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ADRMS - OBGYN Penny > The placenta and Umbilical cord > Flashcards

The placenta and Umbilical cord Flashcards

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1
Q

AKA TROPHOBLAST, also called CHORIONIC FRONDOSUM
Highly vascular, 2-4 cm thick
Transfers nourishment, removes waste, produces hCG
Divided into 2 portions: Fetal and maternal portions NEVER cross

A

Normal placenta

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2
Q

DECIDUA BASALIS

▪ Consists of Cotyledons

A

Maternal portion

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3
Q

▪ Major functioning unit= chorionic villi

▪ Consists of a fused layer of amnion and chorion

A

Fetal portion - chorionic frondosum and chorionic plate

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4
Q 
Circumvalle
succenteriate
chorionagioma
placenta previa
placenta abruption
abnormal adherence
A

Placental variants

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5
Q

Chorion does not extend to the edge (elf shoe)

• May predispose to early separation from UT wall, threatened Ab and bleeding

A

Circumvallate

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6
Q
  • Lobe that is connected to main lobe of placenta by blood vessels
  • If vessels cross internal os = vasa previa
A

Succenuriate / accessori lobe

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7
Q

● M/C benign tumor of the placenta
● well circumscribed mass near CI
● Increased vascularity

A

Chorioangioma

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8
Q
  • Partial or complete coverage of cervical os
  • Primary cause of 3rd trimester bleeding
  • Classifications:
  • Complete- covers entire internal os
  • Partial- incomplete covering of internal os
  • Marginal- Placenta touches the edge of the internal os
  • Low lying- Placenta is within 2cm of os
  • Vasa Previa- vessels overlying CX
A

Placenta previa

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9
Q
  • Premature separation of placenta from UT wall after 20 weeks
  • S/S: bleeding and abdominal pain
  • Assoc: w/ HTN, ABD trauma, Vascular disease, cocaine or smoking
A

Placental abruption

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10
Q

Abnormal adherence of placenta tissue to UT
Risk Factors: c- section scarring and advanced maternal age (AMA)
Three classifications:
Placenta Accreta – placenta attached to Myometrium…NO invasion
Placenta Increta- Placenta invades into UT/ Myometrium
Placenta Percreta- Placenta invades UT, Bladder or Rectum

A

Abrnoaml adherence

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11
Q 
***>6cm abnormal***
Thin placenta					THICK placenta
•	IUGR					Gestational diabetes
•	Preeclampsia				Non-immune hydrops
•	Juvenile diabetes			Congenital abnormalities
Multiple gestation
Rh sensitization
A

Placenta abnormalities

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12
Q

Consists of 2 arteries and 1 vein
• Measures 1-2cm in diameter
• Average length is 55cm and covered by Wharton’s jelly and amnion
• SUA (2 vessel cord) assoc. with other fetal anomalies
• Check for 2 kidneys
• Trisomy 13 and 18
• GU, CNS and heart anomalies

A

Umbilical cord

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13
Q
  • Wrapping of umbilical cord around fetal neck

* 2 x around assoc. w/ fetal death

A

Nuchal cord

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14
Q

Short umbilical cord
NOT compatible with life
Lack of closure of anterior abdominal wall

A

Body stalk anomaly

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15
Q

torsion, Knotting or compression of umbilical cord can cause thrombosis= fetal death

A

Umbilical venous thrombosis

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16
Q
  • Umbilical cord attaches to the membrane rather than placenta
  • Assoc w/ IUGR, preterm birth and congenital anomalies
A

Velamentous cord

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17
Q

= VERTEX – head presenting

A

Cephalic

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18
Q

feet first

A

breech

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19
Q

used to determine whether head shape is appropriate

A

cephalic index

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20
Q
  • Axial section at the level of the thalami falx & CSP
  • 1st measurable between 10-12 weeks
  • Angle os asynclitism- angle should be 90°
A

BPD

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21
Q
  • Should not include scalp echoes

* Should be measured outer edge to outer edge

A

head circumference

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22
Q
  • Should include soft tissue and least reliable

* Measured at level of portal vein and stomach & aorta

A

Abdominal circumference

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23
Q

• Includes only ossified diaphysis, exclude epiphyseal cartilage

** Epiphyseal ossified centers will be identified after 30 weeks**

A

Femur length

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24
Q

Designed to detect fetal asphyxia
Scored 0 or 2
o Fetal Breathing- lasts 30 sec over 30 min period
o Movement- 3 body /limb movements
o Tone- extension/ flexion
o AFI- should not exceed 5.0cm
o NST (non-stress test)- 2 acceleration > 15 bpm/15sec

A

Biophysical profile

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25
* Produced by fetal kidneys, tissue, and skin * 2-3 trimesters consists primarily of fetal urine * Functions of fluid: cushion from injury, nutrition, movement, temperature & lung development * Normal range- 5-22 cm
AFI
26
Lecithin/ Sphingomyelin (LS ratio) | -Most accurate measurement of fetal lung maturity done by amnio
fetal lung maturity
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• Decreased fluid that allows a DRIPP to remain ``` D emise R enal abnormalities I UGR P ROM P ost dates/ preeclampsia ```
oligohydramnios
28
``` • Increased fluid: pocket will be ≥ 8cm • Associated with: neural tube defects, upper GI obstructions, hydrops, Trisomy 18 (from esophageal atresia), cystic hygroma, placenta, twin-twin syndrome ```
Polyhydramnios
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o Anemia o UTI o Preeclampsia o Prepartum hemorrhage
Maternal complications
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o Premature or difficult delivery o Prolapse entanglement or compression of umbilical cord o Growth restriction due to placenta insufficiency o Hypoxia of 1 second twin due to premature separation of placenta
Fetal complications
31
reabsorption of a non-viable fetus that was previously demonstrated
Vanishing twin
32
o Increased MSAFP o SOB o Increased UT size and fetal activity o Earlier and mores severe pressure problems in pelvis
clinical finding in twin pregnancies
33
OF ZYGOTES / EGGS
Zygosity
34
“true” or identical twins (always SAME GENDER) from a SINGLE fertilized ovum by single sperm
MONOzygotic
35
SINGLE PLACENTA (days 10-13)
Monochorionic,monoamnitoic
36
SINGLE PLACENTA, 2 amnions (days 5-10 after conception)
Monochorionic, Diamnotic
37
fraternal” twins from separate ova & separate sperm (day 5) **** dizygotic twins will ALWAYS have 2 placentas, 2 amnions,& 2 chorions “twin peak” sign refers to Dichorionic, Diamniotic because placenta grows between sacs ***on TEST***
Dizygotic
38
* Incomplete ÷ of a fertilized ovum after 13 days post-conception * They can be joined by the chest, head, abdominal wall, pelvis or sacrum * Cords of conjoined fetus have between 2-6 vessels
conjoined twins
39
• MONOzygotic twin severely malformed, acardiac and often anencephalic twin is perfused by the normal twin • Normal twin supplies blood to malformed twin. • SONO: POLY o Pump/normal twin=hydrops fetalis
acardiac twins
40
• MONOzygotic twins w/ shared monochorionic placenta (cross transfusion of vascular supply of each twin to the placenta) (ARTERY TO VEIN ANASTOMOSIS) o Donor twin- ( the stuck twin) ▪ OLIGO, small for dates and restricted movement o Recipient twin- ▪ POLY, ascites, Hydropic enlarged liver, heart and kidney
twin to twin transfusion syndrome (TTTS)
41
Passage of thromboplastic material/blood clots from a dead MONOCHORIONIC twin to remaining live twin through shared intra-placental vessels
twin embolization syndrome
42
• Fetus weighing below 10th percentile • D/X: the HC/AC ratio is abnormal in approx 2/3 of all restricted fetuses • Sono: OLIGO, grade 3 placenta & delayed ossification of bones • ETIOLOGY OF IUGR: O Maternal: HTN, diabetes, renal disease, alcohol/ drug abuse, anemia, smoking or mult gestations O Placenta: SUA, plac insufficiency, infarcts & hemangiomas O Fetal: genetic or chromosomal defects, intrauterine infection
IUGR
43
O Etiology: often genetic as result of 1st trimester insult O Fetus is proportionately small throughout pregnancy (2 weeks) o SONO: oligo, early mature placenta, low BPP
symmetric IUGR (25%)
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o Occurs in last 8-10 weeks of pregnancy o Hemodynamic pattern protects brain = “brain sparring” o AC measures > 2 weeks behind HC; head is usually normal o SONO: oligo & mature placentas
Ayssmetrical IUGR (75%)
45
Used to identify growth restriction, hypoxia and/or distressed fetus
Doppler Evaluation
46
NORMAL: as gestation progresses, INCREASE in diastolic flow velocity which reflects a DECREASE in placenta resistance (RI > 0.8) S/D ratio > 2.6 after 30 weeks = ABNORMAL Absence or reversed diastolic flow in the UA is NOT GOOD! CI @ placenta = LOW resistance & CI @ fetal abd. = HIGH resistance
Umbilical artery
47
LOW resistance in 2nd & 3rd trimester is NORMAL | Appearance of “notch” is ABNORMAL & predictor of placenta insufficiency leading to IUGR
Uterine artery
48
* Determines fetal anemia using velocity of PI * Checking IUGR use S/D ratio & MCA s/b ↑ than umbilical artery * In a hypoxia fetus, vessels become enlarged from “brain sparing” * Normal values > 4 throughout pregnancy w/ LITTLE diastolic flow * Use near field vessel for Doppler w/angle @ 5° or less 0° is best
MCA- Middle Cerebral Artery “Circle of Willis” (closest to orbits)
49
• 2 or more fluid filled fetal body cavities & skin thickening • 2 Categories: o IMMUNE- caused by Rh incompatibility (mother) o NON-IMMUNE- caused by abnormal FETAL fluid balance • Fetal GU, cardio, chromosomal, cord/placenta abnormalities, malformation or TORCH infections • SONO: pericardial effusions, POLY, ↑ liver, heart, UV, skin & THICK placenta (> 4 cm) • “ANASARCA” – skin edema
Hydrops fettles
50
* Puncturing the VEIN of the umbilical cord | * Used as a treatment for immune hydrops
PUBS (Percutaneous Umbilical Blood Sampling)
51
• During 2nd & 3rd trimester sono appearance dependant upon when demise occurs after fetal examination o ROBERT’S SIGN- echogenic foci (gas) in pulmonary vessels or in abdomen o SPALDING SIGN- overlapping skull bones ** IMAGES of both on exam & BOTH are visualized 1 WEEK AFTER DEMISE**
FETAL DEMIWE
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Sequence- single defect leading to the development of other defects Syndrome- 2 or more embryological, unrelated anomalies occurring together affecting 2 or more different organs or body areas Association- Non-random occurrence of 2 or more defects
FETAL SYNDROMES
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• Bands of tissue the trap/ encircle parts of the fetal body in early pregnancy o Limb defects: amputation, club feet, constrictions, pseudosyndactyly o Craniofacial defects: encephalocele, facial cleft, asymmetric anencephaly o Visceral defects: gastroschisis, ectopia cordis
AMNIOTIC BAND SYNDROME
54
• Chromosomal abnormalities w/ multiple anatomic problems o HOLOPROCENCEPHALY o IUGR, POLY, agenesis of corpus callosum, micrognathia, cleft lip/palate o Omphalocele, VSD, GU abnormalities, polycystic kidney
TRISOMY 13 PATAU'S SYNDROME
55
• Karyotype abnormalities o Clenched hand w/ finger/thumb crossover (clinodactyly) o VSD, ASD, CP cysts, ↑ cisterna magna/ Dandy-Walker o Micrognathia, dolichocephaly, IUGR, POLY (3rd trimester) o Omphalocele, hydro, diaphragmatic hernia
TRISOMY 18 (EDWARDS SYNDOME)
56
• Malformation w/ mental retardation & characteristic physical appearance o Nuchal fold measuring > 6mm between 15-21 weeks o VSD, ASD, mild ventriculomegaly o Absent or small nasal bone, duodenal atresia, renal pylectasis & echogenic bowel
TRISOMY 21 (DOWN SYNDROME)
57
• Malformation syndrome of complete or partial absence of the X chromosome in phenotype females o Cystic hygroma, lymphadema o Cardiac anomalies, horseshoe kidney or uni-renal agenesis
TURNERS SYNDROME (XO KARYOTYPE)
58
• “Cloverleaf skull”
KLEEBATTSCHADEL SYNDROME
59
• Related to autosomal recessive inheritance o Encephalocele & polycystic kidneys o Cleft lip, polydactyly
MECKEL-GRUBER SYNDROME
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BECKWITH-WEIDMAN SYNDROME • Group of congentital disorders o Macroglossia, gigantIsm & omphalocele o Placenta ↑ or chorioangiomas, cardiac malformation & post natal Wilm’s tumor
BECKWITH-WEIDMAN SYNDROME
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• Association of 2 major defects: Omphalocele & ectopia cordis, along with 3 other defects involving lower sternum, diaphragm or pericardium
PENTOLOGY OF CANTRELL
62
POTTER’S SYNDROME | • BILATERAL renal agenesis & OLIGO
POTTERS SYNDROME
63
• extra set of chromosomes
TRIPLOIDY

ADRMS - OBGYN Penny (23 decks)

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