Angioarquitectura placentaria
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Transcript of Angioarquitectura placentaria
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Dr. Jorge AvalosGineco-Obstetra
AngioarquitecturaplacentariaPresentacion de caso clinico
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medicina maternofetal
HNDAC
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medicina maternofetal
HNDAC
escisión deblastómeros
monocigóticos
3er día post-concepcion
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medicina maternofetal
HNDAC
formación de la placenta
compartida
Vellosidadeprimari
as
atrofia
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medicina maternofetal
HNDAC
formación de la placenta
compartida
Vellosidadeterciari
as
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medicina maternofetal
HNDAC
formación de la placenta
compartida
Placenta monocorial
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medicina maternofetal
HNDAC
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medicina maternofetal
HNDAC
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medicina maternofetal
HNDAC
mayor territorio
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medicina maternofetal
HNDAC
RCIUsSTFFTAPSTRAP
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medicina maternofetal
HNDAC
aarteriaavena
Intercambio normal
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medicina maternofetal
HNDAC
arteria
venaGemelo 1
Gemelo 2
unidireccional
Anastomosisprofundas
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medicina maternofetal
HNDAC
arteria
arteria
Gemelo 1
Gemelo 2
bidireccional
Anastomosissuperficiales
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medicina maternofetal
HNDAC
vena vena
Gemelo 1
Gemelo 2
bidireccional
Anastomosissuperficiales
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medicina maternofetal
HNDAC
Anastomosisatipicas
aaarteriaavena
arteria
bidireccional
avena
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a
medicina maternofetal
HNDAC
aarteriaavena
Anastomosisatipicas
arteria
unidireccional
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a
medicina maternofetal
HNDAC
aarteriaavena
Anastomosisatipicas
vena
unidireccional
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Las placentas en TTTS tienen
menos Anastomosis A-A
30%
Wee LY.Longitudinal blood flow in shared and non-shared cotyledons in monochorionic placentae. Placenta 2007
medicina maternofetal
HNDAC
AnastomosisArterio-arterial
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Las anastomosisArterio-arterial
Es un factor Protector
Nikkels PG. Pathology of twin placentas with special attention to monochorionic twin placentas. J Clin Pathol 2008
medicina maternofetal
HNDAC
AnastomosisArterio-arterial
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Las anastomosisArterio-arterial
Determina el riesgo
STFF
Wee LY.Longitudinal blood flow in shared and non-shared cotyledons in monochorionic placentae. Placenta 2007
medicina maternofetal
HNDAC
AnastomosisArterio-arterial
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Caso 1
RCIU – selectivo tipo3
medicina
fetalmaterno
SIMPOSIOGESTACIONMULTIPLE
HNDAC
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medicina maternofetal
HNDAC
Discordancia
48%
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medicina maternofetal
HNDAC
Doppler Arteria Umbilical
diástole ausente o reversa -
intermitente
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medicina maternofetal
HNDAC
arteria
arteria
Gemelo 1
Gemelo 2
bidireccional
Anastomosissuperficiales
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medicina maternofetal
HNDAC
gran Anastomosis arterio - arterial
bidireccional
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medicina maternofetal
HNDAC
asimetria territorios
placentarios
Feto 2 Feto 1
ecuador placentario
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medicina maternofetal
HNDAC
inserciónmarginal de
cordón umbilical
Feto 2
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medicina maternofetal
HNDAC
IdentificacionAnastomosis
veno - venosa
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medicina maternofetal
HNDAC
IdentificaciónAnastomosis
arterio arterial
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medicina maternofetal
HNDAC
IdentificaciónAnastomosis
arterio arterial
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medicina maternofetal
HNDAC
IdentificaciónAnastomosis
arterio arterial
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medicina maternofetal
HNDAC
bidireccional
5mm
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Caso 2
RCIU – selectivo tipo2
Anastomosis atípicasunidireccionales
medicina
fetalmaterno
SIMPOSIOGESTACIONMULTIPLE
HNDAC
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medicina maternofetal
HNDAC
Discordancia
35%
A.D.M
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medicina maternofetal
HNDAC
doppler arteria
umbilical
Feto 2: normal
Feto 1: rciu
A.D.M A.D.M
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medicina maternofetal
HNDAC
A.D.M
doppler arteria umbilicaldiastole ausente
28+4 ss
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medicina maternofetal
HNDAC
doppler arteria
umbilical
Feto 2: normal
Feto 1: rciu
A.D.M A.D.M
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medicina maternofetal
HNDAC
A.D.M
doppler arteria umbilical
32+2 ssFeto 2
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medicina maternofetal
HNDAC
A.D.M
doppler arteria umbilical
32+2 ssFeto 1
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medicina maternofetal
HNDAC
Discordancia
39%
A.D.M
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medicina maternofetal
HNDAC
A.D.M
doppler arteria umbilical
33+0 ssDV:1.48 IP
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medicina maternofetal
HNDAC
termino de gestaciónpor cesárea
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medicina maternofetal
HNDAC
asimetríadistribuciónplacentaria
Feto 2 Feto 1
ecuador placentario
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medicina maternofetal
HNDAC
asimetríadistribuciónplacentaria
Feto 2 Feto 1
ecuador placentario
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medicina maternofetal
HNDAC
Inserciónmarginal
velamentosa
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medicina maternofetal
HNDAC
Identificación
Anastomosisarterioarterial
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medicina maternofetal
HNDAC
Identificación
Anastomosisarterioarterial
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medicina maternofetal
HNDAC
IdentificaciónAnastomosis
atípicaunidireccional
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medicina maternofetal
HNDAC
IdentificaciónAnastomosis
atípicaunidireccional
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medicina maternofetal
HNDAC
unidireccional
unidireccional
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Caso 3Síndrome transfusión
feto fetal – RCIU selectivoStuck twin
Inserción de cordón umbilical en la membrana amniótica
Polihidramnios severoPrematuridad extrema
medicina
fetalmaterno
SIMPOSIOGESTACIONMULTIPLE
HNDAC
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medicina maternofetal
HNDAC
polihidramnios severo
sintomatología:parto pretérmino
dificultad respiratoria
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medicina maternofetal
HNDAC
21cm pozo mayor
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medicina maternofetal
HNDAC
perimetro abdominalFeto donante
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medicina maternofetal
HNDAC
Longitud de femur: <p2.3%
Peso: 291gr
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medicina maternofetal
HNDAC
Amniodenajeterapeutico
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medicina maternofetal
HNDAC
5litrosliquido
amniótico
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medicina maternofetal
HNDAC
post amnio drenaje
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medicina maternofetal
HNDAC
pozo mayor3 litros menos de liquido amniótico
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medicina maternofetal
HNDAC
gemelo donanteanhidramnios
obito fetal
gemelo receptorApgar 1 -1
Falleció a los 50 minutos
Peso:510gr
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medicina maternofetal
HNDAC
gran asimetríade territorios
placentario
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medicina maternofetal
HNDAC
inserción de cordón umbilicalvelamentosa del
feto donante - rciu
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medicina maternofetal
HNDAC
identificaciónde
anastomosis
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“La experiencia nubla nuestras mentes con conceptos preconcebidos que
tomamos como verdades universales. Es importante tener conceptos claros en
medicina para tomar decisiones. Pero estos conceptos nunca aportan soluciones a los
nuevos retos. Necesitas escuchar a todos, ver sus ideas y así solucionar los
problemas”Edward Gratacos