妇产科学教学课件：Umbilical Cord Abnormality, Liquor Volume Abnormality

1、Abnormal Umbilical Cord Liquor Volume AbnormalityPremature Delivery Premature Rupture of MembraneProlonged Pregnancy, Multiple Pregnancy,Abnormal Umbilical Cord,Abnormal cord length Cord entanglement Knot of cord Torsion of cord Abnormal cord insertion Cord presentation and cord prolapse Single umbi

2、lical artery,Abnormal cord length,Normal cord length is 30-100cm, averagely 55cm Short cord: 100cm is defined as long cord, higher occurrence of cord around neck, cord around body, cord knot, cord prolapse and cord compression,Abnormal cord insertion,Marginal cord insertion into placenta, known as r

3、acket placenta Cord insertion onto membrane, runs between chorionic membrane and amniotic membrane before inserting into placenta, known as cord velamentous insertion Blood vessels on membrane passing internal cervical os anterior to fetal presenting part, known as vasa previa Velamentous cord inser

4、tion, commonly seen with single umbilical artery In vasa previa rupture, blood loss of 200-300ml can lead to fetal demise,velamentous cord insertion,velamentous cord insertion,Cord presentation and Cord prolapse,Cord located anterior or lateral to fetal presenting part, known as cord presentation, a

5、lso known as occult cord prolapse At membrane rupture, cord prolapse out of cervical os, descending into vagina, known as cord prolapse Cord prolapse is life-threatening to the fetus,Cord presentation,Cord prolapse,Knot of cord,Cord entanglement,Cord entanglement,Abnormal Liquor Volume,Polyhydramnio

6、s Oligohydramnios,Polyhydramnios,Defined as amniotic fluid volume more than 2000ml at any period of gestation Incidence 0.5% - 1.0% If amniotic fluid volume increase progressively over months, the symptoms are usually milder, known as chronic polyhydramnios If amniotic fluid volume increase rapidly

7、over days, can causse severe compression symptoms, known as acute polyhydramnios Fetal structural deformity: ( neural tube defect, NTD,Ultrasound examination,Amniotic fluid index, AFI 25cm AFI 25-35cm, as mild polyhydramnios AFI 36-45cm, as moderate polyhydramnios AFI 46cm, as severe polyhydramnios

8、Depth of largest amniotic fluid pool (amniotic fluid volume, AFV) 8cm AFV 8-11cm, as mild polyhydramnios AFV 12-15cm, as moderate polyhydramnios AFV 16cm, as severe polyhydramnios,Oligohydramnios,Third trimester amniotic fluid volume less than 300ml is known as oligohydramnios Incidence 0.4% - 4.0%

9、Fetal structural deformity,Ultrasound examination,AFV 2cm oligohydramnios AFV 1cm severe oligohydramnios AFI 5cm oligohydramnios 5cm AFI 8cm suspicious oligohydramnios,Preterm labour,Preterm labour,Defined as delivery after gestation 28 completed weeks till 37 weeks (196-258 days). Birth weight 1000

10、g - 2449g Preterm labour makes up 5% - 15% of total number of delivery Can the lower limit of preterm labour be brought earlier to 20 or 24 weeks gestation,Diagnosis of preterm labour,Labour occurring between gestation 28 completed weeks and 37 weeks regular uterine contraction: 4 times in 20 minute

11、s or 8 times in 60 minutes cervical shortening of 80% progressive cervical dilatation of 1cm and above,Prediction of preterm labour,Ultrasound assessing cervical length and internal os funnel formation, when internal os funnel is longer than the total cervical length by 25%, or total cervical length

12、 3cm, indicating high possibility of preterm labour,Prediction of preterm labour,Fetal fibronectine (fFN), after 20 weeks gestation fFN50ng/ml, indicates possibility of preterm labour. Its sensitivity is up to 50%, specificity 80%-90,Premature rupture of membrane,Premature rupture of membrane,Membra

13、ne rupture occurring before labour, known as premature rupture of membrane (PROM) Occurring after 37 completed weeks gestation, is called premature rupture of membrane at term Occurring before 37 weeks gestation, called preterm premature rupture of membrane (PPROM,Effect to mother and fetus,Feto-mat

14、ernal infection Placenta abruptio Premature infant: 30% - 40% of premature labour is associated with premature rupture of membrane Cord prolapse, cord compression Poor fetal lung development and fetal compression syndrome,Post-term pregnancy,Prolonged pregnancy,Prolonged pregnancy,Gestation at or be

15、yond 42 weeks gestation (294 days), known as post-term pregnancy Important factor for fetal distress, meconium aspiration syndrome, maturation disturbance syndrome, newborn asphysia, perinatal death, macrosomia and dystocia,Diagnosis,Determine gestational age Calculation based on last menstrual peri

16、od Calculation based on ovulation, . Ultrasound examination to ascertain gestation age Period of manifestation of early pregnancy symptoms, quickening First trimester pelvic examination assessing uterine size,Diagnosis,Assess placental function Fetal movement count Fetal electronic monitoring Fetal

17、biophysical profile (Ultrasound) Amnioscopy Urine E/C 10 or 24 hours urine E3 10mg,Management,Prevent post-term labour, effectively manage at term Decide appropriate mode of delivery based on placental function、estimated fetal weight、cervical effacement etc。 Cervical ripening Induced labour Caesarea

18、n section Neonatal resuscitation,Multiple pregnancy,Multiple pregnancy,Conception of 2 or more fetuses in the same intra-uterine pregnancy Incidence of multiple pregnancy: 1:89n-1 (n represents number of fetus in a single pregnancy,Dizygotic twin,Dizygotic twin makes up 70% of twin pregnancy Associa

19、ted with ovulation induction, multi-embryo intrauterine transplantation and genetic factors Two separate ova being fertilized forming two zygotes, each genetic compositions is not identical, hence the differences in both fetuses,Dizygotic twin,The placentas are usually dichorionic, can be fused toge

20、ther, but each has own independent blood circulation Two amniotic cavities are seen at the fetal surface of placenta, two layers of amniotic membrane and two layer of chorionic membrane present within,Monozygotic twin,Monozygotic twin makes up approximately 30% of twin pregnancy Unclear cause, highe

21、r incidence in older pregnant women Single fertilized ovum differentiating into two fetuses, thus gender, blood type and other phenotypes are identical As the fertilized ovum differentiates at different times, forming 4 types,Diamniotic dichorionic monozygotic twin,Differentiate within 72 hours of fertilization Form two independent fertilized ova and two amniotic sac, two layers of chorionic membranes and two layers amniotic membranes within the amniotic sacs Maybe single or two placentas Makes up approximately 30% of monozygotic twins,Diamniot