MindMap Gallery Medicine - fetal appendage abnormalities
This is a mind map about fetal appendage abnormalities, including placenta previa, placental abruption, placenta accreta, abnormal amniotic fluid volume, Umbilical cord abnormalities, etc.
Edited at 2023-12-22 21:13:32One Hundred Years of Solitude is the masterpiece of Gabriel Garcia Marquez. Reading this book begins with making sense of the characters' relationships, which are centered on the Buendía family and tells the story of the family's prosperity and decline, internal relationships and political struggles, self-mixing and rebirth over the course of a hundred years.
One Hundred Years of Solitude is the masterpiece of Gabriel Garcia Marquez. Reading this book begins with making sense of the characters' relationships, which are centered on the Buendía family and tells the story of the family's prosperity and decline, internal relationships and political struggles, self-mixing and rebirth over the course of a hundred years.
Project management is the process of applying specialized knowledge, skills, tools, and methods to project activities so that the project can achieve or exceed the set needs and expectations within the constraints of limited resources. This diagram provides a comprehensive overview of the 8 components of the project management process and can be used as a generic template for direct application.
One Hundred Years of Solitude is the masterpiece of Gabriel Garcia Marquez. Reading this book begins with making sense of the characters' relationships, which are centered on the Buendía family and tells the story of the family's prosperity and decline, internal relationships and political struggles, self-mixing and rebirth over the course of a hundred years.
One Hundred Years of Solitude is the masterpiece of Gabriel Garcia Marquez. Reading this book begins with making sense of the characters' relationships, which are centered on the Buendía family and tells the story of the family's prosperity and decline, internal relationships and political struggles, self-mixing and rebirth over the course of a hundred years.
Project management is the process of applying specialized knowledge, skills, tools, and methods to project activities so that the project can achieve or exceed the set needs and expectations within the constraints of limited resources. This diagram provides a comprehensive overview of the 8 components of the project management process and can be used as a generic template for direct application.
fetal appendage abnormalities
placenta previa
Overview
After 28 weeks
The placenta is positioned lower than the fetal presentation → attached to the lower segment of the uterus → covering the internal cervical os
Cause
Placental abnormalities
Placenta area is too large
Abnormal placental morphology
★Twins are more likely to occur → the placenta is larger
Endometrial lesions/injury
cesarean section
History of uterine surgery
Multiple miscarriages and curettage
★The fertilized egg implants into the damaged endometrium → Poor placental formation → Poor blood supply → In order to absorb nutrients → Extend to the lower segment of the uterus
advanced maternal age
★Not related to gestational hypertension ★Pregnant hypertension is related to placental abruption
Classification
Complete placenta previa (central placenta previa) → the largest amount of bleeding
Placental tissue completely covers the internal cervical os
partial placenta previa
Partially covering the internal cervical os
Borderline placenta previa → very little bleeding
The lower edge of the placenta reaches the internal cervical os but does not go beyond it
low lying placenta
The placenta is attached to the lower segment of the uterus, but the edge is less than 2cm from the cervix.
Dangerous placenta previa
The placenta is attached to a scarred area from previous surgery
clinical manifestations
symptom
Late pregnancy/labor
Unprovoked and painless recurrent vaginal bleeding (blood from placenta previa will not cause intrauterine irritation)
physical signs
Uterus soft without tenderness
Size is consistent with gestational age
★High floating fetal head and abnormal fetal position
The placenta occupies the lower segment of the uterus → affects the fetus’ entry into the pelvis → cannot be connected
Intrauterine hypoxia, abnormal fetal heart rate → If there is excessive bleeding
Placenta previa attached to the front wall of the uterus
Placental blood flow murmur can be heard
on pubic symphysis
diagnosis
★The placenta attached to the lower segment of the uterus can change into a normal placenta as the uterus moves upward.
The placenta can change as the uterus moves
high risk factors
history of multiple miscarriages
old age
clinical manifestations
symptom
Unprovoked, painless, recurrent vaginal bleeding
Abdominal examination
The uterus is soft and non-tender
The size of the uterus is consistent with the gestational age
vaginal examination
Mainly B-ultrasound
No anal examination
Film degree exam
B-ultrasound first choice
MRI → Dangerous placenta is more helpful
Impact on mother and child
Secondary uterine atony → postpartum hemorrhage
Bleeding during cesarean section
During delivery → Placenta previa is not easy to separate completely
placenta accreta
puerperal infection
Poor perinatal prognosis
Hemorrhage→Fetal distress
deal with
Expectant therapy (available for <36 weeks) (cannot give birth yet)
Termination of labor (available at >36 weeks) (you can already give birth at this time)
Indications
hemorrhagic shock
fetal distress
Placenta previa, heavy bleeding, inability to deliver for a short period of time
Digital anal examination is prohibited
placental abruption
Brief description
Normal position of the fetus after 20 weeks of pregnancy before delivery
Partial/total detachment from the uterine wall
Cause
Vascular disease
★Preeclampsia→common
hypertension
↑Can cause spasm and hardening of small arteries
Capillary necrosis and bleeding → hematoma formation → separation of placenta and uterine wall
Mechanical factors
Sudden trauma/blunt trauma
Sudden stretching/contraction of the uterus → placental abruption
sudden decrease in uterine pressure
Preterm premature rupture of membranes
Twin pregnancy: the first baby is delivered too quickly
polyhydramnios
pathology
Decidual hemorrhage → hematoma → placenta and uterine wall detachment
Overt dissection (dissection area ↑ amount of bleeding ↑) (blood can break through the edge of the placenta and flow out through the cervical canal)
Hidden dissection (the placenta and uterine wall are not separated) (blood accumulates between the placenta and uterine wall and cannot flow out → no vaginal bleeding)
Hidden dissection blood flow increases sharply → blood pressure ↑ → blood soaks into the myometrium → purple-blue ecchymosis on the surface of the uterus
uteroplacental apoplexy
Clinical manifestations/grading
Typical performance
vaginal bleeding
Old and not coagulating
The amount of bleeding is not proportional to the degree of pain/placenta detachment
stomach ache
increased uterine tone
Uterine tenderness
page rating
Level 0
Level 1
Soft uterus without distress
Level 2 (distress)→stripping 3/1-2-1
fetal distress intrauterine fetal death
Bleeding volume is not proportional to anemia
Level 3 (shock) → peeling > 2/1
Symptoms of shock occur. Intravascular coagulation.
Bleeding volume is not proportional to anemia
Auxiliary inspection
Ultrasonography
Diagnosis and Differential Diagnosis
complication
intrauterine fetal death
Large area of placental detachment→profuse bleeding→death of fetus due to hypoxia
Disseminated intravascular coagulation (most common)
hemorrhagic shock
acute renal failure
Massive bleeding→severe impairment of renal perfusion→ischemic necrosis
amniotic fluid embolism
treat
Pregnancy should be terminated for 2-3 degrees of abruption
placental uterine stroke
The situation is good (massage the uterus and apply hot compress → promote contraction)
Have DIC and massive bleeding (blood transfusion and coagulation factors, hysterectomy)
1st degree placental abruption can be observed and treated
placenta accreta
Brief description
Placental villi and myometrium link
Depth indexing
Placenta accreta
Placental villi attached to the surface of the myometrium
placenta accreta
Placental villi penetrate deeply into the myometrium
placenta percreta
Placental villi penetrate the myometrium
clinical manifestations
>30 minutes after delivery of the fetus, the placenta still cannot be separated
deal with
Placenta adhesion→Remove the placenta with bare hands
Most of the placenta implanted → uterus removed
premature rupture of membranes ★Only in premature rupture of membranes will amniotic fluid flow out
Cause
Reproductive tract infection (main cause)
Increased amniotic pressure
Twins
polyhydramnios
Uneven stress on fetal membranes
Abnormal fetal position
Cephalopelvic disproportion
trauma
puncture
physical collision
clinical manifestations
Feeling of excessive fluid flowing out of the vagina uncontrollably
Increased vaginal fluid volume associated with meconium and vernix when pushing up the fetal presenting part
Influence
maternal body
Amniotic fluid↓ susceptible to infection
placental abruption
fetus
prone to premature birth
Infect
Umbilical cord prolapse/compression
deal with
term fetus
Membrane rupture >12 hours
prophylactic antibiotics
Rupture of membranes takes 1 to 12 hours (and there is no indication for cesarean section)
normal delivery
There are indications for cesarean section → cesarean section
After rupture of fetal membranes
First check the fetal heart rate
Observe the characteristics of amniotic fluid
Record membrane rupture time
Abnormal amniotic fluid volume
polyhydramnios
Brief description(>2000ml)
clinical manifestations
abdominal bloating
Difficulty breathing (diaphragm elevation)
Skin becomes tight and thin
Compression of the inferior vena cava → swelling/edema of the lower limbs/vulva
The fetal position is unclear and the fetal heart rate is far away
Oligohydramnios
<300ml
reason
infant deformity
Mainly urinary system malformations
Placental hypofunction
Performance
Increased uterine sensitivity → slight stimulation can induce uterine contractions
Fetal heart rate monitoring → late deceleration (placental dysfunction)
Umbilical cord abnormalities
umbilical cord prolapse
Brief description (when the fetal membranes are not ruptured, the umbilical cord is located in front of the fetal presentation)
Palpable pulsating cord → prolapsed umbilical cord
Replenish
completeness partiality
cesarean section
Preliminary edge
normal delivery
★★★Central placenta previa → There may be an elevated fetal head
Replenish
Regular contractions ≥ 12 hours → labor has started
Drainage after 12 hours is not considered premature rupture
Premature rupture occurred 37 weeks ago
Replenish
placenta previa
painless bleeding
Bleeding is proportional (external bleeding)
The uterus is soft and the fetal heartbeat can be heard clearly
Most common complications (postpartum hemorrhage)
placental abruption
painful bleeding
Bleeding is not proportional (internal bleeding)
The uterus is hard and the fetal heartbeat cannot be heard clearly
Most common complications (dic)
premature rupture of membranes
Painless discharge
time replenishment
Early pregnancy <14 weeks
Second trimester 14-28 weeks
Late pregnancy >28 weeks