ANOMALIES OF THE PLACENTA AND CORD

Functions and External Features of the Human Placenta and Cord

Placenta

- Provides oxygen and nutrients to a growing baby.

- Removes waste products from the baby's blood

- Composed of a fetal part or chorionic plate, and a maternal part or basal plate.
- Generally round-oval in shape, but irregular shapes are common.

Cord

- Carries the baby's blood back and forth.

- Often called ‘supply line’ or passage way of oxygen and nutrients.

- Contains three blood vessels: two arteries and one vein.

- Narrow tube-like structure.

The normal placenta weighs approximately 500 g and is 15 to 20 cm in diameter and 1.5
to 3.0 cm thick. Its weight is approximately one sixth that of the fetus.

At birth, the normal mature cord is about 50-60 cm in length and 12 mm in diameter.
Anomalies of the Placenta

Placenta Succenturiata

A placenta succenturiata is a placenta that has one or more accessory lobes connected
to the main placenta by blood vessels.

- No fetal abnormality is associated with this type.

- Small lobes may be retained in the uterus after birth that may lead to severe maternal
hemorrhage.

Placenta Circumvallata

In placenta circumvallata, the fetal side of the placenta is covered to some extent with
chorion.

- 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.
- No abnormalities are associated with this type of placenta.

Battledore Placenta

In a battledore placenta, the cord is inserted marginally rather than centrally. This
anomaly is rare and has no known clinical significance either.
Velamentous Insertion of the Cord

Cord 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 gestations.
- Infant with this type of placenta needs to be examined carefully at birth.

Vasa Previa

In vasa previa, the umbilical vessels of a velamentous cord insertion cross the cervical os
and therefore deliver before the fetus. The vessels may tear with cervical dilatation, just
as a placenta previa may tear.

- If vasa previa is identified, the infant needs to be born by cesarean birth.

Placenta Accreta

Placenta accreta is an unusually deep attachment of the placenta to the uterine

myometrium, so deep that the placenta will not loosen and deliver.

- Attempts to remove it manually may lead to extreme hemorrhage because of the deep
attachment.
- Hysterectomy may be needed.

Anomalies of the Cord

Two-Vessel Cord

A normal cord contains one vein and two arteries. The absence of one of the umbilical
arteries is associated with congenital heart and kidney anomalies because the insult that
caused the loss of the vessel may have also affected other mesoderm germ layer
structures.

Unusual Cord Length

An unusually short umbilical cord can result in premature separation of the placenta or
an abnormal fetal lie. An unusually long cord may be easily compromised because of its
tendency to twist or knot. Occasionally, a cord actually forms a knot, but the natural
pulsations of the blood through the vessels and the muscular vessel walls usually keep
the blood flow adequate.