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].

• Respiratory Disorders

  DISORDERS respiratory distress respiratory distress, including asthma SKELETAL DISORDERS limb anomalies, limb defects lethality, in malformations, no chondrodystrophy, no chromosomopathies Super group: complex plurimalformations neuro-skeletal disorders [studyres.com]

• Placental Disorder

  ( O44.- ) placental polyp ( O90.89 ) placentitis ( O41.14- ) premature separation of placenta [abruptio placentae] ( O45.- ) Placental disorders ICD-10-CM O43.113 is grouped within Diagnostic Related Group(s) (MS-DRG v 36.0): 817 Other antepartum diagnoses [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]

• Withdrawn

  According to this deep implantation theory, an early placenta covers more than half of the fetal sac as a result of the deep implantation, and as the amniotic sac expands, the peripheral excess placental tissue is withdrawn from the uterine wall. [radiologykey.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].

• Treponema Pallidum

  We conducted an extended screening including tests for HIV, hepatitis B, hepatitis C, cytomegalovirus, coxsackievirus, parvovirus, varicella virus, rubella, Epstein-Barr virus, herpes simplex and also for Treponema pallidum and toxoplasma. [degruyter.com]

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

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]

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 [radiopaedia.org]

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]

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]

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 [radiopaedia.org]

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

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]

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]

(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]

The epidemiology of placenta previa in the United States, 1979-1987. Am J Obstet Gynecol 1999; 168:1424-9. Jacques SM et al. Placenta accreta: mild cases diagnosed by placenta examination. Int J Gynecol Pathol 1996;15:28-33. Khong TY, Weger AC. [uscapknowledgehub.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]

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]

Finally, we explain several newer techniques for placental imaging, which can provide additional information about placental pathophysiology in selected patients. [pubs.rsna.org]

RDS Preterm-cut cord ASAP to prevent jaundice or hyperbilirubenia. [nursescentermcn.blogspot.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.