Beruflich Dokumente
Kultur Dokumente
PLACENTAL DISORDERS
I. Diseases and Abnormalities of the Fetal
Membranes
1. Diseases of the Chorioamnion
2. Disorders of Amniotic Fluid Volume
Abnormalities of Placentation
Circulatory Disturbances
Abnormalities of the Umbilical Cord (Funis)
Gestational Trophoblastic Diseases
Other Tumours of the Placenta
PLACENTAL DISORDERS
Diseases and Abnormalities of the Fetal
Membranes
Diseases of the Chorioamnion
Meconium Staining
Chorioamniotis
Amnionitic Cysts
Amnion Nodosum
Amnionic Bands
< 38 weeks
> 40 weeks
Amnion disruption
bands/string
formation adhere to the fetus and impaire
growth and development
PLACENTAL DISORDERS
Diseases and abnormalities of the fetal
membranes
Disorders of amnionic fluid volume
Oligohydramnios
< 500 ml
Hydramnios, polyhydramnios > 2000 ml
Chronic
Acute
Measurement of Amnionic Fluid
Phelan and Colleagues (1987) :
Amnionic Fluid Index (Ultrasonic Method)
Adding the vertical depths of the longest pocket in
each of four equal uterine quadrant
Hydramnios : > 24 cm
Inaccurate to diagnosis oligohydramnios
Placenta
(g)
Fluid
16
100
100
200
50
28
1000
200
1000
45
36
2500
400
900
24
40
3300
500
800
17
Hydramnios
Causes :
Associated to fetal malformation
- CNS i.e anencephaly, spina bifida
- GIT i.e esophageal atresia
- Perinatal mortality increase
Pathogenesis
- Increase of amnionic fluid production
- Disturbance of volume control mechanism
Hydramnios
Symptoms
Diagnosis
Hydramnios
Prognosis
Higher perinatal mortality rate :
fetal malformation, preterm labor,
cord prolapse erythroblastosis
Hydramnios
Management
Minor degrees rarely require treatment
Moderate degrees with dyspnea,
abdominal pain, ambulation difficulty need
hospitalization
- amniocentesis
- amniotomy
- indomethacin therapy :
1.5 to 3 mg/kg per day
Oligohydramnios
Marks and Divon (1992) : Amnionic fluid index < 5
cm
Risk of cord compression
fetal distress
Early onset oligohydramnios
- Associated to obstruction of fetal urinary tract
or renal agenesis
anuria
- Chronic leak from a defect in the membranes
- Fetal prognosis is poor
- Pulmonary hypoplasia :
- thoracic compression
- lack of fetal breathing movements
- failure to retain amnionic fluid or increased
Oligohydramnios
Amnio infusion
PLACENTAL DISORDERS
Diseases and abnormalities of the placenta
Abnormalities of placentation
PLACENTA BIPARTITA
OR BILOBED
PLACENTA
ACCESORIES
PLACENTA
TRIPLE PLACENTA
EXTRACHORIAL PLACENTA
Circumvalate placenta
EXTRACHORIAL PLACENTA
Circummarginate placenta
CORD INSERTION
Velamoentous insertion
PLACENTAL DISORDERS
Diseases and abnormalities of the placenta
Circulatory disturbances
Placental infarcts
Placental calcification
Villous (fetal) artery thrombosis
Clinical significance
Hypertrophic lesions of the chorionic villi
Microscopic placental abnormalities
Placental inflamation
PLACENTA INFARCTS
PLACENTAL INFARCTS
Red Brown Infarcts
PLACENTAL DISORDERS
Diseases and abnormalities of the placenta
Abnormalities of the umbilical cord (funis)
Cord length
Absence of one umbilical artery
congenital anomalies
Cord coiling
Four-vessel cord
Cord insertion : - marginal insertion
- velamentous insertion
- vasa previa
PLACENTAL DISORDERS
Diseases and abnormalities of the placenta
Abnormalities of the umbilical cord (funis)
FALSE KNOT
TRUE KNOT
PLACENTAL DISORDERS
Diseases and abnormalities of the placenta
Gestational trophoblastic diseases
Other tumours of the placenta
- Chorioangioma (Hemangioma)
- Tumor metastatic to the placenta