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OBGYN > Placenta and umbilical cord registry review > Flashcards

Placenta and umbilical cord registry review Flashcards

(64 cards)

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1
Q

Normal placenta

A

-2 to 4cm thick
-Normal function as excretory organ
-Exchange gas and waste with nutrients and oxygen
-Means of nutrition and respiration

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2
Q

Maternal side of placenta

A

Decidua basalis or basal plate. Maternal vessels enter intervillous spaces where the exchanges occur

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3
Q

Fetal side of placenta

A

Chorion frondosum or chorionic plate which contains extensions called chorionic villi

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4
Q

Functional unit of placenta

A

Lobes of chorionic villi termed cotyledons

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5
Q

Bilobed placental variant

A

2 discs of equal size joined together by an isthmus of placental tissue (connects 2 lobes)

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6
Q

Accessory lobe/succenturiate lobe variant

A

Additional small lobe separate from main placental mass but connect by vascular connections
*NO placental tissue connection

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7
Q

Circumvallate variant

A

Curled up placental contour appearing as a shelf. Curled edges, do not lay flat or smooth along wall
-Increased risk of abnormal placental development and future abruption

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8
Q

Venous lakes/maternal lakes/placental lakes/lacunae variant

A

Pools of maternal venous blood. Sonolucent areas within placental mass
-Won’t fill with color
-“Swirling” in B mode

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9
Q

Placental grading

A

Placenta should be age appropriate
-Advance maturation indicates maternal complications leading to insufficiency and asymmetrical IUGR

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10
Q

Grade 0 placenta

A

Homogenous, smooth echotexture. No indentations in chorionic plate, smooth borders
-1st trimester to early 2nd trimester

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11
Q

Grade 1 placenta

A

Subtle indentations in chorionic plate, small random hyperechoic foci
-2nd to early 3rd trimester
*normal for anatomy scan

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12
Q

Grade 2 placenta

A

Large comma-like indentations alter chorionic plate, larger calcifications in basal plate
-Late 3rd trimester

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13
Q

Grade 3 placenta

A

Complete indentations chorionic to basal plate. Irregular calcifications with shadowing. Related to drug abuse and preeclampsia. May cause IUGR in early gestation
-Post dates/advanced

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14
Q

Asymmetrical IUGR

A

Poor placental health. Fetus isn’t getting enough oxygen, nutrients and growth will be affected. Brain will shunt more blood to itself

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15
Q

Dopplers

A

The arteries feeding the placenta may have increased resistance patterns. Includes uterine and umbilical artery

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16
Q

Placenta previa

A

Placenta is implanted within the LUS and covers or is near the internal os
-Increased risk with advanced maternal age, hx of c section, multiparty
-ONLY diagnosed 20 weeks+ due to possible migration
*MOST likely cause of painless vaginal bleeding in 2nd/3rd trimester

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17
Q

May result in false positive placenta previa

A

Overly distended bladder or LUS contraction
*Best to scan with empty bladder or soft touch TV

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18
Q

Complete previa

A

Internal os is completely covered by placental tissue

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19
Q

Marginal previa

A

Edge of placenta touches internal os

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20
Q

Low-lying placenta

A

edge of placenta is within 2cm of internal os

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21
Q

Accreta

A

Abnormal adherence of placenta to myometrium

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22
Q

Increased risk of accreta

A

Hx of multiple c sections and/or uterine surgery
-Scarring causes the disruption of the basal plate, special LUS placental location with a hx of multiple c sections

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23
Q

Sonographic appearance of placenta accreta

A

Loss of basal plate or myometrial/serous layer, multiple placental lacunae, and increased peripheral vascularity

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24
Q

Placenta accreta

A

Adhered to wall
*MOST common

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25
Placenta increta
Invades myometrium
26
Placenta percreta
Penetrates through uterus and breach serosal layer
27
Placental abruption
Premature separation of placenta from uterine wall -High risk of fetal death *CRITICAL FINDING
28
Risk factors of placental abruption
Hypertension, preeclampsia, drug/alcohol abuse, smoking, poor maternal health/nutrition
29
Clinical findings of placenta abruption
Bleeding, pain, tenderness, trauma, decreased hematocrit
30
Sonographic appearance of placental abruption
Hypo or anechoic region between placenta and uterine wall at level of basal plate
31
Complete placental abruption
Most severe, entire retroplacental hematoma
32
Partial placental abruption
Few centimeters of separation
33
Marginal placental abruption
Placental edge, lifting the chorionic membrane from wall
34
Chorioangioma
Vascular tumor, most common location is adjacent to umbilical cord insertion at placenta. *most common placental tumor
35
Umbilical cord
-2 arteries, 1 vein -surrounded by Wharton's jelly
36
What does the umbilical cord develop from?
Yolk sac and vitelline duct
37
Umbilical vein
Carries oxygenated blood to fetus
38
Umbilical arteries
Carries deoxygenated blood back to placenta
39
Placental cord insertion (PCI)
-Normally at central part of placenta -Free floating cord attachment into the placenta helps locate
40
Marginal PCI
Within 2 cm of edge of placenta -AKA battledore placenta
41
Velamentous/membraneous cord
Insertion into the membranes beyond the placental edge and insert into side of UTERINE wall. Vessels must travel to insert into placenta.
42
Vasa previa
Vessels implanted across the internal os -May rupture if cervix dilates, can lead to exsanguination of fetus
43
Exsanguination
The loss of blood from the body's circulatory system, usually resulting in death
44
Allantoic cyst
Cyst of cord, adjacent to vessels (may look like bubble) -Near placenta
45
Omphalomesenteric cyst
Cyst of cord near fetal abdomen (at level of fetal CI)
46
Hemangioma
Solid, hyperechoic mass near placenta *most common tumor of cord
47
Single umbilical artery (2 vessel cord)
1 umbilical artery and 1 umbilical vein. Most likely associated with congenital anomalies
48
Umbilical dopplers
-Resistance determined by demand of organ -More volume flow (blood)=lower resistance -Less volume flow (blood)=higher resistance
49
Measuring resistance in umbilical dopplers
Evaluate change in diastolic flow
50
Uterine arteries
-Supplies uterus and placenta *gravida uterus requires HIGH volume flow aka LOW RESISTANCE
51
When to doppler uterine arteries
-Preeclampsia -At risk for placental complications/insufficiency
52
Abnormal uterine artery doppler
Increased resistance/ decreased EDV
53
Umbilical artery
Evaluates placental resistance AND fetal well being -Increased placental resistance indicates insufficiency which leads to FETAL consequences (IUGR/hypoxia)
54
Normal umbilical artery doppler
-Low resistance, HIGH diastolic flow -S/D ratio < 3.0 -Resistance decreases with gestational age
55
Abnormal umbilical artery doppler
-Increased resistance, DECREASED diastolic flow -Diastolic flow REVERSAL -S/D ratio > 3.0 (a lot of PEAKS, not hills)
56
Intrauterine growth restriction (IUGR)
-EFW below 10th percentile -Biometry measures 2 weeks below expected gestational age -AC used to evaluate
57
Symmetric IUGR
Entire fetus is evenly small. Usually starts earlier and related to fetal syndrome
58
Asymmetric IUGR
Head biometry may be WNL -ABNORMAL AC/HC ratio -Usually presents in 2nd trimester -Related to maternal complications, placental insufficiency and abnormal dopplers *IMPORTANT to check MCA for intracranial shunting
59
Middle cerebral artery (MCA)
Normal = high resistance Abnormal = lower resistance
60
Intracranial shunting
Fetal brain takes priority and shunts increased volume of blood to the head to "spare" the brain -Decreasing resistance = increasing volume *increasing blood supply to brain = head keeps growing therefore asymmetrical growth
61
Anemia
Reduces hemoglobin, making blood thinner. -Thin blood flows faster therefore increasing PSV of MCA
62
Umbilical vein
-Steady, minimally phasic with constant flow to fetus -Placenta --> fetus -Flow is forward and constant
63
Ductus venosus
More pulsatile waveform (closer to heart), reflects arterial contractions
64
Abnormal flow of ductus venosus
Increased fetal resistance, abnormal flow patterns -Causes: CHF, hydrops, pulmonary hypoplasia

OBGYN (17 decks)

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