医学精品课件：3脐带异常等.ppt

1、Abnormal Umbilical Cord Liquor Volume AbnormalityPremature Delivery Premature Rupture of MembraneProlonged Pregnancy,Multiple PregnancyWomen Hospital,School of Medical,ZheJiang University Wang Zheng Ping Abnormal Umbilical CordnAbnormal cord lengthnCord entanglementnKnot of cordnTorsion of cordnAbno

2、rmal cord insertionnCord presentation and cord prolapsenSingle umbilical artery Abnormal cord lengthnNormal cord length is 30-100cm,averagely 55cmnShort cord:100cm is defined as long cord,higher occurrence of cord around neck,cord around body,cord knot,cord prolapse and cord compression Abnormal cor

3、d insertionnMarginal cord insertion into placenta,known as racket placentanCord insertion onto membrane,runs between chorionic membrane and amniotic membrane before inserting into placenta,known as cord velamentous insertionnBlood vessels on membrane passing internal cervical os anterior to fetal pr

4、esenting part,known as vasa previanVelamentous cord insertion,commonly seen with single umbilical arterynIn vasa previa rupture,blood loss of 200-300ml can lead to fetal demisevelamentous cord insertionvelamentous cord insertionCord presentation and Cord prolapsenCord located anterior or lateral to

5、fetal presenting part,known as cord presentation,also known as occult cord prolapse nAt membrane rupture,cord prolapse out of cervical os,descending into vagina,known as cord prolapsenCord prolapse is life-threatening to the fetus Cord presentation Cord prolapse Knot of cord Cord entanglement Cord e

6、ntanglementAbnormal Liquor VolumePolyhydramnios Oligohydramnios Polyhydramnios nDefined as amniotic fluid volume more than 2000ml at any period of gestationnIncidence 0.5%-1.0%nIf amniotic fluid volume increase progressively over months,the symptoms are usually milder,known as chronic polyhydramnios

7、nIf amniotic fluid volume increase rapidly over days,can causse severe compression symptoms,known as acute polyhydramniosnFetal structural deformity:(neural tube defect,NTD)Ultrasound examination nAmniotic fluid index,AFI 25cmAFI 25-35cm,as mild polyhydramniosAFI 36-45cm,as moderate polyhydramniosAF

8、I 46cm,as severe polyhydramnios nDepth of largest amniotic fluid pool(amniotic fluid volume,AFV)8cmAFV 8-11cm,as mild polyhydramniosAFV 12-15cm,as moderate polyhydramniosAFV 16cm,as severe polyhydramnios Oligohydramnios nThird trimester amniotic fluid volume less than 300ml is known as oligohydramni

9、osnIncidence 0.4%-4.0%nFetal structural deformity Ultrasound examinationnAFV 2cm oligohydramniosnAFV 1cm severe oligohydramniosnAFI 5cm oligohydramniosn5cm AFI 8cm suspicious oligohydramnios Preterm labour Preterm labournDefined as delivery after gestation 28 completed weeks till 37 weeks (196-258 d

10、ays).Birth weight 1000g-2449gnPreterm labour makes up 5%-15%of total number of deliverynCan the lower limit of preterm labour be brought earlier to 20 or 24 weeks gestation?Diagnosis of preterm labournLabour occurring between gestation 28 completed weeks and 37 weeksnregular uterine contraction:4 ti

11、mes in 20 minutes or 8 times in 60 minutesncervical shortening of 80%nprogressive cervical dilatation of 1cm and above Prediction of preterm labournUltrasound assessing cervical length and internal os funnel formation,when internal os funnel is longer than the total cervical length by 25%,or total c

12、ervical length 50ng/ml,indicates possibility of preterm labour.Its sensitivity is up to 50%,specificity 80%-90%Premature rupture of membrane Premature rupture of membranenMembrane rupture occurring before labour,known as premature rupture of membrane(PROM)nOccurring after 37 completed weeks gestatio

13、n,is called premature rupture of membrane at termnOccurring before 37 weeks gestation,called preterm premature rupture of membrane(PPROM)Effect to mother and fetusnFeto-maternal infectionnPlacenta abruptionPremature infant:30%-40%of premature labour is associated with premature rupture of membranenC

14、ord prolapse,cord compressionnPoor fetal lung development and fetal compression syndromePost-term pregnancyProlonged pregnancy Prolonged pregnancynGestation at or beyond 42 weeks gestation(294 days),known as post-term pregnancynImportant factor for fetal distress,meconium aspiration syndrome,maturat

15、ion disturbance syndrome,newborn asphysia,perinatal death,macrosomia and dystocia DiagnosisnDetermine gestational ageCalculation based on last menstrual periodCalculation based on ovulationUltrasound examination to ascertain gestation agePeriod of manifestation of early pregnancy symptoms,quickening

16、 First trimester pelvic examination assessing uterine size Diagnosis nAssess placental functionFetal movement countFetal electronic monitoringFetal biophysical profile(Ultrasound)Amnioscopy Urine E/C 10 or 24 hours urine E3 10mg Management nPrevent post-term labour,effectively manage at term nDecide

17、 appropriate mode of delivery based on placental function、estimated fetal weight、cervical effacement etc。nInduced labournCaesarean sectionnNeonatal resuscitation Multiple pregnancy Multiple pregnancynConception of 2 or more fetuses in the same intra-uterine pregnancy nIncidence of multiple pregnancy

18、:1:89n-1 (n represents number of fetus in a single pregnancy)Dizygotic twinnDizygotic twin makes up 70%of twin pregnancynAssociated with ovulation induction,multi-embryo intrauterine transplantation and genetic factorsnTwo separate ova being fertilized forming two zygotes,each genetic compositions i

19、s not identical,hence the differences in both fetusesDizygotic twinnThe placentas are usually dichorionic,can be fused together,but each has own independent blood circulationnTwo amniotic cavities are seen at the fetal surface of placenta,two layers of amniotic membrane and two layer of chorionic me

20、mbrane present within Monozygotic twinnMonozygotic twin makes up approximately 30%of twin pregnancynUnclear cause,higher incidence in older pregnant womennSingle fertilized ovum differentiating into two fetuses,thus gender,blood type and other phenotypes are identicalnAs the fertilized ovum differen

21、tiates at different times,forming 4 types Diamniotic dichorionic monozygotic twinnDifferentiate within 72 hours of fertilizationnForm two independent fertilized ova and two amniotic sac,two layers of chorionic membranes and two layers amniotic membranes within the amniotic sacsnMaybe single or two p

22、lacentasnMakes up approximately 30%of monozygotic twins Diamniotic monochorionic monozygotic twinnDifferentiation occurs from 72 hours to 8 days of fertilizationnOne layer of chorionic membranes and Two layers of amniotic membranes within two amniotic sacsnSingle placentanMakes up 68%of monozygotic

23、twinsMonoamniotic monochorionic monozygotic twinnDifferentiation within 9-13 days after fertilizationnBoth fetuses share a single amniotic cavitynSingle placentanMakes up 1%-2%of monozygotic twins Conjoined twinnDifferentiation after 13 days of fertilization,during which the primitive embryo has formed,the body cannot completely differentiate into two separate bodies,thus leading to different types of conjoined twinsnIncidence is 1/1500 of monozygotic twins Conjoined twin