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Placenta Circumvallata

Placenta Circumvallate

Placenta circumvallata is a structural abnormality of the placenta in which the chorionic plate is smaller than the basal plate, leading to folding back of the placental and fetal membranes. It is associated with numerous prenatal and perinatal complications, including placental abruption, preterm delivery, fetal malformations, growth restriction, and perinatal death in rare cases. The diagnosis can be made by standard ultrasonography during the second or third trimester.


Presentation

The development of placenta circumvallata carries a significant risk for the development of complications during pregnancy. These complications carry a poor prognosis and include ascending infection and consequent chorioamnionitis due to formation of a hematoma, or oligohydramnios [1], while placental abruption, preterm delivery, and emergency cesarean section have also been reported in women suffering from this condition [1] [2]. Additionally, the abnormality of the placenta impairs normal nutrient delivery (placental hypoplasia, deposition of hemosiderin and infarcts are suspected mechanisms of disease), which is why intrauterine growth restriction, fetal malformations, and even perinatal death was observed in some cases [3]. Persistent vaginal bleeding is one of the most prominent clinical manifestations of placenta circumvallata and is usually present during the first and second trimesters [1], but other authors claim that bleeding may be present during the 3rd trimester as well [3]. Women who eventually had a preterm delivery were more likely experiencing bleeding episodes, predominantly during the second semester, whereas intrauterine growth abnormalities (IUGR) and a small weight and/or height for gestational age were significantly linked with hemorrhage during the third semester [1]. Premature rupture of the membranes (PROM) and chronic fetal lung disease (CLD) may also be induced by this placental abnormality [1] [3].

Placental Disorder
  • ICD-10-CM Codes › O00-O9A Pregnancy, childbirth and the puerperium › O30-O48 Maternal care related to the fetus and amniotic cavity and possible delivery problems › O43- Placental disorders › Circumvallate placenta, unspecified trimester 2016 2017 2018[icd10data.com]
  • ICD-10-CM Codes › O00-O9A Pregnancy, childbirth and the puerperium › O30-O48 Maternal care related to the fetus and amniotic cavity and possible delivery problems › O43- Placental disorders › Circumvallate placenta, third trimester 2016 2017 2018 2019[icd10data.com]
  • Unfortunately, the accuracy of ultrasonography is quite limited when it comes to detecting this placental disorder, as certain reports show a very low rate of diagnosis.[symptoma.com]
  • disorders: placental polyps, placental infections, placental infarcts, placental tumors Umbilical cord – structure Abnormalities of the umbilical cord: velamentous insertion, variations in length, knots, loops, torsion, single artery in the umbilical[umfcv.ro]
Intracranial Hemorrhage
  • Polyhydramnios, neonatal cutaneous/intracranial hemorrhage, CNS depression, skeletal anomalies, respiratory distress.[studyres.com]

Workup

The first step in the diagnostic workup is obtaining a detailed patient history that will identify the onset and frequency of symptoms, and their features should immediately point to a fetal-related disorder. The majority of pregnancies in whom placenta circumvallata develops, unfortunately, receive a diagnosis after gross examination of this organ following delivery or termination of pregnancy [1]. Nevertheless, persistent bleeding during pregnancy, miscarriage or development of complications without an identifiable cause must raise suspicion regarding placental abnormalities, and a meticulous examination must be performed, since placenta circumvallata may be difficult to visualize. A rounded placental margin with an irregular, uplifted edge is one of the typical signs detected using standard ultrasonography, but measurement of placental thickness may also be highly useful [4] [5]. Unfortunately, the accuracy of ultrasonography is quite limited when it comes to detecting this placental disorder, as certain reports show a very low rate of diagnosis [4]. The introduction of more advanced imaging studies, however, such as HD live and live silhouette mode imaging, has shown promising results and their use in clinical practice might be of significant benefit [6]. A central placental depression with very thick folded edges that form the irregular placental margins (which are the hallmark of the condition) may be visualized by this procedure, making it highly useful if the diagnosis remains uncertain [6].

Treatment

  • There is also no specific treatment of Circumvallate Placenta.[dovemed.com]
  • There is no specific treatment schedule or protocol for circumvallate placenta. Many women deliver a normal healthy baby even if they have circumvallate placenta.[tandurust.com]
  • Treatment and prognosis Recognised complications include 1,4 : higher incidence of placental abruption increased risk of IUGR For a raised placental edge on ultrasound: amniotic shelf (amniotic sheet) part of an amniotic band close to the placenta[radiopaedia.org]
  • If the placenta separates and a woman is not given immediate medical treatment, the baby can die.[wisegeek.org]

Prognosis

  • Currently, there are no definitive methods available to prevent Circumvallate Placenta Expectant mothers diagnosed with Circumvallate Placenta require regular prenatal care to monitor complications associated with the condition What is the Prognosis of[dovemed.com]
  • These complications carry a poor prognosis and include ascending infection and consequent chorioamnionitis due to formation of a hematoma, or oligohydramnios, while placental abruption, preterm delivery, and emergency cesarean section have also been reported[symptoma.com]
  • The prognosis depends how early the condition is detected and how efficiently the complications are managed.[tandurust.com]
  • Treatment and prognosis Recognised complications include 1,4 : higher incidence of placental abruption increased risk of IUGR For a raised placental edge on ultrasound: amniotic shelf (amniotic sheet) part of an amniotic band close to the placenta[radiopaedia.org]

Etiology

  • Definition / general Insertion of the membranes away from the peripheral edge due to a folding / rolling of the chorion on itself Portion of extrachorial disc is present at the edge Associated with low birth weight and multigravid pregnancies Etiology[pathologyoutlines.com]
  • Etiologi Diduga chorion frondosum terlalu kecil dan untuk mencukupi kebutuhan vili menyerbu ke dalam desidua diluar permukaan frondosuin. Insiden : 2 – 18 %. C.[eviyulianti12.blogspot.com]

Epidemiology

  • Epidemiology of fetal alcohol syndrome in a South African community in the Western Cape Province. ‎[books.google.com]
  • (Abramowicz 2008) Ultrasound Levels used today have never been studied epidemiologically. (Stratmeyer, et al 2008) First trimester is a period of high sensitivity of the fetus to teratologic insults.[kghypnobirthing.com]
  • Frøen JF, Arnestad M, Frey K, Vege Å, Saugstad OD, et al. (2001) Risk factors for sudden intrauterine unexplained death: Epidemiologic characteristics of singleton cases in Oslo, Norway, 1986–1995. Am J Obstet Gynecol 184: 694–702.[journals.plos.org]
Sex distribution
Age distribution

Pathophysiology

  • Idiopathic fetal growth restriction: a pathophysiologic approach. Obstet Gynecol Surv 1996;51:376–82. Hargreaves K, Cameron M, Edwards H, Gray R, Deane K.[kghypnobirthing.com]

Prevention

  • Seite 1-4 - This care includes preventative measures, the detection of abnormal conditions in mother and child, the procurement of medical assistance and the execution of emergency measures in the absence of medical help.[books.google.com]
  • There are many instances of pregnant women delivering healthy baby with circumvallate placenta, however, careful monitoring is needed to prevent or manage complications once the condition is known during the time of pregnancy.[tandurust.com]
  • Use: methotrexate to prevent choriocarcinoma Assessment: Early signs - vesicles passed thru the vagina Hyperemesis gravidarium increase HCG Fundal height Vaginal bleeding( scant or profuse) Early in pregnancy High levels of HCG Preeclampsia at about 12[nursescentermcn.blogspot.com]

References

Article

  1. Taniguchi H, Aoki S, Sakamaki K, et al. Circumvallate Placenta: Associated Clinical Manifestations and Complications—A Retrospective Study Obstet Gynecol Int. 2014; 2014:986230.
  2. Suzuki S. Clinical significance of pregnancies with circumvallate placenta. J Obstet Gynaecol Res. 2008 Feb;34(1):51-54.
  3. Shen O, Golomb E, Lavie O, Goldberg Y, Eitan R, Rabinowitz RR. Placental shelf - a common, typically transient and benign finding on early second-trimester sonography. Ultrasound Obstet Gynecol. 2007;29(2):192-194.
  4. Harris RD, Wells WA, Black WC, et al. Accuracy of prenatal sonography for detecting circumvallate placenta. AJR Am J Roentgenol. 1997;168(6):1603-1608.
  5. Suzuki S. Antenatal screening for circumvallate placenta. J Med Ultrason (2001). 2008;35(2):71-73.
  6. AboEllail MA, Kanenishi K, Mori N, Kurobe A, Hata T. HDlive imaging of circumvallate placenta. Ultrasound Obstet Gynecol. 2015;46(4):513-514.

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Last updated: 2018-06-22 01:05