Placental Dysfunction Flashcards

1
Q

What is placental dysfunction?

A
  • it is when the placenta is unable to deliver an adequate supply of nutrients and oxygen to the fetus and thus cannot fully support the developing baby
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2
Q

What can be the complication of a true knot in the umbilical cord?

A
  • restricts blood flow to the fetus
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3
Q

What are the anatomical variations of the placenta?

A
  • succenturiate lobe
  • battledore insertion
  • velamentous insertion
  • bipartite/tripartite placenta
  • circumvallate placenta - opaque thickened ridge is seen on fetal surface due to the doubling back of the membranes, associated with growth retardation
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4
Q

What is polyhydramnios?

A
  • can affect around 1.5% of pregnancies
  • if severe and the fetus cannot swallow there may be in excess of 2000ml of amniotic fluid
  • may be chronic, more common and occurs after 30/40
  • may be acute, rare, occurs at 20/40 and may be associated with mono-ovular twins or severe abnormality
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5
Q

What are the signs of polyhydramnios?

A
  • uterus is large for dates
  • easy ballottment of the fetus
  • fetal parts difficult to palpate
  • FH muffled
  • maternal symptoms - breathlessness, vulval varicosities, oedema and gastric problems
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6
Q

What are the causes of polyhydramnios?

A
- fetal causes
      —> multiple pregnancy
      —> CNS anomalies 
      —> GI anomalies 
      —> haematological anomalies 
      —> skeletal anomalies 
      —> chromosomal anomalies
      —> intrauterine infections 
- maternal causes 
      —> diabetes 
      —> Rhesus isoimmunisation
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7
Q

What are the complications of polyhydramnios?

A
  • unstable lie
  • malpresentation
  • cord presentation and prolapse
  • preterm labour
  • preterm ROM
  • PPH
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8
Q

What is oligohydramnios?

A
  • defined as <500ml of amniotic fluid at term, however may be much less
  • affects 4% of pregnancies
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9
Q

What are the signs of oligohydramnios?

A
  • SGA uterus
  • decreased FM’s
  • fetus feels compact with parts easily palpated
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10
Q

What are the causes of oligohydramnios?

A
  • severe IUGR associated with maternal disease such as hypertension or renal disease
  • fetal renal anomalies
  • other anomalies
  • chronic placental abruption
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11
Q

What are the complications of oligohydramnios?

A
  • poor prognosis
  • pulmonary hypoplasia affects 60% of those deprived for many weeks
  • treatment - amnioinfusion but not widely used, delivery of infant
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12
Q

What is IUGR?

A
  • fetus that fails to reach it’s personal growth potential
  • SGA
  • essential substrates for growth are oxygen, glucose and amino acids
    —> any decrease in substrate availability due to pathological conditions affecting mother, placenta or fetus will result in poor growth
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13
Q

What is asymmetric fetal growth restriction?

A
  • fetal weight is reduced out of proportion to length and head circumference
  • little subcutaneous fat
  • usually maternal in origin
  • growth may ‘tail off’ having been normal
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14
Q

What maternal conditions can cause IUGR?

A
  • hypertension
  • chronic renal disease
  • sickle cell anaemia
  • severe cardiac disease
  • severe malnutrition
  • smoking
  • alcohol ingestion
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15
Q

What fetoplacental problems can cause IUGR?

A
  • chromosomal abnormalities
  • intrauterine infections
  • h/o IUGR
  • multiple pregnancy
  • placenta praevia
  • placenta infarcts
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16
Q

How is IUGR diagnosed and managed?

A
  • fetal weight - uss
  • Doppler velocimetry abnormalities
  • measuring subcutaneous fat
  • fetal biophysical profile
  • is baby better in or out?
    —> steroids
    —> ctg
    —> paed at delivery
    —> blood gases
17
Q

What is the role of the midwife?

A
  • support
  • discussion with family/translation of medical terms
  • work closely with MDT
  • close monitoring of mother and baby
  • visit NNU with parents
  • preparation for birth