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OBGYN > Placenta and umbilical cord registry review > Flashcards

Placenta and umbilical cord registry review Flashcards

1
Q

Normal placenta

A

-2 to 4cm thick
-Normal function as excretory organ
-Exchange gas and waste with nutrients and oxygen
-Means of nutrition and respiration

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2
Q

Maternal side of placenta

A

Decidua basalis or basal plate. Maternal vessels enter intervillous spaces where the exchanges occur

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3
Q

Fetal side of placenta

A

Chorion frondosum or chorionic plate which contains extensions called chorionic villi

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4
Q

Functional unit of placenta

A

Lobes of chorionic villi termed cotyledons

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5
Q

Bilobed placental variant

A

2 discs of equal size joined together by an isthmus of placental tissue (connects 2 lobes)

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6
Q

Accessory lobe/succenturiate lobe variant

A

Additional small lobe separate from main placental mass but connect by vascular connections
*NO placental tissue connection

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7
Q

Circumvallate variant

A

Curled up placental contour appearing as a shelf. Curled edges, do not lay flat or smooth along wall
-Increased risk of abnormal placental development and future abruption

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8
Q

Venous lakes/maternal lakes/placental lakes/lacunae variant

A

Pools of maternal venous blood. Sonolucent areas within placental mass
-Won’t fill with color
-“Swirling” in B mode

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9
Q

Placental grading

A

Placenta should be age appropriate
-Advance maturation indicates maternal complications leading to insufficiency and asymmetrical IUGR

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10
Q

Grade 0 placenta

A

Homogenous, smooth echotexture. No indentations in chorionic plate, smooth borders
-1st trimester to early 2nd trimester

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11
Q

Grade 1 placenta

A

Subtle indentations in chorionic plate, small random hyperechoic foci
-2nd to early 3rd trimester
*normal for anatomy scan

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12
Q

Grade 2 placenta

A

Large comma-like indentations alter chorionic plate, larger calcifications in basal plate
-Late 3rd trimester

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13
Q

Grade 3 placenta

A

Complete indentations chorionic to basal plate. Irregular calcifications with shadowing. Related to drug abuse and preeclampsia. May cause IUGR in early gestation
-Post dates/advanced

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14
Q

Asymmetrical IUGR

A

Poor placental health. Fetus isn’t getting enough oxygen, nutrients and growth will be affected. Brain will shunt more blood to itself

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15
Q

Dopplers

A

The arteries feeding the placenta may have increased resistance patterns. Includes uterine and umbilical artery

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16
Q

Placenta previa

A

Placenta is implanted within the LUS and covers or is near the internal os
-Increased risk with advanced maternal age, hx of c section, multiparty
-ONLY diagnosed 20 weeks+ due to possible migration
*MOST likely cause of painless vaginal bleeding in 2nd/3rd trimester

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17
Q

May result in false positive placenta previa

A

Overly distended bladder or LUS contraction
*Best to scan with empty bladder or soft touch TV

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18
Q

Complete previa

A

Internal os is completely covered by placental tissue

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19
Q

Marginal previa

A

Edge of placenta touches internal os

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20
Q

Low-lying placenta

A

edge of placenta is within 2cm of internal os

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21
Q

Accreta

A

Abnormal adherence of placenta to myometrium

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22
Q

Increased risk of accreta

A

Hx of multiple c sections and/or uterine surgery
-Scarring causes the disruption of the basal plate, special LUS placental location with a hx of multiple c sections

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23
Q

Sonographic appearance of placenta accreta

A

Loss of basal plate or myometrial/serous layer, multiple placental lacunae, and increased peripheral vascularity

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24
Q

Placenta accreta

A

Adhered to wall
*MOST common

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25
Q

Placenta increta

A

Invades myometrium

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26
Q

Placenta percreta

A

Penetrates through uterus and breach serosal layer

27
Q

Placental abruption

A

Premature separation of placenta from uterine wall
-High risk of fetal death
*CRITICAL FINDING

28
Q

Risk factors of placental abruption

A

Hypertension, preeclampsia, drug/alcohol abuse, smoking, poor maternal health/nutrition

29
Q

Clinical findings of placenta abruption

A

Bleeding, pain, tenderness, trauma, decreased hematocrit

30
Q

Sonographic appearance of placental abruption

A

Hypo or anechoic region between placenta and uterine wall at level of basal plate

31
Q

Complete placental abruption

A

Most severe, entire retroplacental hematoma

32
Q

Partial placental abruption

A

Few centimeters of separation

33
Q

Marginal placental abruption

A

Placental edge, lifting the chorionic membrane from wall

34
Q

Chorioangioma

A

Vascular tumor, most common location is adjacent to umbilical cord insertion at placenta.
*most common placental tumor

35
Q

Umbilical cord

A

-2 arteries, 1 vein
-surrounded by Wharton’s jelly

36
Q

What does the umbilical cord develop from?

A

Yolk sac and vitelline duct

37
Q

Umbilical vein

A

Carries oxygenated blood to fetus

38
Q

Umbilical arteries

A

Carries deoxygenated blood back to placenta

39
Q

Placental cord insertion (PCI)

A

-Normally at central part of placenta
-Free floating cord attachment into the placenta helps locate

40
Q

Marginal PCI

A

Within 2 cm of edge of placenta
-AKA battledore placenta

41
Q

Velamentous/membraneous cord

A

Insertion into the membranes beyond the placental edge and insert into side of UTERINE wall. Vessels must travel to insert into placenta.

42
Q

Vasa previa

A

Vessels implanted across the internal os
-May rupture if cervix dilates, can lead to exsanguination of fetus

43
Q

Exsanguination

A

The loss of blood from the body’s circulatory system, usually resulting in death

44
Q

Allantoic cyst

A

Cyst of cord, adjacent to vessels (may look like bubble)
-Near placenta

45
Q

Omphalomesenteric cyst

A

Cyst of cord near fetal abdomen (at level of fetal CI)

46
Q

Hemangioma

A

Solid, hyperechoic mass near placenta
*most common tumor of cord

47
Q

Single umbilical artery (2 vessel cord)

A

1 umbilical artery and 1 umbilical vein. Most likely associated with congenital anomalies

48
Q

Umbilical dopplers

A

-Resistance determined by demand of organ
-More volume flow (blood)=lower resistance
-Less volume flow (blood)=higher resistance

49
Q

Measuring resistance in umbilical dopplers

A

Evaluate change in diastolic flow

50
Q

Uterine arteries

A

-Supplies uterus and placenta
*gravida uterus requires HIGH volume flow aka LOW RESISTANCE

51
Q

When to doppler uterine arteries

A

-Preeclampsia
-At risk for placental complications/insufficiency

52
Q

Abnormal uterine artery doppler

A

Increased resistance/ decreased EDV

53
Q

Umbilical artery

A

Evaluates placental resistance AND fetal well being
-Increased placental resistance indicates insufficiency which leads to FETAL consequences (IUGR/hypoxia)

54
Q

Normal umbilical artery doppler

A

-Low resistance, HIGH diastolic flow
-S/D ratio < 3.0
-Resistance decreases with gestational age

55
Q

Abnormal umbilical artery doppler

A

-Increased resistance, DECREASED diastolic flow
-Diastolic flow REVERSAL
-S/D ratio > 3.0
(a lot of PEAKS, not hills)

56
Q

Intrauterine growth restriction (IUGR)

A

-EFW below 10th percentile
-Biometry measures 2 weeks below expected gestational age
-AC used to evaluate

57
Q

Symmetric IUGR

A

Entire fetus is evenly small. Usually starts earlier and related to fetal syndrome

58
Q

Asymmetric IUGR

A

Head biometry may be WNL
-ABNORMAL AC/HC ratio
-Usually presents in 2nd trimester
-Related to maternal complications, placental insufficiency and abnormal dopplers
*IMPORTANT to check MCA for intracranial shunting

59
Q

Middle cerebral artery (MCA)

A

Normal = high resistance
Abnormal = lower resistance

60
Q

Intracranial shunting

A

Fetal brain takes priority and shunts increased volume of blood to the head to “spare” the brain
-Decreasing resistance = increasing volume
*increasing blood supply to brain = head keeps growing therefore asymmetrical growth

61
Q

Anemia

A

Reduces hemoglobin, making blood thinner.
-Thin blood flows faster therefore increasing PSV of MCA

62
Q

Umbilical vein

A

-Steady, minimally phasic with constant flow to fetus
-Placenta –> fetus
-Flow is forward and constant

63
Q

Ductus venosus

A

More pulsatile waveform (closer to heart), reflects arterial contractions

64
Q

Abnormal flow of ductus venosus

A

Increased fetal resistance, abnormal flow patterns
-Causes: CHF, hydrops, pulmonary hypoplasia

OBGYN (17 decks)

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