Placental anomalies

Placental
Anomalies
Presented by Hana Nicole Caceres | RR22
NCMP107 (Maternal & Child Nursing)
College of Nursing
Ateneo de Naga University |

THE NORMAL PLACENTA
Usually round or oval shaped
Weighs approximately 500g
15-20cm in diameter
1.5-3.0cm thick
Its weight is approximately one-sixth that of the fetus.
Maternal & Child Nursing
Placental Anomalies |

Simple Diffusion (e.g O2 and CO2)
Facilitated Diffusion
(e.g Glucose & Vitamins)
Active Transfer
(e.g Amino Acids)
Pinocytosis (e.g IgG molecules)
Secretes hormones
hCG
Estrogen
Progesterone
hPL
Usually substances of high
molecular weight (> 500 daltons)
do not cross the placenta.
Only IgG can cross the placental
barrier
Exchange of
Substances
Endocrine Function Barrier Function
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After birth, the placenta is always
examined for the presence of anomalies
The third stage of labor (i.e., delivery of the placenta) can also result
in complications; therefore continued careful observation of the
mother is VITAL.
Did you know ?

BILOBED
PLACENTA
Cord inserts between the two placental
lobes.
Either into a connecting chorionic bridge
or into intervening membranes.
Three or more equivalently sized
lobes
MULTILOBED
PLACENTA

WHAT IS IT?
A placenta that has one or more accessory lobes
connected to the main placenta by blood vessel.
CLINICAL
SIGNIFICANCE
Retained in the uterus after delivery and may cause
PPH
APPEARANCE
On inspection, the placenta appears torn at the edge,
or torn blood vessels extend beyond the edge of the
placenta.
PLACENTA
SUCCENTURIATA

Causes
Researchers don’t know
precisely what causes it, but
it’s not caused by anything
you did or didn’t do.
Symptoms
No signs and symptoms
Complication
Low Birth Weight
Placental Abruption
Oligohydramnios
Miscarriage
Preterm birth

THERAPEUTIC MANAGEMENT
Manually removed
Monitor bleeding (no clots or excessive bleeding)
Administer Medications as prescribed

WHAT IS IT?
The fetal side of the placenta is covered to some
extent with chorion
CLINICAL
SIGNIFICANCE
Increased risk for
Antepartum bleeding
Abruption
Fetal demise
Preterm birth
APPEARANCE
Amnion and chorion are folded and rolled back to
form a ring leaving a rim of uncovered placental tissue
PLACENTA
CIRCUMVALLATA

Symptoms
No signs and symptoms
Complication
The risks of vasa previa
and retained placenta are
increased with this
condition, like bilobed
and multilobate
placentas.
Risk Factors
Advanced maternal age
in vitro fertilization

WHAT IS IT?
Placetna wherein the cord is inserted marginally rather
than centrally.
CLINICAL
SIGNIFICANCE
Rare anomaly bu thas no clinical significance.
APPEARANCE
Umbilical cord is inserted at or near the placental
margin rather than in the center
BATTLEDORE
PLACENTA

The cord can be inserted as close to 2 cm from the edge of the placenta
(velamentous cord insertion)
INCIDENCE RATE
7% to 9% of singleton pregnancies and 24% to 33% in
twin pregnancies
COMPLICATIONS
Preterm labor, fetal distress, and intrauterine growth
restriction.
BATTLEDORE
PLACENTA

Most frequently found with multiple gestations
This type of placenta is associated with fetal anomalies
An infant born with this type of placenta needs to be
examined carefully at birth
A situation in which the cord, instead of entering the placenta
directly, separates into small vessels that reach the placenta by
spreading across a fold of amnion.
VELAMENTOUS
INSERTION OF THE CORD

If sudden, painless bleeding occurs with the beginning of cervical
dilatation, either placenta previa or vasa previa is suspected
It can be confirmed by ultrasound
If vasa previa is identified, the infant needs to be born by
cesarean birth.
Umbilical vessels of a velamentous cord insertion cross the cervical
os and therefore deliver before the fetus.
The vessels may tear with cervical dilatation, just as a placenta previa
may tear.
VASA PREVIA

VASA PREVIA
Latin
"Vasa" Vessels
"Pre" Before
"Via" Way
Vessels lie before the fetus in the birth canal.

Causes
Velamentous cord
insertion
Bilobed placenta
Symptoms
A sign that a woman
might have vasa previa is
if the blood is very dark, a
burgundy red.
there are no symptoms of
vasa previa at all.
Risk Factors
Low lying placenta
Prev. Cesarean Delivery
Multiple babies
Prev. Uterine Surgery
Complication
Does not pose any
physical health risks to
the mother, but the risks
to the baby can be
significant and can
ultimately result in the
loss of their life.

>37 weeks pregnant and Bleeding recurrent (delivery is recommended)
If under control (Vaginal)
If still bleeding (CS)
<37 weeks, controlled.
Fetal Monitoring (Bradycardia, decreased blood supply)
Neonatal Blood Transfusion (To replenish huge blood loss)

WHAT IS IT?
An unusually deep attachment of the placenta to the
uterine myometrium, so deep that the placenta will not
loosen and deliver
CLINICAL
SIGNIFICANCE
Can cause severe blood loss after delivery.
It's also possible for the placenta to invade the
muscles of the uterus (placenta increta) or grow
through the uterine wall (placenta percreta).
PLACENTA
ACCRETA

WHAT IS IT?
The placenta attaches deep into the uterine wall and
penetrates into the uterine muscle, but does not
penetrate the uterine serosa.
PLACENTA
INCRETA

WHAT IS IT?
The placental villi penetrate the myometrium and
through to uterine serosa.
PLACENTA
PERCRETA

Causes
Typically due to scarring
after a C-section or other
uterine surgery. Sometimes,
however, placenta accreta
occurs without a history of
uterine surgery
Symptoms
Placenta accreta often
causes no signs or
symptoms during pregnancy
— although vaginal bleeding
during the third trimester
might occur.
Risk Factors
Previous uterine surgery.
Placenta position
Maternal age
Previous childbirth
Complication
Heavy vaginal bleeding
Premature birth

If forced, might lead to huge amount of bleeding/hemorrhage and leaving it intact will
lead to infection.
Only solution is HYSTERECTOMY.

JoAnne Silbert-Flagg, & Adele Pillitteri. (2018). Maternal
and Child Health Nursing (8th ed.). Wolters Kluwer.
Kimberly M. Rathbun, & Jason P. Hildebrand. (2020,
October 23). Placenta Abnormalities. NCBI.
https://www.ncbi.nlm.nih.gov/books/NBK459355/
Mayo Clinic Staff. (n.d.). Placenta accreta. Mayo Clinic.
Retrieved April 2, 2021, from
https://www.mayoclinic.org/diseases-
conditions/placenta-accreta/symptoms-causes
Placenta - Abnormalities. (n.d.). Embryology. Retrieved
April 2, 2021, from
https://embryology.med.unsw.edu.au/embryology/index
.php/Placenta_-_Abnormalities#Placenta_Increta
Becky Young. (2017, December 11). Everything
You Need to Know About Vasa Previa. Healthline.
https://www.healthline.com/health/pregnancy/va
sa-previa#outlook
Becky Young. (2018, April 3). What Is
Circumvallate Placenta? Healthline.
https://www.healthline.com/health/pregnancy/cir
cumvallate-placenta#symptoms
bhoomikasingh8. (2019, September 9). Placenta
development and its abnormalities. Slideshare.
https://www.slideshare.net/bhoomikasingh8/plac
enta-development-and-its-abnormalities

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