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OBGYN Ultrasound > placental pathology > Flashcards

placental pathology Flashcards

1
Q

Fibroid versus contraction

A

Equivalent sonographic appearance

Braxton-Hicks relaxes with time

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2
Q

what is cervical incompetence

A

Painless spnataonous dilation of the cervix

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3
Q

cervical incompetence can cause what

A

second trimester preganncy failre

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4
Q

nomral cervix

A

at least 30mm

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5
Q

cervical incompetnce meaurement

A

less than 25mm at 24 weeks

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6
Q

what are risk factors for cervical incompetence

A

history of preterm labour or borth
PROM
uterine abnormalities
multiple gestations

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7
Q

what is cord prolapse

A

presentation of the umbilical cord in advance of presenting fetus during labour and deverlivery

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8
Q

cord proplase may lead to what

A

Sono detection is clinically important b/c it may lead to cord compression and fetal vascular compromise

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9
Q

1st trimester umbilcal cord cysts

A

defined as echolucent area within the umbilical cord with YS separate

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10
Q

if cystic cord masses are seen between 7 and 13 weeks

A

20% are associated with chromosal strctural defects

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11
Q

when is fetal abnormality more likley (cystic cord masses)

A

more likley if a cyst is close to the placenta or close to the fetus or if it persists beyond 12 weeks GA

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12
Q

what does vasa previa result in

A

fetal hypoxia or fetal blood loss

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13
Q

what can occur in vasa previa during labour

A

Can be easily compressed or rupture when uterine contractions or membrane rupture occurs

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14
Q

vasa previa is associated with what

A

bleeding

fetal morbidity

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15
Q

what is vasa previa

A

Condition where umbilical vessels run within membranes near or across the internal cervical os

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16
Q

what is velamentous insertion

A

umbilical vessels separate and course b/t the amnion and chorion at a distance from the placental margin surrounded only by a fold of amnion

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17
Q

velamentous insertion is asscoiated with what

A 
Devoid of Wharton’s jelly 
Associated with cord compression 
Poor fetal growth 
Thrombosis 
Miscarriage 
Prematurity
Lowe birth weight 
Fetal malformation 
Perinatal death 
Low apgar scores 
Placenta previa 
Vasa previa 
Retained placenta
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18
Q

what is marginal insertion known as

A

Battledore placenta

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19
Q

in marginal/battledore placenta

A

CI is within a cenitmere of the placental margin

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20
Q

what is umbilical vein vanix

A

focal dilation of the umbilical vein

usually seen intraabdominal

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21
Q

umbilcal vein varnix diameter

A

greater than 9mm

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22
Q

umbilcal vein varnix outcome

A

usually normal

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23
Q

what anomalies can be associated with umbilcal vein varnix

A

Aneuploidy
Perinatal death
Hydrops

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24
Q

fetusues with SUA have a high rate of structural anomaies

A 
Cardiovascular Malformations 
CNS 
Gastrointestinal
Genitourinary defects 
MSK Malformations
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25
Q

what chromosomal abnormalities can be associated

A

trisomy 13 and trisomy 18

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26
Q

SUA is asscoiated with

A

Growth restriction
prematurely
increased perinatal mortality rate

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27
Q

what is PMD

A

relatively recently recognized, rare placental vascular anomaly characterized by mesenchymal stem villous hyperplasia.
placentomegaly
often clinically mistakenly as partial hydatidiform mole
Fetus may be completely normal or have intrauterine growth restriction (IUGR)

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28
Q

Sono appearance of choriocarcnoma

A

Focal, hemorrhagic nodule within endometrium
Secondary masses to cervix or vagina
Metastasis to liver

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29
Q

symptoms of choriocarcinoma

A

cough
hemoptysis
neurologic disturbances or hemorrhage

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30
Q

what is choriocarcinoma

A

Abnormal tissue beyond the myometrium that is capable of mets

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31
Q

when does choriocarcinoma occur

A

50 % arise after a molar pregnancy
25 % arise after abortion
25 % after a normal pregnancy

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32
Q

invasive mole sonographic appearacne

A

focal areas of increase echogenicity

33
Q

what is invasive mole

A

characterized by proliferation of trophoblats and presence of chorionc vill within the endometrium and myoetrium

34
Q

what can invasive mole sometimes cause

A

This focal invasion can, on rare occasions, penetrate through the myometrium and blood vessels, causing uterine rupture and potential death from severe intraperitoneal hemorrhage.

35
Q

Complete hydatifiform mole

A

molar pregnancy

36
Q

what is the sono appearance of a moLar poregancy

A

Distention of the uterine cavity with a heterogenous echogenic mass “snow storm appearance”

37
Q

complete mole

A

Absence of amniotic fluid and a fetus

38
Q

partial mole

A

presence of co-excistng fetus along wuth an enlarged thickened placenta with mutlple cystic spaces

39
Q

what abnormaloty is noted in most molar pregnancies

A

triploidy

Severe IUGR and fetal anomalies

40
Q

Complete hydatidiform mole characterization

A

Characterized by chorionic villi that are markedly hydropic, swollen and proliferation of the trophoblast cell
Results in excessive production of b HCG

41
Q

signs of molar pregnany

A

Uterine enlargement
Hyperemesis gravidarum
Vaginal bleeding

42
Q

gestational trophoblastic disease

A

encompassses disease processes that originate within the placenta
can be benign or malignant

43
Q

what is gestational trophoblastic neoplasia

A

complciation of pregnancy results from an abnormal proliferation of trophoblastic tissue

44
Q

benign trophoblastic disease

A

hydatiform mole (complete or partial mole)

45
Q

malignant trophoblastic disease

A

invasive mole
choriocarcinoma
PSTT
ETT

46
Q

chorioangioma sonographic appearance

A

Well circumscribed hyperechoic or hypoechoic ovoid mass protruding form the fetal surface of the placenta
Near cord insertion
May see necrosis or calcifications
Increased vascularity

47
Q

what is chorioangioma

A

benign vascular malformation

48
Q

what is chorangioma assciated with

A

Elevated maternal AFP or bHCG

49
Q

what fetal complications can chorioangioma lead to

A 
Anemia
Heart failure 
Nonimmune hydrops 
Thrombocytopenia 
Polyhydramnios 
IUGR 
Prematurity 
Placenta abruption
50
Q

Placenta abruption prognosis

A 
Depends on degree of placenta detachment and gestational age 
Fetal growth restriction 
Oligohydramnios
PTD (preterm delivery)
Fetal Demise
51
Q

Placenta abruption symtptoms

A

Acute abdominal and pelvic pain
Vaginal bleeding
Uterine tenderness
Fetal distress

52
Q

placenta abruption risk factors

A 
Maternal HTN (hypertension) 
Drug use 
Smoking 
Trauma 
Uterine anomalies 
PROM (Premature rupture of mebranes)
53
Q

what is placental abruption

A

Premature separation of all or part of the placenta from the underlying myometrium
Occurs in 1 in 120 pregnancies
Bleeding in decidua basalis occurs with separation

54
Q

how is placenta abruption classified

A

Classified according to the location of separation
Occurring hemorrhage:
Retroplacental
Intraplacental
Marginal
Subchorionic blood clot (may be at a distance from the placenta with or without vaginal bleeding).

55
Q

placenta infarcts sono appearance

A

Evolve through acute, subacute, and chronic stages
Majority hypoechoic in acute stage; ultrasound may be unable to distinguish them from intraplacental hemorrhages
Calcification may occur over time.

56
Q

what is placental infarction

A

Placental infarction occurs as a result of obstruction of the spiral arteries and is usually found at the periphery of the placenta.

57
Q

what is a placental lake

A

Placental infarction occurs as a result of obstruction of the spiral arteries and is usually found at the periphery of the placenta.

58
Q

what is a finding of placental lakes during second semester indicative of

A

A finding of placental lakes during the second-trimester ultrasound scan does not appear to be associated with uteroplacental complications or an adverse pregnancy outcome.
q

59
Q

placental invasion

A

Abnormal penetration of placental tissue beyond endometrial lining of uterus

60
Q

placenta accreta

A

Chorionic villi attach to myometrium without muscular invasion.

61
Q

placenta increta

A

is further extension of the chorionic villi into the myometrium.

62
Q

placenta percreta

A

penetration of the chorionic villi through the uterus.

63
Q

what is placenta increta the result of

A

Placenta increta results from underdeveloped decidualization of endometrium.

64
Q

what is the best way to idnetify lower uterine segment

A

transvag

65
Q

complications of placental previa

A 
Preterm delivery 
Maternal hemorrhage 
Increased risk of placental invasion 
Increased risk of postpartum hemorrhage 
IUGR
66
Q

factors associated with placenta previa

A 
Advanced maternal age
Smoking 
Cocaine abuse 
Prior placental previa 
Multiparity 
Prior cesarean section 
Uterine surgery
67
Q

Placenta previa

A

implantation of the placenta completely crosses the internal os

68
Q

marginal (partil previa)

A

edge of the placenta is abut or covering the os

69
Q

low lying placenta

A

edge of the placenta is near but not abutting the os

< 2.0 cm from Internal os

70
Q

amniotic bands sonographically

A

collapsed amnion images, multiple linear wavy echoes

amniotic bands are linear echoes transversing the amniotic cavity

71
Q

in most cases amniotic bands

A

Do not disturb the fetus

72
Q

amniotic band syndrome can result in what

A

feral entanglement

Can result in limb deformities, spine and facial abnormalities, amputation

73
Q

what may abnormal membranes present as

A

without complications or with vaginal bleeding

74
Q

Circumvallate placenta

A

Attachment of the placental membranes to the fetal surface of the placenta rather than to the underlying villous placental margin

75
Q

what does circumvallate placenta result in

A 
Results in placental villi around the border of the placenta that are not covered by the chorionic plate.
Rim forms (Fibrinoid tissue)
Most cases have no clinical significance
76
Q

what ay circumvallate placenta be associated with

A 
Maternal bleeding
Placenta Abruption 
Preterm loss 
Oligohydramnios 
Involved in amniotic band syndrome
77
Q

Bilobed placenta

A

Two lobes that are similar size
Separated by membranes with some vascular connation between the lobes
Communication of placental tissue between the lobes (chorionic bridge).
The cord commonly attaches to a thin connecting rim of chorionic tissue which bridges the two lobes.

78
Q

Succenturiate lobe

A

Visu: 6 % of cases
Connected to main placenta by – vessels with in a membrane or by a bridge of membranes
Main Placenta- larger & is where Umb. Cord inserts
Visu. of Accessory Lobe –clinical relevant b/c of increased risk of infarction, placenta previa, vasa previa, postpartum and hemorrhage assoc. with retained accessory lobe

OBGYN Ultrasound (5 decks)

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