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Diseases of the Placenta 1

tissue, inflammation, decidua, connective, surface and cells

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1. Place nt it i s.

The disease, described by Geoffroy de Montreuil, Brachet, Simpson, Fer dinand Robert and Cauwenberghe, under the title of placentitis, is an endometritis, but a distinction must be made between inflammation of the fcetal and of the maternal placenta. Indeed, excluding the observa tions of Brachet, Stratfordt, Dance, Simpson, Cruveilhier, Wilde, Dubois and Desormeaux, Ramsbotham and Geoffroy de Montreuil, inflammation of the ketal placenta has not been demonstrated. But inflammation of the maternal placenta has been observed and constitutes the organized ad hesions of Brachet; the placentitis of the second degree with effusion of coagulable lymph on the ut,erine surface of the placenta of Simpson; and the metamorphoses of plastic inflammatory exudation .on the uterine pla cental surface .of Ferdinand Robert. This is the acute inflammation of Meckel; the chronic inflammation, the primitiva or secondary chronic endometritis of Braun, Schroeder and Spiegelberg; the interstitial endo metritis of Hegar and Maier, in which the villi are agglutinated and com pressed by the hypertrophied decidua serotina, and a new connective tissue.

Here is their microscopical description, after Cauwenberghe: The fusi form cells which, with little amorphous intercellular substance, form the in terstitial tissue of the decidua serotina or maternal placenta, are larger than normal, but in various stages of retrogressive metamorphosis. In , the points where the change is most recent, the' cells are alone. They are now regularly arranged, side by side, fusiform as in their normal state, and only slightly degenerated; now deformed, rounded, distended by finely granular matter or by a fatty granular substance, they either possess a plain nucleus or have none. Their arrangement is less uniform, and between them is free fat in globular masses or in scattered granules.

As the affection a,dvances, we see new elements appearing between those of the interstitial tissue. The new tissue is now fibrillary, finely reticulated, its meshes being filled with nuclei and cells, now fibroid, striated or homogeneous. It displaces the older cells, deforms them or

leads to their degeneration, so that a few fatty granules alone testify to their previous existence. In many places, the new connective tissue quite displaces the old. The utero-plucental vessels undergo various changes, the constant result of which is atrophy and degeneration from compres sion, so that there finally remain only hard and whitish foci, comparable to old connective tissue, imbedded in the spongy mass of the placenta. This progressive formation of connective tissue, on the uterine surface and in the placenta, produces induration, the plainest result of which is obliteration of the fcetal and maternal vessels, with more or leas extensive thromboses and apoplexies.

As early as 1842, Devilliers, in 1849, Dance, and later, Lesauvage, Breschet, Dubreuilh de Montpellier and Jacquemier, reported congestions of the decidua, leading to thickening and the production of white, pseudo membranous concretions, analogous to pleuritic false membranes. (Dance reported a layer of thickened pus, between the uterus and the placenta). Cangestions of the uterus may lead to apoplexies, that is hemorrhagic extravasations, either partial or general, in the decidual tissue or in its cavity, transforming the abortive ovum into a sort of coagulum, as almost all observers have noticed. If the hemorrhage is violent, the extravasa tion may occupy not only the thickness of the deciclure and their cavity, but may also rupture the membranes and penetrate their interior. Devilliers has reported a case which he considers a hypertrophy of the two folds of the decidua greatly congested around the hypertrophied pla centa, the first cause of which was an active congestion or some state peculiar to this membrane. The result is congestion of the uterus fol lowed by a granulo-fatty degeneration (interstitial endometritis of Ilegar). Ire adds that, if one finds pus on the surface of the decidua, it can only come from the inflamed uterus.

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