placental and cord abnormalities

unusually large

a. diabetic

b. syphilitic

c.erthroblastosis fetalis (largest)

wide diameter

(uterus has scars & septum)

placenta succenturiata

has one or more accessory lobes connected to main placenta by blood vessels--no fetal abnormality but small lobes may retained.

Placenta circumvallata

fetal side of placenta is covered to some extent with chorion. The umbilical cord enters the placenta at usual midpoint, & large vessels spread from there.

Placenta Marginata

the fold of the chorion reaches just to the edge of the placenta.

Battledore Placenta

the cord is inserted marginally rather than centrally

Velamentos Insertion of the Cord

the cord separate into small vessels that reach the placenta by spreading across a fold of amnion (multiple pregnancy)

Placenta Accreta

unusually deep attachment of the placenta to the uterine myometrium, will not loosen or be delivered (hysterectomy)

Vasa Previa

the umbilical vessels of a velamentous cord insertion cross the cervical os so they would deliver before fetus. The vessels may tear—fetal blood loss. Compressed vessels—FH changes. If sudden painless bleeding occur with beginning of dilatation (SUSPECT!)

Placenta Biparteta or Bilobed Placenta

placenta division INC & vessels of fetal origin extend from one lobe to the other before uniting to form the umbilical cord.

Placenta Duplex

two lobes separated entirely

placenta accreta

villi are attached to myometrium but do not invade the muscles

placenta increta

villi partially invade the myometrium

placenta percreta

villi invade up to or beyond the uterine serosa

Extrachorial Placenta

chorionic plate, which is on fetal side is smaller than basal plate(maternal side)

Circummarginata Placenta

-fetal surface of placenta represents a central depression surrounded by a thickened, grayish- white ring, ring with double fold amnion/chorion, degenerated deidua

-hemorrhage, preterm, perinatal death, fetal

malformations

Placenta Polyp

-parts retained after delivery/form polyps consisting of villi cause late postpartum Hemorrhage

-enlarge chorionic villi—severe erythroblastosis,fetal hydrops, DM, severe fetal CHF

Two vessel cord

one umbilical artery absent, associated with congenital heart & kidney anomalies.

unusual cord length

Short - premature separation of placenta/uterine inversion

Long - 80 cm tendency to twist or knot, thrombi, prolapse

no cord

Achordia

Single artery

major malformations/growth retarded/preterm, incidence increase in DM

Two vessel cord

spontaneous abortion

Four vessel cord

venous remnant

marginal cord insertion

inserted at placental margin(battledore); pulled off during delivery of placenta

velamentous cord insertion

frequent with twins, almost the rule with triplets

false knots

kinking of blood vessel(long cord)

True knots

active fetal movements (monoamniotic twins)

loops of the cord (Nuchal cord)

change in FHR

torsion(Twisted cord/Entwining)

due to fetal movements; causes changes in FHR

Stricture

extreme focal deficiency in Wharton’s jelly, associated with torsion, has role in fetal death

Hematoma

rupture of umbilical vein, with effusion of blood into the cord

true cysts

small, derived from remnants of umbilical vessel

False cysts

from liquefaction of Wharton’s jelly