Malformation of Placenta

Subject: Midwifery I (Theory)

Overview

Placenta malformations comprise Placenta succenturiata, Circumvallate placenta, Placenta accrete, Placenta Bipartite, and Placenta membranecae. It is also known as the lobed placenta or Placenta succenturiata if it has one or more minor lobes that are accessory lobes located some distance from the main placental mass and attached to it by membranes containing branches of the umbilical arteries. Circumvallate placenta is a condition in which the membrane has adhered some distance from the border to a thickened white ridge on the fetal surface of the placenta, and the fetal surface of the placenta is divided into a normal-seeming core big region and a raised outer zone of 1-3 cm. Placenta accrete is caused by pathological adhesion between the placenta and the uterine wall, which obliterates the usual plane of cleavage for placental separation following the baby's delivery. Placenta membranecae is another placental anomaly in which the placenta is excessively big and thin. Similarly, cord anomalies include Battledore insertion, Velamentous insertion of the chord, single umbilical artery, and so on.

Placenta Succenturiata

One or more tiny lobes are accessory lobes that are separated from the main placental mass by membranes containing umbilical vessel branches. The lobed placenta is another name for it.

Clinical Significances

  • Post-partum hemorrhage
  • Subinvolution of uterus
  • Sepsis
  • Polyp formation

 

Circumvallate Placenta

Instead of being linked to the placenta's extreme perimeter, the membrane has attached some distance from the edge to a thickened white ridge on the placenta's fetal surface, which is separated between a normal-looking center big region and a raised peripheral zone of 1-3 cm.

Clinical Significances

  • Abortion
  • Premature labor
  • Antepartum hemorrhage
  • Fetal malformation
  • Retained placenta
  • Fetal death

Placenta Accreta

Pathological adhesion between the placenta and the uterine wall causes it, obliterating the usual plane of cleavage for placental separation after the baby is born. Although limited adherence is usual, 100% adherence has been documented.

Clinical Significances

  • Even when the placenta is manually detached and removed, life-threatening post-partum hemorrhage can occur.

Placenta Bipartite

The placenta is divided into two equal halves that are joined by membranes. The umbilical cord is put into one lobe, and veins from it traverse the membranes to the other. The umbilical cord rarely separates into two branches, each supplying a lobe. The placenta is made up of two lobes that are linked together by membranes. The umbilical cord is put into the large lobe, and veins from it bridge the membranes to reach the little succenturiate (accessory) lobe.

Placenta Membranecae

The placenta is very big and thin. The placenta develops not only from the chorionic frondosum but also from the chorionic leaf, such that the placenta almost covers the entire ovum.

Clinical Significances

  • Placenta previa
  • Imperfect separation leads to PPH
  • Chance of retained placenta

References

  • Embryology. 27 01 2017. 07 03 2017 <https://embryology.med.unsw.edu.au/embryology/index.php/Placenta_-_Abnormalities>.
  • Nursing Crib. 11 November 2010. <http://nursingcrib.com/nursing-notes-reviewer/maternal-child-health/anomalies-of-the-placenta/>.
  • Access Medicine. <http://accessmedicine.mhmedical.com/content.aspx?bookid=350&sectionid=41680591&jumpsectionID=41685878>.
  • Sweet, B.r., 1989, Maye's midwifery, A textbook for midwives; 11th edition, Bailliere Tindall, London, Philadelphia
  • Tuitui R. 2002, A textbook of Midwifery A (Antenatal), 3rd edition, Vidyarthi Pustak Bhandari (Publisher and Distributor), Bhotahity, Kathmandu
Things to remember
  • Placenta malformations include Placenta succenturiata, Circumvallate placenta, Placenta accrete, Placenta Bipartite, and Placenta membranecae.
  • It is also known as the lobed placenta or Placenta succenturiata if it has one or more minor lobes that are accessory lobes located some distance from the main placental mass and attached to it by membranes containing branches of the umbilical arteries.
  • Circumvallate placenta is a condition in which the membrane has adhered some distance from the border to a thickened white ridge on the fetal surface of the placenta, and the fetal surface of the placenta is divided into a normal-seeming core big region and a raised outer zone of 1-3 cm.
  • Placenta accrete is caused by pathological adhesion between the placenta and the uterine wall, obliterating the natural plane of cleavage for placental separation following the baby's delivery.
  • Placenta membranecae is another placental anomaly in which the placenta is abnormally big and thin.
  • Cord abnormalities include Battledore insertion, Velamentous insertion of the cord, single umbilical artery insertion, and so on.
Questions and Answers

Malformation of placenta

Placenta succenturiata:

A small accessory lobe or lobes, one or more, that are connected to the main placental mass by membranes that contain branches of the umbilical vessels and are located some distance away from it. It goes by the name lobed placenta.

Clinical significances:

  • Post-partum hemorrhage
  • Subinvolution of uterus
  • Sepsis
  • Polyp formation

Circumvallate placenta:

The membrane, which was originally attached to the placenta's extreme periphery, has now grown attached to a thickened white ridge on the fetal surface of the placenta, which is divided into a normal-looking central large area and a raised peripheral zone of 1–3 cm.

Clinical significances:

  • Abortion
  • Premature labor
  • Antepartum hemorrhage
  • Fetal malformation
  • Retained placenta
  • Fetal death

Placenta accreta:

The natural plane of cleavage for placental separation following childbirth is destroyed as a result of morbid adhesion between the placenta and the uterine wall. Although complete accreta is not common, partial adherence is the norm.

Clinical significances:

  • Even if the placenta is separated, a retained placenta that requires manual removal and a life-threatening postpartum hemorrhage are still possible.

Placenta Bipartite:

Two equal halves of the placenta are joined by membranes. Branching from the umbilical cord's vessels that are introduced into one lobe and go through the membranes to the other lobe. The umbilical cord rarely splits into two branches, each of which supplies a lobe. A larger and a smaller lobe that are connected by membranes make up the placenta. The branches of the umbilical cord's vessels pass through the membranes to the small succenturiate (accessory) lobe after being inserted into the large lobe.

Placenta membranecae:

The placenta is excessively big and frail. In order to practically cover the entire ovum, the placenta develops not only from the chorionic frondosum but also from the chorionic leave.

Clinical significances:

  • Placenta previa
  • Imperfect separation leads to PPH
  • Chance of retained placenta

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