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OBS > Placenta > Flashcards

Placenta Flashcards

1
Q

Human placenta is .?

A

Discoid - Disc Shaped
Deciduate - Sheds off after Delivery
Hemochorial - Lies in contact with Maternal Blood

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2
Q

Deciduate -?

A

Sheds off after Delivery

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3
Q

Hemochorial ?

A

Lies in contact with Maternal Blood.

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4
Q

Weight of placenta at term.?

A

500 gms

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5
Q

Wgt of placenta = Weight of Fetus at what week.?

A

17 wks

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6
Q

Hofbauer cell..? where .?

A

Placenta.

Zika Virus can Affect this.

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7
Q

PEG cells .. Where.?

A

FT.

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8
Q

Langerhan Cells.. Where.?

A

Cytotrophoblast.

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9
Q

Nitabuch Layer.. Where.?

A

Btw Chorion and Decidua.

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10
Q

Primary Villi.?
Secondary Villi.?
Tertiary Villi.?

A

Trophoblastic Shell .
Mesodermal Core.
Vascular.

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11
Q

Placental membrane barrier..

From Outside to inside.

A

Syncytiotrophoblast-Trophoblast-Extraembryonic Mesoderm- Fetal Capillary Endothelium

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12
Q

Uteroplacental Blood Flow at term.?

A

500-750 ml / min

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13
Q

Uterine Blood Flow at term.?

A

750 ml / min

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14
Q

Fetal Blood flow at term.?

A

125ml / kg

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15
Q

Rate of Oxygen Delivery at birth.?

A

8ml /kg/min

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16
Q

Fetoplacental Blood flow at term.?

A

400ml/min

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17
Q

Which vessel carries oxygenated blood to Fetus.?

A

Umbilical Vein

O2 saturation- 70-80%

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18
Q

Remnant of Umbilical vein.

A

Ligamentum Teres

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19
Q

Remnant of Umbilical Artery

A

Medial umbilical ligament.

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20
Q

Lateral umbilical Ligament is a remnant of .?

A

Inferior epigastric artery

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21
Q

Urachus forms.?

A

Median Umbilical Ligament.

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22
Q

Functional unit of Placenta.?

A

Cotyledons.

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23
Q

USG for Localization of placenta is done in.?

A

Third trimester.

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24
Q

Placentomegaly..

A

Thickness above 4 cms.

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25
Q

Thickness of placenta at term.?

A

2.5 cms.

at 40 wks = 4 cms.

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26
Q

Maternal Causes of Placentomegaly.

A

Diabetes
Severe Anemia
Alpha Thalasemia

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27
Q

Fetal Causes of Placentomegaly.

A

Hydrops Fetalis.
Infections like Syphilis and Torch.
Triploidy.

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28
Q

Battledore Placenta.

A

Cord attached to the edge or Margin of Placenta or Marginal Insertion of the Cord.
Normally attached to the middle.

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29
Q

Extrachorial Placenta.

A

Maternal Side bigger than Fetal Side
Forms Ring.
Can lead to IUGR or APH

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30
Q

Types Of ExtraChorial Placenta.?

A

Circumvallate - Valve Like Thickening.

Circummarginate - Smooth.

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31
Q

Succenturiate Placenta.

A

Two unequal lobes connected by Blood vessels.

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32
Q

Placenta Spuria.

A

Two unequal Lobes no connecting blood vessels.

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33
Q

Placenta Bilobata.

A

Two Equal Lobes With Blood Vessels connecting them.

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34
Q

Placenta Bipartite

A

Bilobata.

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35
Q

Placenta Duplex

A

Bilobata.

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36
Q

Mx of Succenturiate or spuria or bilobata.

A

Curettage.

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37
Q

Complication of Succenturiate or spuria or bilobata.

A

Secondary PPH.

After 24 hrs within 12 weeks post delivery.

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38
Q

MCC of Asherman Syndrome.

A

Curettage.

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39
Q

Fenestrated Placenta.

A

Central portion of Discoidal Placenta is missing.

Missing Chorionic plate and villi.

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40
Q

Placenta Membranacea.

A

Thin placenta where all fetal membrane is covered by villi.

Leads to serious hemorrhage due to Placenta Previa or accreta..

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41
Q

Morbidly Adherent placenta.

A

Absent nitabuch’s layer.

Deep penetration of blastocyst.

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42
Q

Types of Morbidly Adherent Placenta.

A

P. Accreta.
P. Increta.
P. Percreta.

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43
Q

P. Accreta.

A

Superficially Attached to Myometrium.

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44
Q

P. Increta.

A

Deep Inside Myometrium.

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45
Q

P. Percreta.

A

Chorionic Villi Attached to Serosa.

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46
Q

Pathogenesis of Morbidly Adherent Placenta.

A

Absent nitabuch’s layer and Decidua Basalis.

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47
Q

Clinical Presentation of Refractory PPH - Suspect

A

Think Morbidly adherent placentas.

48
Q

Risk Factor for Morbidly adherent placenta.

A

Placenta previa.
Previous LSCS.
H/O Curettage or uterine surgery.

49
Q

IOC for diagnosing Morbidly Adherent Placenta.

A

USG

50
Q

USG finding for Morbidly Adherent placenta.

A

Absence of Subplacental Shadow which represents D. Basalis.
Heterogeneous appearance of placenta.
Placental Lakes.

51
Q

Gold Standard for Morbidly Adherent Placenta.

A

MRI.

52
Q

Mx of Morbidly Adherent Placenta.

A

Elective CS + Hysterectomy.
But upper segment CS .
Do Hysterectomy to avoid Refractory PPH. if Pt refuses clear as much placenta as possible and give MTX to prevent Gestational Trophoblastic neoplasia.

53
Q

Hormones produced by Placenta

A

Progesterone - from 8 wks
Estrogen.
HCG
HPL- Human Placental Lactogen.

54
Q

Luteal Placental Shift.

A

Functional shift from Luteum to Placenta.

55
Q

Lifespan of Corpus Luteum

A

10-12 wks

56
Q

Precursor of Progestrone.

A

Maternal LDL and Cholestrol.

57
Q

Decidual reaction.

A

Glands become Hypersecretory and stroma becomes edematous and rich in glycogen.

58
Q

Arias- Stella Reaction.

A

Glands become hypersecretory and there are changes in nucleus.

59
Q

Arias Stella Reaction is seen in

A

Intrauterine, Molar, and Ectopic Pregnancy.

60
Q

Enzyme required for Estrogen Synthesis.

A

17-OH-Hydroxylase.

Req for Conversion of 17-OH progesterone to Androstenedione. A c21 steroid req for estrogen synthesis

61
Q

Estrogen in Pregnancy.

A

Fetal ACTH converts DHEA-S to E2 by Sulphatase and Aromatase.

62
Q

Most Common Estrogen in pregnancy

A

E2

63
Q

Most Specific Estrogen in Pregnancy

A

E3

64
Q

role of E in Pregnancy

A

At term causes uterine contraction.

65
Q

Inc E is seen in

A

Conditions with Inc Placental Tissue.

Erythroblastosis Fetalis`

66
Q

Dec E is seen in

A

Absent or Hypoplastic Adrenal glands - Anencephaly
Deficiency of Aromatase and Sulphatase.
Down’s Syndrome - Low levels of C19 steroids.

67
Q

C-19 Steroid

A

DHEA-S and Androstenedione.

68
Q

C-21 Steroid

A

17-OH Progesterone

69
Q

Main Site of HCG prod.

A

Syncytiotrophoblast.

70
Q

Hormone with Max glycogen Content.

A

HCG

71
Q

Hormones with alpha and beta subunits

A

HCG, LH, FSH and TSH.

72
Q

HCG is Structurally similar to

A

LH, FSH and TSH.

73
Q

HCG is Functionally similar to

A

LH

74
Q

Low levels of E can lead to

A

Post term pregnancy due to Inability to start contractions.

75
Q

When is HCG detected in blood.

A

8 days after fertilisation

5-6 days before period.

76
Q

Most sensitive test to detect HSG

A

FIA > RIA

77
Q

Level of HCG.

1) Early preg.
2) Max at.
3) Min at

A

1) Nearly Doubles every 48 hrs.
2) Max at 10 wks. 50k-10*5 IU
3) Min at 16 wks.

78
Q

T half of HCG

A

36 Hrs.

79
Q

HCG becomes normal.?

A

2 wks after delivery.

4 wks after abortion.

80
Q

Functions of HCG- 3

A

Supports Corpus luteum
Initial stimulus for Prod of Testosterone from leydig cells.
Prevents rejection of Fetus

81
Q

Very High levels of HCG seen in

A

Twin, Molar, Choriocarcinoma, Down’s, Erythroblastosis fetalis.

82
Q

Dec Levels of HCG is seen in

A

Ectopic, All trisomies expt down’s, Abortion.

83
Q

UPT.

A

Sandwich elisa test.

min detection level 20 IU/L

84
Q

Critical Titre of HCG

A

Value which confirms Intrauterine Pregnancy with a visible gestational sac.
TVS- 1500 IU/L
TAS- >5000 IU/L

85
Q

HPL aka

A

Human Chorionic somatotropin.

86
Q

Marker for checking Placental functioning

A

HPL or HCS

87
Q

Max HPL at

A

36 wks.

88
Q

Hormone that is produced max at term is

A

HPL at 1g/dl

89
Q

t half of LH

A

2 hrs

90
Q

t half of HPL

A

30 mins

91
Q

Hormone that brings about insulin resistance in mother

A

HPL

92
Q

Functions of HPL

A

1) Lipolysis in mother- inc FA- Which provides energy for mother and glucose sparing for fetus.
2) Insulin resistance in mother.

93
Q

Hormone not responsible for insulin resistance in mothers

A

HCG

94
Q

4 layers of Fetal membrane

A

Chorion
Amnion
Yolk Sac
Allantois.

95
Q

Fetal membrane layer with most tensile strength

A

Amnion

96
Q

Avascular fetal membrane layer

A

Amnion

97
Q

Site for hematopoeisis

A

Yolk Sac

98
Q

Allantois.

A

Diverticulum derived from hind gut and grows in connecting stalk.

99
Q

PG Prevalent in Fetal membranes -

A

PGE2 -

100
Q

PGE2 function at labour

A

Accelerates labour.

101
Q

Umbilical cord is derived from.

A

Connecting Stalk.

102
Q

Short cord.

A

< 30 cms

103
Q

Connective tissue of cord

A

Wharton’s jelly

104
Q

Coils of cord is called as

A

Folds of Hobokon

105
Q

Which Umbilical vein disappears

A

Right UV

106
Q

MC vascular anomaly of the cord.

A

Single Uterine Artery.

107
Q

Single Uterine Artery indication.

A

MC in diabetic and twins
Significant finding.
inc chances of renal and cvs malformations.

108
Q

Malformations and Single Umbilical artery is seen in

A

Trisomy.

109
Q

Velamentous cord insertion.

A

Cord attaches to fetal membrane before insertion into placenta.

110
Q

Vasa Previa.

A

Rupture of blood vessels leading to fetal blood loss.`

111
Q

How to diff btw vasa and placenta previa.

A

Singers Alkali Denaturation test.

112
Q

HbF and HbA which is resistant to alkali and acid.

A

HbF resistant to Acid.

HbA sensitive to Acid.

113
Q

Reagent in APT test.

A

NaOH or KOH.

114
Q

Mx of Vasa Previa.

A

LSCS.

115
Q

Hyrtil’s anastomosis.

A

Connection of 2 umbilical artery before insertion into cord.

OBS (13 decks)

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