Placental Variations and Abnormalities

Question 1

What risks are associated w/ battledore placenta?

Answer 1

marginal insertion

• preterm labor
• abnormal FHT patterns in labor d/t compression
• bleeding in labor d/t vessel rupture

Question 2

What risks are associated w/ succenturiate/accessory lobes?

Answer 2

• more common in multifetal gestations

- may be retained –> PPH, infection

Question 3

What risks are associated w/ velamentous cord insertion?

Answer 3

umbilical cord vessels run through amnion and chorion before entering placenta –> unprotected

• rupture
• fetal hemorrhage
• common in twin placenta

Question 4

What risks are associated w/ circumvallate placenta?

Answer 4

membranes do not originate from placental edge but closer to cord

• reduced chorionic plate area
• fetal membranes fold on selves –> dense, gray/white ring
• placental abruption
• threatened abortion
• preterm labor
• painless vaginal bleeding after 20w GA
• placental insufficiency
• fetal growth restriction
• intrapartum/PP hemorrhage

Question 5

What are risk factors for placenta previa?

Answer 5

• hx C/S
• hx uterine curettage
• hx placenta previa
• inc parity, multiple gestation
• male fetus
• infertility tx
• short pregnancy interval
• AMA
• higher altitudes

Question 6

s/sx placenta previa in labor

Answer 6

• painless bleeding in late 2nd or early 3rd tri
• acute hemorrhage
• bleeding usually stops and mother/baby stable

Question 7

What is often the cause of abruptio placenta?

Answer 7

rupture of maternal vessels in decidua basalis

one of leading causes of OB hemorrhage in 2nd and 3rd tri

Question 8

s/sx abruptio placenta in labor

Answer 8

depends on degree of separation and blood loss

• vaginal bleeding
• abdominal pain
• mild, generalized back discomfort/abdominal cramping
• demeanor/distress out of proportion

Question 9

How is prolonged third stage defined?

Answer 9

> 30min w/out placental expulsion

WHO : wait another 30min before manual removing if no bleeding