00:01
Our topic now brings us to
various placental abnormalities.
00:05
I will walk you through
those placental
abnormalities that
you will encounter
on a frequent basis.
00:12
Our first diagnosis here
will be placenta accreta.
00:16
Once we understand accreta,
then I’ll quickly tell you about
others that share the name
and we’ll tell you exactly as to where
the placenta is then attaching.
00:27
The reason I
emphasized "attaching"
is because accreta has
the letter A in it.
00:32
It is going to attach to what?
Now that’s the pathology
that I will describe to you.
00:39
What ends up happening
is that normally,
if you have implantation
in the uterus.
00:43
Now, this is not
ectopic pregnancy.
00:46
The fertilized egg has
made its way to the uterus
and this time, normally
speaking,
this fertlized egg should implant
and attach to the decidua.
00:57
The decidua is part of the
endometrium of the female uterus.
01:01
Think of it as such.
01:03
What ends up happening here –
Well, what’s the next superficial
layer of the uterus?
It’s called the
myometrium, correct?
My goodness, there should
be no implantation
or attachment to the myometrium.
01:15
But if that occurs,
this brings you to the diagnosis
of placental accreta.
01:20
Partial or complete
absence of decidua,
which means that the
normal endometrium tissue
that should be attaching
to the chorionic villi
of the placenta
is not occurring.
01:33
Therefore, you’ll notice
here that the placenta
is directly attaching
to the myometrium.
01:39
Once you understand that,
let’s go on to
complications here
and you’ll find this
be quite interesting
and makes perfect sense.
01:46
If you have a placenta that’s
attaching the myometrium,
that is a very firm
and pathologically strong
attachment to the myometrium.
01:57
So now it’s time for
delivery, parturition.
02:01
And so therefore the placenta
is having a hard time
coming off the myometrium.
02:06
What does that mean?
That means that now,
perhaps if it finally detaches,
you have complications
because now you
might cause tearing
and there might be
massive hemorrhage.
02:18
So now you tell me,
as soon as you hear about placental
abnormalities and in complications,
and you’re thinking
about hemorrhage,
What’s going on
with your patients?
Both the fetus, the newborn,
and perhaps the mother?
The mother is experiencing
Sheehan syndrome. Clear?
So that will be the scenario or
that will be the type of scenario
that you’re going to get with
pituitary infarction in the mother.
02:43
This will be a good one for you
to put all of that together.
02:47
Predisposed by
inflammation or scarring.
02:50
Causes postpartum bleeding.
02:52
Keep in mind that this
may then result in
pituitary infarction
of the mother.
02:57
We call this Sheehan.
02:59
Associated with placenta previa as well,
which will be a separate
topic upcoming.
03:05
But we know accreta.
03:07
And I told you earlier that once you
understand the foundation of accreta
and where it attaches to, then we’ll
talk about other attachments.
03:15
And meaning to say that instead
of attaching to the myometrium,
it might then infiltrate or
invade, you call that increta.
03:22
Or perhaps, you even –
Not only do you invade,
but then you perforate.
03:26
That’s called perforeta.
03:29
Understand the
foundation though.
03:30
Accreta, not -- not -- attaching
to the normal decidua
and so therefore from here,
you can go into accreta,
increta and perforeta.
03:44
A placental abnormality
known as placenta previa.
03:48
I’d like for you to
take the "V" in previa
and take a look at the shape
and work with me here,
I’ll make your life easier.
03:56
I want you think of that
V as being the uterus.
03:59
And the bottom of the V, it
converged to a single point.
04:03
I want you to go ahead
and imagine the uterus
and you’re going t converge
into the cervix, aren’t you?
So the V, think of it
as being the cervix,
the convergence point.
04:15
Normally speaking, the placenta
should be attaching to the
proximal portion of the fundus.
04:20
The wide body portion
of the fundus, correct?
Instead of that, you
have the placenta,
which is attaching down
by the cervical os.
04:30
Now can you imagine as to what
that pathology looks like?
Placenta implants in lower
uterine segment or cervix
with serious antepartum
bleeding here as well.
04:41
So many of your
placental abnormalities
that we had been looking
at including accreta
and we have previa,
may be associated with
bleeding taking place.
04:50
Understand the
foundation of previa
and that from here,
you could either have
partial or complete
type of previa,
But at this point,
I’m just going to walk you
through the fundamentals.
05:04
Here,
you have a patient who --
A pregnant woman, who gets
infected with whatever organism.
05:12
Now, what ends up happening is
the fact that the chorio --
We’re going to split
this up for you.
05:17
The chorio means the
side of the fetus
and specifically referring
to the placenta.
05:24
And the finger-like
projections of
the fetal placenta is known
as your chorionic villi.
05:31
Chorionic villi.
05:33
Think of that as
being like fingers.
05:36
I’m just speaking generally.
05:38
Fingers. Villi.
05:39
And the chorionic villi of the
placenta is responsible for extracting
the oxygen from
the mother, okay?
What may then happen is the
fact that the chorioamnion,
once it becomes infected, you
call this chorioamnionitis.
05:55
This is not good.
05:57
It follows premature
rupture of the membrane.
06:00
Usually due to an
ascending infection.
06:03
What ascending infection?
Are you picturing this?
There’s an infection
taking place
from the vagina, maybe a
sexually transmitted infection
making its way up the
vagina, up the cervix,
and oh my goodness,
it’s affecting the fetus,
specifically the placenta.
06:18
Even more specific,
chorionic villi.
06:20
Now we have chorioamnionitis.
06:23
If you have rupture of such
membranes, what’s going to happen?
Early birth, pre-term.
06:29
And upon such preterm
babies being delivered,
obviously these are low birth
or perhaps even very low birth weight
and that’s a problem, isn’t it?
It could be a host of
complications including
neonatal respiratory
distress syndrome,
so on and so forth.
06:45
You see as to how everything’s
being connected here.
06:47
We can’t just memorize
one thing at a time.
06:49
It’s all about, well,
what are the consequences
that may occur following.