PLACENTA -FORENSIC journal

1. Placenta: The Wonder Organ
IAFM APRIL –JUNE 2011,VOL-33 NO-2
Dr.Nafeeya
Department Of Forensic Medicine & Toxicology

2. • Journal Of Indian Academy Of Forensic Medicine April –June 2011
Vol 33,no.2
• Placenta –Wonder organ
• Corresponding Author:
• *Assistant Professor, Anatomy
• SGRRIM&HS, Patel Nagar, Dehradun 248001 E-mail:
drshashimunjal@yahoo.in
• **Prof. & HOD, Anatomy
• SGRRIM&HS,Patel Nagar, Dehradun 248001
• *** Prof. & HOD
• Deptt. of Forensic Medicine &Toxicology, SMS&R, Sharda
University,
• Greater Noida, Gautam Budha Nagar, 206308

3. overview
• Journal Study
– Aim of the study
– Materials and methods
– Results & conclusion
• Discussion
• Limitations
• References

4. Aim of the study
• To Find out morphological changes in placenta of anaemic mothers.
• To Find out effect of anaemia (in mothers) over fetal outcome, gestational
age and baby birth.
• Benefits-
• To know, it is how much important to correct anemia in antenatal period to
prevent worst fetal outcome

5. Materials and methods
• 120 placentas were taken from the mothers who delivered either vaginally
or by caesarian section.
• The Department Of Obstetrics And Gynecology Of SMIH, Patel Nagar,
Dehradun.
• 60 placentas were of control group - Group I with Hb >11gm% .
• 60 placentas of study - Group 2 with Hb<11gm%.
• Placenta taken after delivery were cleaned keeping 1 centimeter long
umbilical cord.
• Gross- weight, volume, shape, and number of cotyledons-noted.
• Tissue size 2x 2 cm was taken and processed for histological examination.

6. Results and conclusions
Mean placental
weight
Control group-
480gms
IIA-350gms
IIB-320gms
IIC-250gms
Mean placental
volume
360cc
320cc
300cc
250cc
Fibrin deposit
ratio
7%
20%
20%
60%
Number of
cotyledons
18
15
12
9

7. result
Correlation of anaemia with gestational age at delivery

8. foetal outcome

9. Few other journals
• Severity of anaemia -prematurity(23%)
• Low birth weight-23%
• IUD 27%
• Kelly S. Scanlon, Ray Yip, Laura A, Schieve and Mary E. Cogswell. High and low
Haemoglobin levels during pregnancy: Diffrential risks for preterm birth and small for
gestational age. Journal of obstetrics and Gynaecology. Nov 2000; 96 No. 5 Part I: 745-
747.
• Number of cotyledons decreases-with severity of anaemia
• Average-Control group-18,study group-12
• Olga S, Reshetnikova, Graham J Burton and Olga V Teleshova. Placental
Histomorphometry and Morphometric Diffusing capacity of the Villous Membrane in
Pregnancy Copmlicated by Maternal Iron Deficiency Anaemia. American Journal
Obstetrics Gynecology. Sept 1995; 173: (I) - 3: 724 - 727.

10. • Umbilical cord insertion was more towards the margin with the
increase in severity of anaemia.
• In study group 59% of cases were eccentric of umbilical cord insertion
whereas it was 34% cases in control group.
Manikanta Reddy ,et al, Prevalence And Pattern Of Abnormalities
Occurring In Placenta And Umbilical Cord, International Journal of
Medical Research & Health Sciences.Department of Anatomy, Department
of Reproductive Medicine, Sri Ramachandra Medical College and
Research Institute, Chennai, Tamilnadu, India.

11. histological features
• Study group –syncytial knot increased
• Cyto trophoblastic proliferation
• Basement membrane thickening
• Formation of vasculosyncytial membrane
• Capillaries per vill increased
• Stromal fibrosis increased

12. Placenta villi with intervillous spaces of
study group(mild to moderate anaemia)
Cytotrophoblastic
proliferation with
syncytical knots and
increase in number of
dilated capillaries
with vasculosyncytial
membrane

13. Placenta villi with intervillous spaces of study
group(severe anaemia)
Villi are full of
stromal fibrosis

14. discussion

15. Fetomaternal circulation

16. Influence of Maternal Anemia During Pregnancy on Placenta and Newborns
• Moderate maternal anemia causes significant increase of terminal villi
blood vessels and advanced placental maturity that could be reason for
earlier delivery among anemic expecting woman.
• Long lasting hypoxia, results with significantly lower birth weight and
length of newborns, intrauterine death of anemic mothers.
• Heart failure, shock,pulmonary embolism

17. Medicolegal importance
• Perinatal morbidity and mortality, and long-term adverse effects in the new
born.
• Life-threatening complications if the diagnosis is not made in good time
• Severe anemia during pregnancy increases your risk of premature birth,
having a low birth weight baby and postpartum depression.
• Some studies also show an increased risk of infant death immediately
before or after birth-neonatal mortality

18. • Medicolegal importance of placenta:
• Placental transfer-antibodies,drugs,poisons,microorganisms-result in
abnormalities,disease and death of fetus.
• Estimation of length of gestation.
• Retained placenta or placental pieces-indicate criminal
abortion,performed by untrained abortionist.

19. Limitation of the study
• Methodology not clear
• Sample size is very low
• HB not same-hemo-dilution will occur
• They had not mention about HB levels taken at what time.
• Histopathology changes depends on pathologist skill –observer variation
will be there.
• Ultrasound guidelines not mentioned properly
• Conclusion – not mention properly
• Not mention about medicolegal importance of the study

20. • D.C.Dutta Textbook of obstetrics and gynaecology.
• Anil Aggarwal textbook of forensic medicine and toxicology.
• Melisa Lelic, Gordana Bogdanovic, Suada Ramic, Elvira Brkicevic
• Influence of Maternal Anemia During Pregnancy on Placenta and Newborns
• Manikanta Reddy. V, Senthil Kumar. S, Sanjeeva Reddy.
• Prevalence and pattern of abnormalities occurring in placenta and umbilical cord
• International Journal of Medical Research & Health Sciences
• Department of Anatomy, Department of Reproductive Medicine, Sri Ramachandra Medical College and
Research Institute, Chennai, Tamilnadu, India
• V. Manikanta Reddy, S.P.Geetha, V.K. Nim.
• Variations in placental attachment of umbilical cord
• Departmenl of Anatomy, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry
• Kelly S. Scanlon, Ray Yip, Laura A, Schieve and Mary E. Cogswell. High and low Haemoglobin levels
during pregnancy: Diffrential risks for preterm birth and small for gestational age. Journal of obstetrics
and Gynaecology. Nov 2000; 96 No. 5 Part I: 745-747
• Olga S, Reshetnikova, Graham J Burton and Olga V Teleshova. Placental Histomorphometry and
Morphometric Diffusing capacity of the Villous Membrane in Pregnancy Copmlicated by Maternal Iron
Deficiency Anaemia. American Journal Obstetrics Gynecology. Sept 1995; 173: (I) - 3: 724 - 727.
.