Study Of Variations In Human Placental Attachment Of Umbilical Cord And Its Clinical Significance

Introduction: The word placenta comes from Latin - flat cake and Greek -”Plakous” which means “flat, slab like.”Only eutherian mammals possess placenta. The human placenta is discoid, hemochorial and deciduate whichfunctions as a fetomaternal organ. It is developed from chorion frondosum & decidua basalis. Abnormalities inthe development and site of insertion of the umbilical cord can affect maternal and fetal well-being. The umbilicalcord is usually attached near the centre of the placenta. The various types of umbilical cord attachment into theplacenta are: central, eccentric, battledore (marginal), velamentous (membranous) and furcate. Hence knowledgeabout the variations in the placental attachment of umbilical cord is important for clinicians.Aims and Objectives: The present study is undertaken to study various types of placental attachment of umbilicalcord.Materials and methods: The study was carried out on 10% formalin fixed 100 normal human placenta collectedfrom department of Obstetrics and Gynaecology, Cheluvamba Hospital for children & women, Mysore medicalcollege and research institute, Mysuru, Karnataka. The study was carried out in department of Anatomy, MMC&RI,Mysuru. Study of various types of placental attachment of umbilical cord was done by naked eye observation.The data obtained was tabulated & statistically analysed.Observations and Results: Out of 100 placenta observed 68 placenta had central attachment of umbilical cord,16 placenta had eccentric attachment, 12 placenta had battledore (marginal) attachment and 04 placenta hadmembranous (velamentous) attachment.Conclusion: Variation in the placental attachment of umbilical cord is associated with various congenitalanomalies. Therefore early prenatal ultrasonographic identification of anomalies helps in reducing risk inmaternal and perinatal outcome.

Placenta succenturiata. Reporte de un caso / Succenturiate placenta. Case report

Resumen La placenta succenturiata es una anomalía morfológica de la placenta donde se presentan uno o más lóbulos accesorios por fuera del cuerpo placentario, pueden ser de diferentes tamaños y estar conectados mediante vasos sanguíneos a la placenta principal. El lóbulo accesorio se desarrolla a partir de las vellosidades coriónicas no asociadas al corion leve. La incidencia estimada a nivel mundial es de 1.04% y los principales factores de riesgo asociado a esta entidad son edad materna avanzada y el antecedente de haberse sometido a fertilización in vitro. Presentamos el caso de una paciente de 18 años con diagnóstico de placenta succenturiata con inserción marginal y velamentosa del cordón umbilical, la cual tuvo la finalización de la gestación por parto eutócico en el que se obtuvo recién un nacido eutrófico y sano, con tercer período de trabajo de parto prolongado y retención placentaria, por lo que se realizó alumbramiento manual, y se obtuvo la placenta completa con la presencia de un lóbulo accesorio con conexiones vasculares con el cuerpo placentario. En conclusión, la placenta succenturiata es una anormalidad morfológica relativamente rara, de diagnóstico clínico y morfológico en el puerperio inmediato, sin embargo, debe buscarse de manera intencionada mediante ultrasonido Doppler color en el período prenatal debido a que esta variedad de placenta conlleva a riesgos que pueden comprometer la salud y la vida tanto del feto como de la madre.

Abstract Placenta succenturiate is a morphological anomaly of the placenta where one or more of the lobes are present at a distance, which can be of different sizes and are connected by blood vessels to the main placenta. The accessory lobe develops from the chorionic villi that did not involute from the mild chorion. The estimated incidence worldwide is 1.04%. This entity has been associated with two main risk factors, advanced maternal age and women who have undergone in vitro fertilization. We report the case of a finding of placenta succenturiate in the postpartum period, in an 18-year-old woman in her first pregnancy, with vaginal delivery, eutrophic and apparently healthy newborn was obtained. During the third period of labor the patient presented placental retention, for which manual delivery was performed, obtaining a complete placenta that upon inspection was observed the presence of an accessory lobe in the membranes, which had vascular connections with the main placenta. In conclusion, placenta succenturiata is a relatively rare morphological abnormality, diagnosed in the postpartum period, but it can be diagnosed intentionally by color Doppler ultrasound in the prenatal period. This variety of placenta carries many risks that can compromise the health and life of both the fetus and the mother.

Veracity of Umbilical Cord Insertion at 11th-13+6 th Gestational Weeks with HD-FLOW / 中山大学学报(医学科学版)

[Objective]To investigate the feasibility of screening for velamentous umbilical cord insertion in early pregnancy by ultrasound.[Methods]A total of 2,796 cases of pregnant women,2 998 cases of fetuses that underwent prenatal ultrasound screening in the early and middle stage pregnancy and delivered in Dalian Women and Children Healthcare Center were included. The results of ultrasound screening of umbilical cord insertion during early pregnancy(11~13+6 w)were divided into three groups. GroupⅠ:it is clear that the placenta of the umbilical cord is located in the fetal membranes ,and then along with the fetal membranes for a long distance,and then enter the placenta. GroupⅡ:The placenta of the umbilical cord is located at the edge of the placenta,and then insert point is not distinguished between the placenta and fetal membranes. Group Ⅲ:It is clearly shows that the umbilical cord inserted into the placenta.[Results]1. The display rate of the umbilical cord in early and mid pregnancy ultrasound examinationearly pregnancyan examination showed that the rate of 99.23%(2 975/2 998). The single child display rate of 99.77%(2 590/2 596),twindisplay rate of 95.96%(380/396),three fetal the rate of 83.33%(5/6).In the second trimester of pregnancy(22~26 w)and examination showed that the rate of 86.99%(2 608/2 998). The single child display rate of 90.99%(2 362/2 596),twin display rate of 61.61%(244/396),three fetal the rate of 33.33%(2/6). 2. The results of early pregnancy,pregnancy,the examination of after birth Regard?ing to early pregnancy,28 cases were included in GroupⅠ,42 cases in GroupⅡand 2928 cases in GroupⅢ. Regarding to second pregnancy,37 cases were evaluated as velamentous umbilical cord insertion,30 cases were evaluated as battledore placenta and 2931 cases were evaluated as normal placenta. The results of postnatal examination were as follows:36 cases were identified as velamentous umbilical cord insertion,30 cases were evaluated as battledore placenta and 2932 cases were evaluated as normal placenta. 3. Comparison of 3 groups,early pregnancy examination results and pregnancy and after the birth. In early pregnancy,28 cases of GroupⅠwere diagnosed as velamentous umbilical cord insertion in the examination during the second trimester of pregnancy and after delivery. In the 42 cases of early pregnancy in Group Ⅱ,7 cases were diagnosed as velamentous umbilical cord insertion ,22 cases were diagnosed as battledore placenta and 13 cases were normal placenta. After birth ,6 cases were diagnosed as diagnosed as velamentous umbilical cord insertion ,23 cases were battledore placenta and 13 cases were normal placenta. In the 2928 cases of early pregnancy of Group Ⅲ,2 cases were diagnosed as diagnosed as velamentous umbilical cord insertion ,8 cases were battledore placenta and 2918 cases were normal placenta. After birth ,2 cases were diagnosed as diagnosed as velamentous umbilical cord insertion,7 cases were battledore placenta and 2919 cases were normal placenta.The diagnostic accuracy of early pregnancy was 98.29%.[Conclusion]Application of HD-Flow blood flow pattern in early pregnancy can make a diagnosis of some of the sail-shaped placenta.

Variations in Placental Attachment of Umbilical Cord.

Background: Our study aims to evaluate the variations in umbilical cord attachment to placenta by dissection method. Methods: Placentas for this study were obtained from the OBG Department and collected by the Department of Anatomy SRMS IMS. The placentas were washed, cleared, dissected and site of placental attachment to umbilical cord were observed. Variations in the type of insertion were noted. Result: Majority of the placentas showed central and eccentric attachments of the cord. Few abnormal placentas were observed with velamentous and marginal insertions of the umbilical cord. Conclusion: Abnormalities in the placental attachment of the umbilical cord can result in various complications of pregnancy and adversely affect the fetal outcome as well. Knowledge of the variations in attachment of the umbilical cord is very significant and of extensive use to obstetricians as well as anatomists. Frequently abnormal cord insertions may be associated with intrauterine growth retardation, preterm labour and congenital abnormalities.

Alteraciones morfológicas de la placenta / Placenta Morphological Changes

Suelen reportarse casos aislados de anomalías morfológicas placentarias; pero últimamente existe una incidencia del 9 % digna de atención. La placenta puede tener diferentes anomalías o producir alteraciones que complican el embarazo, el parto o el puerperio. Se presenta un caso clínico de una paciente con inserción velamentosa del cordón y placenta bilobulada en el Hospital Ginecobstétrico Docente “Ramón González Coro” durante un parto eutócico. Los resultados perinatales, a pesar de todas las complicaciones, fueron favorables y el recién nacido presentó un conteo de Apgar adecuado al nacimiento. A pesar de los pocos casos reportados se confirmó la relación entre el retardo fetal y la morbilidad hemorrágica materna en el alumbramiento.

Isolated cases of placental morphological abnormalities are often reported; but lately there is an incidence of 9 % noteworthy. The placenta may have different abnormalities or alter complicating pregnancy, childbirth, and the postpartum period. A case of a patient with velamentous cord insertion and bilobed placenta during a vaginal delivery at Ramón Gonzalez Coro Gynecobstetric Teaching Hospital is presented here. Perinatal outcomes, despite all the complications were favorable and the newborn presented a proper Apgar count at birth. Despite the few reported cases, the relationship between fetal delay and maternal hemorrhagic morbidity at delivery was confirmed.

Inserción velamentosa de cordón y desaceleración variable en el monitoreo cardiaco fetal / Velamentous cord insertion and variable deceleration of fetal heart rate monitoring

La inserción velamentosa de cordón es una patología inusual de la inserción de cordón, el cual carece de gelatina de Wharton. Presentamos el caso de una paciente que ingresó con diagnóstico presuntivo de corioamnionitis que presentó desaceleración variable (DIP III) durante el monitoreo fetal. La paciente fue operada sin estar en labor de parto y con membranas integras; el diagnóstico post cesárea fue inserción velamentosa de cordón. (AU)

Velamentous cord insertion is an unusual condition, Wharton´s gelly protection is absent in this entity. We report a patient admitted with a presumptive diagnosis of chorioamnionitis that presented variable deceleration of fetal heart rate. A cesarean section was performed despite of not being in labor and having intact membranes. A velamentous cord insertion was confirmed. (AU)

Hemorragia fetal aguda letal por rotura de vasa previa / Lethal acute fetal hemorrhage from ruptured vasa previa

La vasa previa es una afección rara asociada a una elevada mortalidad perinatal. Los vasos sanguíneos fetales cruzan por encima del orificio cervical interno y son el resultado de una inserción velamentosa del cordón umbilical. Se presenta un caso de sufrimiento fetal agudo letal causado por rotura de un vaso previo durante el segundo periodo del parto. Se comenta la etiología y el manejo clínico de esta afección.

Vasa previa is a rare condition associated with high perinatal mortality. Fetal blood vessels cross over the internal os and they are the result of an insertion cord velamentous. We report a case of fatal acute fetal distress caused by rupture of a vessel in the second period before delivery. We discuss the etiology and clinical management of this condition.

Velamentous insertion of umbilical cord in twin pregnancy.

Lifeline of the fetus in the womb is umbilical cord and is not spared in having anatomical and functional variance. Velamentous insertion of umbilical cord is more common in twins (incidence 8.7%). Increased risk for intra uterine growth retardation, preterm birth, congenital anomalies and fetal bleeding is associated with it. Intrauterine diagnosis can help to improve the fetal prognosis. So we have presented a case of twin pregnancy with one cord have Velamentous insertion and the other has normal; increase of Monochorionic diamniotic placenta. Both baby were still birth.

A Case of Vasa Previa / 대한산부인과학회잡지

Vasa previa is one of the most unusual and tragic accidents to fetus in obstetrics. This condition is not diagnosed easily because it is rare and unexpected. To improve the perinatal outcome, early detection by ultrasonography is very important during pregnancy. We present a case of vasa previa with velamentous insertion of cord with a brief review of the literatures concerned.