Pemeriksaan Khusus

Plasenta, Tali Pusat

dan Air Ketuban

 Dr. Muara P Lubis, SpOG(K)

UMBILICAL CORD

Normal Cord has three vessels encased in Wharton

Jelly
• 2 arteries carry deoxygenated blood to placenta
• 1 vein brings oxygenated blood back to fetus

Cord Coiled : arteries coil around vein

Connections
• Abdominal wall insertion surrounded by intact skin
• Placental insertion normally centered on
placental disc
DOPPLER

• Best to evaluate UA flow in a free floating

loop of cord

• Use of ratios overcomes angle dependent of

velocity measurements

• UA should have low resistance flow

• Evaluation of UA assesses fetal

hemodynamic status in multiple condition
Placental insufficiency major cause of
abnormal doppler
•  placental vascular resistance 
 forward flow in UA   diastolic flow

• SD ratio, PI and RI all increase

• Eventually diastolic flow reaches zero =

AEDF
Single Umbilical Artery

BEST DIAGNOSTIC CLUE

- FREE LOOP OF CORD WITH 2 VESSELS
SEEN BEST ON CROSS SECTION
- COLOR DOPPLER OF FETAL PELVIS
TRANSVERSE VIEW OF THE BLADDER
ONLY 1 UA ADJACENT TO FETAL BLADDER
ULTRASONOGRAPHIC FINDINGS :

NORMAL UMBILICAL CORD

FREE LOOP CROSS SECTION VIEW

. 2 UA + 1 UV
. “MICKEY MOUSE” APPEARANCE ON CROSS SECTION
. UA DIAMETER < 50% UV DIAMETER

LONGITUDINAL VIEW
- ARTERIES COIL AROUND VEIN
- CORD IS FULLY COILED BY END OF 1ST TRIMESTER

COLOR DOPPLER TRANSVERSE FETAL PELVIS VIEW

- ONE UA ON EACH SIDE OF BLADDER
- UA INSERT INTO ILIAC ARTERIES
SUA AND IUGR
15% DEVELOP IUGR
SUA CORD DOPPLER
- SAME VALUES AS FOR NORMAL CORD
-  S/D RATIOS SUGGEST  IUGR RISK

NON ISOLATED SUA

50% ANEUPLOID RATE
TRISOMI 18
TRISOMI 13
UNILATERAL RENAL AGENESIS
SIRENOMELIA
VELAMENTOUS CORD ORIGIN
TWIN REVERSED ARTERIAL PERFUSION SEQUENCE
Umbilical Cord Cyst

Thin walled cyst or cysts

• Usually anechoic
• Rarely with minimal internal echo

Doppler
• Differentiates UCC from vessels
Umbilical Cord Cyst
Vasa Previa

Definitions
• Submembranous fetal vessels cross cervical os

Best Diagnostic Clue

• Pulsed Doppler shows fixed vessels overlying
cervical os
• Associated with succenturiate lobe and
velamentous cord insertion
Nuchal Cord

Definitions
• One or more complete loops of umbilical cord
around fetal neck

• Best diagnostic clue

• Must see both sagittal and transverse planes to rule
out false positive diagnosis

Follow up ultrasound with attention to:

• Growth
• Amniotic fluidoligohidramnios increases risk of
complication
• Umbilical cord Doppler flow
• Fetal movement
PLACENTA & MEMBRANES

PLACENTA PREVIA

Definitions
Placenta implants in lower uterine segment
Placenta crosses or lies close to internal os (IO)
of cervix

Best diagnostic clue :

TVS shows placental edge near or covering IO
 VELAMENTOUS CORD

Definitions
Umbilical vessels insert on membranes

Best diagnostic clue :

color doppler shows velamentous cord insertion
(CI) Adjacent to placenta

Some or all vessels on membranes

PLACENTAL ABRUPTION

Definitions
Premature separation of placenta from uterus

Best diagnostic clue

• Hypoechoic blood clot near or behind placenta
• Location : abruptions may be marginal (most
common), retroplacental

Evaluate fetal heart rate

SUCCENTURIATE LOBE

Definitions
• 1 or more accessory placental lobes
• Separate from main placenta
• Connected by placental vessels

Best diagnostic clue :

two separate placentas seen on routine
Ultrasound

Location : anywhere in uterus, including previa

Siz e: succenturiate lobe is smaller than primary lobe

Most common cause of vasa previa
PLACENTA ACRETA

Definitions
Abnormal penetration of placental tissue beyond
endometrial lining Of uterus

Best diagnostic clue

• Loss of subplacental hypoechoic zone
• Irreguler placental vasculer lacunae

Placenta previa in almost all cases

 USG Air Ketuban

 Digunakan untuk menentukan volume air ketuban

(AFV)

 Penting : oligohidramnion <22 wga 

perkembangan paru terganggu, mekonium tebal,
severe FHR decceleration, IUGR, asfiksia
intrapartum, dan kematian perinatal;
Polihidramnion  resiko kematian janin dan
neonatus meningkat

 2 metode: SDP dan AFI

Moore TR. The Role of Amniotic Fluid

Assessment in Evaluating Fetal Well-Being
 Faktor yang
mempengaruhi AFV

Urinasi dan Sekresi cairan

proses menelan paru fetus
oleh fetus •Normal netto=150-
•Urinasi normal: 1- 170 mL/hari
1,5L/hari
•Proses menelan:
0,5-0,7 L/hari

Moore TR. The Role of Amniotic Fluid

Assessment in Evaluating Fetal Well-Being
 Prosedur USG
 Arah sinar transduser tegak lurus dengan sumbu
koronalis pasien dan sejajar dengan sumbu sagital
pasien

 Cari kantung terdalam yang tidak terhalangi untuk

mengukur DP (deepest pocket)

 Jangan ukur pada daerah abu-abu pada layar, cairan

amnion harus berwarna yang paling hitam

 Jangan ukur pada daerah yang sangat sempit antara

struktur fetus (min ada jarak beberapa mm)

 Jangan ukur di antara ekstremitas atau untaian tali

pusat
Moore TR. The Role of Amniotic Fluid
Assessment in Evaluating Fetal Well-Being
Single Deepest Pocket

Moore TR. The Role of Amniotic Fluid

Assessment in Evaluating Fetal Well-Being
Amniotic Fluid Index

Moore TR. The Role of Amniotic Fluid

Assessment in Evaluating Fetal Well-Being
THANK YOU