Session 6 Placental development and maternal adaptations

• Placental functions?

  • Transport
  • Supplying nutrients and immunoglobulins
  • Eliminating waste products
  • Enabling gas exchange
• Placenta synthesizes?

  • Glycogen
  • Cholesterol
  • Fatty acids
• • Primary chorionic villi: Cytotrophoblast
  • Secondary chorionic villi: Cytotrophoblast with an extra embryonic mesoderm core.
  • Tertiary chorionic villi: Embryonic vessels form in the extra embryonic mesoderm.
• Haemolytic disease of the fetus?

  • Destruction of the red blood cells of the fetus / newborn by maternal IgG antibodies.
  • These IgGs are expressed when an RBC antigen not expressed in the mother gains access to the maternal circulation.
• Haemolytic disease in newborns - detailed?

  • Requirements:
  • RhD positive newborn born to a RhD negative mother
  • Mother has previously been exposed to RhD positive blood and developed an immune response to it.
  • Signs and symptoms:
  • Early onset of jaundice and unconjugated hyperbilirubinaemia
  • Symptomatic anaemia
  • If severe anaemia: heart failure, hydrops fetalis and stillbirth
  • Management:
  • Prevention with anti-D
  • Phototherapy, blood transfusions, and intravenous immunoglobulins.
• Placenta lies directly over the internal os (blocks the uterus - thereby causing issues for normal delivery) - placenta praevia
• Placenta praevia?

  • Risk factors:
  • Previous placenta praevia
  • caesarean section
  • uterine surgery
  • Multiple pregnancy
  • Increased maternal age
  • Use of assisted reproductive technology
  • Signs and symptoms:
  • Asymptomatic
  • Painless bleeding
  • Management:
  • Caesarean section
  • Blood transfusions as required
• Label the following

  A) Accreta

  B) Increta

  C) Percreta

  
• Abnormal trophoblast invasion resulting in an abnormally adherent placenta - placenta accreta spectrum (includes increta and percreta)
• Placenta accreta spectrum?

  • Risk factors: Previous C section, Previous uterine surgery, pelvic irradiation, manual removal of placenta, postpartum endometritis, >35yrs,Use of assisted reproductive technology
  • Signs and symptoms:
  • Asymptomatic
  • Abnormally adherent placenta
  • Life-threatening haemorrhage at the time of placental separation.
  • Management:
  • Planned delivery - CS
  • Blood transfusion
  • Caesarean hysterectomy
• Management for pre-eclampsia?

  • Monitoring
  • Anti-hypertensives
  • Expedite delivery if required.
• Chorioamnionitis?

  • Infection and inflammation of intrauterine structures
  • Migration of cervico-vaginal microorganisms through the cervical canal .
  • Maternal fever, leukocytosis, tachycardia and / or uterine tenderness, fetal tachycardia.
  • Treatment: antibiotic therapy +/- expediting delivery.
• Premature separation of the placenta from the decidua at or after 20wks gestation - placental abruption
• Defects in spiral artery remodelling and cytotrophoblast invasion are characteristic of pre eclampsia.