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1. Tracing of fetal heart rate monitor showed " sinusoidal pattern "
15/08/2011
08:25 am.
BKK, Thailand
This is the one example of placenta insufficient case. We
found abnormal fetal heart rate pattern from fetal monitoring
graph. Patient felt decreased fetal movement when near term
pregnancy. And her weight decreased too. So she was test fetal
condition and placenta function by NST ( non stress test ).

2. "" Decreased fetal movement ""
From this graph pattern , we called "Sinusidal pattern " .
Picture of this graph is as same as "Sine wave" in radio
frequency. This pattern is caused from some degree of fetal
anemia. There are many reasons of fetal anemia.
So she was adviced to terminate the pregnancy. Because
now, the baby was very risk for fetal hypoxia. From graph
tracing warned that we should very closed monitoring of baby.

3. But in the real situation, if we delayed decision , when we have
to really really delivery. It's may have unexpected factors
which delayed management. Such as , no vacancy of operating
room, anesthesiologist was busy in other cases, etc.
So she accepted to cesarean section.
In the operation , we founded the first reason of sinusoidal
pattern. It wass " true knot " of umbilical cord , only single
knot but it was tightly knot. This knot may obstructed the blood
flow to baby. And the baby may received oxygen insufficiency.
"" True knot ""

4. Maternal side of placenta " succenturiata ".
Fortunately , we delivered well female baby. Her body weight
was 2946 gm.. And we founded abnormal type of placenta.
It is " placenta succenturiata " , it has small placenta which
attach the larged placenta with only membrane. Placenta weight
= 680 gm. The larged placenta diameter = 21 x 21 cm. And
diameter of small placenta = 10 x 9 cm. Umbilical cord length =
54 cm.
Length of umbilical cord is lower limit of umbilical length
( normal length about 50 - 100 cm. ) And it had true knot , so
it increased low blood flow to baby.
In this case , may be retain pieces of placenta occured if
spontaneous vaginal delivery. It may caused of post partum
hemorrhage and procedure of mannual removal placenta.

5. Fetal side of placenta " succenturiata ".
Finally I would liked to tell you that , we should awreness
about weight gain , movement of baby. And we should alert to
check "NST" when pregnancy aged about 28 wk. and over.
Because we can early detection sign of risk to baby from this
test.
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