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ADRMS - OBGYN Penny > The placenta and Umbilical cord > Flashcards

The placenta and Umbilical cord Flashcards

1
Q

AKA TROPHOBLAST, also called CHORIONIC FRONDOSUM
Highly vascular, 2-4 cm thick
Transfers nourishment, removes waste, produces hCG
Divided into 2 portions: Fetal and maternal portions NEVER cross

A

Normal placenta

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2
Q

DECIDUA BASALIS

▪ Consists of Cotyledons

A

Maternal portion

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3
Q

▪ Major functioning unit= chorionic villi

▪ Consists of a fused layer of amnion and chorion

A

Fetal portion - chorionic frondosum and chorionic plate

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4
Q 
Circumvalle
succenteriate
chorionagioma
placenta previa
placenta abruption
abnormal adherence
A

Placental variants

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5
Q

Chorion does not extend to the edge (elf shoe)

• May predispose to early separation from UT wall, threatened Ab and bleeding

A

Circumvallate

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6
Q
  • Lobe that is connected to main lobe of placenta by blood vessels
  • If vessels cross internal os = vasa previa
A

Succenuriate / accessori lobe

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7
Q

● M/C benign tumor of the placenta
● well circumscribed mass near CI
● Increased vascularity

A

Chorioangioma

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8
Q
  • Partial or complete coverage of cervical os
  • Primary cause of 3rd trimester bleeding
  • Classifications:
  • Complete- covers entire internal os
  • Partial- incomplete covering of internal os
  • Marginal- Placenta touches the edge of the internal os
  • Low lying- Placenta is within 2cm of os
  • Vasa Previa- vessels overlying CX
A

Placenta previa

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9
Q
  • Premature separation of placenta from UT wall after 20 weeks
  • S/S: bleeding and abdominal pain
  • Assoc: w/ HTN, ABD trauma, Vascular disease, cocaine or smoking
A

Placental abruption

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10
Q

Abnormal adherence of placenta tissue to UT
Risk Factors: c- section scarring and advanced maternal age (AMA)
Three classifications:
Placenta Accreta – placenta attached to Myometrium…NO invasion
Placenta Increta- Placenta invades into UT/ Myometrium
Placenta Percreta- Placenta invades UT, Bladder or Rectum

A

Abrnoaml adherence

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11
Q 
***>6cm abnormal***
Thin placenta					THICK placenta
•	IUGR					Gestational diabetes
•	Preeclampsia				Non-immune hydrops
•	Juvenile diabetes			Congenital abnormalities
Multiple gestation
Rh sensitization
A

Placenta abnormalities

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12
Q

Consists of 2 arteries and 1 vein
• Measures 1-2cm in diameter
• Average length is 55cm and covered by Wharton’s jelly and amnion
• SUA (2 vessel cord) assoc. with other fetal anomalies
• Check for 2 kidneys
• Trisomy 13 and 18
• GU, CNS and heart anomalies

A

Umbilical cord

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13
Q
  • Wrapping of umbilical cord around fetal neck

* 2 x around assoc. w/ fetal death

A

Nuchal cord

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14
Q

Short umbilical cord
NOT compatible with life
Lack of closure of anterior abdominal wall

A

Body stalk anomaly

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15
Q

torsion, Knotting or compression of umbilical cord can cause thrombosis= fetal death

A

Umbilical venous thrombosis

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16
Q
  • Umbilical cord attaches to the membrane rather than placenta
  • Assoc w/ IUGR, preterm birth and congenital anomalies
A

Velamentous cord

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17
Q

= VERTEX – head presenting

A

Cephalic

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18
Q

feet first

A

breech

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19
Q

used to determine whether head shape is appropriate

A

cephalic index

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20
Q
  • Axial section at the level of the thalami falx & CSP
  • 1st measurable between 10-12 weeks
  • Angle os asynclitism- angle should be 90°
A

BPD

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21
Q
  • Should not include scalp echoes

* Should be measured outer edge to outer edge

A

head circumference

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22
Q
  • Should include soft tissue and least reliable

* Measured at level of portal vein and stomach & aorta

A

Abdominal circumference

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23
Q

• Includes only ossified diaphysis, exclude epiphyseal cartilage

** Epiphyseal ossified centers will be identified after 30 weeks**

A

Femur length

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24
Q

Designed to detect fetal asphyxia
Scored 0 or 2
o Fetal Breathing- lasts 30 sec over 30 min period
o Movement- 3 body /limb movements
o Tone- extension/ flexion
o AFI- should not exceed 5.0cm
o NST (non-stress test)- 2 acceleration > 15 bpm/15sec

A

Biophysical profile

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25
Q
  • Produced by fetal kidneys, tissue, and skin
  • 2-3 trimesters consists primarily of fetal urine
  • Functions of fluid: cushion from injury, nutrition, movement, temperature & lung development
  • Normal range- 5-22 cm
A

AFI

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26
Q

Lecithin/ Sphingomyelin (LS ratio)

-Most accurate measurement of fetal lung maturity done by amnio

A

fetal lung maturity

27
Q

• Decreased fluid that allows a DRIPP to remain

D emise
R enal abnormalities
I  UGR
P ROM
P ost dates/ preeclampsia
A

oligohydramnios

28
Q 
•	Increased fluid: pocket will be ≥ 8cm
•	Associated with: neural tube defects, upper GI obstructions, hydrops, 
Trisomy 18 (from esophageal atresia), cystic hygroma, placenta, twin-twin syndrome
A

Polyhydramnios

29
Q

o Anemia
o UTI
o Preeclampsia
o Prepartum hemorrhage

A

Maternal complications

30
Q

o Premature or difficult delivery
o Prolapse entanglement or compression of umbilical cord
o Growth restriction due to placenta insufficiency
o Hypoxia of 1 second twin due to premature separation of placenta

A

Fetal complications

31
Q

reabsorption of a non-viable fetus that was previously demonstrated

A

Vanishing twin

32
Q

o Increased MSAFP
o SOB
o Increased UT size and fetal activity
o Earlier and mores severe pressure problems in pelvis

A

clinical finding in twin pregnancies

33
Q

OF ZYGOTES / EGGS

A

Zygosity

34
Q

“true” or identical twins (always SAME GENDER) from a SINGLE fertilized ovum by single sperm

A

MONOzygotic

35
Q

SINGLE PLACENTA (days 10-13)

A

Monochorionic,monoamnitoic

36
Q

SINGLE PLACENTA, 2 amnions (days 5-10 after conception)

A

Monochorionic, Diamnotic

37
Q

fraternal” twins from separate ova & separate sperm (day 5)
** dizygotic twins will ALWAYS have 2 placentas, 2 amnions,& 2 chorions

“twin peak” sign refers to Dichorionic, Diamniotic because placenta grows between sacs on TEST

A

Dizygotic

38
Q
  • Incomplete ÷ of a fertilized ovum after 13 days post-conception
  • They can be joined by the chest, head, abdominal wall, pelvis or sacrum
  • Cords of conjoined fetus have between 2-6 vessels
A

conjoined twins

39
Q

• MONOzygotic twin severely malformed, acardiac and often anencephalic twin is perfused by the normal twin
• Normal twin supplies blood to malformed twin.
• SONO: POLY
o Pump/normal twin=hydrops fetalis

A

acardiac twins

40
Q

• MONOzygotic twins w/ shared monochorionic placenta (cross transfusion of vascular supply of each twin to the placenta) (ARTERY TO VEIN ANASTOMOSIS)
o Donor twin- ( the stuck twin)
▪ OLIGO, small for dates and restricted movement
o Recipient twin-
▪ POLY, ascites, Hydropic enlarged liver, heart and kidney

A

twin to twin transfusion syndrome (TTTS)

41
Q

Passage of thromboplastic material/blood clots from a dead MONOCHORIONIC twin to remaining live twin through shared intra-placental vessels

A

twin embolization syndrome

42
Q

• Fetus weighing below 10th percentile
• D/X: the HC/AC ratio is abnormal in approx 2/3 of all restricted fetuses
• Sono: OLIGO, grade 3 placenta & delayed ossification of bones
• ETIOLOGY OF IUGR:
O Maternal: HTN, diabetes, renal disease, alcohol/ drug abuse, anemia, smoking or mult gestations
O Placenta: SUA, plac insufficiency, infarcts & hemangiomas
O Fetal: genetic or chromosomal defects, intrauterine infection

A

IUGR

43
Q

O Etiology: often genetic as result of 1st trimester insult
O Fetus is proportionately small throughout pregnancy (2 weeks)
o SONO: oligo, early mature placenta, low BPP

A

symmetric IUGR (25%)

44
Q

o Occurs in last 8-10 weeks of pregnancy
o Hemodynamic pattern protects brain = “brain sparring”
o AC measures > 2 weeks behind HC; head is usually normal
o SONO: oligo & mature placentas

A

Ayssmetrical IUGR (75%)

45
Q

Used to identify growth restriction, hypoxia and/or distressed fetus

A

Doppler Evaluation

46
Q

NORMAL: as gestation progresses, INCREASE in diastolic flow velocity
which reflects a DECREASE in placenta resistance (RI > 0.8)
S/D ratio > 2.6 after 30 weeks = ABNORMAL
Absence or reversed diastolic flow in the UA is NOT GOOD!
CI @ placenta = LOW resistance & CI @ fetal abd. = HIGH resistance

A

Umbilical artery

47
Q

LOW resistance in 2nd & 3rd trimester is NORMAL

Appearance of “notch” is ABNORMAL & predictor of placenta insufficiency leading to IUGR

A

Uterine artery

48
Q
  • Determines fetal anemia using velocity of PI
  • Checking IUGR use S/D ratio & MCA s/b ↑ than umbilical artery
  • In a hypoxia fetus, vessels become enlarged from “brain sparing”
  • Normal values > 4 throughout pregnancy w/ LITTLE diastolic flow
  • Use near field vessel for Doppler w/angle @ 5° or less 0° is best
A

MCA- Middle Cerebral Artery “Circle of Willis” (closest to orbits)

49
Q

• 2 or more fluid filled fetal body cavities & skin thickening
• 2 Categories:
o IMMUNE- caused by Rh incompatibility (mother)
o NON-IMMUNE- caused by abnormal FETAL fluid balance
• Fetal GU, cardio, chromosomal, cord/placenta abnormalities, malformation or TORCH infections
• SONO: pericardial effusions, POLY, ↑ liver, heart, UV, skin & THICK placenta (> 4 cm)
• “ANASARCA” – skin edema

A

Hydrops fettles

50
Q
  • Puncturing the VEIN of the umbilical cord

* Used as a treatment for immune hydrops

A

PUBS (Percutaneous Umbilical Blood Sampling)

51
Q

• During 2nd & 3rd trimester sono appearance dependant upon when demise occurs after fetal examination
o ROBERT’S SIGN- echogenic foci (gas) in pulmonary vessels or in abdomen
o SPALDING SIGN- overlapping skull bones
** IMAGES of both on exam & BOTH are visualized 1 WEEK AFTER DEMISE**

A

FETAL DEMIWE

52
Q

Sequence- single defect leading to the development of other defects
Syndrome- 2 or more embryological, unrelated anomalies occurring together
affecting 2 or more different organs or body areas
Association- Non-random occurrence of 2 or more defects

A

FETAL SYNDROMES

53
Q

• Bands of tissue the trap/ encircle parts of the fetal body in early pregnancy
o Limb defects: amputation, club feet, constrictions, pseudosyndactyly
o Craniofacial defects: encephalocele, facial cleft, asymmetric anencephaly
o Visceral defects: gastroschisis, ectopia cordis

A

AMNIOTIC BAND SYNDROME

54
Q

• Chromosomal abnormalities w/ multiple anatomic problems
o HOLOPROCENCEPHALY
o IUGR, POLY, agenesis of corpus callosum, micrognathia, cleft lip/palate
o Omphalocele, VSD, GU abnormalities, polycystic kidney

A

TRISOMY 13 PATAU’S SYNDROME

55
Q

• Karyotype abnormalities
o Clenched hand w/ finger/thumb crossover (clinodactyly)
o VSD, ASD, CP cysts, ↑ cisterna magna/ Dandy-Walker
o Micrognathia, dolichocephaly, IUGR, POLY (3rd trimester)
o Omphalocele, hydro, diaphragmatic hernia

A

TRISOMY 18 (EDWARDS SYNDOME)

56
Q

• Malformation w/ mental retardation & characteristic physical appearance
o Nuchal fold measuring > 6mm between 15-21 weeks
o VSD, ASD, mild ventriculomegaly
o Absent or small nasal bone, duodenal atresia, renal pylectasis & echogenic bowel

A

TRISOMY 21 (DOWN SYNDROME)

57
Q

• Malformation syndrome of complete or partial absence of the X chromosome in phenotype females
o Cystic hygroma, lymphadema
o Cardiac anomalies, horseshoe kidney or uni-renal agenesis

A

TURNERS SYNDROME (XO KARYOTYPE)

58
Q

• “Cloverleaf skull”

A

KLEEBATTSCHADEL SYNDROME

59
Q

• Related to autosomal recessive inheritance
o Encephalocele & polycystic kidneys
o Cleft lip, polydactyly

A

MECKEL-GRUBER SYNDROME

60
Q

BECKWITH-WEIDMAN SYNDROME
• Group of congentital disorders
o Macroglossia, gigantIsm & omphalocele
o Placenta ↑ or chorioangiomas, cardiac malformation & post natal Wilm’s tumor

A

BECKWITH-WEIDMAN SYNDROME

61
Q

• Association of 2 major defects: Omphalocele & ectopia cordis, along with 3 other defects involving lower sternum, diaphragm or pericardium

A

PENTOLOGY OF CANTRELL

62
Q

POTTER’S SYNDROME

• BILATERAL renal agenesis & OLIGO

A

POTTERS SYNDROME

63
Q

• extra set of chromosomes

A

TRIPLOIDY

ADRMS - OBGYN Penny (23 decks)

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