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Delivery pain (Placenta (villi (Villi – basic structural and functional…
Delivery pain
Placenta
- Structure:
round or oval, in the diameter of 20 cm and weight of 500g
Development of a placenta starts with evolution of chorion frondosum and ends around 6th week of pregnancy
- consits of:
Amniotic simple cylindric epithelium
Basement membrane
Chorion frondosum
Intervillous space
Basal decidua
- Decidua: Partly changed mucous membrane of a uterus, created during fertilization and disappears when pregnancy ends
- Types:
Decidua basalis
Decidua capsularis
Decidua parietalis
- Decidua basalis:
mucous membrane under implanted ovum, and later under placenta (between ovum and muscular layer of a uterus).
Consists of decidua compacta, decidua spongiosa, within which placenta separates during 3rd stage of delivery
- Decidua capsularis: Covers implanted ovum and enlarges during it’s development until 16th-18th week of pregnancy that is till conecting with decidua parietalis
- Decidua parietalis: Includes remaining area of uterus’ cavity, apart from ovum
Chorion
In 1-8th week of pregnancy chorioni villi cover all chorion (chorion frondosum)
Around 8th week villi adhering to decidua capsularis disappear and chorion frondosum changes into smooth chorion
The rest of chorion frondosum transforms into placenta
villi
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- There are:
Primary chorionic villi – build of trophoblast without connective tissue and vessels; originate from trophoblast cord
Secondary chorionic villi – build of trophoblast and connective tissue
Tertiary chorionic villi – integumentary epithelium (trophoblast consisting of 2 layers – peripherial that is syncytium and internal – cytotrophoblast) + mesoderm core and capillaries
Function
Exchange of gaseous and nutritious components between fetus and mother
Immunological barrier between ovum and mother
production of placental hormones and proteins
Placental hormones
Albominous (created only within placenta) - human chorionic gonadotropin (HCG), human placental lactogen (HPL) and human chorionic thyrotropin (HCT)
Steroid - estrogens and gestagens
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Umbilical cord
Connects fetus to placenta
Average length 30-70cm
Consists of: mucous connective tissue (Wharton’s jelly) covered by amnion, integumentary epithelium, vessels
- Blood vessels: two arteries are the latter of the fetal internal iliac arteries (venous blood) and one umbilical vein which transports blood through ductus venosus and liver vessels to the inferior vena cava (arterial blood)
Pathology
- Valementous insertion of umbilical cord is characterized by membranous umbilical vessels at the placental insertion site
- Erratic vessels: permeating membranes (between amnion and chorion) and then track their way back to the placenta
- Vasa previa: these vessels course within the membranes, unsupported by the umbilical cord or placental tissue and cross or run in close proximity to the inner cervical os
- Marginal umbilical cord insertion
- Too short: premature placental abruption, inversion of the uterus
- Too long: umbilical cord prolapse, umbilical cord wrapped around fetus
- Rare pathologies: knobly thickening of Wharton’s jelly, varicose distention of umbilical vessels, true knots
- Unproper system of vessels: single umbilical artery which usually coexist with heart or renal abnormalities
Methods of pain relief
Non-pharmacological
physical activity:
Body positions causing relief of pain”
walking
body balancing
squatting position
vertical position
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musicotherapy
relaxing massage
compress (poultice)
physiotherapy
nerve stimulation
acupuncture & acupressure
water immersion
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Pharmacological
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regional analgesia
- Analgetic methods:
Extradural (ZOP)
Subarachnoid (POP)
mixed extradural & subarachnoid
local – pudendal nerve block
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