Problems with the Placenta

Question 1

Anomalies of the Placenta

Answer 1

1. Placenta Succenturiata
2. Placenta Circumvallata
3. Battledore Placenta
4. Velamentous Insertion of the Cord
5. Vasa Previa
6. Placenta Accreta

Question 2

Placenta that has one or more accessory lobes connected to the main placenta by blood vessels

No fetal abnormality

Answer 2

Placenta Succenturiata

Question 3

It is a smaller variant of a bilobed placenta

The vessels are supported only by communicating membranes

Answer 3

Placenta Succenturiata

Question 4

Placenta Succenturiata is important to recognize because the small lobes may be retained in the uterus after birth, leading to what condition

Answer 4

Severe obstetric hemorrhage

Question 5

The umbilical cord enters the placenta at the usual midpoint, and large vessels spread out from there however, they end abruptly at the point where the chorion folds back onto the surface

Answer 5

Placenta Circumvallata

Question 6

The fetal side of the placenta is covered to some extent with chorion

Answer 6

Placenta Circumvallata

Question 7

An extrachorial, annularly-shaped placenta with raised edges composed of a double fold of chorion, amnion, degenerated decidua, and fibrin deposits

Answer 7

Placenta Circumvallata

Question 8

Placenta Circumvallata is associated with the following conditions

Answer 8

1. Poor pregnancy outcomes due to increased risk of vaginal bleeding (1st trimester)
2. Premature rupture of the membranes
3. Preterm delivery
4. Placenta insufficiency
5. Placental abruption

Question 9

True or False: The diagnosis of Placenta Circumvallata is difficult to make during pregnancy and is often made on visual inspection of the placenta after delivery

Answer 9

True

Question 10

The cord is inserted marginally rather than centrally

Answer 10

Battledore Placenta

Question 11

This anomaly is rare and has no known clinical significance either

Answer 11

Battledore Placenta

Question 12

It is a condition in which the umbilical cord is inserted at or near the placental margin rather than in the center

Answer 12

Battledore Placenta

Question 13

The cord, instead of entering the placenta directly, separates into small vessels that reach the placenta by spreading across a fold of amnion

This form of cord insertion is most frequently found with multiple gestation

Answer 13

Velamentous Insertion of the Cord

Question 14

This type of placenta is associated with fetal anomalies

Answer 14

Velamentous Insertion of the Cord

Question 15

It is a pregnancy complication that happens when the umbilical cord from a fetus does not insert into the placenta correctly

Answer 15

Velamentous Insertion of the Cord

Question 16

The cord does not attach directly to the placenta but instead attaches to other membranes in the uterus

Answer 16

Velamentous Insertion of the Cord

Question 17

If velamentous Insertion of the Cord is seen during ultrasound during pregnancy

Answer 17

1. Cord traction should be avoided
2. Used cautiously during the delivery of the placenta

Question 18

The umbilical vessels of a velamentous cord insertion cross the cervical os – deliver first before the fetus

Answer 18

Vasa Previa

Question 19

If sudden, painless bleeding occurs with the beginning of cervical dilatation

Answer 19

1. Possible placenta previa
2. Possible vasa previa

Both can be confirmed by an ultrasound

Question 20

If vasa previa is identified during an ultrasound, the infants needs to be born through what delivery?

Answer 20

CS

Question 21

If vasa previa is identified prenatally on an ultrasound, what will be the next course of action?

Answer 21

Scheduled CS prior to full term to prevent risks of spontaneous labor

Question 22

Unusually deep attachment of the placenta to the uterine myometrium – so deep that the placenta will not loosen and deliver

Answer 22

Placenta Accreta

Question 23

Abnormal adherence of the placenta to the myometrium, associated with partial or complete absence of the decidua basalis

Answer 23

Placenta Accreta

Question 24

Risk factors that can lead to Placenta Accreta

Answer 24

1. Previous CS
2. Other uterine surgery
3. Advanced maternal age
4. High gravidity
5. Multiparity
6. Previous curettage
7. Placenta previa

Question 25

Higher risk for a placenta accreta is in pregnancies with

Answer 25

1. History of a cesarean section 2. Current placenta previa

Question 26

Therapeutic management for Placenta Accreta

Answer 26

1. Hysterectomy to remove the uterus 2. Administration of methotrexate to destroy the still-attached tissue

Question 27

What will happen if placenta accreta was manually removed?

Answer 27

Extreme hemorrhage

Question 28

Anomalies of the Cord

Answer 28

1. Two-Vessel Cord 2. Unusual cord length

Question 29

Anomalies of the Cord The absence of one of the umbilical arteries is associated with what conditions?

Answer 29

Congenital heart and Kidney anomalies

Question 30

Anomalies of the Cord The absence of one of the umbilical arteries is associated with congenital heart and kidney anomalies

Answer 30

Two-Vessel Cord

Question 31

What will happen if the cord dries out?

Answer 31

It distorts the appearance of the cord

Question 32

What course of action if the infant has two vessels?

Answer 32

Needs to be observed carefully for other anomalies during the newborn period

Question 33

An infant having a short cord length

Answer 33

1. Premature separation of the Placenta 2. Abnormal lie

Question 34

An infant having an unusually long cord length

Answer 34

May be easily compromised because of its tendency to twist and knot