| caption = [[Micrograph]] of a [[chorangioma]]. [[H&E stain]].
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A '''placental disease''' is any disease, disorder, or pathology of the [[placenta]].<ref name="pmid19337544">{{cite journal |vauthors=Furuya M, Ishida J, Aoki I, Fukamizu A |title=Pathophysiology of placentation abnormalities in pregnancy-induced hypertension |journal=Vasc Health Risk Manag |volume=4 |issue=6 |pages=1301–13 |year=2008 |pmid=19337544 |pmc=2663465 |doi= 10.2147/vhrm.s4009|url=}}</ref><ref name="pmid19099348">{{cite journal |vauthors=Cheng MH, Wang PH |title=Placentation abnormalities in the pathophysiology of preeclampsia |journal=Expert Rev. Mol. Diagn. |volume=9 |issue=1 |pages=37–49 |date=January 2009 |pmid=19099348 |doi=10.1586/14737159.9.1.37 |url=}}</ref>
[[File:Chorangioma_-_intermed_mag.jpg|thumb|right|Micrograph of a chorangioma, a type of placental tumor.]]
Ischemic placental disease leads to the attachment of the [[placenta]] to the uterine wall to become under-perfused, causing uteroplacental [[ischemia]]. Where the term overarches the pathology associated with [[preeclampsia]], placental abruptions and [[intrauterine growth restriction]] (IUGR).<ref name="pmid 24836824">{{cite journal |vauthors= Parker S, Werler M |year=2014 |title= Epidemiology of ischemic placental disease: A focus on preterm gestations. |journal=Seminars in Perinatology |volume=38 |issue=1 |pages=133–138 |pmid=24836824 |pmc=4824536 |doi=10.1053/j.semperi.2014.03.004 |url=}}</ref> These factors are known to be the primary pathophysiology cause placental disease. Which is considered to be associated with more than half of premature births.<ref name="pmid18280875 ">{{cite journal |vauthors=Ananth C, Vintzileos A |year=2008 |title=Medically Indicated Preterm Birth: Recognizing the Importance of the Problem |journal=Clin Perinatol |volume=35 |issue=1 |pages=53–67 |pmid=18280875 |doi=10.1016/j.clp.2007.11.001 |url=}}</ref>
'''Placental disease''' refers to any disorder or pathology affecting the [[placenta]], an essential organ in [[pregnancy]] that facilitates nutrient and gas exchange between the [[mother]] and the [[fetus]]. Placental diseases can have significant implications for both maternal and fetal health, potentially leading to complications such as [[preeclampsia]], [[fetal growth restriction]], and [[preterm birth]].
Abnormalities present within the spiral arteries lead to higher velocities in blood, in turn causes the maternal villi to shred.<ref name="pmid24836825">{{cite journal |vauthors= Roberts J |year=2014 |title= Pathophysiology of ischemic placental disease |journal=Seminars in Perinatology |volume=38 |issue=1 |pages=139–145 |pmid=24836825 |pmc=4040272 |doi=10.1053/j.semperi.2014.03.005 |url=}}</ref> Which trigger pro-coagulator molecules to be released into the blood stream causing action of the coagulator cascade, eventually leading to placental infarction.<ref name="pmid24836825"/> Risk factors such as diabetes, chronic blood pressure and multiple pregnancies can increase the risk of developing placental disease.<ref name="pmid 24836824"/> Also, exposure to sudden trauma can increase the risk of placental abruption which coincides with placental disease.<ref name="pmid24836826 ">{{cite journal |vauthors=Adam T, Yeh C, Bennett-Kunzier N, Kinzler W |year=2014 |title= Long-term maternal morbidity and mortality associated with ischemic placental disease |journal=Seminars in Perinatology |volume=38 |issue=1 |pages=146–150 |pmid=24836826 |doi= 10.1053/j.semperi.2014.03.003 |url=}}</ref>
== Types of Placental Disease ==
There is no target treatment available for placental disease. Associative prevention mechanisms can be a method of minimising the risk of developing the disease, within early stages of pregnancy.
Placental diseases can be broadly categorized into several types based on their pathophysiology and clinical manifestations:
==Signs and symptoms==
=== Placental Insufficiency ===
The abnormal spiral arteries lead decreased level of oxygen diffusion through the placental villus,<ref name="pmid24836825"/> which cause chronic [[hypoxia]]. The abnormal [[trophoblast]] invasion,<ref name="pmid24836825"/> lead to overall [[uteroplacental]] insufficiencies and uteroplacental underperfusion. It is due to the decreased [[vascularisation]], there are reduced levels of nutrient delivery to the foetus.<ref name="pmid15058904">{{cite journal |vauthors=Baschat A, Hechert K |year=2004 |title=Fetal Growth Restriction due to Placental Disease |journal=Seminars in Perinatology |volume=28 |issue=1 |pages=67–80 |pmid=15058904|doi= 10.1053/j.semperi.2003.10.014|url=}}</ref> Also, cases of still births can be associated with placental disease.<ref name="pmid19782960 ">{{cite journal |vauthors=Verspyck E, Borg J, Roman H, Thobois B, Pia P, Marpeau L |year=2010 |title=Hereditary thrombophilia and recurrence of ischemic placental disease |journal=American Journal of Obstetrics and Gynecology |volume=2002 |issue=1 |pages=54e1–54e5 |pmid=19782960 |doi=10.1016/j.ajog.2009.08.019 |url=}}</ref>
Placental insufficiency occurs when the placenta is unable to deliver an adequate supply of nutrients and oxygen to the fetus. This condition can lead to [[intrauterine growth restriction]] (IUGR) and is a common cause of [[fetal distress]].
==Causes==
=== Placental Abruption ===
[[Preeclampsia]] is considered to be linked with Placental Disease, as well as [[intrauterine growth restriction]] (IUGR) and placental abruptions are risk factors that lead to placental disease.<ref name="pmid21839575">{{cite journal |vauthors=Ananth C, Vintzileos A |year=2011 |title=Ischemic placental disease: epidemiology and risk factors |journal=European Journal of Obstetrics & Gynecology and Reproductive Biology |volume=159 |issue=1 |pages=77–82 |doi= 10.1016/j.ejogrb.2011.07.025 |pmid=21839575}}</ref> Especially when these symptoms are evident at early stages of pregnancy.<ref name="pmid 24836824"/> The abnormal invasion of the [[trophoblast]] cells, lack of important growth factors such as [[vascular endothelial growth factor]] (VEGF) and placental growth factor (PlGF), has an association with the onset of placental disease.<ref name="pmid24836830 ">{{cite journal |vauthors=Friedman A, Cleary K |year=2014 |title= Prediction and prevention of ischemic placental disease |journal=Seminars in Perinatology |volume=38 |issue=1 |pages=177–182 |pmid=24836830 |doi=10.1053/j.semperi.2014.03.002 |url=}}</ref>
[[Placental abruption]] is a serious condition where the placenta detaches from the uterine wall before delivery. This can cause severe bleeding and compromise fetal oxygenation, necessitating immediate medical intervention.
===Risk factors ===
=== Placenta Previa ===
Risk factors associated with placental disease are as follows:<ref name="pmid 24836824"/>
[[Placenta previa]] is a condition where the placenta covers the cervix, which can cause bleeding during pregnancy and complications during delivery. It often requires careful monitoring and may necessitate a [[cesarean section]].
* Smoking cigarettes and use other forms of drugs such as cocaine.
=== Placental Tumors ===
* [[Diabetes mellitus]]
* Maternal age less than 20 years or over the age of 35
* Multiple pregnancies
* Chronic high blood pressure
* Being underweight or obese
Also, chronic renal disease, collagen vascular disease and [[thrombophilia]], increases the risk of developing placental disease.<ref name="pmid15058904"/> Moreover, being exposed to severe trauma within the pregnancy period, rapid acceleration and deceleration and uterine compression increase the risk of placental abruption, in turn leading to placental disease.<ref name="pmid24836826 "/>
Placental tumors, such as [[chorangioma]], are rare but can affect placental function. Chorangiomas are benign vascular tumors of the placenta that can lead to complications if they grow large.
===Adherence/penetration===
== Pathophysiology ==
* [[Abruptio placentae]]
The pathophysiology of placental diseases often involves abnormal placental development or function. Factors such as [[maternal hypertension]], [[diabetes]], and [[autoimmune disorders]] can contribute to placental dysfunction. Abnormalities in placental blood flow, inflammation, and [[thrombosis]] are common underlying mechanisms.
* [[Placenta accreta]]
* [[Placenta increta]]
* [[Placenta percreta]]
===Inflammatory/infectious===
== Diagnosis ==
* [[Chorioamnionitis]]
Diagnosis of placental disease typically involves a combination of [[ultrasound]] imaging, [[Doppler studies]], and [[maternal blood tests]]. Ultrasound can assess placental position, structure, and blood flow, while Doppler studies evaluate fetal circulation. Blood tests may reveal markers of placental dysfunction.
* [[Villitis of unknown etiology]]
* [[Intervillitis]]
* [[TORCH infections]]
** [[CMV placentitis]]
* [[Chronic deciduitis]]
===Placental development===
== Management ==
* [[Circumvallate placenta]]
Management of placental disease depends on the specific condition and its severity. It may involve close monitoring, [[bed rest]], medication to manage symptoms, and in some cases, early delivery to prevent complications.
* [[Placental villous immaturity]]
===Obstruction of os===
== Related Pages ==
* [[Placenta previa]]
* [[Pregnancy]]
* [[Vasa previa]]
* [[Fetal development]]
* [[Obstetrics]]
* [[Maternal-fetal medicine]]
===Vascular===
{{Reproductive system}}
{{Pregnancy}}
* [[Fetal thrombotic vasculopathy]]
[[Category:Obstetrics]]
* [[Hypertrophic decidual vasculopathy]]
[[Category:Pregnancy complications]]
* [[Chorangiosis]]
* [[Chorangioma]]
* [[Placental infarction]]
===Neoplastic===
[[Trophoblastic neoplasms]] derive from trophoblastic tissue. Examples include:
*[[Choriocarcinoma]]
*[[Hydatidiform mole]]
==Mechanism==
In placental disease, there's abnormalities present within the spiral arties of the uterus, where the terminal part of the [[spinal arteries]] does not [[dilate]]. This leads to decrease oxygen carried past the maternal villi into the intervillus space. The lack of terminal dilation and inclining blood velocity causes shredding of the villi into the maternal blood, releasing blood coagulants activating the [[coagulation cascade]]. Which then leads to blocking of the blood vessels causing placental infarction.<ref name="pmid24836825"/>
==Diagnosis==
Placental Disease can be diagnosed through technologies such as, [[Prenatal]] [[ultrasound]] evaluation and [[invasive]] foetal testing. The size of the foetus is taken into account through [[ultrasonography]] in terms of intrauterine growth restriction (IUGR). In conjunction with taking into account the maternal history.<ref name="pmid15058904"/>
==Prevention==
The following factors can be linked with reducing the likelihood of developing placental disease:<ref name="pmid24836830 "/>
*Use of [[aspirin]], can reduce the risks associated with [[preeclampsia]]
*Low calcium intake can reduce the risk of preeclampsia
*Reducing [[oxidative stress]] present within the body
*Intake of prenatal [[multivitamins]]
==Treatment==
Treatment of placental disease would require a premature birth, in order to avoid a still birth.
==Epidemiology==
Placental disease is more common in preterm gestation than with full term.<ref name="pmid21839575"/> Which leads to serious injuries to both the mother and the new-born.<ref name="pmid24836830 "/> Women who endured placental disease within the first pregnancy has an increased risk of the disease progressing within future pregnancies.<ref name="pmid17601907 ">{{cite journal |vauthors=Ananth C, Peltier M, Chavez M, Kirby R, Getahun D, Vintzileos A |year=2017 |title=Recurrence of Ischemic Placental Disease |journal= American College of Obstetricians and Gynaecologists |volume=110 |issue=1 |pages=128–133 |pmid=17601907 |doi=10.1097/01.AOG.0000266983.77458.71 |url=}}</ref> The onset of the disease within the first trimester leads to preterm delivery of a premature baby.<ref name="pmid24836828 ">{{cite journal |vauthors=Vintzileos A, Ananth, C |year=2014 |title=First trimester prediction of ischemic placental disease |journal=Seminars in Perinatology |volume=38 |issue=1 |pages=159–166 |pmid=24836828 |doi=10.1053/j.semperi.2014.03.006 |url=}}</ref> Preeclampsia is diagnosed in 3-5% of pregnancies that place them at risk of developing placental disease.<ref name="pmid24836826 "/> Ischemic placental disease is linked with approximately more than half of premature births.<ref name="pmid18280875 "/>
Micrograph of a chorangioma, a type of placental tumor.
Placental disease refers to any disorder or pathology affecting the placenta, an essential organ in pregnancy that facilitates nutrient and gas exchange between the mother and the fetus. Placental diseases can have significant implications for both maternal and fetal health, potentially leading to complications such as preeclampsia, fetal growth restriction, and preterm birth.
Types of Placental Disease
Placental diseases can be broadly categorized into several types based on their pathophysiology and clinical manifestations:
Placental Insufficiency
Placental insufficiency occurs when the placenta is unable to deliver an adequate supply of nutrients and oxygen to the fetus. This condition can lead to intrauterine growth restriction (IUGR) and is a common cause of fetal distress.
Placental Abruption
Placental abruption is a serious condition where the placenta detaches from the uterine wall before delivery. This can cause severe bleeding and compromise fetal oxygenation, necessitating immediate medical intervention.
Placenta Previa
Placenta previa is a condition where the placenta covers the cervix, which can cause bleeding during pregnancy and complications during delivery. It often requires careful monitoring and may necessitate a cesarean section.
Placental Tumors
Placental tumors, such as chorangioma, are rare but can affect placental function. Chorangiomas are benign vascular tumors of the placenta that can lead to complications if they grow large.
Pathophysiology
The pathophysiology of placental diseases often involves abnormal placental development or function. Factors such as maternal hypertension, diabetes, and autoimmune disorders can contribute to placental dysfunction. Abnormalities in placental blood flow, inflammation, and thrombosis are common underlying mechanisms.
Diagnosis
Diagnosis of placental disease typically involves a combination of ultrasound imaging, Doppler studies, and maternal blood tests. Ultrasound can assess placental position, structure, and blood flow, while Doppler studies evaluate fetal circulation. Blood tests may reveal markers of placental dysfunction.
Management
Management of placental disease depends on the specific condition and its severity. It may involve close monitoring, bed rest, medication to manage symptoms, and in some cases, early delivery to prevent complications.
