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    Placental Placental Presentation Transcript

    • Placental insufficiency: diagnostics and treatment. Methods of investigation of placenta. Fetal hypoxia. Asphyxia of newborn. Lecture by Andriy Berbets
    • Placental insufficiency  This is complex of disorders of trophic, endocrine and metabolic functions of placenta.  It causes inability to maintain the interchange between mother and fetus The syndrome has multifactorial genesis
    • Placental physiology
    • Placental physiology
    • Placental villi
    • Placental functions
    • Endocrine functions of the placenta
    • The umbilical cord
    • Forms of placental insufficiency: • Hemodynamic, provoked by disorders of uterine-placental blood flow; • Membranous – placental membranes are unable to transport metabolits; • Cellular, linked with decreased metabolic activity of placental cells
    • Placental insufficiency classified by time of manifestation • Primary • Secondary
    • Placental insufficiency classified by clinical flow • Acute • Chronic
    • Blood circulation disorders in placenta 1. Compensated 2. Particularly compensated 3. Non-compensated
    • Hypoxia of fetus • It’s one of the main complications of pregnancy with frequency 4-6% • It’s the most common reason of antenatal and intranatal death of fetus • “Hypoxia” means insufficient oxygen supply and/or utilization by tissues
    • Hypoxia classification 4 types • 1. Hypoxic (low concentration of O2 in the blood) • 2. Circulatory (disorder of transporting of the oxygen when its blood concentration is normal) • 3. Hemic (level of hemoglobin is decreased) • 4. Tissue (low utilization of oxygen by tissues)
    • Severity of hypoxia: Functional – mild form: only hemodynamic changes (tachycardia, increased blood pressure) Metabolic – moderate form (reversible tissue changes) Destructive – severe form, irreversible tissue changes
    • Causes of fetal hypoxia • Maternal • Fetal • Placental Maternal • Extragenital pathology • Infections • Gestoses • Immune conflict • Intoxications • Over-termed pregnancy • Bleeding etc
    • Fetal: • Intra-uterine infection • Encephalopathy • Brain misdevelopments • Hemolytic diseases Placental: • Primary PI • Secondary PI
    • Diagnostics of fetal hypoxia • Cardiotocography • Ultrasound and biophysical profile of fetus • Test of fetal movements • Ultrasound placentography and measurement of its maturity • Hormonal examination (including colpocytology) • Cordo- and placentocentesis etc
    • Correction of fetal hypoxia • Improvement of the blood perfusion • Normalization of metabolism • Improvement of oxygen interchange • Blood vessels dilatation • Uterus muscle relaxation
    • Asphyxia – it’s a syndrome characterized by absence of breathing movements but with presence of heartbeat of fetus Classification: 1. Central (suppression of breathing centre) 2. Peripheric 3. May be caused by trauma, immaturity of fetus nervous system, pharmacological depression etc. 4. May be cased by lungs, heart dysfunction or anemia
    • Apgar score
    • 3 degrees of asphyxia Mild, moderate, severe Apgar score 6-7 (1st min) – mild Apgar score 5-4 (1st and 5th min) – moderate Apgar less 3 – severe Three stages of reanimation of the newborn 1 ABC-reanimation 2 Intensive therapy 3 Reabilitation АВС-steps А- airways В- breathing С-circulation
    • А-step 1. To put the newborn in the correct position 2. Free the nose, mouth and trachea (if needed) 3. Intubation (if needed) В-step 1. Tactile stimulation to cause breathing 2. Artificial breathing (if needed) • Bag and mask ventilation • Trachea intubation (if needed) C-step 1. To support blood circulation 2. Indirect heart massage 3. Treatment by medication Don’t forget about “heating chain”!
    • Bag and mask ventilation
    • Assessment of efficacy of reanimation Breath evaluation • If spontaneous breathing is present, we can access the ECG • If no spontaneous breath movements are present, we start artificial breathing with 90-100 % of oxygen
    • Heartbeat evaluation Heartbeat (HB) is more then 100 per min: 1. If there is spontaneous breathing, and HB is more then 100/min, we stop artificial breathing (AB) and evaluate cyanosis of the skin 2. If there is no spontaneous breathing, we continue AB 3. If there is less then 100 HB per min, AB has to be continued: • Heartbeat is 60-100 beats – continue AB • Heartbeat is less then 60 min – indirect heart massage
    • Indications for intubation: • Long-time AB • Aspiration by meconium • Diaphragmal hernia • No effect from bag/mask artificial breathing Medication for C-step • Adrenalin • Infusive solutions • Solution of soda (NaHCO3) for acidosis correction • Antagonists of narcotic drugs (naloxon 0.1 mg/kg) i.v. or per os
    • Trachea intubation
    • Indications for adrenaline • HB < 60/min after 30 sec of AB 100% O2 • Absence of heartbeat Solution 1:10000 Infusion therapy Ringer’s solution (5-10 ml/kg) in umbilical vein Blood plasma (indications only!) 0,9% NaCl
    • Resuscitation measures
    • Thank you!