Its one of the important topic in obstetrics

2. Abnormalities
of
Placenta and Cord
GUIDE: LT COL AJITHA T Y SPEAKER: MAJ B ROSHNI
I YEAR MSC NURSING
COLLEGE OF NURSING
CH(EC) KOLKATA

3. What is Placenta?
 It is an organ which is responsible for nourishing and
protecting a fetus during pregnancy
Placental abnormalities-
 it refers to marked variations including anatomical,
physiological and abnormal implantations of
placenta that may lead to serious placental maternal
fetal effects

4. Functions of placenta
 Respiratory
 Excretory
 Nutritive
 Endocrine functions
 Barrier function
 Immunological function

5. Abnormalities of placenta
 Classified according to
Size and shape
Placental implantation
Circulatory disturbances
Placental tumors

6. Abnormalities of shape and size
A. Placenta succenturiate

8. Placenta succenturiate
 one or more small lobes of placenta, size of cotyledon may be
placed at varying distances from the placental margin
 Incidence- 3%
 Clinical significance-
 If the succenturiate lobe is retained following delivery of
placenta it may lead to
 PPH
 Subinvolution
 Uterine sepsis
 Polyp formation

9.  Placenta Spuria-
 Placenta succenturiate in which
there is absence of communicating
blood vessels it is called placenta
spuria

10. Placenta extrachorialis
It is of two types:-
 Circumvallate placenta
 Placenta marginata

11. Circumvallate placenta
 The fetal surface is divided into a
central depressed zone surrounded by
a thickened white ring which is usually
complete.
 Vessels radiate from the cord
insertion as far as the ring and
then disappear from view.
 The peripheral zone outside the ring
is thicker and the edge is elevated
and rounded.
 Incidence- 0.5-18%

12. Placenta Marginata
 A thin fibrous ring is present at
the margin of the chorionic
plate where the fetal vessels
appear to terminate.

13. Clinical significance
There are increased chance of
 Antepartum hemorrhage
 FGR baby
 Abortion
 Preterm delivery
 Retained placenta or membranes

14. Placenta Membranecea
 Placenta is unduly large and thin
 The placenta not only develops
from the chorion frondosum but
also from the chorion laeve so
that the whole of the ovum is
practically covered by the
placenta

16. Clinical significance
 Encroachment of some part over the lower
segment.
 Imperfect separation in the third stage.
 Chance of retained placenta is more and
manual removal becomes difficult.

17. Placenta bilobate/Bipartite
 Placenta may develop as separate and
nearly equally sized discs
 Umbilical cord is attached into a
connecting chorionic bridge or
intervening membranes
 Clinical significance
 Same as placenta Succenturiate

18. Placenta Fenestrata
 This is due to missing of
central portion of the
placental disk
 Clinical Significance
 It may be mistaken as if the
central cotyledon is retained
inside uterus

19. Abnormalities of placental
implantation
 Mal adherent placenta
 Mal positioned placenta

20. Placenta accrete Syndromes
These are abnormally implanted
invasive or adhered placenta
 Placenta accreta - indicates villi are
attached in myometrium
 Placenta increta - indicates villi
actually invade the myometrium
 Placenta percreta- villi that
penetrate through the myometrium
and to or through serosa

21. Clinical significance
 They are leading cause of intractable postpartum
haemorrhage and emergency peripartum
hysterectomy

22. ABNORMALITIES RELATED TO
CIRCULATION

23. Abnormalities R/T circulation
A. Subchorionic fibrin deposition- These are caused
by slowing of maternal blood flow within the
intervillus space
B. Perivillous fibrin deposition-maternal flow stasis
around an individual villus results in perivillous
fibrin deposition
C. Maternal floor infarction
D. Intervillous thrombus
E. Infarction

24. Clinical significance
 These are common lesions in mature placentas and
are benign in limited numbers
 If they are numerous placental insufficiency can
develop

25. Hematoma
 Types
 Retroplacental hematoma
 Marginal hematoma
 Subchorial thrombosis
 Subamnionic hematoma

27. Placental calcification
 Calcium salts may be deposited throughout the placenta, but
are most common on basal plate
 Calcification arises within advancing gestation and is
associated with nullipariy, smoking, Increase in maternal
serum calcium levels

28. ABNORMALITIES OF MEMBRANES

29. Abnormality of Membranes
Meconium staining
chorioamnionitis

30. ABNORMALITIES OF UMBILICAL CORD

31. Abnormalities of Umbilical Cord
 Short cord - Less than 20cm or commonly relative
due to entanglement of the cord round any fetal part.
 In exceptional circumstances, the cord may be absent and
the placenta may be attached to the liver as in
exomphalus.(acordia)

33. Clinical significance
 Prevent descent of the presenting part specially during labour
 Separation of normally situated placenta
 Favour malpresentation
 Acute inversion
 Fetal growth restriction
 Intrapartum distress
 Failure of external version
 Two fold risk of fetal death

34. Long cord -
 If length is more than 100cm
 Clinical significance
 cord prolapse
 cord entanglement round the neck or the body
 True knot False knots

36. Single umbilical artery
 It is more common in twins and in babies born of
diabetic mothers or in polyhydramnios

37. Clinical significance
 It is frequently associated with congenital
malformation of the fetus (10-20%).
 Renal and genital anomalies, Trisomy 18 are
common.
 There is increased chance of
 Abortion, Prematurity, FGR
 Perinatal mortality

38. Cord insertion
 Battledore placenta-
The cord is attachedto the margin of the
placenta.
If associated with low implantation of the
placenta, there is chance of cord compression in
vaginal delivery leading to fetal anoxia or even
death; otherwise, it has got little clinical
significance.

39. Battledore placenta-

40. Velamentous placenta
 The umbilical vessels spread within the
membranes at a distance from the placental
margin, which they reach surrounded only by a fold
of amnion.
 Although their incidence is approximately 1
percent, velamentous insertion develops in
more commonly with placenta previa and
multifetal gestations.

42. Vasa previa
 If the leash of blood vessels happen to
traverse through the membranes overlying the
internal os, infront of the presenting part, the
condition is called vasa praevia.

43. Cord abnormalities of impending
blood flow
Knots
True knots
False knots
 Loops
 Umbilical cord stricture

44.  False Knots
False knots appear as knobs protruding from the cord surface and are
focal redundancies of a vessel or Wharton jelly, with no clinical significance.

45. True knots
 Active fetal movements create cord knotting.
 Incidence : approximately 1%, and these are
more common in monoamnionic twins.
 The risk of stillbirth is increased five- to
tenfold.

46. Loops
 The cord frequentlybecomes coiled around portions of the
fetus.
 Those looped around theneck aretermed a nuchal
cord
 several large studies have reported one loop of nuchal
cord in 20 to 34 percent of deliveries; two loops in 2.5
to 5 percent; and three loops in 0.2 to 0.5 percent

47. Nuchal cord

48. Clinical significance
 As labor progresses, contractions may
compress the cord vessels and create fetal
heart rate decelerations that persist until
the contraction ceases.

49. Umbilical stricture

50. Umbilical stricture
 This is a focal narrowing of the cord diameter that typically
develops in the area of fetal umbilical insertion .
 Absence of Wharton Jelly and stenosis or obliteration of cord
vessels at the narrow segment are characteristic pathological
feature
 Most foetuses are stillborn

51. Hematomas

52. Hematomas
Associated with short cords,trauma and entanglement
Results from varix rupture usually of the umbilical vein
May also be caused by umbilical vessel venipuncture

53. Cysts

54. Cysts
 True cysts are epithelium-lined remnants of
the allantois and may co-exist with a persistently
patent urachus.
 In contrast,the more common pseudocysts
form from local degeneration of Wharton jelly.

55. Clinical significance
 Single umbilical cord cysts found in the first
trimester tend to resolve completely, whereas
multiple cysts may portend miscarriage or
aneuploidy.
 Moreover, pseudocysts persisting beyond this can
be associated with structural and
chromosomal anomalies defects, especially
trisomy 18 and 13.

56. Summary

57. Queries?

58. Assignment
 Identify the abnormalities of placenta in following pictures-

64. Q.2-Umbilical cord comprises how many arteries &
veins?
a) 2 arteries & 2 veins
b) 2 arteries & 1 vein
c) 1 artery & 2 veins
d) 1 artery & 1 vein

65. Q.3 what is clinical significance of battledore
placenta?
 Postpartum haemorrhage
 Cord compression
 Retained placenta
 None of the above

66. Q.4 what is chorioamnionitis?
 Abnormality of chorion
 Abnormality of placental membranes
 Inflammation of placental membranes
 Inflammation of placenta