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Placenta previa and placental abruption
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Vasa previa is defined as fetal blood vessels running through the membranes over the maternal cervix, unprotected by either the umbilical cord or the placenta (Figure 4). It is associated with velamentous umbilical cord insertion. With the rupture of membranes, these fetal vessels can rupture and result in significant fetal bleeding. The fetus can lose a large portion of its blood volume; therefore, this condition is associated with a high fetal mortality rate (8). It is also noteworthy that vasa previa can be present after a low-lying placenta is visualized on a second-trimester ultrasound (15).
Antepartum Haemorrhage
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Similar to placenta praevia, the term ‘vasa praevia’ is used when vessels lie before the fetus in the birth canal. These vessels traversing the free placental membranes are unprotected by placental tissue or Wharton’s jelly of the umbilical cord and are prone to rupture during labour or at amniotomy, particularly when located over or near the cervix. Vasa praevia is classified as type I when the vessels are connected to a velamentous umbilical cord, and type II when the vessels connect the placenta to a succenturiate (accessory) lobe (Figure 13.16). Risk factors for vasa praevia include a low-lying placenta, multiple pregnancy and in vitro fertilisation. Although rare, with an incidence between 1 in 1,200 to 1 in 5,000 pregnancies, it bears a 60% fetal mortality rate, as rapid fetal exsanguination can occur following rupture of these vessels.
Obstetric Hemorrhage I: Antepartum Hemorrhage
Published in Lauren A. Plante, Expecting Trouble, 2018
John C. Smulian, Casey Brown, Amanda Flicker
If a prior ultrasound determined that the lower edge of the placenta was >2 cm from the internal os, then significant bleeding from a low placental implantation is unlikely (10,11). However, a prior ultrasound that showed a placenta previa, a low-lying placenta, or a vasa previa suggests that placental or fetal vessel bleeding would be the most likely etiology of the hemorrhage. It is essential to confirm the placental location prior to performing a digital cervical examination, since the manual disruption of a placenta previa can lead to catastrophic bleeding. Importantly, even if a prior placenta previa has resolved, there may still be a residual vasa previa that can spontaneously rupture, usually after 34 weeks (12). Bleeding from a vasa previa is an obstetric emergency and requires urgent delivery for fetal indications, even though the maternal condition is usually unaffected. Ultrasounds for placental location and for vasa previa not only are highly accurate when transvaginally performed, but can also be performed with a translabial approach with an abdominal transducer covered by a sterile glove (Figure 13.3). Although the diagnosis is often straightforward using color Doppler imaging when the vessels are intact, the accuracy of detection in the presence of a bleeding vessel is not known.
The evaluation of maternal systemic thiol/disulphide homeostasis for the short-term prediction of preterm birth in women with threatened preterm labour: a pilot study
Published in Journal of Obstetrics and Gynaecology, 2022
Orkun Cetin, Erbil Karaman, Murat Alisik, Ozcan Erel, Ali Kolusari, Hanım Guler Sahin
This prospective, observational and pilot study was performed at Yuzuncu Yıl University Medical Faculty, Department of Obstetrics and Gynaecology between December 2015 and July 2020. The study was approved by University’s Local Ethics Committee and all patients provided written informed consent. The initial power analysis based on the preterm delivery prevalence suggested a sample size of 70 symptomatic pregnant women for both groups. Ninety-one singleton pregnancies complicated by TPL, between 24+0 and 33+6 gestational weeks were screened and recruited to the study. The flow diagram of the patients is shown in Figure 1. The final sample size of 75 consecutive singleton pregnancies, complicated with TPL was followed-up until delivery. Exclusion criteria were: pregnancies with ≥34 weeks, multiple gestations, preterm premature rupture of membranes (PPROM), antepartum haemorrhage (placental abruption, placenta previa or vasa previa), gestational diabetes mellitus, foetal congenital anomalies, cervical cerclage, gestational hypertensive diseases, non-reassuring foetal condition and obstetric comorbidities. TPL was described as the presence of documented regular uterine contractions at ≤8 min apart with or without cervical dilatation and/or effacement (dilatation < 4 cm and/or effacement ≤ 50%). The gestational age was defined by last menstrual bleeding and corrected by ultrasound if necessary.
A Case of Osteogenesis Imperfecta Type II With Additional Balanced Translocation t(1;20)(p13;p11.2)
Published in Fetal and Pediatric Pathology, 2019
Nasma K. Majeed, Diana Oramas, Valerie Lindgren, Steven Garzon, Dr. Elizabeth Wiley, Christopher Enakpene, Rajyasree Emmadi
The patient was a 27-week gestation male fetus born to a 19-year-old G2P1001 mother. The previous pregnancy three years prior resulted in a full term cesarean section with a normal fetus, and there was no history of prior miscarriages or termination of pregnancy. The mother presented with vaginal bleeding at 25 weeks of gestation. Ultrasound showed placenta previa with vasa previa and a fetus with enlarged posterior fossa, small thorax, large ventricular septal defect, short superior and inferior limbs and a club foot. Eleven days later an emergency cesarean section was performed due to heavy bleeding. The baby did not survive delivery, and an autopsy was performed. The fetus was a 490 g, phenotypically dysmorphic male with brachydactyly, macrocephaly, frontal bossing, soft calvarium, saddle nose, micrognathia, low set ears, and a narrow thoracic cavity. The chest circumference was 13.5 cm (Reference: 20.8 cm), and the combined lung weight was 4.7 g (Reference: 14.4 ± 9.7 g). Crown-heel length was 23.1 cm (Reference: 33.6 ± 3.2 cm), crown-rump length 19.2 cm (Reference: 24.1 ± 2.9 cm) and foot-length 3.4 cm (Reference: 4.9 ± 1.4 cm). The clinical differential diagnosis based upon the gross phenotype included thanatophoric dysplasia (Fig. 1).
Pathology of the Placenta in Singletons after Assisted Reproductive Technology Compared to Singletons after Spontaneous Conception: A Systematic Review
Published in Fetal and Pediatric Pathology, 2023
Urška Belak, Bojana Pinter, Helena Ban Frangež, Mojca Velikonja, Sara Korošec
Due to unknown reasons, fresh ET pregnancies in comparison to spontaneous pregnancies result in higher preterm birth rates, lower birth weights, and maternal complications during pregnancy. Regardless of known factors for preterm birth and lower birth weight, such as higher maternal age, lower parity, and various gynecologic infertility conditions and procedures, new-borns conceived by ART have two times higher probability of preterm birth [3]. Pregnant women after fresh ET have more frequently ovarian hyperstimulation syndrome, placenta previa, vasa previa and placental abruption. Fetuses are more frequently affected by fetal growth restriction (FGR) [4,5].