Problems with the Placenta Flashcards
Anomalies of the Placenta
- Placenta Succenturiata
- Placenta Circumvallata
- Battledore Placenta
- Velamentous Insertion of the Cord
- Vasa Previa
- Placenta Accreta
Placenta that has one or more accessory lobes connected to the main placenta by blood vessels
No fetal abnormality
Placenta Succenturiata
It is a smaller variant of a bilobed placenta
The vessels are supported only by communicating membranes
Placenta Succenturiata
Placenta Succenturiata is important to recognize because the small lobes may be retained in the uterus after birth, leading to what condition
Severe obstetric hemorrhage
The umbilical cord enters the placenta at the usual midpoint, and large vessels spread out from there however, they end abruptly at the point where the chorion folds back onto the surface
Placenta Circumvallata
The fetal side of the placenta is covered to some extent with chorion
Placenta Circumvallata
An extrachorial, annularly-shaped placenta with raised edges composed of a double fold of chorion, amnion, degenerated decidua, and fibrin deposits
Placenta Circumvallata
Placenta Circumvallata is associated with the following conditions
- Poor pregnancy outcomes due to increased risk of vaginal bleeding (1st trimester)
- Premature rupture of the membranes
- Preterm delivery
- Placenta insufficiency
- Placental abruption
True or False: The diagnosis of Placenta Circumvallata is difficult to make during pregnancy and is often made on visual inspection of the placenta after delivery
True
The cord is inserted marginally rather than centrally
Battledore Placenta
This anomaly is rare and has no known clinical significance either
Battledore Placenta
It is a condition in which the umbilical cord is inserted at or near the placental margin rather than in the center
Battledore Placenta
The cord, instead of entering the placenta directly, separates into small vessels that reach the placenta by spreading across a fold of amnion
This form of cord insertion is most frequently found with multiple gestation
Velamentous Insertion of the Cord
This type of placenta is associated with fetal anomalies
Velamentous Insertion of the Cord
It is a pregnancy complication that happens when the umbilical cord from a fetus does not insert into the placenta correctly
Velamentous Insertion of the Cord
The cord does not attach directly to the placenta but instead attaches to other membranes in the uterus
Velamentous Insertion of the Cord
If velamentous Insertion of the Cord is seen during ultrasound during pregnancy
- Cord traction should be avoided
- Used cautiously during the delivery of the placenta
The umbilical vessels of a velamentous cord insertion cross the cervical os – deliver first before the fetus
Vasa Previa
If sudden, painless bleeding occurs with the beginning of cervical dilatation
- Possible placenta previa
- Possible vasa previa
Both can be confirmed by an ultrasound
If vasa previa is identified during an ultrasound, the infants needs to be born through what delivery?
CS
If vasa previa is identified prenatally on an ultrasound, what will be the next course of action?
Scheduled CS prior to full term to prevent risks of spontaneous labor
Unusually deep attachment of the placenta to the uterine myometrium – so deep that the placenta will not loosen and deliver
Placenta Accreta
Abnormal adherence of the placenta to the myometrium, associated with partial or complete absence of the decidua basalis
Placenta Accreta
Risk factors that can lead to Placenta Accreta
- Previous CS
- Other uterine surgery
- Advanced maternal age
- High gravidity
- Multiparity
- Previous curettage
- Placenta previa
Higher risk for a placenta accreta is in pregnancies with
- History of a cesarean section
- Current placenta previa
Therapeutic management for Placenta Accreta
- Hysterectomy to remove the uterus
- Administration of methotrexate to destroy the still-attached tissue
What will happen if placenta accreta was manually removed?
Extreme hemorrhage
Anomalies of the Cord
- Two-Vessel Cord
- Unusual cord length
Anomalies of the Cord
The absence of one of the umbilical arteries is associated with what conditions?
Congenital heart and Kidney anomalies
Anomalies of the Cord
The absence of one of the umbilical arteries is associated with congenital heart and kidney anomalies
Two-Vessel Cord
What will happen if the cord dries out?
It distorts the appearance of the cord
What course of action if the infant has two vessels?
Needs to be observed carefully for other anomalies during the newborn period
An infant having a short cord length
- Premature separation of the Placenta
- Abnormal lie
An infant having an unusually long cord length
May be easily compromised because of its tendency to twist and knot
