OB Psyche and Placenta

• Hormones released in response to anxiety can cause DYSTOCIA
• Intense anxiety stimulates Sympathetic nervous system which releases catecholamines that lead to myometrial dysfunction
• Norepinephrine and epinephrine lead to uncoordinated or increased uterine activity
• Precipitate labor is the birth that is completed in less than 3 hours
• Always prepare oxytocin as a piggyback solution, extremely careful of the dose used
• Uterine rupture, although rare, is a complication that is an immediate emergency (blood loss to the mother and anoxia to fetus)
• Uterine inversion is another rare but grave complication (inability to control hemorrhage)- hysterectomy as surgical management
• Amniotic fluid embolism occurs when amniotic is forced into an open maternal uterine blood sinus.
• Prolapsed umbilical cord

  -Position in Trendelenburg or knee-chest to relieve cord compression
• THE NORMAL PLACENTA

  -Weight – 500 grams (1/6 of the fetus)
• THE NORMAL PLACENTA

  -Diameter – 15 to 20 cm
• THE NORMAL PLACENTA

  -Thickness – 1.5 to 3 cm
• In certain disease (syphilis or erythroblastosis) its weight is half of the weight of the fetus
• PLACENTA SUCCENTURIATA

  -A placenta that has one or more accessory lobes connected to the main placenta by blood vessels
• PLACENTA SUCCENTURIATA

  -No fetal abnormality is associated with this type

  -But important to be recognized because the small lobes may be retained in the uterus (severe maternal hemorrhage)
• PLACENTA SUCCENTURIATA - Placenta appears torn at the edge or torn blood vessels extend beyond the edge of the placenta
• PLACENTA CIRCUMVALLATA

  -The umbilical cord enters the placenta at the usual midpoint

  -Large vessels spread out from there but end abruptly at the point where the chorion folds back onto the surface
• Placenta marginata

  -In this, the ring is formed at the margin of the chorionic plate and the fetal vessels appears to terminate
• BATTLEDORE PLACENTA

  -The cord is inserted marginally rather than centrally

  -Rare -Has no known clinical significance
• VELAMENTOUS INSERTION OF THE CORD

  -The cord that instead of entering the placenta directly, separates into small vessels that reach the placenta by spreading across a fold of amnion
• VELAMENTOUS INSERTION OF THE CORD

  -Associated with fetal anomalies (fetal blood supply may not be adequate)
• VASA PREVIA

  -The cord of the velamentous cord insertion cross the cervical os

  -It is delivered before the fetus

  -Vessels may tear with cervical dilatation
• Placenta Percreta - Chorionic villi invade the uterine myometrium and serosa may also invade adjacent organs
• Placenta increta - choronic villi invade the uterine myometrium
• Placenta accreta - chorionic villi attach to the uterine myometrium
• Normal - fibrinous layer seperates placenta from the uterine wall
• MANAGEMENT

  -Hysterectomy

  -Methotrexate to destroy the still attached tissue
• Absence of one umbilical artery is associated with congenital heart and kidney anomalies
• Normal cord - length is 50-60 cm and Ave 55 cm
• Short cord - lenth is <35 cm, may lead to fetal distress, placental abruptio, prolonged labor
• long cord - lenght is <80 cm, occurance of cord around the neck and bocy, cord knot, cord prolapse and cord compression