Placental

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Placental

  1. 1. Placental insufficiency: diagnostics and treatment. Methods of investigation of placenta. Fetal hypoxia. Asphyxia of newborn. Lecture by Andriy Berbets
  2. 2. 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
  3. 3. Placental physiology
  4. 4. Placental physiology
  5. 5. Placental villi
  6. 6. Placental functions
  7. 7. Endocrine functions of the placenta
  8. 8. The umbilical cord
  9. 9. 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
  10. 10. Placental insufficiency classified by time of manifestation • Primary • Secondary
  11. 11. Placental insufficiency classified by clinical flow • Acute • Chronic
  12. 12. Blood circulation disorders in placenta 1. Compensated 2. Particularly compensated 3. Non-compensated
  13. 13. 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
  14. 14. 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)
  15. 15. 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
  16. 16. Causes of fetal hypoxia • Maternal • Fetal • Placental Maternal • Extragenital pathology • Infections • Gestoses • Immune conflict • Intoxications • Over-termed pregnancy • Bleeding etc
  17. 17. Fetal: • Intra-uterine infection • Encephalopathy • Brain misdevelopments • Hemolytic diseases Placental: • Primary PI • Secondary PI
  18. 18. 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
  19. 19. Correction of fetal hypoxia • Improvement of the blood perfusion • Normalization of metabolism • Improvement of oxygen interchange • Blood vessels dilatation • Uterus muscle relaxation
  20. 20. 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
  21. 21. Apgar score
  22. 22. 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
  23. 23. 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”!
  24. 24. Bag and mask ventilation
  25. 25. 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
  26. 26. 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
  27. 27. 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
  28. 28. Trachea intubation
  29. 29. 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
  30. 30. Resuscitation measures
  31. 31. Thank you!

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