Beruflich Dokumente
Kultur Dokumente
470gms
22cm
2.5cm
Composed of:
1. Placental disc
2. Extraplacental membranes
3. 3 vessel umbilical cord(AVA)
Maternal surface
Is the basal plate
SONOGRAPHICALLY
Placenta is homogenous
2-4cm thick
Lies against the myometrium
Indents into the amnionic sac
During sonographic exams,you can
examine:
1. Placental location
2. Relationship to the internal cervical os
3. Umbilical cord is imaged
4. Fetal and placental insertion sites
examined
5. Vessels counted
Retroplacental space
A hypoechoic area that separates the
myometrium form the placentas basal
plate and measures less than 1-2 cm.
ABNORMALITIES of PLACENTA
Placentas may infrequently form as
separate , nearly equally sized disc.
1. Bilobate Placenta
Also known as bipartite placenta/placenta
duplex
Cord inserts between the two placental
lobes- either into
a. connecting chorionic bridge or into
b. intervening membranes
2. Multibilobate
Placenta containing 3 or more equally
sized lobes
Rare
3. Succenturiate lobes
One or more small accessory lobes
May develop in the membranes at a
distance from the main placenta
These lobes have vessels that course
through the membranes
Located on the anterior uterine wall across
the amnionic cavity
Placenta Membranacea
All or nearly all of the membranes are
covered with villi
These placenta may give rise to serious
hemorrhage because of associated
placenta previa or accreta.
Ring shaped Placenta
May be a variant of membranacea
Placenta is annular and a partial or
complete ring of placental tissue is
present
Associated with greater likelihood of
antepartum and postpartum bleeding and
fetal growth restriction.
Placenta Fenestrata
Central portion of placental disc is missing
There is actual hole in the placenta, but
more often, the defect involves only
villous tissue and the chorionic plate
remains intact.
Erroneously prompt a search for retained
placental cotyledons.
During pregnancy, Normal placenta increases its
thickness at a rate of approximately 1mm per
week and does not exceed 40mm.
Placentomegaly defines those thicker than
40mm and commonly results from striking villous
enlargement.
May result from collections of blood and
fibrin like:
a. Perivillous fibrin deposition
b. Intervillous or subchronic thrombosis
c. Large retroplacental hematomas
Secondary to:
a. Maternal diabetes
b. Severe maternal hernia
c. Fetal hydrops or infection caused by:
1. Syphilis
2. Toxoplasmosis
3. Cytomegalovirus (CMV)
Less common
a. Villi are enlarged and edematous and fetal
parts are present
b. Such as in cases of partial mole/complete
mole
Cystic Vesicles
Seen with placental mesenchymal
dysplasia
Rare condition
Correspond to enlarged stem villi, but
unlike moar pregnancy, there is not
excessive trophoblast proliferation.
ExtraChorial Placentation(EP)
The chorionic plate normally extends to
the periphery of the placenta and has a
diameter similar to that of basal plate.
But with EP, chorionic plate fails to extend
to this periphery and leads to chorionic
plate that is smaller than basal plate.
Most pregnancies with EP have normal
outcome
1. Circummarginate placenta
Fibrin and old hemorrhage lie between the
placenta and the overlying amniochorion
2. Circumvallate placenta
The peripheral chorion is a thickened,
opaque, gray white circular ridge
composed of a double fold of chorion and
amnion.
Sonographically=double fold can be seen
as thick as linear band of echoes
extending from one placental edge to the
other.
On cross section, it appears as SHELF
This is important because its location may
help to differentiate this shelf from
amnionic bands and amnionic sheets.
Associated with increased risk for
antepartum bleeding and preterm birth.
Placenta Accreta,Increta,Percreta
TORRENTIAL HEMORRAGE is a frequent
Complication
Placenta Accrete Syndromes
Abnormally implanted, invasive or
adhered placenta
To grow from adhesion or coaslescence, to
adhere or to become attached to.
Any placental implantation with
abnormally firm adherence to
myometrium because of partial or total
absence of the decidua basalis and
imperfect development of the fibrinoid or
NITABUCH layer.
Potentially cause hemorrhage
Etiopathogenesis
Management
Surgical, anesthesia and blood blanking
Timing of delivery-deliver the baby until
36 weeks or later
Preoperative arterial catheterization
Cesarean delivery and hysterectomy
Circulatory Disturbances
Placenta is a target organ of maternal
disease
Placental perfusion disorders can be grouped
into/
1. Hose in which there is disrupted maternal
blood flow or within the intervillous space
2. Those with disturbed fetal blood flow
through the villi.
1. Subchorionic fibrin deposition
2. Perivillous fibrin deposition
3. Intervillous thrombosis.May be a focal
sonolucensis w/n the placenta.
4. In the absence of maternal or fetal
complications, isolated placental
sonoluceincies are considered incidental
finding.
Maternal blood flow disruption
1. Subchorionic fibrin deposition
Caused by slowing of maternal
blood flow within the intervillous
space with subsequent fibrin
deposition.
Blood stasis specifically occurs in
the subchorionic area
Lesions are commonly seen as
white or yellow firm plaques on
fetal surface.
2. Perivillous fibrin deposition
Stasis around the villous
Results in fibrin deposition and can
lead to diminished villous
oxygenation and
syncytiotrophoblastic necrosis.
These visible small yellow white
placental nodules are considered to
be normal placental aging.
Maternal floor infarction
Extreme variant of perivillous fibrinoid
deposition
Dense fibrinoid layer within the placental
basal plate and is erroneously termed an
infarction.
Intervillous thrombus
Collection of coagulated maternal blood
normally found in the intervillous space
mixed with fetal blood from a break in a
villous,
Round or oval collections vary in size up to
several centimeters
They appear red if recent or white- yellow
if older
Develop at any placental depth.
NOT associated with adverse fetal
sequelae
Can cause elevated maternal serum alpha
fetoprotein levels.
Infarction
Chorionic villi themselves receives oxygen
solely from maternal circulation suplied to
the intervillous space.
Any utroplacental disease that diminishes
or obstructs this supply can result in
infarction of individual villus.
These are common lesions in mature
placentas and are benign in limited
numbers.
If numerous, placental insufficeincy can
develop
When they are thick , centrally located
and randomly distributed.
Associated with:
a. Preecclampsia
b. Lupus anticoagulant
Hematoma
Maternal-placental-fetal unit can develop a
number of hematoma types include:
a. Retroplacental hematoma
b/w placenta and adjacent
decidua
b. marginal hematoma
b/w chorion and decidua at the
placental periphery
kown as subchorionic
hemorrhage
c. subchorial thrombosis
b. Most common:
a. Melanomas
b. Leukemia
c. Lymphomas
d. Breast cancer
c. Tumor cells usually are confined within the
intervillous space.
d. As a result: metastasis to the fetus is
uncommon but is most often seen with
MELANOMA.
ABNORMALITIES of the MEMBRANES
1. Meconium Staining
Fetal passage of meconium before or
during labor is common with cited
incidences that range from 12-20 percent.
2. Chorioamnionitis
Non genital tract flora can colonize and
infect membranes, umbilical cord, fetus.
Bacteria most commonly ascend after
prolonged membranes rupture and during
labor to cause infection
Organisms initially infect the chorion and
infect the chorion and adjacent decidua in
the area overlying the internal os.
Progression leads to full thickness
involvement of the membraneschorioamnionitis.
Inflammation of the chorionic plate and
umbilical cord- funisitis
Fetal infection may result from
hematogenous spread if the mother has
bacteremia
But mote likely from :
a. Aspiration
b. Swallowing
c. Direct contact with infected amnionic
fluid.
Most commonly there is microscopic or
occult chorioamnionitis
In some cases, infection characterized by
membrane clouding accompanied by foul
odor that depends on bacterial species.
Other membrane abnormalities
1. Amnion Nodosum
Characterized by numeous small,
light-tan nodules on the amnion
overlying the chorionic plate.
These may be scraped off the fetal
surface and contain deposits of
fetal squames and fibrin that
reflect prolonged and severe
oligohydramnios.
Amnionic band sequence
An anatomic fetal disruption
sequence caused by bands
of am ion that entrap fetal
Velamentous insertion
Umbilical vessels spread within the
membranes at a distance from the
placental margin surrounded by
fold of amnion
As a result: vessels are vulnerable
to compression leading to fetal
hypoperfusion and academia.
Commonly seen in placenta previa
and multifetal gestations
Fureate insertions
Cord connection onto the placental
disc is central but umbilical vessels
lose their protection.
Prone to compression, twisting, and
thrombosis.
Vasa Previa
Dangerous variation of
velamentous insertion in w/c the
vessels within membranes overlie
the cervical os.
The vessels can be interposed b/w
the cervix and the presenting fetal
part.
Risk factors:
a. Bilobate
b. Succenturiate placentas
c. 2nd tri placenta previa
True knots
Caused by fetal movements
Common and dangerous in monoamnionic
twins
Assoc. with singleton fetuses
False knots
Cord stricture
Focal narrowing of its diameter that
usually develops near the fetal cord
insertion.
Feature: absence of wharton jelly and
stenosis or obliteration of cord vessels at
the narrow segment.
Cord loops
Frequent encountered and are caused by
coiling around various fetal parts during
movement.
Nuchal cord is common.and have mod to
severe variable heart decelerations and
assoc with lower umbilical artery pH.
Cord Hematomas
Uncommon
Assoc with abnormal cord length, vessel
aneurysm, trauma entanglement,
umbilical vessel puncture and funisitis
Complications: rupture or thrombosis,
compression of the umbilical artery, fetal
cardiac failure due to increased preload.