ABNORMALITIES OF PLACENTA AND CORD - NURSING ASSIGNMENT

INTRODUCTION

        In the fetal life, the fetal is getting oxygen, nutrients, immunoglobulin and hormones from mothers to placenta. The survival of the fetus depends upon the placenta’s integrity and efficiency. Any abnormality of the placenta can leads to complications in mothers and foetus or newborn. The ambilical cord extends from fetus to the placenta. Any abnormalities in the ambilial cord can also cause maternal and fetal complications.

ABNORMALITIES OF PLACENTA AND CORD

        There is a marked variation in the morphology including size, shape and weight of placenta. Variation of the cord is also acute common. Only those of clinical importance are described.

Placenta Succenturiata

Morphology

·        One or more small lobes of placenta, size of cotyledon, may be placed at varying distances from the main placental margin

·        A leash of vessels connecting the main to the small lobe transverse through the membrane

·        The accessory lobe is developed from the activated villi in on the chronic leave

·        In case of absence of communicating blood vessels, it is called placenta spuria

Diagnosis

        Diagnosis is made following inspection of the placenta after its expulsion.

·        With intact lobe

·        With missing lobe

o       There is a gap in the chorian

o       Torn ends of blood vessels are found on the margin of the gap

Clinical Significance

·        Post partum haemorrhage which may be primary or secondary

·        Subinvolution

·        Uterine sepsis

·        Polyp formation

Treatment

        Whenever the diagnosis of missing lobe is made, exploration of uterus and removal of the lobe under general anaesthesia is to be done.

Placenta Extrachorialis

        Two types and described

·        Circumvallate placenta

·        Placenta marginata

Development

·        The placenta of such type is due to the smaller chronic plate than the basal plate

·        Recurrent marginal haemorrhage as diagnosed on serial ultrasound is thought to be cause

·        The chronic plate does not extend to the placental margin

·        The membranes (ammien and chrorien) are folded, rolled back upon itself to form a margin is reflected centrally.

·         

Morphology

Circumvallate Placenta

·        The fetal surface is divided into a central depressed zone surrounded by a thickened white ring which  is usually complete

o       The ring is situated at varying distance from the margin of placenta

o       The ring is composed of double fold of amnies and chocrien with degenerative deciduas and fibrin in between

·        Vessels eradiate from the cord insertion as far as the ring and them disappears from view

·        The peripheral zone outside the ring is thicker and the edge is elevated and rounded

Placenta Marginata

        A thin fibrous ring is present at the margin of the chocrienic plate where the fetal vessels appear to terminate.

Clinical Significance

There is a increased chance of

·        Abortion

·        Hydrourrhoea gravidarum – excessive watery vaginal discharge

·        Antepartum haemorrhage

·        Growth eratardation of the baby

·        Preterm delivery

·        Retained placenta or membranes

Placenta Membranecae

·        The placenta is unduly large and thin

·        The placenta not only develops from the choriess serondosum but also serum the chorine lacue so that the whole of the ovum is practically  covered by the placenta

Clinical Significance

·        Encroachment of some part over the lower segment leads to placenta premia

·        Imperfect separation in third stage leads to post partum haemorrhage

·        Chance of retained placenta is the third stage leads to post partum haemorrhage

Lobulated Placenta

·        There appears to be multiple placentas for a single baby

·        Infact, it is one placenta divided into two or more parts either completely separated or joined in part

·        The lobes are held together by the one set of membranes and blood vessels

·        Lobulated placenta is thought to be due to abnormalities in the blood supply to the deciduas

Excessive Infarct Formation

·        Infarction of cotyledons happens due to disease process, such as severe maternal hypertension, severe pre-eclampsia

·        It is also seeing with the aging process

·        The extensive infracting reduces effective placental functioning

·        It may result in intrauterine growth retardation

·        If a sustained portion of placenta is infracted, it may leads in fetal death

Edema of the Placenta

·        Edematous placenta is mushy, thick and pale fluid can be squeezed form it

·        This may be caused by severe maternal heart disease diabetes or nephritis and by severe erythroblastosis

Larger and Heavier Placenta

·        Larger and heavies than normal placentas are seen with excessively large fetus, fetal syphilis and crythroblastosis

Nursing Management

·        A through inspection of placenta should be carried out in order to make sure that no parts of placenta or membranes has been retained in the uterus

·        Antibiotics should be administered if chances of infection is observed in mother

·        Intake output chart in maintained to minutes the fluid and electrolyte balance in mother incase of PPH

·        Aseptic precautions should be maintained through out the process of labour

·        The pulse, respiration and BP should be checked and if normal the mother should be send to ward

·        If the placenta is found in complete, the doctor should be informed immediately or PPH in occur

·        Observe the mothers for about two hours after the delivery for any abnormal bleeding

·        The baby should be shifted to NICU for intensive care, if any abnormalities is observed in the heart rate and respiratory rate, and blood transfusion is carried out if advised

·        The nurse should explain the mother about the disease if present and its effect on the fetus or newborn

·        The nurse should provide psychological support to the mothers and the family

CORD ABNORMALITIES

Battledore Placenta

·        The cord is attached to the margin of the placenta

·        It is associated with low implantation of the placenta

·        There is a chance of cord compression in vaginal delivery leading to fetal anoxia or even death

Velamentous Placenta

·        The cord is attached to the membrane

·        The branching vessels transverse between the membrane for a varying distance before they reach and supply the placenta

·        If the leash of blood vessels happen to transverse through the membranes overlying the internal os, in front of the presenting part, the conditions is called vara praevia

Management

        In the presence of fetal bleeding urgent delivery is essential either vaginally or by caesarean section. The infants haemoglobin should be estimated and if necessary blood transfusion be carried out. If the baby is dead vaginal delivery is awaited.

Abnormal Length

        The cord may be unduly long or short

Short cord

·        The short cord may be true (less than 20cm) or commonly relative due to enlargement of the cord round any fetal part

·        In exceptional circumstances the cord may be absent and the placenta may be attached to the lines as in exomphalos

Clinical Significance

·        Failure of external version

·        Prevent descent of presenting past specially during

·        Separation of a normally situated placenta

Long cord

        The clinical significance due to the presence of a long cord is that there is an increased chance of

·        Cord perolapse

·        Cord enlargement round the neck or the body

·        True knot is rare. Even with true knot the fetal vessels are protected from compression by the whartens jelly

·        False knots are the result of accumulation of whartons jelly or due to varices

Single Umbilical Artery

·        Single umbilical artery is present in about 1-2 percent of cases. It may be due to failure of development of one artery or due to its atrophy in later months

·        It is more common in twins and in babies born of diabetic mother or in polyhydramnios

·        It is frequently associated with congenital malformation of the foetus

·        Renal and genital anomalies trisomy 18 are common

·        There is increased chance of abortion, prematurity, IUGR and increased perinatal mortality

Nursing Management

·        A thorough inspection of umbilieal cord is done to rule out any abnormalities

·        Observe the mother for about two hours after delivery

·        Aseptic precautions is maintained during the process of labour

·        Antibiotics  are administered of chances of infection is observed.

·        The infant is shifted to NICu, if any abnormality in the heart rate or respiratory rate is observed

·        Blood transfusion is carried out, in case of decreased blood in the new born

·        Oxygen administration is done in case of respiratory distress

CONCLUSION

        Any abnormalities in palcenta and cord cause maternal and fetal complications. The survival of fetus depends upon placneta’s integrity and efficiency. The umbilical cord with two arteries and one vein forms the connection for maternal blood to flow into the fetal circulation. The complications should be identified as early as possible and managed to reducing the effect on the mother and new born.

BIBLIOGRAPHY

·        A Text Book Obstetrics of D C Dutta

6^th Edition, Page No. 218-220

·        Myles Text Book of midwives

14^th Edition, Edited by Diane M Fraser and Margaret A Cooper

Page No. 216-217