vasa previa
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Vasa previa is a condition where the fetal blood vessels run through or near the internal opening of the uterus, placing them at risk of rupture during membrane rupture or labor. Without diagnosis, 56% of cases result in stillbirth, but detection during pregnancy increases survival chances for the fetus to 97%. Risk factors include low-lying placenta, abnormal placenta positioning, IVF/multiple pregnancies, and velamentous cord insertion. Ultrasound can detect vasa previa as early as 16 weeks. Cesarean section is the only treatment and should be scheduled between 35-36 weeks to deliver the baby safely.
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Uterine displacement occurs when the uterus is moved from its normal position, either backward (retroverted uterus) or downward (uterine prolapse). Common causes include repeated pregnancies close together, heavy lifting after childbirth, certain sports/dances, vaginal tears during delivery, constipation, bladder issues, tumors, or pelvic injuries. Symptoms of a retroverted uterus include back pain, painful periods, constipation, frequent urination, and miscarriages. Diagnosis involves a pelvic exam and imaging tests. Treatment options are nonsurgical like pessaries and exercises or surgical like hysterectomy or uterine suspension.
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Umbilical cord prolapse occurs when the umbilical cord drops through the cervix ahead of the presenting fetal part during labor and delivery. This can lead to oxygen deprivation for the fetus if not promptly addressed. Cord prolapse is classified as overt if the cord is visible in the vaginal canal or occult if it is not visible but suspected based on fetal heart rate changes. Immediate cesarean delivery is usually required for overt prolapse while occult prolapse may allow continued monitoring and trial of vaginal delivery if the heart rate recovers. Factors that increase risk include premature delivery, multiple gestation, polyhydramnios, and breech presentation.
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Physiological changes during pregnancy include hormonal, physical, cardiovascular, hematological, metabolic, and other adaptations. Hormone levels like progesterone, estrogen, and prolactin rise to support the pregnancy. Physically, a woman gains weight and her breasts enlarge. Her blood volume increases 40-50% and heart rate rises to support nutrient exchange. Kidney and liver function is altered to meet increased nutrient demands for the fetus. These normal changes help the woman's body accommodate the growing embryo or fetus.Abnormal Labour
1. Obstructed labour occurs when the baby is unable to descend through the birth canal due to issues like a small pelvis, large baby, or abnormal presentation. It can lead to prolonged labour, fetal distress, and rupture of the uterus or development of fistulas.
2. Umbilical cord prolapse is a medical emergency where the cord precedes the baby during delivery. It cuts off oxygen to the baby. Immediate delivery via c-section is usually needed to prevent brain damage or death.
3. Uterine rupture is a serious complication during labour where the uterine wall tears. It commonly occurs during labour in women with a prior c-section scar. Symptoms may include abdominal pain
Placenta previa, accreta, etc
Three clinically important causes of bleeding in late pregnancy and labor are placenta previa, placenta accreta, and vasa previa. Placenta previa occurs when the placenta implants in the lower uterine segment near or over the internal cervical os, and risks include antepartum bleeding, postpartum hemorrhage, and need for hysterectomy. Transvaginal ultrasound is the preferred method for diagnosing placenta previa. Women with a complete placenta previa should deliver via cesarean section. While in the hospital for bleeding, intravenous access and blood work should be obtained to prepare for potential hemorrhage during delivery.
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Uterine malformations
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Puerperium
The document discusses the process of puerperium, which is the period following childbirth where the body returns to its pre-pregnant state over approximately 6 weeks. Key changes include the uterus involuting from 1000g to 100g over this time, the return of ovarian function and menstruation between 8-12 weeks (or longer while breastfeeding), and the production and composition of colostrum and breastmilk. Proper breastfeeding and lactation is encouraged for infant health and development during this postpartum period of maternal physiological changes.
Uterine abnormalities
This document defines and classifies uterine abnormalities, or mullerian duct anomalies. It describes 7 classes of anomalies resulting from abnormal development of the mullerian ducts during embryogenesis. Class 1 involves complete or partial mullerian agenesis. Classes 2 through 5 involve various degrees of failure of the mullerian ducts to fully fuse, resulting in anomalies like a unicornuate, didelphys, bicornuate, or septate uterus. Class 6 is an arcuate uterus and Class 7 involves DES exposure in utero causing a T-shaped uterus. Symptoms may include pain or infertility. Diagnosis involves imaging tests. Treatment depends on symptoms but may involve surgery to correct the anomaly
Management of third stage of labour
The third stage of labor involves the delivery of the placenta after childbirth. It is important to monitor for complications and allow the placenta to separate and deliver naturally without pulling on the umbilical cord. Signs of placental separation include lengthening of the cord and a gush of blood. Active management with controlled cord traction is commonly used to expedite delivery but physiological management without intervention is also appropriate for low risk births. Close monitoring during the third stage is important to detect any postpartum hemorrhage or retained placenta.
Subinvolution of the uterus
The document discusses uterine involution and subinvolution after pregnancy. During involution, the uterus reverts back to its non-pregnant size of 7.5cm in length and 60g in weight. Subinvolution occurs when this process is impaired or retarded. Risk factors for subinvolution include grand multiparity, over-distension of the uterus, maternal ill health, cesarean section, uterine fibroids, and retained products of conception or uterine sepsis. Symptoms of subinvolution can include abnormal or prolonged bleeding. Treatment depends on the underlying cause, such as antibiotics for endometritis, uterine exploration for retained products, or medications to enhance involution.
Medical induction of labour
This document discusses induction of labor, including definitions, purposes, indications, contraindications, and methods. The key methods of medical induction discussed are prostaglandins like dinoprostone and misoprostol, oxytocin, and mifepristone. Prostaglandins work to ripen the cervix and stimulate contractions through local effects on cervical collagen and myometrium. Oxytocin stimulates contractions through receptor-mediated pathways. Mifepristone is a progesterone antagonist that blocks progesterone receptors to ripen the cervix. The document compares these methods and provides dosing and administration details.
Placental abnormalities
The document discusses several types of placental abnormalities including abruptio placenta, placenta previa, placenta accreta, and other rare conditions. Abruptio placenta is the premature separation of the placenta from the uterus after 20 weeks of gestation. Placenta previa occurs when the placenta implants in the lower uterine segment, covering all or part of the cervical os. Placenta accreta involves abnormal placental attachment to the myometrium, which can cause life-threatening bleeding during delivery.
Fetal skull
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Malposition and malpresentations
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Management of 3rd stage of labor
The third stage of labor involves the delivery of the placenta after birth of the baby. Active management with controlled cord traction and uterotonic drugs is recommended to prevent postpartum hemorrhage. After ensuring placental separation with signs like cord lengthening and uterine contraction, gentle traction is applied to the cord while massaging the uterus to deliver the placenta in a controlled manner. Rapid intravenous oxytocin is given after birth to aid placental separation and reduce bleeding risk.
Sign and symptoms of pregnancy
This document provides an overview of the signs and symptoms of pregnancy presented by Nidhi Maurya. It begins with objectives to define pregnancy and explain signs and symptoms in each trimester. Common early signs include missed period, nausea, frequent urination and breast changes. Objective signs assessed include uterine size and fetal heart sound detectable after 18 weeks. Signs in the second trimester include quickening and skin changes. Third trimester brings prominent fetal movement and engagement of the presenting part. Fundal height increases throughout pregnancy.
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This document discusses placental and umbilical cord abnormalities. It begins by describing normal placental anatomy and development. It then covers various types of placental anomalies including abnormalities of form, position, relationships to cord/membranes, and diseases. Umbilical cord abnormalities such as short/long length, knots, torsion, and single umbilical artery are also reviewed. In summary, the document provides an overview of common placental and umbilical cord abnormalities for Mrs. Savita presented by Nikita Sharma.
Ectopic pregnancy
An ectopic pregnancy occurs when a fertilized egg implants and grows outside the uterus, usually in one of the fallopian tubes. This is a medical emergency that requires prompt treatment to stop potentially life-threatening bleeding. Most ectopic pregnancies occur in the fallopian tubes. While the incidence of ectopic pregnancy is rising due to increased rates of pelvic inflammatory disease, early diagnosis and treatment have reduced maternal death and illness.
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Prolapse of the uterus refers to the downward displacement of the vagina and uterus. It can be congenital or acquired due to factors like childbirth, obesity, chronic coughing, and uterine fibroids. Symptoms include feeling something coming down in the vagina, backache, difficulty urinating, and incomplete bowel movements. Diagnosis involves physical examination in both dorsal and standing positions. Management includes preventative measures, conservative options like pessaries and exercises, and surgery if symptoms become worse.
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The puerperium period lasts approximately 6 weeks after childbirth. During this time, the body reverts back to a non-pregnant state through the involution of organs like the uterus, cervix, and vagina. The uterus undergoes the most dramatic changes, decreasing in size from 1000g immediately after birth to about 50g by 6 weeks postpartum. Other physiological changes include a decrease in temperature, pulse rate returning to normal, diuresis and weight loss from fluid loss. Lochia discharge gradually decreases in amount and changes color over a 2-3 week period as the reproductive system completes its postpartum transformation.
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uterine abnormality
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Pregnancy (physiological changes during pregnancy)
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Physiological changes during pregnancy include hormonal, physical, cardiovascular, hematological, metabolic, and other adaptations. Hormone levels like progesterone, estrogen, and prolactin rise to support the pregnancy. Physically, a woman gains weight and her breasts enlarge. Her blood volume increases 40-50% and heart rate rises to support nutrient exchange. Kidney and liver function is altered to meet increased nutrient demands for the fetus. These normal changes help the woman's body accommodate the growing embryo or fetus.What's hot (20)
Pregnancy (physiological changes during pregnancy)
Pregnancy (physiological changes during pregnancy)
Similar to vasa previa
Abnormal Labour
1. Obstructed labour occurs when the baby is unable to descend through the birth canal due to issues like a small pelvis, large baby, or abnormal presentation. It can lead to prolonged labour, fetal distress, and rupture of the uterus or development of fistulas.
2. Umbilical cord prolapse is a medical emergency where the cord precedes the baby during delivery. It cuts off oxygen to the baby. Immediate delivery via c-section is usually needed to prevent brain damage or death.
3. Uterine rupture is a serious complication during labour where the uterine wall tears. It commonly occurs during labour in women with a prior c-section scar. Symptoms may include abdominal pain
Placenta previa, accreta, etc
Three clinically important causes of bleeding in late pregnancy and labor are placenta previa, placenta accreta, and vasa previa. Placenta previa occurs when the placenta implants in the lower uterine segment near or over the internal cervical os, and risks include antepartum bleeding, postpartum hemorrhage, and need for hysterectomy. Transvaginal ultrasound is the preferred method for diagnosing placenta previa. Women with a complete placenta previa should deliver via cesarean section. While in the hospital for bleeding, intravenous access and blood work should be obtained to prepare for potential hemorrhage during delivery.
Late pregn bleeding 1.11.12 — копия
Late pregnancy bleeding can be caused by several conditions including abruption placenta, placenta previa, vasa previa, and uterine rupture. Abruption placenta involves the separation of the placenta from the uterus before delivery and can range from mild to severe. Placenta previa occurs when the placenta implants in the lower uterine segment which can cause painless bleeding. Vasa previa involves blood vessels crossing over the cervical opening which can lead to exsanguination of the fetus if ruptured. Uterine rupture is a complete tear of the uterus wall which endangers the mother and fetus. Immediate delivery is usually required for management of these conditions.
Myoma & preg
uterine fibroid, fibroid with pregnancy, myoma during pregnancy, complication of myoma, high risk pregnancy, myoma during cesarean section, myomectomy, red degeneration, abruptio placenta, oversized uterus, malpresentation, complicated pregnancy.
Placenta accreta
Placenta accreta is currently the most common indication for peripartum hysterectomy. It occurs when the placenta invades and attaches abnormally to the myometrium. The risk and incidence of placenta accreta has increased significantly in recent decades due to rising cesarean delivery rates. Prenatal diagnosis using ultrasound and MRI is important to identify high-risk women and allow planning with a multidisciplinary team. Optimal management involves scheduled cesarean hysterectomy between 34-35 weeks gestation. Conservative management can be considered but is associated with higher risks of hemorrhage, infection and need for emergency hysterectomy.
Sites of implantation of embryo
This document summarizes various sites of embryo implantation and placental abnormalities in pregnancy. It describes normal implantation in the uterus and discusses abnormal locations including placenta praevia where the placenta is close to or covers the cervix. Rare sites of ectopic pregnancy outside the uterus are also outlined. The document then examines placental abnormalities categorized by shape, implantation site and degenerative lesions. Specific conditions like placenta accreta where the placenta invades the uterus are defined. In summary, the key sites of abnormal embryo implantation and classifications of placental anomalies are concisely presented.
Transverse lie and unstable lie
This document defines and discusses transverse lie, an abnormal fetal position where the long axis of the fetus is perpendicular to that of the mother. Key points include:
- Transverse lie results in a shoulder presentation and has a 1 in 200 incidence rate. It is more common in preterm/macerated fetuses and multiparous women.
- Diagnosis involves abdominal/pelvic examination and ultrasound to confirm the lie beyond 36 weeks.
- Untreated transverse lie poses risks like cord prolapse and obstructed labor. Modern management includes external cephalic version or cesarean section for delivery.
- Unstable lie with constantly changing presentation poses similar risks and is managed with version attempts and close monitoring
Cord prolapse
Cord prolapse occurs when the umbilical cord descends through the cervix alongside or past the presenting fetal part. It has an incidence of 0.2% of births and can result in high rates of fetal death from asphyxia. Risk factors include breech presentation, multiple gestation, and premature rupture of membranes. Management involves prompt diagnosis, keeping the presenting part elevated, and expedited delivery by caesarean section if vaginal delivery is not imminent. For live fetuses, minimizing cord compression and reducing the decision to delivery time are critical.
Abnormalities of cord & placenta
The document summarizes various placental and umbilical cord abnormalities. It describes the typical shapes of most placentae as round or oval but notes that variations are common, including multiple placentae or bilobed placentae. It also discusses abnormalities in placental structure, cord insertion sites, umbilical cord vessels, and other variations that can occur in the placenta and umbilical cord. Many of these abnormalities are associated with risks like abnormal fetal growth, preterm delivery, fetal distress, or hemorrhage. The document provides details on the incidence, risk factors, pathogenesis, and clinical implications of numerous placental and umbilical cord variations.
Aph
This document discusses antepartum hemorrhage (APH), which is bleeding during pregnancy after 24 weeks of gestation. It describes the main causes of APH as placental abnormalities like placenta previa, placenta abruption, and vasa previa. Placenta previa is when the placenta implants in the lower uterine segment or over the cervical os. Risk factors include previous c-sections and advanced maternal age. Diagnosis is usually by ultrasound and digital exams are avoided due to risk of bleeding. Management depends on severity but often involves admission, monitoring, and eventual c-section delivery. The document contrasts the presentations and management of placenta previa versus placenta abruption.
Placental evaluation
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..
Umbilical cord prolapse
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Multiple pregnancy
1) Multiple pregnancies occur when more than one fetus develops simultaneously in the uterus. The main types are dizygotic (non-identical) twins, which account for 80% of twins, and monozygotic (identical) twins, which make up 20%.
2) Risk factors for dizygotic twins include being between 30-40 years old, above average height and weight, previous pregnancies, and certain fertility treatments.
3) Managing a twin pregnancy involves regular monitoring for complications like prematurity, anemia, preeclampsia, and intrauterine growth restriction. Labour involves close fetal monitoring and the potential for a higher rate of interventions.
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This document summarizes the sonographic evaluation of the placenta. It describes normal placental anatomy and variants. It discusses pathologies like placenta previa, vasa previa, placental abruption, and placenta accreta that can cause antepartum hemorrhage. It also covers twin gestations, placental tumors, cystic lesions, and how the placenta changes during pregnancy. Sonography is highlighted as the main imaging method for placental evaluation.
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vasa previa
- 1. BY, MS.PRIYANKA GOHIL M.Sc. (N) OBG PhD Scholar
- 2. Vasa previa is an obstetric complication in which the fetal blood vessels cross or run near the internal orifice of the uterus. These vessels are at risk of rupture when the supporting membranes rupture as they are unsupported by the umbilical cord or placental tissue. This complication can happen during labour.
- 3. In terms of risk, 56% of instances of vasa previa that go undiagnosed result in stillbirth. However, when the condition is detected in pregnancy, the chances of survival for the fetus rise to 97 %.
- 5. 1. A low lying placenta. It can be due to scarring of the uterus as a result of previous miscarriage and D/C ( Dilatation and Curettage) 2. An abnormally or unusually form placenta. It can be a bilobed placenta or succenturiate- low placenta.
- 6. 3. In cases of in-vitro fertilization pregnancies and multiple pregnancies ( twins, triplets, etc) 4. In case of velamentous insertion of umbilical cord.
- 7. By noting the triad signs Painless vaginal bleeding Membrane rupture Fetal bradycardia or death. Ultrasonography Transvaginal sonography in combination with color doppler help to detect vasa previa as early as 16th week of pregnancy.
- 8. There are no warning sign but these can be... Painless vaginal bleeding (2nd and 3rd trimester) Darker red color blood (as the baby blood is dark in color, bright red blood signifies blood from the mother.) Fetal bradycardia
- 9. The only treatment plan to be followed is a healthy delivery by cesarean section. Cesarean section should be planned as early enough to avoid an emergency and should be late enough in orde to prevent the problems related with prematurity. Usually cesarean section is recommonded at 35-36 weeks provided the mother is normal without any risk.