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(Maternal anatomy), Placenta, image, image, image, image, image, image,…

- - - - Long and Closed
      - ≥ 2.5cm (3cm at some sites)
    - - Use amniotic fluid as a window
      - Pitfalls
        
        Bladder too full
        
        LUS contraction
    - - Beaking/Funneling :Opening of CX from Int Os
      - Rx: Cerclage
    - - Early rupture of Membranes
      - No EV (infection), do a Translabial instead
  - - - Most Important = Proximity to Cx
      - Assess size and location
      - Assess interval growth on each scan
- - - - Adjacent to MOTHER
      - Attaches to uterus/decidua
    - - Functional lobes
      - Contain chorionic villi
    - - Adjacent to FETUS
      - Fetal arteries/veins branch over surface
      - Amnion attaches here
  - - - O2 from Mom to Baby
      - CO2 from Baby to Mom
  - - - Anterior / Posterior
      - Fundal
      - Rt or Lt Lateral
- - - - painless bleeding OB3
      - often asymptomatic
  - - - Symmetric -centered over cervix
      - Asymmetric -not centered over cervix
  - - - Bladder empty
      - Very useful if
        
        Low fetal head
        
        Posterior Placenta
- - - - Most often considered a normal finding
      - Increased significance if:
        
        Early presentation
        
        Increased size and number
    - - IntervillousThrombosis
        
        What?
        
        Thrombosis of Placental Lake or
        
        Blood Clot within intervillous space
      - Placental Lakes
        
        NOT CLINICALLY SIGNIFICANT , Increased incidence with gestational age
        
        2D -Swirling maternal blood , Anechoic/Hypoechoic
        
        No Flow on Doppler
        
        Single or Multiple. Variable Size and Location
        
        Common
        
        Maternal blood within the intervillous space
    - - Tumour
        
        Chorioangioma
        
        Benign, vascular mass
        
        ? ↑hCG/ αFP
        
        If Large/Multiple
        
        AV shunting
        
        Fetal compromise
        
        US
        
        Hypoechoic Solid mass with flow within/feeder Spectral doppler Fetal pulse rate
        
        Usually near cord insertion, fetal side placenta / chorionic plate
      - Infarction
        
        Localized area of ischemia
        
        Caused by:
        
        Thrombotic occlusion of uteroplacental (spiral) artery
        
        Retroplacental hematoma
        
        Clinically insignificant
        
        Associated with:
        
        post term pregnancies
        
        maternal hypertension
        
        US
        
        Triangular area of altered echogenicity
      - Abruption
        
        Premature separation from myometrium
        
        Types
        
        Marginal, partial, complete
        
        Revealed, concealed
        
        Retroplacental, marginal
        
        Outcome depends on: size and location
        
        Associated with:
        
        Trauma (MVA, fall)
        
        Retroplacental Fibroids
        
        Smoking/cocaine/HTN
        
        Clinically
        
        +Pain +++
        
        +Tense uterus
        
        +Vaginal bleeding
        
        +Fetal Bradycardia
        
        US
        
        Obstetric emergency:Often bypass SONO dept. Must deliver immediately
        
        Retroplacental hematoma
        
        Marginal hematoma
        
        No flow/Swirling
        
        Evolving Echogenicity:
        
        Acute bleed vs organized clot
        
        Hyperechoic > Isoechoic > Hypoechoic
      - Accreta
  - - - >4cm
      - Usually normal diagnosis
      - Non-specific diagnosis
        
        Maternal Diabetes
        
        Rh Incompatibility
        
        Fetal Hydrops
        
        Fetal Cardiac Overload
        
        Placental Insufficiency
    - - Maternal Hypertension/preeclampsia
      - IUGR
      - Placental Abnormality
    - - Early Second Trimester: Relatively Homogeneous
      - Late Second thru Third: Increasing Heterogeneity
  - - - Occur as placenta matures
      - Usually normal
      - +++ Calcs prior to 37w =↑ risk of adverse outcome
- - - - Adheres to Myometrium
      - Most common (75%)
    - - Invades Myometrium (18%)
    - - Penetrates myometrium
      - May invade bladder / rectum
      - Least common (7%)
  - - - 70% of pts with Accreta have had a previous C/S
      - Scar compromises/disrupts the endo/myo barrier
  - - - Large, numerous vascular lacunae
    - - Myometrium/ Vessels
      - aka: subplacentalzone
      - Loss of distinct RPC
      - Turbulent flow RPC area
- - - - AKA: Accessory Lobe
      - ↑risk RPOC
      - Main + Accessory should have same echogenicity and texture
    - - Contraction, Tumor, mass
      - How to differentiate? dynamic? texture?
    - - Assess and document
        
        Size
        
        Location of connecting vessels
  - - - Connecting vessels cross internal os
      - Risk of hemorrhage during birth
      - 60-80% fetal mortality
    - - use color to r/o unexpected vasa previa
  - - - AKA: “Battledore”
      - Inserts into placental edge
    - - Cord inserts in membranes & Vessels traverse membranes
      - Vessels prone to injury –missing Wharton’s jelly (esp during labour)
      - Associated with: Vasa previa
      - US
        
        Always assess and document Plac CI clear of internal os
        
        If in doubt>> offer EV