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The Pathology of the Human Placenta

This presentation of the diseases of the placenta differs in many ways from the first such treatment in these volumes by the eminent Robert Meyer. It is a deliberate attempt to bring together the practical information which has been gathered about the pathology of this complex organ and to make it available to the practicing pathologist as well as clinician. Despite the ready availability of the placenta for study, the pathologist is often ill-prepared to interpret lesions which he may find. Moreover, it has been difficult for him to find reference material, published commonly in journals and books with which he is not familiar. Further- more, the interpretation of lesions affecting the placenta seemed less challenging since the organ had served its function, was to be discarded and presumably little of significance could be expected from such a retrospective study. Recently, with new emphasis on maternal and fetal health and disease, it has become apparent that knowledge of pathologic changes in the placenta often provides a unique insight into antenatal events. Thus, there has been an abundance of publications in this field in recent years, several in book form. These and the most important older investigations on the morbid anatomy of the human pla- centa are here reviewed. This book has been written with a special point of view, however, which reflects our own bias.
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Table of Contents

I. Examination of the Placenta.- II. Unusual Shapes of the Placenta. Placenta Accreta.- Accessory lobes, placenta duplex, placenta membranacea.- Placenta accreta, increta, percreta, and placenta previa accreta.- Velamentous insertion of the umbilical cord.- Interpositio velamentosa. Insertio funiculi furcata.- Placenta extrachorialis (Placenta marginata and circumvallata).- Extramembranous pregnancy.- III. Amnion and Chorion.- Structure.- Epithelium: Degeneration. Meconium staining. Hemosiderin. Ballooning degeneration. Vessels. Sex chromatin.- Squamous metaplasia.- Amnion nodosum.- Oligohydramnios. Fluid turnover.- Edema. Tensile strength. Amnionic fluid embolization.- Cysts. Cartilage.- Amnionic adhesions and bands.- IV. Pathology of the Umbilical Cord and Major Fetal Vessels.Vestiges of Embryonic Structures.- Vestiges and remarks concerning normal structure. Cysts. Edema.- Length of cord. Spiraling. Torsion. Knots. Hemorrhage.- Absence of one umbilical artery.- Tumors of the umbilical cord.- Amnion nodosum; squamous metaplasia; necrosis; color; inflammation of the cord.- Lesions of the major chorionic vessels.- V. The Placenta of Multiple Pregnancy.- A. Introduction.- 1. Types of twin placentas.- 2. Examination of placentas of multiple pregnancies.- B. Pathologie anatomy of twin placentas 195.- 1. The monoamnionic monochorionic twin placenta.- 2. The diamnionic monochorionic twin placenta.- 3. The transfusion syndrome.- 4. The hydramnios with twin pregnancies.- 5. Fetus papyraceous.- 6. The acardiac twin pregnancy.- 7. The diamnionic dichorionic twin placenta.- 8. Placentation of triplets and higher multiple births.- C. Consequences of inter-twin anastomoses.- Cerebral palsy. Chimerism. Transplantation tolerance.- Freemartinism.- D. Absence of one umbilical artery in twins.- E. Velamentous insertion of umbilical cord in twins.- F. Placentation in relation to zygosity of twins.- 1. Discordant monozygous twins in relation to placental development.- 2. The frequency of twin types. Considerations of studies of abortions.- 3. Perinatal mortality of twins in relation to type of placentation..- 4. Evolution of various types of monozygous twin placentas.- G. Outlook of study on twin placentation.- VI. Cellular Exchange between Mother and Fetus. Intervillous.- Thrombosis. Tumor Metastasis.- Fetal to maternal red cell transfer.- Intervillous thrombosis.- Classification, nomenclature. Pathology. Incidence. Pathogenesis.....- Breus' mole (subchorionic tuberous hematoma).- Transfer of maternal cells to the fetus. Metastases.- Leukemia.- Metastatic tumors in placenta and fetus.- VII. Cysts and Placental Septa.- Macroscopic appearance.- Microscopic structure. "X-cells".- Development of septa. Pathogenesis of cysts.- Genetic sex of X-cells and septa.- Histochemical studies.- Incidence.- Amnionic cysts. Vernix dissection.- VIII. Circulatory Disturbances.- Infarcts and atrophy.- Normal maternal and fetal circulations.- Decidual vascular lesions.- Abruptio placentae.- Premature senescence and atrophy.- Importance of placental infarction to the fetus.- Maternal floor infarction.- Disturbances of chorionic circulation.- IX. Infections.- Bacterial infection.- Chorioamnionitis.- orificial infection, bacterial.- chemical phenomena, hypoxia.- Hematogenous bacterial infections.- Comment.- Unusual bacterial infections of the placenta.- Listeriosis.- Tuberculosis.- Syphilis.- Fungous infections.- Candidiases.- Coccidioidomycosis.- Parasitic diseases.- Toxoplasmosis.- Trypanosomiasis.- Malaria.- Viral infections.- Cytomegalovirus disease (Cytomegalic inclusion body disease, salivary gland virus infection).- Rubella.- Variola, Vaccina, Varicella.- Herpes simplex.- Other viral diseases.- Comment.- X. Hemolytic Disease of the Newborn.- Pathogenetic considerations.- Macroscopic findings.- Microscopic findings.- Placental diseases simulating erythroblastosis.- XI. Abortion.- Frequency.- Genetic aspects.- Cytogenetics.- Relationship to teratology.- Cord anomalies.- Isoimmunization and abortion.- Infections and abortions.- Toxoplasmosis and abortion.- Morphology of abortion.- Trauma and abortion.- Miscellaneous other types of abortion.- Threatened abortion.- "Habitual" abortion.- "Missed" abortion.- Breus' mole.- "Therapeutic" abortion.- XI A. Ectopic Pregnancy.- XII. Hydatidiform Mole.- Morphology.- Histochemistry.- Electronmicrography.- Incidence. Geographic variation. Effects of age and gravidity. Repetition of molar gestation.- Ectopic molar pregnancy.- Hydatidiform mole with fetus.- Diagnosis.- Etiology, including sex chromatin and chromosome studies. Animal experiments.- Pathogenesis.- Chorioadenoma destruens.- Syncytial endometritis.- Prognosis.- Hormonal aspects.- Deportation, metastasis and regression.- Relationship to toxemia of pregnancy.- Relationship of hydatidiform mole and chorioadenoma.- Treatment.- XIII. Tumors of the Placenta.- A. Chorangioma.- Nomenclature.- Incidence.- Morphology.- Association with hydramnios, and fetal cardiac load.- Other complications.- Morphogenesis.- Chorioangiomatosis.- B. Chorionepithelioma (Choriocarcinoma).- Definition.- Macroscopic, radiologic and microscopic features.- Choriocarcinoma in situ.- Metastases to fetus.- Histologic grading and prognosis.- Cytotoxic therapy.- Immunologic considerations of maternal-fetal relationship, with particular reference to choriocarcinoma.- Additional considerations concerning the interactions of trophoblast and the maternal organism.- Transfer of antibodies.- XIV. The Hormones of the Placenta.- Protein hormones.- Chorionic gonadotropin (HCG).- Placental lactogen (HPL).- Other protein hormones (ACTH, MSH, TSH, relaxin).- Steroid hormone.- Progesterones.- Estrogens.- "Placental function tests".- Corticoids.- Legend to schematic representation of hormones of the placenta.- Schematic representation.- XV. Miscellaneous Conditions.- Diabetes mellitus.- Non-immunologic hydrops placentalis.- General remarks.- Alpha-thalassemia.- Congenital nephrosis.- Anemia.- Sickle cell disease.- Other anemias.- Collagen diseases.- Systemic lupus erythematosus.- Scleroderma.- Allergic dermatitis.- Other abnormal maternal states.- Pheochromocytoma.- Hyperlipemia.- Radiation.- Hepatitis.- Thyroid disorders.- Placental Insufficiency.- Trauma.- Trisomy 18.- High risk group.- Stilbestrol therapy.- Placental calcification.- Closing comment.- Author Index.

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