of all ovarian tumors. The tumors are
bilateral in about 10 percent cases.
2. The chance of malignancy is about 5–10 percent.
• Microscopic examination
1. The cyst is lined by a single layer of tall columnar epithelium
with dark staining basal nucleus but without any cilia. The
epithelial characteristics are like those of endocervix
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