Placenta Variations and Abnormalities

Placenta Variations

• Bipartite (bilobed): A placenta divided into two lobes.
• Circummarginate: A placenta with the attachment margin of the chorionic villi extending to the edge of the placenta.
• Battledore insertion: The umbilical cord is inserted into the edge of the placenta.
• Succenturiate lobe: Extra placental lobes attached to the main placenta.
• Velamentous insertion: The umbilical cord vessels branch out over the membranes before reaching the placenta.
• Circumvallate: A ring-like structure forming a fold around the edge of the placenta.

Placental Abnormalities

• Central Insertion: The umbilical cord is inserted at the center of the placenta. This is the normal placement.
• Lateral Insertion: The umbilical cord is inserted off-center but not at the edge of the placenta.

Velamentous Insertion

• The cord enters the placenta via membranes (fold of amnion).
• Small vessels form, and the vessels are prone to rupture.
• Multiple gestation pregnancies are at increased risk.
• Often associated with other fetal anomalies.

Battledore Insertion

• The umbilical cord is placed at the edge of the placenta.

High Risk Pregnancy

• Consists of pregnancy related complications or external factors endangering the health of the mother, fetus, or both.
• Conditions include multiple premature deliveries, stillbirths, cephalopelvic disproportion (CPD), cervical incompetency, uterine structural anomalies, multiple pregnancies, placental abnormalities, abnormal fetal fluid (AF), hemorrhage, retained placenta issues, inadequate prenatal checkups, substance abuse, and malnutrition.

Hyperemesis Gravidarum

• Severe, persistent nausea and vomiting after the first trimester.
• Caused by high levels of human chorionic gonadotropin (hCG).
• Leads to weight loss, starvation, ketosis, fluid and electrolyte imbalances, malnutrition, and dehydration.

Management of Hyperemesis Gravidarum

• IV fluids (3 liters in 24 hours).
• NPO (nothing by mouth) for 24 hours.
• Medications like Metoclopramide.
• Dietary measures starting with clear liquids, progressing to full liquid, soft, and regular diets; given in small frequent portions.

Nursing Interventions for Hyperemesis Gravidarum

• Administer IV fluids as ordered.
• Monitor intake and output (I&O).
• Provide oral care.
• Instruct patient to remain upright after meals to reduce reflux.
• Recommend dry crackers before getting up.
• Advise on energy conservation and rest methods.

Teratogenic Infections

• Teratogens: Factors (chemical or physical) that negatively impact a fertilized ovum, embryo, or fetus.
• Infections that can be teratogenic include toxoplasmosis, other sexually transmitted or systemic infections, rubella (German measles), cytomegalovirus (CMV), and herpes simplex virus.

Toxoplasmosis

• Caused by Toxoplasma gondii found in animals like mice, sheep, and cats.
• Transmitted through cat feces and infected meat.
• Prenatal care recommendations: avoid handling cat litter, washing hands, and avoiding raw/undercooked meat.

Rubella (German Measles)

• Maternal rubella infection is typically mild, but effects on the fetus are more severe.
• First trimester exposure risks:
  • Deafness
  • Eye defects (cataracts, blindness)
  • Cardiac malformations (PDA)
  • Microcephaly
  • Neonatal diseases
• Second/Third trimester exposure risks include: premature labor, Intrauterine fetal death (IUFD), complications with thyroid or neurological problems.

Cytomegalovirus (CMV)

• Caused by the Herpes virus.
• Transmitted through droplets.
• Effects on the baby may include significant neurologic problems, hydrocephalus, microcephaly, spasticity, eye damage (optic atrophy), deafness, and liver disease.
• Most adult women have antibodies against CMV.

Herpes Simplex Virus (Genital Herpes)

• Systemic involvement can occur, crossing the placenta.
• High risk of severe congenital anomalies in the first trimester.
• Possible spontaneous miscarriages in the first trimester.
• Second and third trimester risks: premature birth, intrauterine growth retardation (IUGR), and continuing infection in the newborn.
• Treatment with IV or oral acyclovir (Zovirax) throughout pregnancy.

Danger Signs of Pregnancy for Management

• Vaginal Bleeding: Report immediately for evaluation.
• Persistent Vomiting (Hyperemesis Gravidarum): Nausea and vomiting past the 12th week can deplete fetal nutrients.
• Chills and Fever: May indicate intrauterine infection (serious complication for both mother and baby).
• Sudden escape of fluid from the vagina: Rupture of membranes may indicate infection risks for mother and baby.
• Fetal Is Small and Head does not fit in the cervix: Uterine rupture or umbilical prolapse.
• Sudden absence of fetal heart sounds: Intrauterine fetal death.
• Abdominal/Chest pain: Potential uterine rupture, placental separation, preterm labor, or pulmonary embolism.
• Facial and Finger Swelling (Edema): Indicates potential complications.

Other Dangerous signs

• Flashes of lights or dots (scotoma), blurring of vision, severe headaches, and/or dizziness: May point to pregnancy-induced hypertension

Explore the different types of placenta variations and common abnormalities that can occur during pregnancy. This quiz covers various conditions such as bipartite, circumvallate, and velamentous insertion. Test your knowledge on placental anatomy and its implications in prenatal care.