ANOMALIES OF THE PLACENTA

AND CORD
 REPORTERS ASSIGNED TOPIC
1. Joanne R. Penaflor – Pathology Of The Placenta,
Anomalies Of The Cord, Unusual
2. Shaina Jane A. Olobia Cord Length
3. Mybert John J. Palco – Placenta Succenturiata
– Placenta Circumvallata
4. Fairy Rose A. Ortega – Battledore Placenta, Velamentous
5. Nicolyn M. Pinca Insertion Of The Cord, Vasa Previa
– Placenta Accreta
ANOMALIES OF THE PLACENTA
– The placenta and cord are always
examined for the presence of
anomalies after birth.
– Normal weight of placenta – 500g
approx.
– 15-20cm in diameter
– 1.5-3.0cm thick
– If the uterus has scars or a septum, the
placenta may be wide in diameter
because it was forced to spread out to
find implantation space.
ANOMALIES OF THE CORD
A normal cord contains one vein and two
arteries. The absence of one umbilical arteries
is associated with congenital heart and kidney
anomalies.
 Studies suggest that babies
with single umbilical artery have
an increased risk for birth
defects, including heart, central
nervous system and 
urinary-tract defects and 
chromosomal abnormalities .
UNUSUAL CORD LENGTH
– Normal cord length is 50-60cm,
averagely 55cm
– Short cord: <35cm is defined as short
cord, may lead to fetal distress,
placental abruptio, prolonged labour.
Long cord: >80cm is defined as
long cord, higher occurrence of
cord neck, cord around body, cord
knot, cord prolapse, and cord
compression.
Short umbilical cord
complications:
Hypoxic-ischemic encephalopathy,
Cerebral palsy, Umbilical cord
rupture, Breech presentation,
Miscarriage/stillbirth, Intrauterine
growth restriction, Placental
disruption.
PLACENTA SUCCENTURIATA
PLACENTA SUCCENTURIATA
The succenturiate placenta is a
condition in which one or more
accessory lobes develop in the
membranes apart from the main
placental body to which vessels of
fetal origin usually connect them.
Risk Factors
Other factors leading to succenturiate
placentas include implantation over
leiomyomas, in areas of previous surgery, in the
cornu, or over the cervical os. Ultrasound,
particularly color Doppler, can be used to
identify this condition. The risks of vasa previa
and retained placenta are increased with this
condition, like bilobed and multilobate
placentas.
 The incidence of succenturiate
placenta among women with singleton
pregnancies was 1.04% (n = 294 of
28,256). Independent risk factors for
succenturiate placenta were gestational
age, prepregnancy BMI, pelvic
infection, prior cesarean section,
infertility, and preeclampsia.
 Placenta succenturiate is a
morphological abnormality of the placenta
where one or more of the lobes are present
outside the placental body. These can have
different sizes and are connected by blood
vessels to the main placenta. The
accessory lobe develops from the
chorionic villi that did not involute from
the mild chorion. The estimated incidence
worldwide is 1.04%. This entity has been
associated with two main risk factors,
advanced maternal age and women who
have undergone in vitro fertilization.
Placenta Circumvallata
Placenta Circumvallata
Placenta Circumvallata is an
abnormality on the shape of the
placenta. It can result in a lack of
nutrients of the fetus in
Circumvallata placenta, The chronic
plate, which is the part of the
placenta that's on the fetal state is
too small that causes the membranes
to double back on the fetal side and Placenta Circumvallata
around the edges.
ARE THERE SYMPTOMS OR WARNING SIGNS?

Here are a few signs that you

may have circumvallate placenta:
- Slow fetal Growth.
- Bleeding from the vigina.
- Premature Rampture of
Membrance.( PROM)
What effects does it have on pregnancy ?

Circumvallate placenta increases

your risk of certain pregnancy
complications , including :
- Low birth weight
- Placental abruption
- Oligohydramnios
- Miscarriage
What causes it?
- Circumvallate placenta is a variation of
placental development, Researchers
don't know precisely what causes it, but
it's not caused by anything you did or
didn't do. Nothing can be done to
prevent a Circumvallate placenta from
developing.
- If you've been diagnosed with the
condition, you should be extra vigilant
about rest and healthy diet to try and
prevent intrauterine growth restriction.
How is Placenta Circumvallate diagnosed?

The condition can be detected

by ultrasound and is usually
diagnosed around the 20th week
of pregnancy.
Is there any treatment?
- Although there is no way to treat a
Circumvallate placenta, a doctor may
take some steps to help reduce the
risk of complications or treat them.
- One of the primary concerns of a
Circumvallate placenta is the
decreased birth of the baby. To help
monitor this, a doctor may
recommend more growth checks
using ultrasound.
- If the fetus is not growing fast enough,
the doctor may recommend early
delivery. A vagina delivery will usually
be possible, but a cesarean section
might be the best option if the baby is
not tolerating labor.
- If a woman has a placental abruption as
a result of a Circumvallate placenta, a
doctor will usually recommend frequent
monitoring hospital bed rest, early
delivery, and, sometimes, an emergency
cesarean section.
BATTLEDORE PLACENTA
VELAMENTOUS INSERTION
OF THE CORD
VASA PREVIA
 What is Battledore Placenta?
- The battledore placenta can be defined as an
abnormal insertion of the umbilical cord. The
condition is also known as the Marginal Cord
Insertion. Battledore placenta can be found in
association with other conditions, such as:
monochorionic twin pregnancy, intrauterine
growth retardation, pre-term birth and low-
weight at birth.
- The name of the condition has been chosen
because of the resemblance that it bears to the
racket used in battledore.
Battledore Placenta Statistics or
Prevalence
This condition has an occurrence
rate of 7% among normal
pregnancies. But if we discuss other
physiological and pathological
pregnancy conditions like twin
pregnancies or triplet pregnancies, the
occurrence rate is 25%.
Battledore Placenta Pathology
– According to the existing research, the
distance is under 2 cm (or 1cm
according to other studies).
– The condition can progress to the
velamentous cord insertion – this is
because of changes, such as the
placental trophotropism and it can be
encountered at a later stage of the
pregnancy.
Battledore Placenta Complications

- Restricted blood supply to placenta

- Increase pressure in lower abdomen
- Distress of the fetus
- Prolapse of the cord
- Pain
- Restriction of the intrauterine
growth
VELAMENTOUS INSERTION
OF THE CORD
What Is Velamentous Cord Insertion?
– A velamentous cord insertion is a rare
pregnancy complication in which the
umbilical cord is abnormally inserted
into the placenta.
– In a velamentous insertion, the umbilical
cord inserts itself into the amniotic
membrane rather than in the placenta.
The baby's blood vessels stretch along
the membrane between the insertion
point and the placenta.
Diagnosis
Velamentous cord insertion can
be diagnosed through an
ultrasound. It may be difficult to
see during the first trimester of
pregnancy, but it is easier to detect
during the second trimester
Statistics or Prevalence
Velamentous insertion occurs in
1.1% of single-baby pregnancies and
8.7% of twin pregnancies. In cases of
miscarriage, velamentous cord
insertion happens around 33% of the
time when the pregnancy ends
between nine and 12 weeks gestation.
In pregnancies that end between 13
and 16 weeks, the rate is a little lower
at 26%.
Signs of Velamentous Cord
Insertion
- Decrease in fetal blood supply.
- If a fetus is not hitting developmental
milestones during your prenatal
appointments, it could be another sign
that there is a complication.
- Additionally, if you experience bleeding
during pregnancy, bring this to the
attention of your doctor or midwife.
Complications
- Once the baby is born, they may be
more likely to be transferred to the
neonatal intensive care unit
(NICU). They may have a low
Apgar score (a ranking of a baby's
physical condition), an abnormal
heart rate, or other physical issues.
- Velamentous insertion also
increases the risk of stillbirth.
Treatment
- There is no way to correct velamentous
cord insertion, but as long as the baby is
still receiving blood from the mother, the
pregnancy can be successful.
- The best course of action, once it is
discovered, is to get regular ultrasounds
and closely monitor the fetus. Your
healthcare provider may also suggest a
nonstress test in the third trimester. This
comprises wearing a belt with built-in
sensors and tracking the baby's movement
and heart rate.
 Risk factors for developing a
velamentous cord include having a two-
lobed placenta, uterine anomalies, and the
fetus having a single umbilical artery. Other
risk factors to consider are:
- Advanced maternal age
- Having a female fetus
- Having twins
- Pregnancies conceived with assisted
reproductive technology like in vitro
fertilization (IVF)
- Prior abnormal cord insertion in
pregnancy
VASA PREVIA
What is Vasa Previa?
– Vasa previa is a “high-risk” condition that can lead
to excessive bleeding, fetal distress, and even
stillbirth. C-sections are necessary when fetal
distress is apparent. Vasa previa is very important to
diagnose and monitor. If untreated, death is likely.
– In an estimated one in 2,500 pregnancies, however,
a serious complication called vasa previa occurs.
With vasa previa, some of the blood vessels grow
along the membranes in the lower part of the uterus
at the cervical opening. If the condition is not
detected in advance, the blood vessels can rupture
during labor, causing massive blood loss for both
mother and baby and potentially resulting in a
stillbirth.
Early Signs and Symptoms of
Vasa Previa
- Experience painless vaginal
bleeding.
- Blood that is darker in color.
- Any signs of fetal distress,
such as bleeding or a slow
heart rate, should be detected
and investigated by a doctor
during prenatal checkups.
Diagnosis
- It is not intentionally screened for during
pregnancy. It will usually be picked up, however,
during the routine ultrasound examination
performed at 18-20 weeks. If a transabdominal
ultrasound, done on the outside of the belly, looks
suspicious, your doctor will follow up with a
transvaginal ultrasound. This, combined with a
color Doppler used to look closely at blood
vessels should confirm the diagnosis.
- The condition can also be diagnosed during labor.
With vasa previa, pulsating vessels can usually be
seen running across the bulging membranes upon
examination of the cervix.
Treatment
– Typically, your provider will offer regular follow-
up ultrasounds to monitor the condition closely.
The aim in managing the condition is to allow the
pregnancy to progress for as long as possible,
ideally 35 weeks.
– In some cases, your doctor may want to hospitalize
you for the duration of your third trimester for
close monitoring and complete bed rest.
– You may also be given steroids to help the baby’s
lungs mature in case they need to be delivered
early. Your doctors will individualize your plan of
care depending on your risk factors, ultrasound
findings, and other factors.
- If vasa previa is present, your doctor may
recommend a Caesarian section (C-section)
between 35 and 37 weeks’ gestation.
- If the vasa previa was not diagnosed, and the
baby is delivered vaginally, doctors will soon
notice that there is a problem. They will
perform resuscitation and blood transfusions to
counteract the baby's blood loss.
- If at any point the mother or fetus are in
danger, an emergency C-section is performed.
Since the baby will not be carried to full term,
doctors prescribe steroids to help the baby
grow as fast as possible while still in the
womb.
Consequences of
Vasa Previa
- During delivery, the amniotic sac pops
and the baby is forced down through
the cervix, rupturing the blood
vessels. Vaginal delivery results in the
baby losing a large quantity of blood.
- Another concern with vasa previa is
that blood vessels can be pinched,
cutting off circulation to the fetus.
Lack of oxygen is a serious concern
because it can result in brain damage.
PLACENTA ACCRETA
PLACENTA ACCRETA
– Occurs when the placenta attached
too deeply to the uterus
– Placenta Accreta can result in
severe bleeding after delivery
WHAT ARE THE SYMPTOMS OF PLACENTA
ACCRETA?

 Often there are no sign or

symptoms of placenta
ACCRETA
 Sometimes bright red vaginal
bleeding during the third
trimester could be a sign that
something is wrong with the
placenta.
WHAT ARE THE CAUSES?
- It's not known exactly what causes
placenta accreta
- In some cases Placenta Accreta
occurs in women without a history
of uterine surgery or placenta previa
- Having a cesarean delivery
increases a woman's risk of placenta
accreta during future pregnancies.
WHO IS AT RISK FOR PLACENTA
ACCRETA?
- Have had previous surgery or the
uterus including cesarean section or
surgery to remove uterine fibroids
- Have been pregnant before
- Being over the age of 35
- Have abnormal placental position
such as condition called Placenta
Previa
- A Placenta located in the lower part
of the uterus
WHAT ARE THE COMPLICATIONS ?
- Severe vaginal bleeding which
may require a blood transfusion
- Problems with blood clotting or
disseminated intravascular
coagulopathy
- Lung failure or adult respiratory,
distress syndrome
- Kidney failure
- Premature birth
HOW IS PLACENTA ACCRETA
DIAGNOSED?
- Placenta is usually diagnosed
with ultrasound
- In some cases, provider may
order a magnetic imaging , MRI
test etc..
HOW IS PLACENTA ACCRETA TREATED?

- Delivery at a high level maternal

center with extensive expertise in
comprehensive care for placenta
accreta is important for your health.
- Severe cases of placenta accreta are
treated with surgery. In some cases ,
early delivery or hysterectomy are
necessary to reduce complications.
IS IT SAFE TO HAVE ANOTHER PREGNANCY?

A woman will no longer be able

to conceive children if a
hysterectomy is performed.