Pathology of the placenta

Pathological form the placenta is associated with deviations of its size, weight and shape. The weight of the placenta in relation to the weight of fruit is 1:4, 1:3 and 1 : 2 when the universal swelling P. (see Rhesus factor) and syphilis. Atrophic changes in decidual shell, the absence of blood vessels in any area of the basal part of it lead to the formation of large but thin Isthmus, sometimes to the so-called membranous P. P. membranacea), for defects in Petrograd (P. fenestrata), of the added segments, horseshoe or poliobraces forms of P.; P. can be divided into two parts. When viewed born of the placenta (see) this should be considered in order to prevent a delay in the uterus part P.
The increment of the placenta. The real increment of the placenta (P. accreta) is very rare (1 : 25 000); often its firm attachment (P. adhaerens). When a dense placentation microscopic changes in decidual shell and muscle layer of the uterus are missing. True increment is characterized by the fact that the chorionic villi are attached directly to the muscle layer or grow into it, the last on the border with villi exposed fibrinoid degeneration and sharply reduces its volume (up to 1 to 2 mm). In a few cases hairs grow up serous cover and lead to intra-abdominal bleeding.
The real increment of the placenta is more common in pregnant again, after suffering inflammatory diseases of the uterus, septic abortion, in the presence of scars on the uterus after surgery (caesarean section, myomectomy, and others). The increment of the placenta can be full or partial. The close attachment and partial increment., in succession of the period of hemorrhaging, separation P. missing. If a complete real increment P., bleeding missing and only appears when you try branch of the children's place, but such attempts were unsuccessful, and can lead to rupture thinning of the uterus.
When a dense placentation produce its separation (see Childbirth), and if true increment - immediate amputation of uterus. The increment P. often repeated. This pathology should be provided in subsequent childbirth, if previously been firm attachment or partial increment P. Prevention true increment P. is the systematic treatment of women undergoing manual separation P., postpartum, post-abortion and other diseases
Incorrect placentation - see placenta Previa.
Premature detachment normally attached placenta - branch of P. from the uterine wall at some period in the last months of pregnancy or in the I and II periods of confinement.
Detachment of the placenta may occur in a small area and accompanied by insignificant external bleeding and formation of small retroplatsentarno hematoma. After the birth of the placenta on maternal surface P. discover firmly attached blood clot, and when it is deleted - clicking in Petrograd With a small detachment P. the General condition of the pregnant woman does not change; if the detachment P. increases, there are complaints about pain in the abdomen, marked change the configuration of the uterus by highlighting wall and tenderness to palpation in the area of detachment, the voltage of the uterus, increased heart rate, paleness of skin and other symptoms of anemia.
The heartbeat of the fetus is impaired (tachycardia, bradycardia, and others). With the detachment more than one third of the placenta to the fetus dies from asphyxia as a result of violations uterine-placental circulation. With sudden detachment P. with the formation of a large retroplatsentarno hematoma external bleeding can be absent or to be minor, dominates the picture of internal bleeding (paleness, a drop in blood pressure, rapid pulse weak filling and others) and shock.
Bleeding can be observed in the wall of the uterus, in the broad ligaments and on the pelvic peritoneum. The uterus is a speckled appearance, in serous cover cracks occur; this form of detachment P. called uteroplacental apoplexy. It occurs rarely and is observed more often at nephropathy, kidney disease and hypertension.
Other causes of placental abruption can be physical stress, short umbilical cord belated rupture of membranes, multiple births after the birth of the first fruit.
The severity of a pregnant with the detachment P. exacerbated by bleeding disorders, the emergence of Hypo or afibrinogenemia due to revenues in the blood thromboplastin of retroplatsentarno hematomas and decidual shell.
The clinical picture uteroplacental apoplexy reminds if the uterine rupture (see Births) and placenta previa (see), but if the uterine rupture no clear contours of hard uterus, more expressed symptoms of peritoneal irritation; when previa P. uterus normal configuration and consistency, the status of women in accordance with the degree of external bleeding.
When a small detachment P. symptoms mild and not always they can be seen. The diagnosis is established only when viewed P.
Partial detachment of the placenta, which is accompanied by a small bleeding, therapy during pregnancy is strict bed rest, transfer small amounts of blood, the appointment of calcium chloride, vitamin K, s, R; in childbirth shows the opening membranes and careful expedite delivery, intravenous drip infusion of oxytocin (3 UNITS per 500 ml of 5% glucose solution, from 15 to 20 drops per 1 minute) or if conditions delivery (forceps, vacuum extraction, and others). If the neck is smoothed, but Zev little open, produce a digital extension of the cervix. During delivery vaginal delivery after the removal of the child need to do a manual examination of the uterus to avoid violations of the integrity of its walls and remove excess tissue P. and blood clots.
When expressed and especially the growing phenomena of acute anemia and shock, a life-threatening women who need it immediately, rumorosissime, even if the birth canal is not prepared. Applies caesarean section. When multiple extensive hemorrhage into the thickness of the uterine wall, cracks serous cover shows supracervical amputation of uterus. In order to combat shock and gipofibrinogenemia apply transfusion of fresh ("warm") citrate blood infusion of fibrinogen (2-8 d), intravenous injection of 10 ml of 1 % solution of proteins.what, concentrated dry plasma, and other poliglyukina
In early succession period may be unusual bleeding, therefore appoint pituitrin, ergometrine and carefully monitor the postpartum women, and prevention of infection used antibiotics.
Heart attacks placenta - areas placenta diameter of 1 - 3 cm, having mostly white (white heart attacks) and less frequently red. Heart attacks are well visible on maternal surface, but can be and on fruit-side. Extensive white heart attacks often occur kidney disease in pregnant women. Heart attacks occur in the result of infringement of blood circulation, accompanied by the loss of fibers (see above Pathological anatomy).
Calcification is the deposition of calcium salts on maternal surface P. a small extent occurs frequently. More pronounced calcification is often observed during the postmaturity.
Cysts P. small size, located under chorionic plate, are often but usually visible.