placenta umbilical cord
TRANSCRIPT
-
8/14/2019 Placenta Umbilical Cord
1/39
Dr. Firmansyah, SpOG
-
8/14/2019 Placenta Umbilical Cord
2/39
The Placenta
-
8/14/2019 Placenta Umbilical Cord
3/39
The placenta develops fromthe chorion frondosum
( foetal origin)
and decidua basalis( maternal origin).
Origin:
-
8/14/2019 Placenta Umbilical Cord
4/39
Anatomy At Term
Shape : discoid.Diameter: 15-20 cm.
Weight: 500 gm.Thickness: 2.5 cm at its center andgradually tapers towards the periphery.
Position : in the upper uterine segment(99.5%),either in the posterior surface
(2/3)or the anterior surface (1/3).
-
8/14/2019 Placenta Umbilical Cord
5/39
Surfaces
Foetal surface Maternal surface
-
8/14/2019 Placenta Umbilical Cord
6/39
a. Foetal surface Smooth, glisteningand is covered
by theamnionwhich is reflected
on the cord. The umbilical cordis inserted near
or at the center of this surface andits radiating branches can be seenbeneath the amnion.
-
8/14/2019 Placenta Umbilical Cord
7/39
b.Maternalsurface
Dull greyish red in colour andis divided into 15-20
cotyledons. Each cotyledon is formed of
the branches of one mainvillus stemcovered by deciduabasalis.
-
8/14/2019 Placenta Umbilical Cord
8/39
(1) Respiratory function(2) Nutritive function
(3) Excretory function
(4) Production of enzymes
(5) Production of pregnancy associated plasma
proteins (PAPP)(6) Barrier function
(7) Endocrine function
Funct ions Of The Placenta
-
8/14/2019 Placenta Umbilical Cord
9/39
Abnormal i t ies Of The Placen ta
(A) Abnormal Shape
(B) Abnormal Diameter(C) Abnormal Weight
(D) Abnormal Position
(E) AbnormalAdhesion
-
8/14/2019 Placenta Umbilical Cord
10/39
(A) Abnormal Shape:
1. Placenta Bilobata
2. Placenta Bipartite3. PlacentaSuccenturiata
4. Placenta Circumvallata5. Placenta Fenestrata
-
8/14/2019 Placenta Umbilical Cord
11/39
The placenta
consists of two
equal lobes
connected by
placentaltissue
1. Placen ta B ilobata:
-
8/14/2019 Placenta Umbilical Cord
12/39
2. Placenta Bipartite:
The placenta consists of two equalparts connected by membranes.
The umbilical cord is inserted in onelobe and branches from its vesselscross the membranes to the other
lobe. Rarely, the umbilical cord divides into
two branches, each supplies a lobe.
-
8/14/2019 Placenta Umbilical Cord
13/39
The placenta consists of a large lobeand a smaller one connecting together
by membranes. The umbilical cord is inserted into the
large lobeand branches of its vesselscross the membranes to the small
succenturiate (accessory) lobe.
3. Placen ta Succen tu r iata:
-
8/14/2019 Placenta Umbilical Cord
14/39
3. Placen ta Succen tur iata:
The accessory lobe may be retained in
the uterus after delivery leading to
postpartum haemorrhage. This is suspected if a circular gapis
detected in the membranes from which
blood vessels pass towards the edge ofthe main placenta.
-
8/14/2019 Placenta Umbilical Cord
15/39
A whitish ring composed of decidua, is seenaround the placenta from its foetal surface.
This may result when the chorion
frondosum is two smallfor the nutrition ofthe foetus, so the peripheral villi grow in
such a way splitting the decidua basalisinto a superficial layer ( the whitish ring)
and a deep layer.
4. Placen ta Circumval lata:
-
8/14/2019 Placenta Umbilical Cord
16/39
4. Placen ta Circumval lata:
-
8/14/2019 Placenta Umbilical Cord
17/39
It can be a cause of :
1. Abortion,
2. Ante partum haemorrhage,
3. Preterm labour and
4. Intrauterine foetal death.
4. Placen ta Circumval lata:
-
8/14/2019 Placenta Umbilical Cord
18/39
5. Placenta Fenestrata:
A gap is seen in the placenta
covered by membranes giving theappearance of a window.
-
8/14/2019 Placenta Umbilical Cord
19/39
Placenta membranacea: A great part of the chorion develops
into placental tissue. The placenta is large, thinand may
measure 30-40 cmin diameter. It may encroach on the lower uterine
segment i.e. placenta praevia.
(B ) Abnormal Diameter:
-
8/14/2019 Placenta Umbilical Cord
20/39
(C) Abnormal Weight:
The placentaincreases in size and weight
as in :1.Congenital syphilis,
2.Hydrops foetalis and3.Diabetes mellitus.
-
8/14/2019 Placenta Umbilical Cord
21/39
Placenta Praev ia:
The placenta is partly orcompletely attached to the
lower uterine segment
(D) Abnormal Position:
-
8/14/2019 Placenta Umbilical Cord
22/39
In this gravid uterus, the placenta implanted over the os.This is called placenta previa.
Implantation in this low lying position can lead to
extensive hemorrhage as the dilation of the cervix
disrupts the placenta.
-
8/14/2019 Placenta Umbilical Cord
23/39
(E) Abnormal Adhesion :
Placenta Accreta: The chorionic villi penetrate deeply into the
uterine wall to reach the myometrium,due to
deficient decidua basalis. When the villi penetrate deeply into the
myometrium, it is called "placenta increta"
and When they reach the peritoneal coat it is called
"placenta percreta".
-
8/14/2019 Placenta Umbilical Cord
24/39
The Umbi lical Cord
AnatomyOrigin :
It develops from the connecting stalk.Length:
At term, it measures about 50 cm.Diameter:
2 cm.
-
8/14/2019 Placenta Umbilical Cord
25/39
Structure:It consists of mesodermal connective
tissue called Wharton's jelly, covered by
amnion.
It contains:1. One umbilical veincarries oxygenated blood
from the placenta to the foetus
2. Two umbilical arteriescarry deoxygenatedblood from the foetus to the placenta,
3. Remnantsof the yolk sac and allantois.
The Umbilical Cord
H i l h l bili l d
-
8/14/2019 Placenta Umbilical Cord
26/39
Here is a normal three vessel umbilical cord.
Note that there are two arteriestoward the right and a
single veinat the left.
Most of the cord consists of a loose mesenchyme withintercellular ground substance (Wharton's jelly).
-
8/14/2019 Placenta Umbilical Cord
27/39
Insertion:
The cord is inserted in the foetalsurface of the placenta near the
center "eccentric insertion" (70%)
Or at the center "central insertion"
(30%).
The Umbi lical Cord
-
8/14/2019 Placenta Umbilical Cord
28/39
Abnormalities
Of The
Umbilical Cord
-
8/14/2019 Placenta Umbilical Cord
29/39
1. Marginal insertion :in the placenta ( battledore insertion).
2. Velamentous insertion:
in the membranes and vessels connect
the cord to the edge of the placenta.
If these vessels pass at the region of theinternal os , the condition is called "
Vasa praevia".
(A ) Abnormal co rd inser t ion :
-
8/14/2019 Placenta Umbilical Cord
30/39
Vasa praevia
Vasa praeviacan occur also
when the vessels connecting asuccenturiate lobe with the
main placenta pass at theregion of the internal os
-
8/14/2019 Placenta Umbilical Cord
31/39
Velamentous insertion
-
8/14/2019 Placenta Umbilical Cord
32/39
1. Short cord which may lead to :
i-Intrapartum haemorrhagedue to
premature separation of the placenta,ii-Delayed descentof the foetus druing
labour,iii-Inversion of the uterus.
(B ) Abno rmal cord leng th:
-
8/14/2019 Placenta Umbilical Cord
33/39
2. Long cord which may lead to:
i-Cord presentationand cordprolapse,
ii-Coiling of the cordaround the neck,iii-True knotsof the cord.
(B ) Abnormal co rd length :
-
8/14/2019 Placenta Umbilical Cord
34/39
(C) Kno ts o f the cord :
1. True knot: when the foetus passes through a loop of
the cord.
If pulled tight, foetal asphyxia may result.
2. False knot:
localized collection of Whartons jelly
containing a loop of umbilical vessels.
-
8/14/2019 Placenta Umbilical Cord
35/39
A long umbilical cord may more easily
become twisted, or even form a knot
-
8/14/2019 Placenta Umbilical Cord
36/39
(D) Tors ion o f the co rd :
may occur particularly in the portion
near the foetus where theWharton's jelly is less abundant.
-
8/14/2019 Placenta Umbilical Cord
37/39
(E) Haematoma :
Due to rupture
of one of the umbilical
vessels.
-
8/14/2019 Placenta Umbilical Cord
38/39
(F) Sing le umb il ical artery :
may be associated with other
foetal congenital anomalies
-
8/14/2019 Placenta Umbilical Cord
39/39
Thank you