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Placental Abnormalities -
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Placental abnormalities refer to a range of conditions where the structure, position, or function of the placenta is compromised, potentially leading to significant maternal and fetal complications. These abnormalities can affect pregnancy outcomes and may require specialized management to ensure the health and safety of both mother and baby.
Types of Placental Abnormalities :
Placenta Previa:
The placenta is abnormally implanted in the lower segment of the uterus, covering part or all of the cervical os. This condition can lead to painless vaginal bleeding in the third trimester and often necessitates delivery by cesarean section.
Placental Abruption:
Premature separation of the placenta from the uterine wall, leading to painful vaginal bleeding, uterine tenderness, and fetal distress. This is a medical emergency requiring immediate intervention to prevent serious outcomes for both mother and fetus.
Placenta Accreta Spectrum:
Placenta Accreta: The placenta attaches too deeply into the uterine wall without penetrating the muscle.
Placenta Increta: The placenta invades the myometrium (muscular layer of the uterus).
Placenta Percreta: The placenta penetrates through the entire uterine wall and may invade nearby organs, such as the bladder. These conditions increase the risk of severe postpartum hemorrhage and often require surgical intervention.
Vasa Previa:
Fetal blood vessels cross or run near the internal os of the cervix, unprotected by the placenta or umbilical cord. This condition can lead to life-threatening bleeding if the vessels rupture during labor.
Circumvallate Placenta:
A placental abnormality where the fetal membranes (chorion and amnion) double back on the fetal side of the placenta, leading to a raised, thickened ring around the placenta. This can increase the risk of bleeding, preterm birth, and fetal growth restriction.
Succenturiate Placenta:
The placenta has one or more accessory lobes connected to the main placenta by blood vessels. This abnormality can lead to retained placental tissue after delivery, increasing the risk of postpartum hemorrhage and infection.
Placental Infarcts:
Areas of dead tissue within the placenta due to interrupted blood supply. Small infarcts are common and generally harmless, but large or multiple infarcts can compromise placental function, leading to fetal growth restriction or stillbirth.
Clinical Significance -
Maternal Complications:
Abnormal bleeding, postpartum hemorrhage, uterine rupture, and increased risk of hysterectomy, particularly in cases of placenta accreta spectrum disorders.
Fetal Complications:
Fetal growth restriction, preterm birth, fetal hypoxia, and increased perinatal mortality, especially in cases of placental abruption or vasa previa.
Diagnosis -
Ultrasound: The primary imaging modality for diagnosing placental abnormalities. Doppler ultrasound may be used to assess blood flow and detect vasa previa or placental infarcts.
MRI: May be employed in complex cases, particularly to evaluate the depth of placental invasion in accreta spectrum disorders.
Management -
Monitoring and Delivery Planning:
Regular monitoring with ultrasound and clinical assessments to track fetal growth and maternal health.
Timing and mode of delivery are crucial, with many cases requiring planned cesarean delivery to avoid complications.
Surgical Interventions:
In cases like placenta accreta or increta, surgical management may include cesarean hysterectomy to control bleeding.
Emergency Management:
Immediate intervention is required for acute conditions like placental abruption or vasa previa, often necessitating rapid delivery and resuscitative measures.
Conclusion -
Placental abnormalities present significant risks during pregnancy, but with early detection and appropriate management, many complications can be minimized or avoided. A multidisciplinary approach is often required to ensure the best outcomes for both mother and baby 🩺🌸.
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Негізгі бет Placental Abnormalities : Obstetrics and Gynaecology Lecture
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