gangguan plasental
TRANSCRIPT
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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
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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
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Diseases and Abnormalities of the FetalMembranes
Diseases of the Chorioamnion Me!oni"m Stainin- Chorioamniotis
Amnioniti! C$sts Amnion Nodos"m Amnioni! ands
PLACENTAL DISORDERS
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Diseases of the Chorioamnion
Me!oni"m Stainin- / 0 &n!ommon 2 %3 4ee5s
In!reases 6 )7 4ee5s NMR %.% '1./ in non0stainin-(
Cesarean deli8er$ 4as do"bled NM asso!iated 4ith me!oni"m as+iration
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*ambar 9 Me!oni"m stainin-
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Diseases of the Chorioamnion
Chorioamnionitis Intra"terine infe!tion: +rolon- membraner"+t"re: lon- labor
Mi!ros!o+i!al findin-: MN and PMNle!o!$tes infiltrate the !horion
≠+lained !ases of r"+t"red membranes
and<or +reterm labor asso!iated 4ith o!!"lt!horioamnionitis
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Diseases of the Chorioamnion
Amnioni! !$sts
F"sion of amnioni! folds 4ith s"bse="entretention of fl"id
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Amnion Nodos"m S="amo"smeta+lasia ofthe amnion
Amnioni!!ar"n!les
Diseases of the ChorioamnionDiseases of the Chorioamnion
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Diseases 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
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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; '<rasoni! 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
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"#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:
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>$dramnios Ca"ses 9
Asso!iated to fetal malformation0 CNS i.e anen!e+hal$: 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
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> d
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>$dramnios S$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
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>$dramnios
Pro-nosis >i-her +erinatal mortalit$ 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
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>$dramnios Mana-ement
Minor de-rees rarel$ 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$
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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$+o+lasia 9
0 thora!i! !om+ression0 la!5 of fetal breathin- mo8ements0 fail"re to retain amnioni! fl"id or in!reased
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Oli-oh$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
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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$+
PLACENTAL DISORDERS
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P'&%+("& B$P&;"$"&P'&%+("& B$P&;"$"&
O; B$'OB+DO; B$'OB+D
P'&%+("&P'&%+("&
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&%%+SO;$+S&%%+SO;$+S
P'&%+("&P'&%+("&
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";$P'+ P'&%+("&";$P'+ P'&%+("&
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+<";&%HO;$&' P'&%+("&+<";&%HO;$&' P'&%+("&
%irc!alate placenta%irc!alate placenta
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+<";&%HO;$&' P'&%+("&+<";&%HO;$&' P'&%+("&
%irc!arginate placenta%irc!arginate placenta
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%O;D $(S+;"$O(%O;D $(S+;"$O(
*elaoento!s insertion*elaoento!s insertion
PLACENTAL DISORDERS
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Diseases and abnormalities of the +la!enta
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
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P'&%+("& $()&;%"SP'&%+("& $()&;%"S
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P'&%+("&' $()&;%"SP'&%+("&' $()&;%"S
;ed Bro=n $nfarcts;ed Bro=n $nfarcts
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PLACENTAL DISORDERS
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Diseases and abnormalities of the +la!enta
Abnormalities of the "mbili!al !ord 'f"nis( Cord len-th Absen!e of one "mbili!al arter$
!on-enital anomalies Cord !oilin- Fo"r08essel !ord
Cord insertion 90 mar-inal insertion0 8elamento"s insertion
0 8asa +re8ia
PLACENTAL DISORDERS
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PLACENTAL DISORDERS
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Diseases and abnormalities of the +la!enta
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
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)&'S+ >(O")&'S+ >(O" ";U+ >(O"";U+ >(O"
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Diseases and abnormalities of the +la!enta
*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