Placenta and its clinical correlations

Elangovan, M (2007) Placenta and its clinical correlations. Masters thesis, Thanjavur Medical College, Thanjavur.


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INTRODUCTION: The word ‘placenta’ connotes a functional union between fetal and maternal structures, and in the human this union has developed to a remarkable degree, as a consequence of the evolutionary development which has followed internal fertilization of a single ovum and the retention of the embryo within the mother for a relatively long time. Placenta is a diplomatic intermediary between mother and child; ten months nourisher of the still helpless fetus; the tender supplier of fetal requisites; eminent emissary of fetal waste; the wise interpreter of harmful intruders ( to the child); the physiological parasite; siphoning off blood not for itself, but for the growing fetus – which in turn as a token of gratitude carries in it’s body during extrauterine life, the only scar a human being is never ashamed of – “the umbilicus”. The placenta is the most accurate record of the infant’s prenatal experiences. The fetus, cord and the placenta constitute genetically identical parts of a unit that share the uterine environment. AIM OF THE STUDY: Placental examination offers a lot of information of prognostic significance for the newborn. This enables the neonatologist to handle the babies much more efficiently. This prompted me to study the placental shapes, cord insertion, lobes and gestational outcome and to correlatre the morphological / morphometric features with clinical picture. MATERIALS AND METHODS: A total number of 100 placentae were collected from Raja Mirasudhar Hospital ‘s Maternity ward and operation theatre. The placentae collected were from normal deliveries & caesarean sections. The collected placentae were washed in tap water and membranes examined. The specimens were transported to the Anatomy Department in 10% Formalin filled bucket. Following parameters were taken into consideration for the study of placenta & umbilical cord. a) Weight was measured using a weighing scale. b) The shape was observed & noted by naked eye examination. c) The Diameter was measured by a measuring tape, d) The thickness was measured using a Webers compass. e) The number of cotyledons were counted visually and, f) The colour of the membranes was noted and presence of any cyst was searched for. As far as the umbilical cord, a) The length was measured from the umbilicus of the baby the cut end. The length of cord upto its insertion on the foetal surface of placenta was also measured using a measuring ape. Cord length was calculated by adding both. This was done prior to transporting placenta. b) The thickness was measured using a measuring tape. Apart from these morphometric analysis, following were also noted. (i) Presence or Absence of placental calcification. (ii) Presence or absence of retroplacental clots. (iii) Abnormalities of wharton’s jelly. (iv) Abnormalities of umbilical vessels such as single umbilical artery, vessel constriction and segmental thinning were looked for (v) Type of insertion of umbilical cord was noted. (vi) Presence of true knots and false knots were looked for as clinical correlation was made. SUMMARY: The summary of the study of morphology & morphometric analysis of placenta is as follows: A total of 100 specimens of placenta and umbilical cord were studied in the present study. The placenta were derived from 53 primigravida and 47 multigravida. 85 were from uncomplicated cases and 15 were from factors complicating pregnancy. Out of 100 specimens, 52 were from male, 48 from female. Out of 100 specimens studied, 93 were circular, 7 were oval. The weight of the placenta ranges from 230 gms to 680 gms in case of female with an average of 512.71 gms & 250 gms to 760 gms with an average of 504.81 gms in case of male children. The diameter of the placenta in the present study ranges from 14 cms to 22 cms, average being 17.6 cms. The placental thickness ranges from 1.1 cms to 2.5 cms, with an average of being about 1.8 cms. The ratio between the foetal weight and placental weight in case of male was 5.98 and in case of female was 6.02. The placental coefficient in the present study is 0.17 both in male and female. The average number of cotyledons was 20. Subchorionic fibrosis and Tasselations seen in all placentae. No placental calcification seen. Retroplacental clots seen in 4 cases and all of them were associated with Abruptio placentae. The average length of the umbilical cord was 54.4 cms. Present study showed eccentric type of cord insertion in 66, central type in 27, Marginal type in 7. False knots noticed in 6 cases. Diameter of the umbilical cord on an average was 1.24 cms. Whartons Jelly present in all specimens. CONCLUSIONS: Morphological studies of placenta in high risk group and subsequent cytogenetic analysis will prove presence or absence of chromosomal foetal malformations in terms of 8 – 24 weeks when termination is possible. Morphometry is an indirect and non-invasive approach to the study of the physiology and physiopathology of gestation in the human. Morphometry is a good adjuvant to histopathology. Gross examination was more informative, though microscopic examination would have been necessary. Triage is the sorting and allocation of treatment according to a system of priorities in order to maximize treatment. Placental triage promptly after delivery of the placenta with documentation of the findings in the medical record only takes a few minutes, and allows for the identification of abnormal placentae to be submitted for detailed gross and microscopic examination. It requires familiarity with normal gross placental anatomy. Our study concludes with a recommendation that a systematic procedure has to be adopted and documentation for comprehensive examination of the placental disk as a whole, the umbilical cord, the extra placental membranes, the fetal surface, the maternal surface and the parenchyma. Otherwise, the placenta is dumped into the dustbin with all its useful information.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Placenta, clinical correlations.
Subjects: MEDICAL > Anatomy
Depositing User: Subramani R
Date Deposited: 05 Oct 2019 12:04
Last Modified: 05 Oct 2019 12:04

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