Placenta Disorders Flashcards

1
Q

Explain in general placenta accreta spectrum

A

Accreta: onto the myometrium
Increta: into myometrium
Percreta: through myometrium and to the uterine serosa or other organs

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2
Q

RF for placenta accreta

A
  • Previous C-section (most common) or uterine surgery or deliveries → scar allows for improper embedding into the wall bc weak point
  • Trauma
  • Concurrent placenta previa
  • ≥ 35Y
  • Hx of placenta accreta
  • Multifetal gestation
  • Placenta previa w/ a hx of c-section
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3
Q

whats the patho for placenta accreta?

A
  1. Defect of the endometrial–myometrial interface
  2. failure of normal decidualization
  3. abnormally deep placental anchoring villi and trophoblast infiltration
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4
Q

how is placenta accreta diagnosis?

A

on u/s

otherwise asymptomatic and cannoy be prevented

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5
Q

what does placenta accreta result in during childbirth?

A

Result: incomplete separation of the placenta after childbirth

Cx: Excessive bleeding, preterm delivery, hysterectomy, surgical injury

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6
Q

what other ix should you do for placenta accreta?

A

CBC, electrolytes, VBG/ABG, coags, group and screen

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7
Q

how would you manage a preg pt with placenta accreta?

A

C-section and hysterectomy (always included in consent discussion)

Can consider uterine sparing procedures (expectant management w/ methotrexate or selective tissue removal) if possible and patient is strongly interested, but pt should be counselled on risks

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8
Q

define placenta previa

A

Placenta implants totally or partially in the lower segment of the uterus

Complete previa: internal os completely covered

Partial previa: portion of internal os covered

Marginal previa: edge of placenta extends to the edge of the cervical os

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9
Q

RF for placenta previa

A
  • Previous C-section, abortion, uterine surgery
  • Smoking
  • Multifetal gestation
  • Increasing parity (more preg)
  • ♀ age
  • Hx of placenta previa
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10
Q

patho for placenta previa

A

Prior uterine scars → environment rich in oxygen and collagen → good environment for trophoblast adherence → placenta previa

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11
Q

what s/s and physical exam results could you expect from placenta previa?

A

Painless vaginal bleeding in 2nd or 3rd trimester

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12
Q

what ix and physical exams would you do for placenta previa?

A

Transabdominal/vaginal U/S to assess location of placenta

Speculum exam: may visualize placenta if cervix is dilated

Do NOT complete a digital exam to avoid hemorrhage

CBC, INR/PTT, type and screen

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13
Q

how would you manage/tx a placenta previa pt?

A

most resolve by the time they are due

pt education: no sex and high pelvic load bearing activities

schedule an elective c-section at 36-37wks
give IV magnesium sulfate and corticosteroids to help with lung maturity and neuroprotection

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14
Q

define vasa previa

A

Unprotected fetal vessels passing over the cervical os

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15
Q

what are some etiologies/RF for vasa previa?

A

Velamentous umbilical cord insertion (not in the middle)

Bilobed placenta

Placenta previa

Multiple gestations
Hx of vasa previa

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16
Q

what s/s are associated vasa previa?

A

Asymptomatic

If rupture of cord - Painless vaginal bleeding, fetal distress

17
Q

how do you evaluate vasa previa?

A

Transabdominal/vaginal U/S to assess location of placenta and umbilical insertion into placenta

18
Q

how do you treat or manage vasa previa?

A
  • Admission to hospital at 32W for close monitoring
  • C-section at 35/36 weeks but if bleeding, URGENT because baby can bleed out within minutes
  • IV mag sulfate and corticosteroids
  • pt education: no sex and high pelvic load bearing activities
19
Q

define placental abruption

A

placenta partly or completely separates from the inner wall of the uterus >20wks and before delivery

20
Q

RF for placental abruption

A

Hx of abruption
Abdo trauma
Cocaine use
Chronic HTN
Preeclampsia
Smoking
Multiple gestation

21
Q

what are s/s placental abruption?

A

painful vaginal bleeding + abdo/back pain
Contractions - threatened preterm labour
Shock s/s

Fetal s/s
- Destress
- bradycardia

22
Q

ix for placental abruption

A

Clinically diagnosis + blood-stained amniotic fluid

Electronic fetal monitoring

CBC, INR/PTT, type and screen

23
Q

tx for placental abruption

A

admit
transfuse
deliver baby
IV mag sulfate and steroids if baby premature