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12 Cards in this Set
- Front
- Back
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Velamentous insertion of cord
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Normally, umbilical cord inserts into the middle of the placenta as it develops.
In velamentous cord insertion, the umbilical cord inserts into the fetal membranes (choriamniotic membranes), then travels within the membranes to the placenta (between the amnion and the chorion). The exposed vessels are not protected by Wharton's jelly and hence are vulnerable to peripartum rupture. |
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What constitutes a long umbilical cord?
Risks? |
>90 cm
Prolapse Knots Entanglement (around extremities--can lead to thrombus formation) Nuchal Cord (wrapped around neck) |
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What constitutes a short umbilical cord?
Risks? |
Cord <30 cm
Delayed second stage of labor Placental abruption Inversion of uterus (pulls on cord-->pulls on uterus) Uterine Rupture Fetal CNS dysfn |
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Retroplacental Hematoma:
Definition Subtypes Causes |
Retroplacental Hematoma = Abruption
Subtypes: Concealed bleeding: disruption of spinal artery accumulates behind edges (usually arterial) Visible bleeding: usually venous, leads to visible bleeding Assocd w/pregnancy induced HTN, preeclamsia Smoking Chorioamnionitis Maternal thrombophilic state Short umbilical cord |
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Heavy Placentas:
Causes |
Villous edema
Maternal DM Hemolytic dz (immune hydrops) Non-immune hydrops fetalis |
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Feto-maternal hemorrhage:
Features How long can you test for this? Is it significant for fetal morbidity and mortality? |
Pale, edematous, friable placenta; may have multiple intervillous thrombi
Can test for feto-maternal hemorrhage for several weeks to a month after delivery if no blood group incompatibility exists between fetus and mother Likely accounts for many unexplained intrauterine fetal demise as well as fetal anemia, arrhythmia, hydrops, cerebral palsy, and maternal isoimmunisation |
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Maternal floor infarction/Massive perivillous fibrin deposition
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Assocaited with third trimester IUFD, recurrent spontaneous a bortions, intrauterine growth restriction (also recurrent)
Surviving fetuses at risk for serious neurologic impairment |
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Complete vs Partial Hydatidiform Mole
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Complete:
Diploid karyotype (46xx, xy), diandric (paternal) origin Embryo does not develop High incidence of invasive mole, choriocarcinoma Partial Hydatidiform Mole: Triploid karyotype (69xxy, xxx, xyy)--3 haploid sets of chromosomes Developing embryo/fetus is common; rarely survives to term Almost never progresses to invasive forms |
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Placenta accreta
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An invasion of the myometrium which does not penetrate the entire thickness of the muscle. This form of the condition accounts for around 75% of all cases.
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Placenta increta
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Occurs when the placenta further extends into the myometrium, penetrating the muscle.
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Placenta percreta
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The worst form of the condition is when the placenta penetrates the entire myometrium to the uterine serosa (invades through entire uterine wall). This variant can lead to the placenta attaching to other organs such as the rectum or bladder.
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Placenta accreta, increta, percreta:
Predisposing Conditions Risks |
Predisposing conds:
Maternal age >35 Previous uterine instrumentation (abortion, c-section) Congenital or acquired uterine structural defects (septa, leiomyomas) Ectopic implantation Antepartum complications: Recurrent vaginal spotting Overt hemorrhage Uterine rupture (esp in percreta assocd w/previous c-section scar) Postpartum complications: Eaerly or delayed postpartum hemorrhage (may necessitate hysterectomy) |
