Placental and cord insertion pathologies: screening, diagnosis, and management.

Placenta previa, low-lying placenta, and placenta accreta are aberrations in the normal development of the placenta. Diagnosis in the prenatal period is essential because each of these pathologies can have a profound impact on the management of labor, birth, and the third stage. In recent years, there has been an increase in the occurrence of these placental abnormalities, with the increase in the cesarean rate considered to be a main cause of this phenomenon. Comprehensive risk assessment, combined with recent advances in ultrasonography, can provide earlier detection of impaired placental implantation. Umbilical cord insertion pathologies are also of concern. Velamentous cord insertion is a defect in the insertion site of the umbilical cord resulting from the atrophy of portions of the developing placenta. In this condition, the blood vessels of the umbilical cord are not protected by Wharton's jelly, resulting in a potential for increased risk of breakage when the amniotic membranes rupture. Vasa previa is a velamentous insertion of the umbilical cord in which the blood vessels are present over the cervical os. If these blood vessels rupture during labor, it can have catastrophic effects on the fetus. Prenatal diagnosis of this condition can allow the certified nurse-midwife/certified midwife (CNM/CM) to plan for the safe birth of the newborn and avoid fetal hemorrhage. This article provides a review of risk factors, diagnosis pathophysiology, and management options for these conditions, thus enabling the CNM/CM to provide safe, effective care and management.

Gestational trophoblastic disease: an overview.

This article reviews the different disease entities that fall under the classification of gestational trophoblastic disease (GTD). The conditions included range from molar pregnancy to the malignant forms of gestational trophoblastic neoplasm (GTN). These disorders all arise from abnormal placental trophoblastic development. The different types of GTD, symptomatology, and diagnostic modalities are examined. The various methods of treatment are reviewed. Although the management of GTD and GTN falls outside the scope of midwifery practice, midwives need to be aware of the incidence, risk factors, and symptoms for specific types of GTD in order to be able to diagnose and refer for treatment in a timely manner. Psychosocial aspects that affect the woman who has not only had a pregnancy loss but also may be faced with a life-threatening illness are examined. The role of the midwife in the management, counseling, and follow-up of GTD and GTN is discussed.

Understanding hydatidiform mole.

Hydatidiform mole (often referred to as molar pregnancy) is the most common disorder in a category of pathologies known as Gestational Trophoblastic Diseases that are associated with abnormal fertilization in pregnancy. Current practices in screening and monitoring during early pregnancy allow for better identification of hydatidiform mole, sometimes prior to the onset of significant symptoms.Once a diagnosis is established, a thorough physical examination and laboratory testing are necessary. Initial treatment includes uterine evacuation. Serial monitoring of serum human chorionic gonadotropin levels is warranted until levels become nondetectable and continues for another 6 months. Reliable contraception is necessary until it has been determined that no trophoblastic tissue persists.Pregnancy is usually a joyful time, with maternal attachment to the developing fetus beginning early in the pregnancy. The woman who experiences hydatiform mole, however, must face the inability to maintain this pregnancy, the possible health consequences of the mole, and then be allowed the time to grieve. Nurses can be the first-line in providing compassionate, empathetic care for women in these circumstances.

Sexually speaking: The whole truth about IUDs.

Nurses are perfectly positioned to offer women accurate information about an often-neglected contraceptive method.