KELAINAN PLASENTASI

KELAINAN PLASENTA
I. kelainan and abnormalitas selaput ketuban
1. kelainan Chorioamnion
2. kelainan Amniotic Fluid Volume
II. kelainan and abnormalitas Placenta
1. abnormalitas Plasentasi
2. sirkulasi gangguan
3. abnormalitas tali pusat (Funis)
4. Gestational Trophoblastic diseases
5. Tumor Placenta lainnya
Kelainan plasentasi
kelainan and abnormalitas selaput ketuban

kelainan Chorioamnion
 Meconium Staining
 Chorioamniotis
 Amnionitic Cysts/kista
 Amnion Nodosum
 Amnionic Bands/lilitan
Kelainan Chorioamnion
Meconium Staining/pewarnaan mekonium
 7 - 22 %
 jarang < 38 weeks
 Increases > 40 weeks
 NMR 3.3 % (1.7 % in non-staining)
 Angka SC meningkat 2X
 Kematian neonatal karena meconium
aspiration
Gambar : Meconium staining
kelainan Chorioamnion
Chorioamnionitis
 Infeksi Intrauterine, PRM lama,partus lama
 Microscopis: leukosit pada korion
kelainan Chorioamnion

Amnionic cysts
 Selaput ketuban melipat dan membentuk
kista
kelainan Chorioamnion

Amnion Nodosum
 Squamous
metaplasia
amnion
 Amnionic
caruncles
kelainan Chorioamnion
Lilitan tali pusat
 Tali pusat melilit pada ekstremitas
 intra uterine amputation
KELAINAN PLASENTASI

kelainan and abnormalitas selaput ketuban

kelainan amnionic fluid volume
 Oligohydramnios < 500 ml
 Hydramnios, polyhydramnios > 2000 ml
 Chronic
 Acute
 TYPICAL AMNIONIC FLUID VOLUME

Weeks Fetus Placenta Amnionic

Percent
Gestation (g) (g) Fluid (ml) Fluid
16 100 100 200 50
28 1000 200 1000 45
36 2500 400 900 24
40 3300 500 800 17
Hydramnios
 penyebab :
berhubungan dengan fetal malformation
- anencephaly, spina bifida
- esophageal atresia
- kematian Perinatal meningkat

 Pathogenesis
- peningkatan produksi cairan amnion
- gangguan mekanisme kontrol
Hydramnios
 gejala
 Berdasarkan uterus yang overdistensi
 Diagnosis
 Uterus membesar, palpasi sukar, mendengar
BJA sukar
 DD : ascites, kista ovarium besar
 USG
Hydramnios
 Prognosis
 Angka kematian perinatal ↗:

fetal malformation, preterm, cord

prolapse
 Komplikasi Maternal : solusio,post
partum hemorrhage
Hydramnios
 Penatalaksanaan
 Sedang : dyspnea, nyeri abdomen, sulit
bergerak
- amniocentesis
- amniotomy
- indomethacin therapy :
1.5 to 3 mg/kg per day
Oligohydramnios
 Oligohydramnios pada kehamilan lanjut
 SC meningkat
 Gangguan DJJ
 Amnio infusion
 Memasukkan cairan kristaloid kedalam uterus
kelainan plasentasi
kelainan dan abnormalitas placenta
abnormalitas Plasentasi
 Multiple placenta dgn janin tunggal
 Succenturiate placenta
 Ring shaped placenta
 Membranaceous placenta
 Fenestrated placenta
 Extrachorial placenta
 Large placenta
 plasentasi polyp
PLACENTA BIPARTITA
OR BILOBED
PLACENTA
ACCESORIES PLACENTA
TRIPLE PLACENTA
EXTRACHORIAL PLACENTA
Circumvalate placenta
EXTRACHORIAL PLACENTA
Circummarginate placenta
 CORD INSERTION
Velamoentous insertion
kelainan plasentasi
kelainan and abnormalitas placenta
gangguan sirkulasi
 plasentasi infarcts
 plasentasi calcification
 Villous (fetal) artery thrombosis
 Clinical significance
 Hypertrophic lesions chorionic villi
 Microscopic plasentasi abnormalitas
 plasentasi inflamation
PLACENTA INFARCTS
plasentasi INFARCTS Red
Brown Infarcts
plasentasi kelainan
kelainan and abnormalitas placenta
abnormalitas tali pusat (funis)
 panjang
 Arteri umbilikalis satu  congenital
anomalies
 puntiran
 Four-vessel cord
 Cord insertion : - marginal insertion
- velamentous insertion
- vasa previa
plasentasi kelainan
kelainan and abnormalitas placenta
abnormalitas tali pusat (funis)
 Kelainan tali pusat : ggn aliran darah
- knots cord
- loops cord
- edema
- torsion
- stricture
- hematoma
- cysts
FALSE KNOT TRUE KNOT
plasentasi kelainan

kelainan and abnormalitas placenta

Gestational trophoblastic kelainan
Other tumours placenta
- Chorioangioma (Hemangioma)
- Tumor metastatic to the placenta