Placenta and Cord Abnormalities Flashcards
(39 cards)
1
Q
Normal Placenta
A
- weighs approximately
500 g and is 15 to 20 cm in diameter - 1.5 to 3 cm thick
- Its weight is approximately one sixth that of the fetus.
2
Q
TYPES OF PLACENTAL ANOMALIES
A
- Placenta Circumvallata
- Battledore Placenta
- Velamentous Insertion of the Cord
- Vasa Previa
- Placenta Accreta
3
Q
Placenta
Succenturiata
A
has one or more accessory lobes
connected to the main placenta by
blood vessels.
4
Q
Placenta
Circumvallata
A
- the fetal side of the placenta is covered to some extent with
chorion - The umbilical cord enters the placenta at the usual midpoint, and large vessels spread out
from there. - Ordinarily, the chorion
membrane begins at the edge of the placenta and spreads to envelop the fetus; no chorion covers the fetal side of the
placenta.
5
Q
Battledore Placenta
A
- The cord is inserted marginally rather than centrally
- This anomaly is rare and has no known clinical significance
either.
6
Q
Velamentous Insertion
of the Cord
A
- cord separates into small vessels that reach the placenta by spreading across a fold of amnion
- frequently found with multiple gestations.
- associated with fetal
anomalies. - fetal blood
supply may not be as
generous as usual
7
Q
Placenta Accreta
A
- is an unusually deep attachment of the
placenta to the uterine myometrium - Attempts to remove it manually may lead to extreme hemorrhage
- MGT: Hysterectomy to remove the uterus or treatment with methotrexate to destroy it
8
Q
2 types of Cord Anomalies
A
- Two Vessel Cord
- Unusual Cord Length
9
Q
Normal Cord
A
- AVA: one vein and
two arteries.
10
Q
Two Vessel Cord
A
contains only two blood vessels instead of the usual three.
11
Q
Unusual Cord Length
A
- short = separation of the placenta or an abnormal fetal lie.
- long = easily
compromised because of its tendency to
twist or knot.
12
Q
Psychological Changes
during Pregnancy: Psychological
Response
A
- Grief
- Mood Swings
- Changes in Sexual
- Desire
- Stress
13
Q
Grief
A
- arise from the realization that one’s roles would be changed permanently
- weaned off her role
as a dependent daughter, or as a happy go lucky girl, or a friend who is always available
14
Q
Mood Swings
A
- Also known as emotional liability
- caused by hormonal
changes or narcissism - Crying is a common manifestation during and even after the pregnancy
15
Q
Changes in Sexual Desire
A
1st Trimester: decrease in libido mainly because of breast tenderness, nausea, and fatigue
2nd Trimester: sexual libido may rise because of increased blood flow to the pelvic area that supplies the placenta
3rd Trimester: may increase or decrease in
sexual libido due to an increase in the abdominal size or
difficulty in finding a comfortable position
*Estrogen increase may also affect sexual libido as it may bring a loss of desire
16
Q
Stress
A
- major change in roles
- affect her ability to decide
- discomforts that she may feel
- abusive relationship
17
Q
Psychological Task
A
1st Trimester: Accepting the Pregnancy
2nd Trimester: Accepting the Baby
3rd Trimester: Preparing for the Baby
18
Q
1st Trimester: Accepting the Pregnancy
A
- shock of learning about a new pregnancy is
sometimes too heavy - need to spend some time recovering from this major life altering situation and avoid overwhelming themselves
- most common reactions is ambivalence, or feeling both pleased and unhappy
19
Q
2nd Trimester: Accepting the Baby
A
- narcissism and introversion are commonly present
- Role playing and increased dreaming
- woman and her partner will start to merge into the role of novice parents
20
Q
3rd Trimester: Preparing for the Baby
A
- couple starts to grow impatient as birth nears
- Preparations for the baby, both small and big, takes place
- baby’s clothing and sleeping arrangements are set and the couple is excited
21
Q
Interventions for Physically and
Mentally Challenged
A
- explore the nature of the woman’s disability to identify the alterations needed
- house bound: compliant in taking a vitamin D supplement
- Assess the woman’s ability to reach her emergency contacts
- Assess the woman’s ability to come for a prenatal visit
- Encourage the woman to increase fluid intake to prevent urinary tract infections and to void frequently even
- Encourage a woman who uses a wheelchair to press with their hands against the armrests and lift their buttocks off for 5 seconds
- Nutrition counseling needs to center on foods that can be prepared without cooking
- Encourage the woman to attend childbirth preparation classes
- encourage exercise
22
Q
Interventions for cognitively challenged
A
give ample time
to talk to her regarding a pelvic examination
23
Q
Interventions for visually challenged woman
A
- trained guide dog may be brought during prenatal visits
- Use demonstration aids
- support person would read the pamphlet to her or she can have a tape recorder with
24
Q
Interventions for hearing impaired woman
A
- show her printed words when teaching
- face the woman not the interpreter
25
Interventions for women with spinal cord injury
- instruct her to palpate
her abdomen for uterine contractions
26
Key Facts
- Cesarean and forceps birth may be necessary
for women with muscle spasticity or spinal
cord injury
- woman who cannot assume a lithotomy
position could be positioned in a dorsal
recumbent or Sims’ position during vaginal
delivery
27
Post Partal Blues
Onset: 1 - 10 days
Symptoms: Sadness, Tears
Incidence: 70% of all births
Etiology: Probable Hormonal Changes, stress of life changes
Therapy: Support, Empathy
Nursing Role: offer compassion and understanding
28
Post Partal Depression
Onset: 1 - 12 months after birth
Symptoms: Anxiety, feeling of loss, sadness
Incidence: 10% of all births
Etiology: Previous depression, hormonal response, lack of social support
Therapy: drug therapy , counseling
Nursing Role: screen for depression and refer to counseling
29
Postpartal Psychosis
Onset: withing 1st year after birth
Symptoms: delusions or hallucinations of harming infant or self
Incidence: 1 - 2% of all births
Etiology: Possible activation of previous mental illness, hormonal changes, family history of bipolar disorder
Therapy: Psychotherapy, drug therapy
Nursing Role: refer to psychiatric care, protect mother from injury to self and newborn
30
Schizophrenia
most common mental disorder for young pregnant women
31
depression
seen as the most common mental illness among pregnant women
32
Mental Disorders Facts
- Childbirth and stress may reveal mental illness
- woman with an existing mental disease must have a psychiatric team and a prenatal group
- Psychotropic medications taken by the woman must be
evaluated first because it might cause teratogenic effects to the fetus
- could also occur during the postpartum period
33
Substance Dependence
- dependent if she has
withdrawal symptoms
34
Substance Dependence Facts
- Assessment of the pregnant woman during the prenatal visit is necessary
- woman may come in late for her prenatal care because she is afraid that her drug use would be discovered
- have difficulty in following instructions for proper nutrition as she may lack sufficient money
- Drug abuse accounts for preterm birth and
fetal abnormalities,
- Illicit drugs can cross the placenta, fetus gets 50% of drug concentration
35
Cocaine
- the most frequently
abused drug during
pregnancy
- it causes extreme vasoconstriction to newborn that can compromise placental circulation leading to premature separation of the placenta and ultimately,
preterm labor or fetal death.
- mother may suffer from immediate effects of intracranial hemorrhage and
withdrawal syndrome.
36
Newborns born to women who use amphetamines
show jitteriness, poor feeding at birth, and growth restriction
37
woman who uses marijuana or hashish
reduced milk production and the risk to the newborn from excretion of the drug in the milk
38
Narcotic agonists such as heroin
fetal opiate dependence and severe withdrawal symptoms in the infant after birth
39
Substance Dependence Management
- enroll in a methadone
maintenance program during pregnancy
- woman may also be treated with buprenorphine if methadone programs are not available
