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Placenta and Umbilical Cord VariationsIncretaPlacental PercretaPlacenta AccretaSuccenturiateplacentaCircumvallateplacentaBattledoreplacentaVelamentous insertion of cordUmbilical Cord PresentationAssess FHR and colorThe presence of the umbilical cord in front of the presenting part before the rupture of membranesProlapsed CordOccurs when the umbilical cord descends into the birth canal before the infant – Medical emergency! May occur with ROMCareful monitoring-compression of cord decreased blood flow to the infant with each uterine contraction less and less blood flow gets to the baby- could die
TXPrefer to PreventIF ROM prefer to keep pt on a horizontal until fetus is well engagedTo relieve compression on the cord until delivery pt maybe placed in knee chest position or in Trendelenburg position Pt is going to OR if can’t be correctedGet her hips higher than her headManagement Prolapsed CordUse 2 fingers and pull cervix off cord – will travel to OR this wayAmniotic Fluid Complications – see photo >Amniotic Fluid Embolism (AFE)Small tear in amnion high in the uterus. Fluid enters maternal circulation and causes embolus and travels to the lungs/s-suddensigns of respiratory distress, shock, SOB, cyanosis, comaTX-1stimmediate c/s delivery of infant (02-100%, IV fluids, meds to maintain cardiac output and BP, hemorrhage DIC)Stability of respiratory and cardiac systems, blood transfusion. Pt is going to ICU(ABG’s, cardio/resp support, blood transfusions, etc.)
DIC>HydramniosMore than 2,000 ml of amniotic fluidAssociated with congenital deformitiesSOB in mom, over-distention of uterine muscles, and increase incidence of postpartum hemorrhageCauses:Failure of fetal kidney development; urine excretion blocked, IUGR, post-term preg., preterm ROM, fetal anomalies. Poor placental functionManagement: Monitor wt. gain. Remove excess amniotic fluid q 1-2 wks.thru amniocentesis. Replaced quickly. Most women with mild hydramnios deliver healthy infants.Meds-Indomethacin, SulindacNSAIDS reduce production of amniotic fluidOligohydramnios<500 ml amniotic fluid (shrink wrap appearance) Causes:Uteroplacental insufficiencyPre-eclampsiaTwin-twin transfusion (vascular abnormality. Sharing placenta, 1 gets too much blood flow, and other not enough) Prostaglandin synthase inhibitor as NSAID (because they reduce production)
IdiopathicEffects of OligohydramniosAmniotic bands (cuts of blood supply and can amputate digits or limbs) Poor pulmonary developmentFlattened facePostural deformitiesHypertensive Disorders of PregnancyUmbrella termGestational Hypertension AKA Pregnancy-induced Hypertension (PIH) Pre-eclampsiaEclampsiaChronic Hypertension Preceding PregnancyWith or without superimposed GHTransient HypertensionHELLP syndrome Gestational Hypertension (PIH)5-7% pregnancies or >Progressive disorderPre-eclampsiaEclampsiaSudden or gradualAfter 20 weeks’ gestation + first 48 hours PP (d/t shifting of fluids)Cure: delivery of neonateAssess BP baselineNarrow blood vessels in placenta.