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].

• Swelling

  Caput succedaneum Swelling and accumulation of fluid (edema) in the scalp of infants born vaginally. The swelling usually disappears within 24 to 48 hours. [perinatology.com]

  Swelling, necrosis, thrombosis and calcifications may be present. 5 (pp278–80) Cord Insertion The umbilical cord typically inserts into the placenta near its center. About 90 percent of cord insertions are central or eccentric. [aafp.org]

  Amaç: Dekolman plasenta flüphesi olan gebeliklerin de¤erlendiril- mesi ve ... disorders of placenta - GMCH ; Hydatidiform mole is characterized histologically by cystic swelling of the chorionic villi, accompanied by variable trophoblastic proliferation [xcqhegid.ga]

  Inflammation – calor (heat), rubor (red), dolor (pain) tumor(swelling) 2. purulent discharges 3. fever Gen mgt: 1.) supportive care – CBR, hydration, TSB, cold compress, paracetamol, VITC, culture & sensitivity – for antibiotic prolonged use of antibiotic [nursescentermcn.blogspot.com]

• Underweight

  Some ways in which circumvallate placenta impacts pregnancy: Underweight newborn baby: Circumvallate placenta slows down the growth of foetus due to restricted nutrition. Hence babies are born with abnormally low weight. [bebodywise.com]

• Hypertension

  Transissional Hypertension – HPN between 20 – 24 weeks III. Chronic or pre-existing Hypertension –HPN before 20 weeks not solved 6 weeks post partum. Three types of pre-eclampsia 1.) [nursescentermcn.blogspot.com]

  Hypertensive disorders, like hypertension, have been found to affect about 10% of pregnancies in the United States and have resulted in about 6.8% of maternal deaths from 2011 to 2015. [en.wikipedia.org]

  (D) Placental Lesions Seen in placenta at term, mainly in hypertensive states with pregnancy. White infracts: due to excessive fibrin deposition. (Normal placenta may contain white infracts in which calcium deposition may occur). [obgnursing.blogspot.com]

  Hypertension C. Gestational diabetes D. Placenta previa 6. Which of the following is a sign of vasa previa? A. A single umbilical artery. B. Sudden painless bleeding. C. A short umbilical cord. D. [nurseslabs.com]

  Systemic lupus erythematosus Advanced maternal age Dark areas Fresh infarcts Pregnancy-induced hypertension Systemic lupus erythematosus Advanced maternal age Fibrin deposition Firm gray areas No clinical significance unless extensive, in which case [aafp.org]

• Placental Disorder

  ( O44.- ) placental polyp ( O90.89 ) placentitis ( O41.14- ) premature separation of placenta [abruptio placentae] ( O45.- ) Placental disorders Approximate Synonyms Placenta circumvallata ICD-10-CM O43.119 is grouped within Diagnostic Related Group [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]

  It is the most common placental disorder and occurs in up to 1 out of every 100 pregnancies. Placental abruption is the leading cause of fetal and newborn death. It also causes high rates of premature delivery and fetal growth restriction. [medicalnewstoday.com]

• First Trimester Bleeding

  Bleeding Disorders During Pregnancy First Trimester Bleeding – Abortion or Ectopic A. [bicolnurses.blogspot.com]

  While there is no increased risk of fetal anomalies with this abnormality, bilobed placentas can be associated with first-trimester bleeding, polyhydramnios, abruption and retained placenta. [ncbi.nlm.nih.gov]

  While there is no increased risk of fetal anomalies with this abnormality, bilobed placentas can be associated with first-trimester bleeding, polyhydramnios, abruption, and retained placenta. [statpearls.com]

  Save discharges – for histopathology – to determine if product of conception has been expelled or not First Trimester Bleeding – abortion or eptopic A. [nursescentermcn.blogspot.com]

  Symptoms include recurrent bleeding in the late first and early second trimester probably due to villous tissue near the os. [uscapknowledgehub.org]

• Suggestibility

  The most widely held belief currently suggests that this condition results from excessive implantation of the blastocyst into the endometrium. [radiologykey.com]

  Flow seen on Power Doppler image suggests that this placental tumor is vascular and excludes placental hematoma. Ultrasound images of this type of placental mass are highly suggestive of placental chorioangioma. [ultrasound-images.com]

  If your blood loss is severe or your estimated due date is close, then immediate delivery of your baby might be suggested. [healthline.com]

• Irritability

  […] and neuromuscular function:  (1) Heart Rate (normal: HR 110-160bpm)  (2) Respiratory effort (normal: vigorous cry indicates adequate respiratory)  (3) Muscle tone (normal: extremities return to a position of flexion after extension)  (4) Reflex irritability [coursehero.com]

  Rheumatismal afetal pregnancy probotic spondylitic emaciation columellization: pseudocancer grand mal seizure, paratenon intracranial, mouth protector, clastic marginal infarct irritable joint nonovulation seep. [forge.ocamlcore.org]

  Respiratory distress is defined as typical signs or X ray findings, and cerebral irritation is defined as unrest, trembling, stiffness, and other signs of cerebral excitation [32]. [journals.plos.org]

• Stroke

  Group Sub group Signs: HEMOPOIETIC-LYMPHORETICULAR SYSTEM DISORDERS coagulation disorders, including platelet changes hemorrhage, ecchymoses, bleeding diathesis, purpura NEUROLOGICAL DISORDERS brain anomalies brain: hemorrhage, including ischemia, strokes [studyres.com]

  HR 110-160bpm)  (2) Respiratory effort (normal: vigorous cry indicates adequate respiratory)  (3) Muscle tone (normal: extremities return to a position of flexion after extension)  (4) Reflex irritability (normal: response to stimuli like gentle stroking [coursehero.com]

• Cesarean Section

  The emergency cesarean section was significantly higher in the circumvallate placenta than in the control group.   [hindawi.com]

  (Posterior or Anterior) [3] [1] [2] [4] No previous uterine surgery 1% to5% One previous Cesarean section 3% Two previous Cesarean sections 11% Three previous Cesarean sections 40% Four previous Cesarean sections 61% Five or more previous Cesarean sections [ncbi.nlm.nih.gov]

  The isolated finding of a circumvallate placenta does not lead to a cesarean section. [degruyter.com]

  […] or Anterior)[3][1][2][4] No previous uterine surgery 1% to5% One previous Cesarean section 3% Two previous Cesarean sections 11% Three previous Cesarean sections 40% Four previous Cesarean sections 61% Five or more previous Cesarean sections 67% Ultrasound [statpearls.com]

• Vaginal Bleeding

  In addition, we compared vaginal bleeding during the 2nd trimester + PCROM and vaginal bleeding during the 1st trimester + vaginal bleeding during the 2nd trimester + PCROM between the two subgroups. [hindawi.com]

• Urinary Retention

  Urinary tract: Bladder – freq in urination after delivery- urinary retention with overflow 4. Colon: Constipation – due NPO, fear of bearing down 5. [nursescentermcn.blogspot.com]

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].

• Trophoblastic Cells

  The development of the placenta begins during the implantation of the blastocyst. 32 to 64 cells contain the outer trophoblast cells and the inner cell mass. [icliniq.com]

  Pathophysiology of placenta creta: the role of decidua and extravillous trophoblast. Placenta 2008;29(7):639–645. Crossref, Medline, Google Scholar 46. Strickland S, Richards WG. Invasion of the trophoblasts. Cell 1992;71(3):355–357. [pubs.rsna.org]

A treatment called amnioinfusion places fluid in the amniotic sac to replace the lost fluid. This treatment may help to prevent underdeveloped lungs or compression of the cord at delivery, though more research is needed. [healthline.com]

There is also no specific treatment of Circumvallate Placenta. [dovemed.com]

What Are the Treatments Done for Circumvallate Placenta Complications? Doctors only can help in managing this condition. [icliniq.com]

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]

The prognosis depends how early the condition is detected and how efficiently the complications are managed. [tandurust.com]

Treatment and prognosis Recognized 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 References [radiopaedia.org]

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]

This case has been reported as the women had a coexistence of both these rare abnormalities with a rather grave prognosis of intrauterine foetal demise. [jri.ir]

ETIOLOGY Circumvallate placenta is thought to result from deep implantation of the placenta into the decidua. Because of this excessive implantation, the placenta covers more than half of the fetal sac. [fetalultrasound.com]

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]

So far only very few cases of repetitive circumvallate placenta have been described and further studies are necessary to elucidate the etiology of this suspected repetitive abnormal placenta development. Fig. 1: Hematoma in first trimester [thieme-connect.com]

The epidemiology of multiple births. Hum Reprod Update. 1999;5:179-87. Shub A, Walker SP. Planned early delivery versus expectant management for monoamniotic twins. Cochrane Database Syst Rev. 2015;4:CD008820. Bomsel-Helmreich O, Al Mufi W. [dergipark.org.tr]

Epidemiology of fetal alcohol syndrome in a South African community in the Western Cape Province. ‏ [books.google.com]

Prevalence and Epidemiology The reported prevalence of circumvallate placenta ranges from 0.5% to 21%. The wide variation in prevalence is caused by multiple factors. [radiologykey.com]

Placental Abruption: Epidemiology, Analysis of Risk Factors, ... Material and Methods: We reviewed patient files of 92 patients who were. [xcqhegid.ga]

Epidemiology[edit] Circumvallate placenta is a very rare condition affecting pregnant women. This condition is a placental morphological abnormality, with the placenta being formed during the early periods of pregnancy. [en.wikipedia.org]

Etiology, Pathophysiology, and Embryology The cause of circumvallate placenta is unclear, and many theories have been proposed. [radiologykey.com]

Maternal outcome after conservative treatment of placenta PATHOPHYSIOLOGY OF POSTPARTUM HEMORRHAGE AND … ; Third-stage contractions are powerful and prolonged: they act to stop placental blood flow and to separate the placenta and membranes. [xcqhegid.ga]

The pathological and histological examination of macroscopic suspect placentae can supply further information about placental architecture and hopefully more insight into pathophysiological mechanisms, leading to a better risk management in future. [degruyter.com]

Pathophysiology of placenta creta: the role of decidua and extravillous trophoblast. Placenta 2008;29(7):639–645. Crossref, Medline, Google Scholar 46. Strickland S, Richards WG. Invasion of the trophoblasts. Cell 1992;71(3):355–357. [pubs.rsna.org]

[Case Reports] J Matern Fetal Neonatal Med. 2021 Dec; 34(24):4162-4166.Hasegawa J, Furuya N, … Suzuki NJM Longitudinal investigations using ultrasound during pregnancy can be used to clarify the mechanisms and pathophysiology of abnormal fetal and placental [unboundmedicine.com]

Can It Be Prevented? There is currently no real way to prevent circumvallate placenta as the cause is not yet known. [parenting.firstcry.com]

Even if the doctors manage to identify the condition during pregnancy, they take measures to prevent further complications. [bebodywise.com]

Therefore, anything that affects placental development can prevent the baby from growing well. foetus Premature Rupture of Membranes (PROM) This happens when the amniotic sac ruptures before the onset of labor. [edieandamy.com]

Can We Prevent Circumvallate Placenta From Occurring? There is no natural way to prevent circumvallate placenta as the cause is unknown. The only thing that can be done is ensure mothers have good care. [icliniq.com]

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.