Abnormalities of the placenta are important to recognize owing to the potential for maternal and fetal morbidity and mortality. Pathologic conditions of the placenta include
Placental causes of hemorrhage,
Gestational trophoblastic disease,
Retained products of conception,
Nontrophoblastic placental tumors, metastases, and
Cystic lesions..
USMLE GENERAL EMBRYOLOGY 015 Fetal Membranes-B Fetal Membranes.pdfAHMED ASHOUR
The fetal membranes, also known as the embryonic or fetal membranes, play a crucial role in the development and protection of the embryo/fetus during pregnancy.
Understanding the structure and functions of the fetal membranes is essential for healthcare providers to monitor the health and well-being of both the mother and the developing fetus during pregnancy.
Issues related to the fetal membranes, such as preterm premature rupture of membranes (PPROM), require careful management to
Data science is an interdisciplinary field that uses algorithms, procedures, and processes to examine large amounts of data in order to uncover hidden patterns, generate insights, and direct decision making.
Normal thyroid on US-
Homogenous with medium level echogenicity.
Thin hyperechoic capsule, which becomes calcified in pts with uremia or calcium metabolism disorder.
Superior and inferior thyroid artery and vein.
Mean diameter of artery 1-2 mm with PSV of 20-30 cm/s
Veins can ne dilated upto 10 mm.
The recurrent laryngeal nerve runs with inf thyroid artery and passes between esophagus and thyroid lobeon left side & logus coli and thyroid lobe on righjt side.
Scrotal Masses
98-100% accuracy in distinguishing intra and extra-testicular masses.
*** Most extratesticular masses are benign & most intratesticular masses are malignant
Malignant lesions are msotly hypoechoic.
Malignant neoplasia pts usually presents as
painless , unlateral testicular mass .
Clinically it is important to differentiate between Seminomas and Non Seminomatous germ cell tumors.
Grey scale Imaging – High frequency Transducers are used for most of peripheral veins (9 MHz). for iliac or inf venacava , transducer of 4-6 MHz are used. Superficial veins such as saphenous vein, calf veins need even higher frequency transducers ( 9-15 MHz).
Doppler Sonography – quantitative (duplex spectral) & qualitative (color Dopler) .
This combination of anatomic and physiologic information makes US-CD such a powerful tool in evaluation of vascular pathology.
The upper and lower extremity arteries , easy to examine, becoz of good imaging window.
Doppler frequencies are typically more than 3 MHz.
Though real-time gray-scale sonography is useful for evaluating the presence of atherosclerotic plaque or confirming the presence of extravascular masses. Color flow Doppler sonographic imaging allows the clinician to survey the area of interest rapidly, determine if vascular structures are present, and if so, characterize their blood flow patterns
Nuchal translucency
It is a sonographic pre natal screening scan to detect cardiovascular abnormality in a fetus.
NT can also detect altered extra cellular matrix composition and limited lymphatic drainage
G Sac seen within the thickened decidua .
Eccentric location within endometrium
Should abut the endometrial canal ( to differentiate it from decidual cyst )
On TVS -4& half -5 weeks
Thresold level – identifies the earliest one can expect to see a sac -4w3d
Discriminatory level – identifies when one should always see the sac- 5w 2d .
Ovulation was initially monitored by conventional methods like BBT, mid luteal serum progesterone and urinary LH.
Nowadays, USG is used for follicular monitoring for both natural and stimulated cycles.
By using transvaginal sonography, the bladder can be seen as early as 11 weeks of gestation. By 12 to 13 weeks, the bladder is visualized in 98% of cases using both transabdominal and transvaginal sonography.
Sonographic evaluation of fetal face is a part of anatomic survey in mid pregnancy
However , little is required; b/c according to american institute of ultrasound in modern practice guidelines, only visualization of fetal upper lip is mandatory during anatomy survey.
3D & 4D images are more informatory in cases where fetal face is hard to evaluate in 2D scan due to fetal position.
Malformations of Cortical Development
Cortex under goes complex development at neuronal/cellular level.
Neurons on outer surface of cortex undergoes 3 overlapping phases from 5th to 28th week.
Proliferation
Migration
organisation
Error of Dorsal Induction
Results in defect of closure of neural tube which leads to various anomalies like anencephaly, encephalocoele, spinal dysraphism and chiari malformations.
In many fetal skeletal dysplasias ,the skin and s/c tissue continues to grow at a rate proportionately greater than the long bones resulting in relatively thickened skin folds (on occasion mistaken for hydrops fetalis ) .
Polyhydraminos –common .cause –variable combination of the following –oesophageal compression by the small chest ,GI abnormalities ,micrognathia ,or hypotonia .
Generally occurs secondary to pulmonary atresia with intact IVS .
Pathophysiology- it develops because of a reduction in the blood flow secondary to inflow impedence from tricuspid atresia or outflow impedence from pulmonary arterial atresia .
Typical findings- a small , hypertrophic RV and a small or absent pulmonary artery
To study the morphological characteristics and enhancement patterns of probably malignant breast lesions on dynamic contrast enhanced MRI and to correlate the findings with Color Doppler imaging and histopathologically.
To evaluate importance of DWI in improving specificity of MR Breast.
4 BASIC TYPES OF DENSITY - air , water /soft tissues, metal /bone , fat
Two substances of the same density, in direct contact, cannot be differentiated from each other on an x-ray.
This phenomenon, the loss of the normal radiographic silhouette (contour), due to loss of difference in density is called the silhouette sign.
2 types (a) cellular NSIP
(b) Fibrotic NSIP (more common)
Fibrosis may involve alveolar septa, peribronchivascular interstitium, interlobular septa and visceral pleura.
Prognosis of fibrotic NSIP is worse , cellular NSIP has good prognosis.
HRCT finding may show both, airspace and interstitial patterns
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
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- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
1. IMAGING OF THE PLACENTA
Dr. Vrishit Saraswat
I Yr. Resident
(M.D. Radio)
2. IMPORTANCE
Abnormalities of the placenta are important to recognize
owing to the potential for maternal and fetal morbidity and
mortality. Pathologic conditions of the placenta include
Placental causes of hemorrhage,
Gestational trophoblastic disease,
Retained products of conception,
Nontrophoblastic placental tumors, metastases, and
Cystic lesions..
3. IMAGING MODALITIES
Sonography remains the imaging modality of choice for
evaluation of the placenta.
Magnetic resonance (MR) imaging can be of added
diagnostic value when further characterization is required,
particularly in the setting of invasive placental processes
such as
placenta accreta and
gestational trophoblastic disease.
4. INTRODUCTION
The placenta is named for its appearance (Greek plakuos,
meaning “flat cake”) and is responsible for the nutritive,
respiratory, and excretory functions of the fetus.
The placenta is often overlooked in the routine evaluation of a
normal gestation, receiving attention only when an
abnormality is detected.
5.
6. EMBRYOLOGIC FEATURES
Both fetal and maternal components contribute to the structure of
the placenta. The villi of the chorion frondosum are fetal in origin
and contain arterial plexuses supplied by the umbilical artery.
These chorionic villi protrude into the intervillous space, where
they are bathed in maternal blood.
The maternal portion of the placenta is composed of the decidua
placentalis, which lines the intervillous space. Fetal trophoblastic
invasion of the endometrium induces decidual changes. Maternal
decidual septa separate groups of villi within the intervillous
space.
7.
8. Normal placenta. (a) US image shows a placenta (P) that is relatively homogeneous in
echo-texture. The retroplacental clear space is hypoechoic (arrowheads).
9. MORPHOLOGY AND
VARIANTS
Typically, the placenta is located along the anterior or
posterior uterine wall, extending onto the lateral walls.
Although usually discoid, the placenta can be variable in
morphology. Variant placental shapes include bi-lobed,
succenturiate, circumvallate, and placenta membranacea.
10.
11. Succenturiate placenta. 2(a) Diagram shows a placenta with a succenturiate lobe. (b) US image shows
a placenta (P) with a succenturiate lobe (S). The main body of the placenta is located along the
posterior uterine wall. A second soft-tissue structure of the same echogenicity but located anteriorly is
the succenturiate lobe.
12. Bilobed placenta.3(a) Diagram shows a bilobed placenta. (b) US image shows a
bilobed placenta. The two lobes of the placenta (P1 and P2) are separated by a thin
bridge of placental tissue that covers the internal os. In this case, the umbilical cord
(arrowhead) inserts into the bridge of tissue.
13. Circumvallate placenta.-4a-US image shows a circumvallate placenta. The chorionic plate (the
fetal surface of the placenta) (black arrowheads) is smaller than the basal plate (the surface
interfacing with the uterus), with rolling and shouldering of the placental margins (white
arrowheads). F = fetus.
15. Velamentous insertion of the umbilical cord. Doppler US image shows insertion (I) (white
arrow) of the umbilical cord into a thin membrane of tissue extending from the margin (black
arrow) of the placenta (P).
16. The umbilical cord typically inserts centrally, but eccentric and
velamentous (outside the placental margin) insertions also occur .
Eccentric insertions are cord insertions that are less than 1 cm
from the placental edge. These are distinguished from a
velamentous insertion, where the umbilical cord inserts on the
chorioamniotic membranes rather than on the placental mass.
This membranous insertion results in a variable segment of the
umbilical vessels running between the amnion and the chorion,
unprotected by Wharton jelly
17. Placental size is expressed in terms of thickness in the
midportion of the organ and should be between 2 and 4 cm.
Placental thinning has been described in systemic vascular and
hematologic diseases that result in microinfarctions.
Thicker placentas (>4 cm) are seen in fetal hydrops,
antepartum infections, maternal diabetes, and maternal
anemia. Placental thickening can be simulated by
myometrial contractions and underlying fibroids.
18. Chorioamniotic separation. Transverse (a) and sagittal (b) images from obstetric US performed
at 20 weeks gestation show a free-floating membrane (arrowheads) surrounding the fetus (F).
This membrane is the amnion, which is completely separated from the underlying chorion;
there is even separation (arrow) over the surface of the placenta (P).
19. CHORIOAMNIOTIC SEPARATION
The placental and fetal membranes (chorion and amnion,
respectively) are separate early in gestation, accounting for the
appearance of the amniotic sac. After approximately 14 weeks
gestation, these membranes fuse and are no longer separately
distinguishable (12).
In rare cases, chorioamniotic separation can occur later in
gestation. This can be focal or extensive, with the amniotic
membrane becoming either free floating or adherent to the fetus.
Extensive cases pose a risk to the fetus, with increased rates of
both preterm delivery and the development of amniotic bands
(12).
20. Chorioamniotic separation is most commonly related to prior
intervention such as amniocentesis or surgery but can occur
sporadically. Sporadic cases have been associated with
increased rates of underlying fetal chromosomal and
developmental abnormalities
21. Chorioamniotic separation is usually detected with US and is
visible as a free-floating or adherent membrane surrounding
the fetus. Separation can extend throughout the entire
uterine cavity and over the surface of the placenta.
22. TWIN GESTATIONS-TWIN PEAK SIGN
Twin peak sign in dichorionic-diamniotic twin gestations. (a) US image of an early twin gestation shows
the separate placentas converging at the insertion of the amniotic membrane (arrowhead), forming the
so-called twin peak that is characteristic of a dichorionic-diamniotic gestation.
23. (b) Sagittal SSFSE MR image shows similar findings, with the twin peak (*) formed by
the two placentas. Arrowhead = intertwin membrane.
24. PLACENTAL CAUSES OF ANTEPARTUM
HEMORRHAGE
Placenta previa and placental abruption account for more
than one-half of cases of antepartum hemorrhage and are
increasing in prevalence as the rate of cesarean section
increases.
25. Placental hematoma. (a) US image shows a rounded collection of mixed- echogenicity material
(arrowheads) deep to the chorion along the lateral margin of the placenta. There is no internal
Doppler signal to suggest blood flow. This appearance is consistent with a subchorionic hematoma.
26. PLACENTAL HEMATOMA
placental hematomas appear as well- circumscribed masses with echogenicity that
varies according to chronicity.
they are hypoechoic or anechoic in the acute phase, heterogeneously echogenic in
the subacute phase, and anechoic in the chronic phase.
doppler interrogation should reveal absence of internal blood flow; this finding allows
differentiation of hematomas from other placental masses.
Placental hematomas are foun d mostly on the fetal side of placenta.
When large in size , are termed as Breus mole.
27. US image shows placental abruption. A crescenteric collection of predominantly hypoechoic
fluid lifts the edge of the placenta (P) away from the underlying myometrium (M).
28. PLACENTALABRUPTION
Placental abruption represents premature separation of the
placenta from the uterine wall
US is frequently performed to confirm the presence of abruption
and assess the extent of subchorionic or retroplacental
hematoma . The presence of blood in large enough volumes to
be visible sonographically indicates retained hemorrhage that
may remain symptomatic.
False-negative results can occur when blood dissects out from
beneath the placenta and drains through the cervix.
29. Transvaginal US image obtained at 20 weeks gestation shows
a low-lying placenta (P). The placental margin comes to within
0.7 cm of the internal cervical os
30. Transvaginal US image obtained at 19 weeks gestation shows marginal
placenta previa. The placental tip (T) is located immediately at the internal
cervical os (O) but does not cover it
31. Transvaginal US image obtained at 19 weeks gestation shows complete placenta
previa. The placenta (P) entirely covers the internal cervical os (O).
32. PLACENTA PREVIA
Placenta previa refers to abnormal implantation of the
placenta in the lower uterine segment, overlying or near the
internal cervical os
Normally, the lower placental edge should be at least 2 cm
from the margin of the internal cervical os.
The diagnosis of placenta previa should not be made before
15 weeks gestation.
33. There is vascular flow in a vessel (V) that is closely
applied to the internal cervical os (O).
34. VASA PREVIA
Vasa previa refers to the presence of abnormal fetal vessels
within the amniotic membranes that cross the internal cervical
os. These vessels are unsupported by Wharton jelly or
placental tissue and are at risk of rupture when the supporting
membranes rupture; such vessels are also at risk of direct
injury during labor. Rupture of these vessels can lead to
catastrophic fetal hemorrhage.
35. The diagnosis of vasa previa is made with Doppler US, which
demonstrates vascular flow within vessels overlying the
internal cervical os .
36. PLACENTA ACCRETA, INCRETA, AND
PERCRETA
During the process of placental development and implantation, a defect in
the normal decidua basalis from prior surgery or instrumentation allows
abnormal adherence or penetration of the chorionic villi to or into the
uterine wall .
The extent of adherence to and invasion of the placental tissue varies:
Superficial invasion of the basalis layer is termed placenta accreta (approximately
75% of cases);
deeper invasion of the myometrium is termed placenta increta ; and
even deeper invasion involving the serosa or adjacent pelvic organs is termed
placenta percreta
37. Sonographic features of placenta accreta include
loss of the normal retroplacental clear space,
anomalies of the bladder-myometrium interface,
prominent placental lacunae, and
increased vascularity at the interface of the uterus and bladder .
Of these various sonographic features, the presence of
prominent placental lacunae has the highest positive predictive
value. Lacunae are characterized by ill-defined margins, irregular
shape, and turbulent flow.
38. US images show disruption of the normal hypoechoic myometrium (black
arrowheads) by invading placental tissue (white arrowheads). B = bladder, P =
placenta.
39. Any input or suggestions are
welcome.
Thanks for listening.
Dr Vrishit Saraswat.