A text-book of obstetrics / by J. Clarence Webster.

  • John Clarence Webster
Date:
1903
Catalogue details

Licence: Public Domain Mark

Credit: A text-book of obstetrics / by J. Clarence Webster. Source: Wellcome Collection.

    77/810 page 67
    6. Very rarely there are scattered through the placenta red or black areas, of various sizes, consisting of blood surrounded by a fibrous-like substance. These are termed by some “red infarcts,” by others “ apoplexies.” Pinard has named the appearance “ pla- centa truffe.’ NNilliams points out that these are quite: distinct in nature from the above-mentioned red infarcts. Very many views have been advanced as to the nature of these infarcts. Williams has fully tabulated them, but it is beyond the scope of this work to refer to them in detail. It is here only necessary to consider their relationship to the changes normally found in placental growth and development. Do they occur in healthy conditions or are they an indication of maternal or fetal disease? In the present state of our knowledge it is impossible to answer this question accurately. Williams noticed infarcts measuring at least 1 cm. in diameter in 315 out of 500 placentae. Smaller ones, many just visible to the naked eye, were observed in the great majority of placente, while microscopic examination revealed early stages of infarct formation in every full-time placenta examined by him. He regards this condition, in a moderate degree of develop- ment, as not pathologic, and exerting no influence upon mother or fetus. It is to be regarded asa sign of senile change in the placenta, as was first suggested by Druitt years ago. My own observations are in harmony with those of Williams, not only as regards the frequency and significance of infarcts, but as regards their mode of formation. The chief cause of the process is the thickening of the intima in vessels of various villi, especially in those of medium size. Of less importance in diminishing the lumen of the vessels is thick- ening of the connective tissue around them. These vascular changes, already fully described by me, have been noted by a number of previous observers, the most prominent of whom was Ackermann. The first result of obliteration of the lumen, according to Williams, is coagulation-necrosis beneath the syncytium, with subsequent formation of canalized fibrin. In my description of full-term villi I have pointed out the frequency of fibrinous material on the surface of the villi, with remains of the syncytial layer external to it, or in some parts none whatever. This fibrin probably results from changes in the Langhans layer of epithelial cells and the underlying stroma. That the Langhans cells do largely undergo this transformation normally, as has been mainly demonstrated by Nitabuch and Eberhardt, my sections clearly show. The syncytium may undergo the same change, but always later, as is best demonstrated in the formation of the infarct. Its
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