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Placenta circumvallata

1940; Elsevier BV; Volume: 39; Issue: 1 Linguagem: Inglês

10.1016/s0002-9378(40)90870-5

1097-6868

John E. Hobbs, Carleton N. Price,

Pregnancy and preeclampsia studies

Table I is a composite picture of the 150 cases studied. 1. ∗. ∗ Abortion, fetus weighing under 1500 gm. and less than 25 cm. in length. Prematures, fetus weighing between 1500 and 2500 gm., and between 25 and 45 cm. in length. Term, fetus weighing over 2500 gm., and over 45 cm. in length. to 38 weeks are premature; and, 38 to 42 weeks are term deliveries. This method is obviously quite inaccurate so the weight-length measurements were also used as defined beneath the table. A Composite Picture of a Clinical and Pathologic Study of 150 Cases of Placenta Circumvallata Occurring in 20,720 Consecutive Deliveries, an Incidence of 1 to 138 or 0.8 Per Cent Clinical classification Fetal mortality Type of circumvallation Average duration of pregnancy weeks Parity Prelabor bleeding cases Retained placenta Wassermann Still born or died immediately Size for viability (117 cases) Total Complete per cent Partial per cent Primiparas Multiparas Periods of Gestation Total Periods of gestation Total Abortions 33 cases 100% 51 49 24 10 cases 33% 23 cases 67% 18 6 cases 18% Negative, 19 cases Positive, 4 cases Unknown, 10 cases 17% of known have positive serology Prematures 23 cases 16% 9 cases 39% 16 deaths, 14% 49 babies, 33% 38 62 31 7 cases 33% 16 cases 67% 6 1 case 4% 12 cases 8% Negative, 17 cases Positive, 3 cases Unknown, 3 cases 15% of known have positive serology 107 known cases 25% positive serology Term 94 cases 62% 7 cases 7% 41 59 39 28 cases 30% 66 cases 70% 9 5 cases 5% Negative, 44 cases Positive, 20 cases Unknown, 30 cases 31% of known have positive serology ∗.Abortion, fetus weighing under 1500 gm. and less than 25 cm. in length.Prematures, fetus weighing between 1500 and 2500 gm., and between 25 and 45 cm. in length.Term, fetus weighing over 2500 gm., and over 45 cm. in length. to 38 weeks are premature; and, 38 to 42 weeks are term deliveries. This method is obviously quite inaccurate so the weight-length measurements were also used as defined beneath the table. Open table in a new tab 2.2. The incidence of abortion and premature labor is very high as compared to the average group of pregnant women. It must be kept in mind that this group of 150 women, other than the abnormality of the placenta, represents a typical sample of clinic and private practice. 3.3. A fetal mortality of 14 per cent in babies born after the twenty-seventh week emphasizes the seriousness of placenta circumvallata. A total mortality of 33 per cent places this abnormality as one of the out-standing feticides. 4.4. We have classified all of the specimens either as complete or partial circumvallata. On first consideration one would think that the complete type would be much more effective in producing complications during pregnancy. However, when one considers that the majority of the partial variety included 50 per cent or more of the circumference and many were almost complete, it can be understood why they are as effective as the complete variety in causing complications. 5.5. The average duration of pregnancy for the series is 32.5 weeks. Some German authors claim that postmaturity is frequently associated with this condition. We cannot substantiate this observation. Most labors occurred around the twentieth week. 6.6. For some unknown reason parity plays a role in the occurrence of placenta circumvallata. Multiparas outnumbered primiparas about two to one in each classification. A count of primaparas and multiparas in successive deliveries in the St. Louis Maternity Hospital for a year showed approximately equal numbers. The youngest patient in this series was 18 years old and the oldest was 42. 7.7. We wish to call attention especially to the uterine bleeding produced by this condition. Thirty-three cases showed prelabor bleeding. It was painless, intermittent in character; although it lasted several weeks at a time, it was usually mild. It occurred at any time during pregnancy and was not always followed by the onset of labor. Many patients bled intermittently for many weeks and delivered a live infant at term. In none of the patients was the bleeding serious, and with bed rest and sedation there was a tendency for cessation of bleeding. If the fetus perished, labor usually soon followed. The most important clinical aspect of this condition is the awareness that painless bleeding during the last trimester is not always pathognomic of placenta previa. A few of these cases were brought into the hospital with that tentative diagnosis. Vaginal examination failed to confirm the diagnosis of placenta previa, and with bed rest the bleeding usually ceased. Unlike placenta previa, bleeding from a circumvallate placenta does not tend to be more severe with each recurrence. It is extremely important to be aware of this condition, for although there is little to be done for these patients, it is a serious mistake to treat them actively for the mistaken diagnosis of placenta previa. 8.8. Twelve patients had retained placentas. These cases were handled in the usual conservative manner. After a reasonable period of time, manual removal was necessary. 9.9. The incidence of syphilis (25 per cent of 107 known cases) was about twice the average in the clinic population. Many of these cases were under antisyphilitic treatment before the onset of pregnancy, and all syphilitic patients received treatment as soon as diagnosed, no matter what the stage of pregnancy. The etiologic relationship, if any, of syphilis to the formation of placenta circumvallata is not clear. 10.10. Hunt reported two cases of hydrorrhea gravidarum associated with placenta circumvallata. In our series four definite cases were noted. In a previous article by one of us, a picture of the placenta of such a case was recorded. We have a placenta, which is not included in this series, since it was delivered after the compilation of these statistics, from a woman who had an intermittent discharge of large amounts of fluid from the sixth month until term. It appears that hydrorrhea gravidarum is frequently associated with this condition.