Placental Problems

Weight 500 Grams 1/6 of fetus

Diameter 15-20 cm

Thickness 1.5 - 3 cm

The normal Placenta

Syphilis

Erythroblastosis

half

In certain disease ( __________________ or _________________) the weight of the placenta is _______ the weight of the fetus

placenta with one more Accessory Lobe connected to the main placenta by blood vessel

Placenta Succenturiata

Placenta Succenturiata

• small lobes may be Retained in the uterus ( Severe Maternal hemorrhage)

No fetal abnormality is associated with this type ?

• but important to recognized because?

succenturiate lobe

placental disc

Leash of blood vessels running through the membranes connecting ____________ to main _________

• placenta appears Torn at the edge or Torn Blood vessels extend beyond the edge of placenta

Inspection in Placenta Succenturiata

Placenta Succenturiata

• manually

• no adverse maternal effects

__________: Remaining lobes must be recognized and removed from the uterus________ the uterus will contract as usual with______________

fetal side of the placenta is covered to some extent with chorion

Placenta Circumvallata

• umbilical cord enters the placenta at usual midpoint

• Large vessels spread out from there but end abruptly at the point where the Chorion fold backs onto the surface

Inspection in Placenta Circumvallata

the ring is formed at the margin of the Chorionic plate, and the fetal vessels appear to Terminate

Placenta Marginata

Placenta marginata

the ring is formed at the margin of the Chorionic plate, and the fetal vessels appear to Terminate

the cord is inserted marginally rather than Centrally

Battledore placenta

battledore placenta

• Rare

• no clinical significance

the cord instead of entering the placenta directly, separates into small vessels that reach the placenta by spreading across a fold of Amnion

Velamentous Insertion of the cord

multiple gestation

Velamentous Insertion of the cord

• most frequently found in ?

Fetal anomalies

• fetal blood supply may not be adequate

Velamentous insertion of the cord is highly associated with?

Velamentous Insertion of the Cord

The cord that instead of entering the placenta directly,

separates into small vessels that reach the placenta by spreading across a fold of amnion

• Most frequently found in

  multiple gestation

  ▪ Associated with fetal anomalies

  (fetal blood supply may mot be

  adequate)

• the cord of velamentous cord insertion Cross the Cervical OS

• it is delivered before the fetus

• vessels may tear with Cervical dilatation

Vasa Previa

Vasa previa

It is delivered before the fetus

Vasa previa

Vessels may tear with cervical dilatation

• placenta previa

• vasa previa

If sudden painless bleeding occurs at the beginning of

cervical dilatation, eithe________or ________-

fibrinous layer separates the placenta from uterine wall

Placental Implantation

• NORMAL

Fibrinous layer (stratum basalis of the endometrium)

what separates the placenta from uterine wall

79% of abnormally implanted placentas

Chorionic Villi attach to uterine myometrium

Placenta Accreta

Uterine myometrium

in Placenta accreta where is the Chorionic villi attached?

14% of abnormally implanted placenta

chorionic villi invade the uterine myometrium

Placenta Increta

7% abnormally implanted placenta

chorionic villi invades uterine myometrium and Serosa

• may also invade adjacent organs (bladder)

Placenta Percreta

• hysterectomy

• methotrexate to destroy still attached tissue

Management for Abnormally Implanted Placenta

Methotrexate Pl

Destroys still attached tissue

• Succenturiate Lobe

• Circumvallate

• Circummarginate

• Bilobed

• battledore / marginal insertion

Placenta Variations

congenital heart and kidney anomalies

Absence of one umbilical artery is associated with ________ and______

one umbilical artery

Absence of __________ is associated with congenital heart and kidney anomalies

Single umbilical artery

term for absent umbilical artery

50-60 cm averagely 55

Normal cord length

<35, may lead to

• fetal distress

• placental abruption

• prolonged labour

Short cord

>80 cm may lead to

• Cord around the neck

• cord around the body

• cord knot

• cord prolapse

• cord compression

Long cord