gangguan plasental

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PLACENTAL DISORDERSPLACENTAL DISORDERS

dr. Benny Hasan, SpOGdr. Benny Hasan, SpOG

Depart. of Obstetrics - GynecologyDepart. of Obstetrics - GynecologyMedicine School of Padjadjaran UniersityMedicine School of Padjadjaran Uniersity

Band!ngBand!ng



I. Diseases and Abnormalities of the Fetal

Membranes1. Diseases of the Chorioamnion

. Disorders of Amnioti! Fl"id #ol"me

II. Diseases and Abnormalities of the Pla!ent1. Abnormalities of Pla!entation

. Cir!"lator$ Dist"rban!es

%. Abnormalities of the &mbili!al Cord 'F"nis(). *estational Tro+hoblasti! Diseases

,. Other T"mo"rs of the Pla!enta

PLACENTAL DISORDERS



Diseases and Abnormalities of the FetalMembranes

Diseases of the Chorioamnion Me!oni"m Stainin- Chorioamniotis

Amnioniti! C$sts Amnion Nodos"m Amnioni! ands

PLACENTAL DISORDERS



Diseases of the Chorioamnion

Me!oni"m Stainin- / 0 &n!ommon 2 %3 4ee5s

In!reases 6 )7 4ee5s NMR %.% '1./ in non0stainin-(

Cesarean deli8er$ 4as do"bled NM asso!iated 4ith me!oni"m as+iration



*ambar 9 Me!oni"m stainin-




Chorioamnionitis Intra"terine infe!tion: +rolon- membraner"+t"re: lon- labor

Mi!ros!o+i!al findin-: MN and PMNle!o!$tes infiltrate the !horion

≠+lained !ases of r"+t"red membranes

and<or +reterm labor asso!iated 4ith o!!"lt!horioamnionitis




Amnioni! !$sts

F"sion of amnioni! folds 4ith s"bse="entretention of fl"id



Amnion Nodos"m S="amo"smeta+lasia ofthe amnion

Amnioni!!ar"n!les

Diseases of the ChorioamnionDiseases of the Chorioamnion




Amnioni! ands Amnion disr"+tion bands<strin-formation adhere to the fet"s and im+aire

-ro4th and de8elo+ment Can !a"se intra "terine am+"tation



Diseases and abnormalities of the fetalmembranesDisorders of amnioni! fl"id 8ol"me Oli-oh$dramnios 2 ,77 ml >$dramnios: +ol$h$dramnios 6 777 ml

Chroni! A!"te

Meas"rement of Amnioni! Fl"idPhelan and Collea-"es '1?3/( 9Amnioni! Fl"id Inde; '&ltrasoni! Method(

Addin- the 8erti!al de+ths of the lon-est +o!5et inea!h of fo"r e="al "terine ="adrant>$dramnios 9 6 ) !mIna!!"rate to dia-nosis oli-oh$dramnios

PLACENTAL DISORDERS





"#P$%&' &M($O($% )'U$D *O'UM+

ees )et!s Placenta&nionic Percent

Gestation /g0 /g0 )l!id

/l0 )l!id

12 133 133 433 53

46 1333 433 1333 75

82 4533 733 933 47

73 8833 533 633 1:



>$dramnios Ca"ses 9

Asso!iated to fetal malformation0 CNS i.e anen!e+hal$: s+ina bifida

0 *IT i.e eso+ha-eal atresia

0 Perinatal mortalit$ in!rease Patho-enesis

0 In!rease of amnioni! fl"id +rod"!tion0 Dist"rban!e of 8ol"me !ontrol me!hanism



> d



>$dramnios S$m+toms

P"rel$ me!hani!al !a"ses and res"lt+rin!i+all$ from +ress"re e;erted 4ithin andaro"nd the o8erdistended "ter"s "+onad@a!ent or-ans

Dia-nosis &terine enlar-ement in asso!iation 4ith

diffi!"lt$ in+al+atin- fetal small +arts and in

hearin- fetal heart tones DD 9 as!ites: a lar-e o8arian !$st Can be made b$ "ltrasoni! e8al"ation



>$dramnios

Pro-nosis >i-her +erinatal mortalit$ rate 9

fetal malformation: +reterm labor:

!ord +rola+se er$throblastosis

Maternal !om+li!ation 9 +la!ental

abr"+tion: "terine d$sf"n!tion: +ost

+art"m hemorrha-e



>$dramnios Mana-ement

Minor de-rees rarel$ re="ire treatment Moderate de-rees 4ith d$s+nea:

abdominal +ain: amb"lation diffi!"lt$ need

hos+italiation 0 amnio!entesis

0 amniotom$

0 indometha!in thera+$ 91., to % m-<5- +er da$



Oli-oh$dramnios

Mar5s and Di8on '1??( 9 Amnioni! fl"id inde; 2 ,!m

Ris5 of !ord !om+ression fetal distress Earl$ onset oli-oh$dramnios

0 Asso!iated to obstr"!tion of fetal "rinar$ tra!t

or renal a-enesis an"ria0 Chroni! lea5 from a defe!t in the membranes0 Fetal +ro-nosis is +oor0 P"lmonar$ h$+o+lasia 9

0 thora!i! !om+ression0 la!5 of fetal breathin- mo8ements0 fail"re to retain amnioni! fl"id or in!reased





Oli-oh$dramnios

Oli-oh$dramnios in late +re-nan!$ In!reased !esarean deli8er$ Fetal heart de!elerations and me!oni"m

Amnio inf"sion

Inf"sion of !r$stalloid to re+la!e+atholo-i!all$ diminised amnioni! fl"id hasmost often been "sed d"rin- labor to+re8ent "mbili!al !ord !om+ression

Inf"sion of isotoni! fl"id b$ amnio!entesisfor "ltrasoni! fetal e8al"ation

PLACENTAL DISORDERS



Diseases and abnormalities of the +la!enta

Abnormalities of +la!entation M"lti+le +la!enta 4ith a sin-le fet"s S"!!ent"riate +la!enta

Rin- sha+ed +la!enta Membrana!eo"s +la!enta Fenestrated +la!enta

E;tra!horial +la!enta Lar-e +la!enta Pla!ental +ol$+

PLACENTAL DISORDERS







P'&%+("& B$P&;"$"&P'&%+("& B$P&;"$"&

O; B$'OB+DO; B$'OB+D

P'&%+("&P'&%+("&



&%%+SO;$+S&%%+SO;$+S

P'&%+("&P'&%+("&



";$P'+ P'&%+("&";$P'+ P'&%+("&



+<";&%HO;$&' P'&%+("&+<";&%HO;$&' P'&%+("&

%irc!alate placenta%irc!alate placenta



+<";&%HO;$&' P'&%+("&+<";&%HO;$&' P'&%+("&

%irc!arginate placenta%irc!arginate placenta



%O;D $(S+;"$O(%O;D $(S+;"$O(

*elaoento!s insertion*elaoento!s insertion

PLACENTAL DISORDERS




Cir!"lator$ dist"rban!es Pla!ental infar!ts Pla!ental !al!ifi!ation

#illo"s 'fetal( arter$ thrombosis Clini!al si-nifi!an!e >$+ertro+hi! lesions of the !horioni! 8illi

Mi!ros!o+i! +la!ental abnormalities Pla!ental inflamation

PLACENTAL DISORDERS



P'&%+("& $()&;%"SP'&%+("& $()&;%"S



P'&%+("&' $()&;%"SP'&%+("&' $()&;%"S

;ed Bro=n $nfarcts;ed Bro=n $nfarcts



PLACENTAL DISORDERS




Abnormalities of the "mbili!al !ord 'f"nis( Cord len-th Absen!e of one "mbili!al arter$

!on-enital anomalies Cord !oilin- Fo"r08essel !ord

Cord insertion 90 mar-inal insertion0 8elamento"s insertion

0 8asa +re8ia

PLACENTAL DISORDERS





PLACENTAL DISORDERS




Abnormalities of the "mbili!al !ord 'f"nis( Cord abnormalities !a+able of im+endin-

blood flo4 9 0 5nots of the !ord

0 loo+s of the !ord0 edema

0 torsion

0 stri!t"re0 hematoma

0 !$sts

PLACENTAL DISORDERS



)&'S+ >(O")&'S+ >(O" ";U+ >(O"";U+ >(O"






*estational tro+hoblasti! diseases

Other t"mo"rs of the +la!enta

0 Chorioan-ioma '>eman-ioma(

0 T"mor metastati! to the +la!enta

PLACENTAL DISORDERS

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