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DMST 244 Obstetrics and Gyn Sonography 1 > Module 9: 2nd and 3rd trimester normal anatomy: placenta and cord > Flashcards

Module 9: 2nd and 3rd trimester normal anatomy: placenta and cord Flashcards

1
Q

What is the placenta classified as an organ that does that? 5

A
  1. Provides nutrients to the fetus
  2. Transfer of oxygen
  3. Removal of fetal waste
  4. Temperature regulation
  5. Excretion of hormones (hCG)
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2
Q

What is some of the waste removed by the placenta? 3

A
  1. Urea
  2. Uric acid
  3. Bilirubin
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3
Q

By 12 weeks gestation how many distinct components of the placenta is recognizable? 2

A

Two
1. Fetal portion: chorion frondosum
2. Maternal portion: decidua basalis

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4
Q

The fetal and maternal portion of the placenta are held together how?

A

By anchoring of stem villi at the cytotrophoblast shell

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5
Q

From top to bottom what does the red arrows point to?

A
  1. Chorion frondosum
  2. Decidua basilis
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6
Q

What does the syncytiotrophoblast do?

A

Create the large intervillous space in the decidua basalis (lacune)

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7
Q

The remaining portions of the decidua basalis are called what?

A

Placental septa.

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8
Q

The placental septa are divided into what?

A

Compartments called Cotyledon

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9
Q

What is the functional unit of the placenta?

A

Cotyledon

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10
Q

Each cotyledon consists of what?

A

Several stem villi

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11
Q

There are how many cotyledons in a placenta?

A

about 20

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12
Q

What does the red arrow point to?

A

Placenta septa

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13
Q

What is the maternal circulation like?

A

Spiral arterioles shoot blood around the chorionic villi

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14
Q

What is fetal circulation like?

A

From umbilical arteries to chorionic villi back to umbilical veins to baby

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15
Q

What does this image show?

A

Left goes towards baby and the right goes towards mom

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16
Q

What is the functions of the placenta? 6

A
  1. Respiration
  2. Nutrition
  3. Excretion
  4. Protection
  5. Storage
  6. Hormonal production
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17
Q

What is the respiration function of the placenta? 3

A
  1. Oxygen in the maternal blood diffuses across the placental membrane into the fetal blood by simple diffusion
  2. CO2 dioxide also passes readily in the opposite direction
  3. The placenta, therefore acts as a the lungs of the fetus
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18
Q

What kind of nutrients from the material blood makes it through the membrane into the fetus? 6

A

Nutrients from maternal blood through the placental membrane into the fetal blood such as,
1. Water
2. inorganic salts
3. Carbs
4. Fats
5. Proteins
6. Vitamins

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19
Q

How does excretion functions of the placenta work? Where is waste excreted?

A
  1. waste products cross the placental membrane from the fetal blood and enter the maternal blood
  2. They are excreted by the mother’s kidneys
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20
Q

How does the placenta protect the baby? Is there blood mixture between mom and baby?

A
  1. Most microorganisms do not cross the placental membrane
  2. There is no appreciable mixture of maternal and fetal blood
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21
Q

The placental membrane is sometimes referred to as what, however they don’t protect against what? 2

A

Placental barrier but it does not protect the fetus from many damaging agents such as
1. Drugs, poisons, carbon monoxides
2. Certain viruses (Rebella)

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22
Q

Once in a fetus, substances can cause what? What are these known as?

A

Congenital malformations, these are known as teratogens

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23
Q

What is the storage function of the placenta? What is stored? 5

A

Nutrients are stored in the placenta and area released into fetal circulation as required. Some things stored are:
1. Carbs
2. Proteins
3. Calcium
4. Iron

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24
Q

Where are hormones produced in the placenta? What is produced? 5

A

Production of the following hormones by the syncytiotrophoblasts
1. HCG
2. Estrogen
3. Progesterone
4. Human chorionic somatomammotropin (HPL human placental lactogen)

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25
Q

What is the sonographic appearance of the placenta around 10-12 weeks? What is present along the basal plate and in the septa?

A
  1. Diffuse granular echo pattern, apparent as early as 10-12 weeks (texture is produced by the echoes from the villi)
  2. Draining veins are present along the entire basal plate and in the septa
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26
Q

In terms of the sonographic appearance, the basic texture does not change with gestational age except for what?

A

The deposition of calcium

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27
Q

Placental calcifications are present in what amount? And when?

A

> 50% of placentas after 33 weeks

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28
Q

Calcium deposits are found primarily where? Where might they be found?

A
  1. The basal plate and septa
  2. May be seen in the subchorionic and perivillous space
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29
Q

Amount of calcification is increased in patients with what? 3

A
  1. IUGR
  2. Hypertension
  3. Smoking
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30
Q

What does this image demonstrate?

A

The early sonographic appearance of the placenta

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31
Q

What does this image demonstrate?

A

Normal placenta

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32
Q

What does these images demonstrate?

A

Maternal Lakes

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33
Q

When grading the placenta what is grade 0?

A

Homogenous, chorionic plate is straight

34
Q

What is a grade 1 placenta

A

Scattered echogenic areas, subtle undulations

35
Q

What is a grade 2 placenta?

A

Indentations, linear echogenic areas

36
Q

What is a grade three placenta?

A

Indentations to the basal layers, cystic areas, shadowing calcifications (after 36 weeks)

37
Q

what does this image demonstrate?

A

Grade 0 Placenta

38
Q

what does this image demonstrate?

A

Chorionic plate is smooth

39
Q

What does this image demonstrate?

A

Grade 1 Placenta: subtle chorionic plate indentations

40
Q

What does this image demonstrate?

A

Grade 1 random echogenic areas

41
Q

What does this image demonstrate?

A

Grade 1 (almost 2) placenta

42
Q

What does this image demonstrate?

A

Grade 2 indentations, linear echogenic areas

43
Q

What does this image demonstrate?

A

Grade 2 (almost 3) placenta

44
Q

What does this image demonstrate?

A

Grade 3: indentations to basal layer

45
Q

What does this image demonstrate?

A

Indentations to basal layer

46
Q

What is the size and the shape of the placenta? How heavy is it? How thick is it?

A
  1. Flat and circular
  2. 500-600 grams
  3. thickness is around 1.5-4cm
47
Q

The placenta grows how much a week?

A

1mm a week

48
Q

What do we not include in the placenta?

A

Myometrium or retroplacental complex

49
Q

What is placentamegaly?

A

When the placenta that is >4cm in thickenss

50
Q

What causes placentamegaly? 7

A
  1. Maternal diabetes
  2. Maternal Anemia
  3. Hydrops
  4. Placental hemorrhage
  5. Intrauterine infection
  6. Partial mole
  7. Chromosomal abnormalities
51
Q

What is a thin placenta?

A

<1.5cm in thickness

52
Q

What causes thin placentas? 2

A
  1. Vascular deficiencies or infarctions
  2. Pre-eclampsia - BP increase
53
Q

What might thin placenta result in? ( In terms of the fetus)

A

IUGR or small baby

54
Q

What are symptoms of pre-eclampsia? 3

A
  1. Hypertension
  2. Proteinuria
  3. Edema
55
Q

What does the umbilical cord form a connecting stalk with?

A

Yolk Sac

56
Q

What vessels does the umbilical cord contain?

A

2 arteries and 1 vein

57
Q

what is the vessels in the umbilical surrounded by?

A

Wharton jelly

58
Q

What is the umbilical covered in?

A

Amnion

59
Q

How long is the amnion?

A

50-100cm long

60
Q

Where should the umbilical cord insert into?

A

Center of placenta

61
Q

The umbilical vein travels in which direction? ( Cephalic or caudal)

A

Travels cephalad to the portal sinus in the fetus

62
Q

Umbilical arteries travel how? ( Caudal or cephalic) What do they eventually become?

A

Caudad to become the hypogastric arteries around fetal bladder?

63
Q

What is being measured here?

A

A fibroid

64
Q

What is a single umbilical artery anomaly called? How often is this finding? What is indicated if we see this?

A
  1. Two vessel cord
  2. Often an isolated finding and very common
  3. Feal echo is indicated
65
Q

What can single umbilical artery associated with? 2

A
  1. Cardiac and renal anomalies
  2. Chromosome abnormalities
66
Q

What does this image point towards?

A

Single umbilical artery

67
Q

What is a uncommon cord anomaly?

A

Cord syst which is a allantoic remnant

68
Q

What are some cord anomalies? 5

A
  1. Cord cyst
  2. Omphalocele
  3. Cord prolapse
  4. Hematoma
  5. Umbilical vein thrombosis
69
Q

What is this an image of?

A

Two umbilical arteries

70
Q

What does this image demonstrate?

A

Single umbilical artery and how it travels

71
Q

What does the red arrow point to?

A

Cord cyst

72
Q

What does this image demonstrate?

A

Omphalocele

73
Q

What does this image demonstrate?

A

Cord prolapse

74
Q

What causes a hematoma in the umbilical cord, and what is the risk? 2

A
  1. Caused by trauma or wall weakness
  2. High risk of perinatal death
75
Q

What is umbilical vein thrombus? How can this develop? What is the risk level of this?

A
  1. Occlusion of vein secondary to increased resistance or stasis
  2. Can develop due to umbilical vein varix or blockage
  3. High risk of perinatal death
76
Q

What is umbilical vein varix?

A

Intra-abdominal focal enlargement of the umbilical vein

77
Q

What may occur during umbilical vein varix? and what might it be associated with?

A
  1. Stasis may occur here and blood may clot
  2. Associated with a higher incidence of adverse outcomes
78
Q

What does this image demonstrate?

A

Umbilical vein varix

79
Q

What does this image demonstrate?

A

Umbilical vein varix

80
Q

What does these images demonstrate?

A

Umbilical vein varix

DMST 244 Obstetrics and Gyn Sonography 1 (22 decks)

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