ch 55 Placenta

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rbeacr
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139501
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ch 55 Placenta
Updated:
2012-03-04 12:09:54
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55 Placenta
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Placenta
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  1. Role of Placenta
    • protection
    • respiration
    • excretion
    • nutrition
    • storage
    • horomone production
  2. decidua basialis
    decidual reaction between myo and blastocyst
  3. decidua capsularis
    decidual reaction that occirs over the blastocyst closest to endo cavity
  4. decidual vera
    • aka parietalis
    • decidual reaction except for the areas beneath and above the implanted ovum
  5. chorionic frondosum
    forms fetal part of placenta and contains villi
  6. chorion laeve
    nonvillious part of the chorion aruond the gest sac
  7. chorionic plate
    fetal surface of the placenta
  8. basal plate
    maternal surface of placenta
  9. synctitrophoblast
    • outer layer of multinuclear cells
    • horomone production- hcg, estrogen, progest, human placental lactogen
  10. cytotrophoblast
    • inner layer of momnuclear cells
    • produce neuropeptides
  11. major functioning unit of placenta
    chorionic villus
  12. battledore placenta
    umbilical cord insertion at margin
  13. Velamentous placents
    • umbilical cord insertion into membrane
    • hemorrhage if located over os
  14. yolk sac
    • 2nd one seen
    • 28 days
    • transfer nutrients during 2-3week while placenta develops
    • connected to midgut by yolk stalk
    • 9weeks diminished to less than 5mm
  15. placenta previa
    • placenta implants over os
    • should not be diagnosed before 20 weeks
    • 1 in 200
  16. chorion
    originates from trophoblastic cells
  17. amnion
    develops at day 28 and is attached to embryonic disk- reduced to umbilicus attachment
  18. chorion and amnion fuse
    16 weeks
  19. amniotic fluid functions
    • room to move around
    • constant fetal body temp
    • protective buffer
    • allow lungs to develop
  20. funtion of HCg
    maintain corpus lut in early preg
  21. whartons jelly
    mucinoid connective tissue in umb cord
  22. placenta can be identified
    early as 8 weeks
  23. placenta thickness
    • usually 2-3cm
    • should not be over 4cm
  24. enlarged placenta associated with
    • Rh sensitivity
    • diabetes of pregnancy
    • congenital anomoly
  25. heterogeneous placenta
    • elevated MSAFP
    • or hx of 1st tri bleed
  26. Braxton Hicks contracations
    • may alter appearance of placenta location
    • distort uterine contour- rescanned 15-20 mins
  27. succenturiate placenta
    • accessory lobe placenta joined by blood vessles
    • infection if lobe left after delivery
  28. placenta at delivery
    • 15-20cm
    • discoid shape
    • 600g
    • less than 4cm thick
  29. fibrin deposition
    • subchorionic- hypoechoic
    • fibrin- protien from fibrinogen
    • most pronounced in floor of placenta
    • may look like hematoma
  30. placentomegaly
    • more than 600g
    • greater than 4cm
    • maternal diabetes
    • Rh incompatibility
  31. complete previa
    • covering os
    • high risk- hemorrhage
  32. partial previa
    placental partially covers os
  33. Marginal previa
    doesnt cover os but comes close to edge
  34. low lying placenta
    • in LUS not covering os
    • no problem
  35. factors that contribute to previa
    • advanced maternal age
    • smoking
    • cocaine
    • prior previa
    • multiparity
    • prior c-section
  36. vasa previa
    • large fetal vessles in membrane across cervical os
    • risk rupture hemorrhage death
    • velamentous insertion
    • succenturiate lobe
  37. placenta accreta
    • villi attach to myo without muscular invasion
    • increases with pts with previa and scar from c-section
  38. placenta increta
    villi into myo
  39. placenta percreta
    • villi through uterus
    • high maternal motality
  40. Circumvallate/Circummarginate placenta
    attachment of placental membrane to the fetal surface of placenta rather than the underlying villious placenta margin
  41. placental hemorrhage locations
    • retroplacental
    • subchorionic
    • subamniotic
    • intraplacental

    more severe if in 3rd tri
  42. placental abruption
    abruptio placenta
    • separation of placenta prior to delivery
    • 1 in 120
    • bleeding in basialis
    • retroplacental or marginal
    • hypoxia to fetus
    • short umb cord
    • myoma
    • trauma
    • previa
    • cocaine tobacoo
    • previous abruption
  43. retroplacental abruption
    • high pressure bleed
    • no vag bleeding
    • shock surgery
  44. Marginal abruption
    • low pressure bleed
    • more common
    • subchorionic bleed
    • edge of placenta
    • can wall off
  45. placental infarcts
    • no clinical significance
    • maternal vascular disease
    • calification over time
    • fibrin deposits
  46. chorioangioma
    • benign vascular tumor of placenta
    • most common placenta tumor
  47. dichor/diamno
    • dizygotic
    • faternal twins
  48. mono/mono mono/di
    • monozygotic
    • Idnetical twins
  49. Grade 0
    • prior to 24 weeks
    • homogenous smooth
  50. Grade 1
    • 24-30 weeks
    • 45% at term
    • echogenic areas
    • subtle indentations
  51. Grade 2
    • 30-38 weeks
    • 55% at term
    • more echogenic esp at basal layer (calcifications)
    • comma like indentations
  52. Grade 3
    • 38 weeks +
    • 5-10% at term
    • used up
    • huge indentations
    • irreg density
    • shadowing
  53. placenta aging
    • should not be immature at term- gest diabetes
    • should not be mature early

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