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Block I: Reproduction & Sexuality > Clinical: Placental Insufficiency > Flashcards

Clinical: Placental Insufficiency Flashcards

1
Q

Size of mature placenta

A
  • 20 cm diameter
  • 2-3 cm thick
  • Weight 1/7th of fetus
  • Villi surface area 11-14 m2
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2
Q

Describe the shape of the mature placenta

A

Discoid (chorionic plate = decidual plate)

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3
Q

2 components of the fetal surface

A

Amnion and chorion, fetal vessels

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4
Q

2 components of the maternal surface of the mature placenta

A

Lobes/cotyledons and placental septae

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5
Q

4 causes of abnormal placentation

A
  • Maternal hyper-coagulability
  • Incomplete invasion of spiral arteries
  • Hydatidiform mole
  • Choriocarcinoma
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6
Q

4 potential consequences of maternal hyper-coagulability

A
  • Blood clots in the lacunae
  • Poor diffusion
  • Fetal death
  • Miscarriage (often recurrent)
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7
Q

5 potential consequences of incomplete invasion of spiral arteries (leading to abnormal placentation)

A
  • Placental ischemia
  • Production of ischemic/necrotic factors
  • Continued high resistance system
  • Fetal growth retardation
  • Pre-eclampsia
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8
Q

3 ischemic/necrotic factors produced due to incomplete invasion of spiral arteries

A
  • Soluble fms-related tyrosine kinase 1
  • Soluble endoglin
  • Decreased PIGF
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9
Q

7 potential consequences of pre-eclampsia

A
  • HTN
  • Proteinuria
  • Edema
  • Fetal growth retardation
  • Cerebral edema – fitting/seizures
  • Still-birth
  • Maternal death
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10
Q

How to diagnose defective placentation

A

Uterine artery Doppler waveforms

  • High resistance to maternal circulation characterized by notching
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11
Q

Define intra-uterine growth retardation/restriction (IUGR)

A
  • Fetal growth failing (arising from maternal, placental, or fetal origins)
  • Birth weight lower than expected in the suitable gestational week
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12
Q

Dynamic definition of IUGR

A

Delay of the growth of the fetus estimated as a decrease of 25 centiles in the measure of the abdominal circumference, according to the standard curve at the gestational age, and in subsequent echographic evaluations performed at least every 2 weeks

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13
Q

2 classes of IUGR

A

Asymmetrical

Symmetrical

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14
Q

Define asymmetrical IUGR

A

Late onset (around 30 weeks) where abdominal growth is more affectedthan head circumference

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15
Q

Define symmetrical IUGR

A

Early onset (beginning of second trimester) where there is proportional lagging of the head circumference, abdominal circumference, and long bone growth

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16
Q

3 fetal risk factors for IUGR

A
  • Chromosomal abnormalities
  • Structural malformations (especially cardiac malformations)
  • Fetal infections
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17
Q

3 chromosomal abnormalities that have a risk for IUGR

A
  • Triploidy
  • Trisomy 13 and 18
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18
Q

4 fetal infections that have a risk for IUGR

A
  • TORCH
  • Parvovirus B19
  • Syphilis
  • Listeriosis
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19
Q

5 placental risk factors for IUGR

A
  • Abnormalities of the placentation
  • Acute atherosis
  • Obliteration of small muscular arteries of the tertiary villi
  • Confined placental mosaicism
  • Chorioangioma
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20
Q

Abnormality of the placentation that may cause IUGR

A

Reduction of number of thin-walled, distended uteroplacental vessels

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21
Q

10 maternal risk factors for IUGR

A
  • Low socioeconomic status
  • Chronic maternal under nutrition
  • Malnutrition (anorexia nervosa, bulimia)
  • CVD (cardiac failures, HTN, pre-eclampsia)
  • Gestroenteric diseases (chronic enteritis, malabsorption)
  • Pulmonary diseasees (CF, asthma, resp failure)
  • Renal diseases
  • Anemia
  • Alcohol and drug abuse, smoking
  • Uterine abnormalities (fibroids, uterine malformations)
22
Q

Approx 25% of women with unilateral persistant notch and 50% of those with bilateral notch on doppler exam of uterine arteries will have what 2 conditions?

A
  • IUGR fetus
  • Develop pre-eclampsia
  • Experience both
23
Q

Doppler exam findings on umbilical arteries for fetuses with IUGR

A

Reduced blood flow pattern during diastole

24
Q

5 signs of fetal compromise

A
  • Gradually increasing resistance to blood flow in umbilical arteries
  • End distolic component may disappear or may reverse
  • Redistribution of blood flow occurs
  • Brain, heart and adrenal glands preferentially perfused
  • MCA blood flow increases
25
Q

Define brain sparing

A

Cerebroplacental ratio is below 2SD prior to abnormal CTG recordings about a couple days to 2 weeks

26
Q

Condition that brain sparing phenomenon is assocaited with

A

Fetal hypoxia

NOTE: When resistance in MCA begins to rise, cerebral edema occurs

27
Q

7 tests of placental function

A
  • Maternal weight
  • Uterine growth - fundal height
  • Fetal body movements
  • Fetal growth (US)
  • Fetal activity (biophysical profile, non-stress test)
  • Color doppler studies
  • Placental biochemical tests
28
Q

Most important indication of placental function

A

Fetal well-being (i.e. “kick count” or how long it takes for the fetus to move 10 times)

29
Q

2 methods of assessing fetal activity

A
  • Non-stress test (Cardiotocography)
  • Biophysical profile
30
Q

Describe the non-stress test

A

Continuous record of FHR over a period of 30 min or more. Includes recording of changes in FHR variability (from beat to beat) in association with fetal movements and uterine contractions

31
Q

Describe the biophysical profile

A

A score based on real time ultrasound observation of fetal breathing, gross body movements, tone and amniotic fluid volume

32
Q

Define hydatidiform mole

A

Benign trophoblastic disease with overactive trophoblast/reduced resistance.

Accumulation in villi before circulation –> distension/swelling –> fetus dies and is resorbed

33
Q

Define still birth

A

Dead fetuses or newborns weighing >500 gm or >20 weeks gestation

34
Q

4 signs of still birth

A
  • Absence of uterine growth
  • Loss of fetal movement
  • Absence of fetal heart
  • Disappearance of the signs & symptoms of pregnancy
35
Q

2 x-ray findings of still birth/IUFD

A
  • Spalding’s sign
  • Robert’s sign
36
Q

4 fetal causes of still birth (IUFD) (25 - 40%)

A
  • Chromosomal anomalies
  • Birth defects
  • Non-immune hydrops
  • Infections
37
Q

7 placental causes of IUFD (still birth) (25 - 35%)

A
  • Abruption
  • Cord accidents
  • Placental insufficiency
  • Intrapartum asphyxia
  • Placental previa
  • Twin to twin transfusion S
  • Chorioamnionitis
38
Q

14 maternal causes of IUFD (still birth) (5 - 10%)

A
  • Antiphospholipid antibody
  • DM
  • HPT
  • Trauma
  • Abnormal labor
  • Sepsis
  • Acidosis/Hypoxia
  • Uterine rupture
  • Postterm pregnancy
  • Drugs
  • Thrombophilia
  • Cyanotic heart disease
  • Epilepsy
  • Severe anemia
39
Q

6 potential aspects of family history for still birth (IUFD)

A
  • Recurrent abortions
  • VTE/PE
  • Congenital anomalies
  • Abnormal karyotype
  • Hereditary conditions
  • Developmental delay
40
Q

10 maternal medical conditions that may be found in a history for IUFD (still birth)

A
  • VTE/PE
  • DM
  • HPT
  • Thrombophilia
  • SLE
  • Autoimmune disease
  • Severe anemia
  • Epilepsy
  • Consanguinity
  • Heart disease
41
Q

6 potential findings of past OB history for IUFD (still birth)

A
  • Baby with congenital anomaly/hereditary condition
  • IUGR
  • Gestational HPT with adverse sequelae
  • Placental abruption
  • IUFD
  • Recurrent abortion
42
Q

9 potential findings of current pregnancy when taking history for IUFD (still birth)

A
  • Maternal age
  • Gestational age at fetal death
  • HPT
  • DM/gestational D
  • Smoking, alcohol, or drug abuse
  • Abdominal trauma
  • Cholestasis
  • Placanetal abruption
  • PROM or prelabor SROM
43
Q

8 potential placental/cord complications when taking history for IUFD (still birth)

A
  • Large or small placenta
  • Hematoma
  • Edema
  • Large infarcts
  • Abnormalities in structure, length or insertion of the umbilical cord
  • Cord prolapse
  • Cord knots
  • Placental tumors
44
Q

6 placental investigatoins in event of IUFD

A
  • Chorionocity of placenta in twins
  • Cord thrombosis or knots
  • Infarcts, thrombosis, abruption
  • Vascular malformations
  • Signs of infectoin
  • Bacterial culture for E coli, Listeria, gp B strep
45
Q

7 places specimen for karyotype fetal investigation can be taken

A
  • Cord blood
  • Intracardiac blood
  • Body fluid
  • Skin
  • Spleen
  • Placental wedge
  • Amniotic fluid
46
Q

Complication of IUFD

A

Hypofibrinogenemia

47
Q

3 abnormal placental invasions

A
  • Placenta accreta
  • Placenta increta
  • Placenta percreta
48
Q

Define placenta accreta

A

Chorionic villi attach to the myometrial cells

49
Q

Define placenta increta

A

Placenta penetrates the myometrium

50
Q

Define placenta percreta

A

Placenta penetrates through the serosal surface

51
Q

3 cancers that may cause placental metastases, although very rare (immunoprotective effect)

A
  • Malignant melanoma
  • Breast cancer
  • Leukemias

Block I: Reproduction & Sexuality (23 decks)

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