Circumvallate placenta is a rare condition affecting about 1-2% of

pregnancies Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but can ...

, in which the

amnion The amnion is a membrane that closely covers the human and various other embryos when first formed. It fills with amniotic fluid, which causes the amnion to expand and become the amniotic sac that provides a protective environment for the devel ...

and

chorion The chorion is the outermost fetal membrane around the embryo in mammals, birds and reptiles ( amniotes). It develops from an outer fold on the surface of the yolk sac, which lies outside the zona pellucida (in mammals), known as the vitellin ...

fetal membranes The fetal membranes are the four extraembryonic membranes, associated with the developing embryo, and fetus in humans and other mammals.. They are the amnion, chorion, allantois, and yolk sac. The amnion and the chorion are the chorioamniotic m ...

essentially "double back" on the fetal side around the edges of the

placenta The placenta is a temporary embryonic and later fetal organ (anatomy), organ that begins embryonic development, developing from the blastocyst shortly after implantation (embryology), implantation. It plays critical roles in facilitating nutrien ...

. After delivery, a circumvallate placenta has a thick ring of membranes on its fetal surface. Circumvallate placenta is a placental morphological abnormality associated with increased fetal

morbidity A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that ...

and

mortality Mortality is the state of being mortal, or susceptible to death; the opposite of immortality. Mortality may also refer to: * Fish mortality, a parameter used in fisheries population dynamics to account for the loss of fish in a fish stock throug ...

due to the restricted availability of nutrients and

oxygen Oxygen is the chemical element with the symbol O and atomic number 8. It is a member of the chalcogen group in the periodic table, a highly reactive nonmetal, and an oxidizing agent that readily forms oxides with most elements as we ...

to the developing

fetus A fetus or foetus (; plural fetuses, feti, foetuses, or foeti) is the unborn offspring that develops from an animal embryo. Following embryonic development the fetal stage of development takes place. In human prenatal development, fetal develo ...

Physicians A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...

may be able to detect a circumvallate placenta during

pregnancy Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but ...

by using an

ultrasound Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies fr ...

. However, in other cases, a circumvallate placenta is not identified until delivery of the baby. Circumvallate placenta can increase the risk of associated complications such as

preterm delivery Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is between 2 ...

and

placental abruption Placental abruption is when the placenta separates early from the uterus, in other words separates before childbirth. It occurs most commonly around 25 weeks of pregnancy. Symptoms may include vaginal bleeding, lower abdominal pain, and dangerou ...

. Occasionally, a circumvallate placenta can also increase the risk of

neonatal death Perinatal mortality (PNM) refers to the death of a fetus or neonate and is the basis to calculate the perinatal mortality rate. Variations in the precise definition of the perinatal mortality exist, specifically concerning the issue of inclusion o ...

and

emergency An emergency is an urgent, unexpected, and usually dangerous situation that poses an immediate risk to health, life, property, or environment and requires immediate action. Most emergencies require urgent intervention to prevent a worsening ...

caesarean section Caesarean section, also known as C-section or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen, often performed because vaginal delivery would put the baby or ...

. Although there is no existing treatment for circumvallate placenta, physicians can attempt to minimize the effects of complications, if they occur, through frequent fetal monitoring and, if necessary,

cesarean section Caesarean section, also known as C-section or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen, often performed because vaginal delivery would put the baby or ...

. In a circumvallate placenta, the chorionic plate, which forms the fetal surface of the

, tends to be smaller than the basal plate, which forms the maternal surface of the

. This results in the elevation of the placental margin and the appearance of an annular shape. The fetal surface is divided into a central depressed zone surrounded by a thickened white ring which is incomplete. The ring is situated at varying distances from the margin, or edges, of the

. This thick ring of membranes is composed of a double fold of

and

with degenerated decidua vera and

fibrin Fibrin (also called Factor Ia) is a fibrous, non-globular protein involved in the clotting of blood. It is formed by the action of the protease thrombin on fibrinogen, which causes it to polymerize. The polymerized fibrin, together with pla ...

in between.

Blood vessel Blood vessels are the structures of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of the body. They also take waste and carbon dioxide away from ...

s, supplying nutrients and carrying waste products to and from the developing

, radiate from the

umbilical cord In placental mammals, the umbilical cord (also called the navel string, birth cord or ''funiculus umbilicalis'') is a conduit between the developing embryo or fetus and the placenta. During prenatal development, the umbilical cord is physiolog ...

insertion to as far as the ring of membranes, and then disappears from view.

Signs & Symptoms

A circumvallate placenta does not always induce associated

symptoms Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality showi ...

during

, making it extremely difficult to

diagnose Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine " cause and effect". In systems enginee ...

a circumvallate placenta in asymptomatic mothers. In symptomatic mothers,

physician A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...

s may be able to detect a circumvallate placenta based on the presentation of the following

signs Signs may refer to: * ''Signs'' (2002 film), a 2002 film by M. Night Shyamalan * ''Signs'' (TV series) (Polish: ''Znaki'') is a 2018 Polish-language television series * ''Signs'' (journal), a journal of women's studies *Signs (band), an American ...

. *

Vaginal bleeding Vaginal bleeding is any expulsion of blood from the vagina. This bleeding may originate from the uterus, vaginal wall, or cervix. Generally, it is either part of a normal menstrual cycle or is caused by hormonal or other problems of the reproducti ...

: A circumvallate placenta can increase the risk of frequent

vaginal bleeding Vaginal bleeding is any expulsion of blood from the vagina. This bleeding may originate from the uterus, vaginal wall, or cervix. Generally, it is either part of a normal menstrual cycle or is caused by hormonal or other problems of the reproducti ...

during the first trimester of pregnancy. In a study conducted with 92 women with a circumvallate placenta, it was concluded that incidences of

were significantly higher in women with a circumvallate placenta during all three trimesters when compared to the

control group In the design of experiments, hypotheses are applied to experimental units in a treatment group. In comparative experiments, members of a control group receive a standard treatment, a placebo, or no treatment at all. There may be more than one t ...

. However, a noted limitation of the study considered by the

research Research is "creative and systematic work undertaken to increase the stock of knowledge". It involves the collection, organization and analysis of evidence to increase understanding of a topic, characterized by a particular attentiveness t ...

ers was that because the study included such a small number of women, the obtained results may not be fully representative of the general population. Because the chorionic plate is much smaller than the basal plate in a circumvallate placenta,

tends to occur at this site where the

is exposed and uncovered. In mothers presenting with vaginal bleeding, circumvallate placenta should be suspected as a possible cause of the vaginal bleeding. * Inhibited fetal growth:

Fetus A fetus or foetus (; plural fetuses, feti, foetuses, or foeti) is the unborn offspring that develops from an animal embryo. Following embryonic development the fetal stage of development takes place. In human prenatal development, fetal develo ...

es tend to develop more slowly when associated with a circumvallate placenta, largely due to the reduced supply of blood and nutrients from mother to

Physician A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...

s will order tests to determine the cause of inhibited fetal growth when a developing

does not meet growth expectations during the course of the

. *

Premature rupture of membranes Prelabor rupture of membranes (PROM), previously known as premature rupture of membranes, is breakage of the amniotic sac before the onset of labor. Women usually experience a painless gush or a steady leakage of fluid from the vagina. Complicati ...

(PROM):

PROM A promenade dance, commonly called a prom, is a dance party for high school students. It may be offered in semi-formal black tie or informal suit for boys, and evening gowns for girls. This event is typically held near the end of the school y ...

happens when the protective covering of the

amniotic sac The amniotic sac, also called the bag of waters or the membranes, is the sac in which the embryo and later fetus develops in amniotes. It is a thin but tough transparent pair of membranes that hold a developing embryo (and later fetus) until sh ...

ruptures before the

onset Onset may refer to: * Onset (audio), the beginning of a musical note or sound * Onset, Massachusetts, village in the United States **Onset Island (Massachusetts), a small island located at the western end of the Cape Cod Canal *Interonset interval ...

labor and delivery Childbirth, also known as labour and delivery, is the ending of pregnancy where one or more babies exits the internal environment of the mother via vaginal delivery or caesarean section. In 2019, there were about 140.11 million births globall ...

. If

occurs within the first 37 weeks of pregnancy, it is termed

preterm Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is between 2 ...

premature rupture of membranes Prelabor rupture of membranes (PROM), previously known as premature rupture of membranes, is breakage of the amniotic sac before the onset of labor. Women usually experience a painless gush or a steady leakage of fluid from the vagina. Complicati ...

(PPROM).

itself has many causes and

risk factor In epidemiology, a risk factor or determinant is a variable associated with an increased risk of disease or infection. Due to a lack of harmonization across disciplines, determinant, in its more widely accepted scientific meaning, is often us ...

s. When

occurs along with

in the second trimester of pregnancy, it is suspected that a mother likely has a circumvallate placenta.

Complications

Circumvallate placenta has also been associated with a higher incidence of complications including

low birth weight Low birth weight (LBW) is defined by the World Health Organization as a birth weight of an infant of or less, regardless of gestational age. Infants born with LBW have added health risks which require close management, often in a neonatal intens ...

premature delivery Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is between 2 ...

perinatal death Perinatal mortality (PNM) refers to the death of a fetus or neonate and is the basis to calculate the perinatal mortality rate. Variations in the precise definition of the perinatal mortality exist, specifically concerning the issue of inclusion o ...

, and

fetal abnormalities Fetal abnormalities are conditions that affect a fetus or embryo, are able to be diagnosed prenatally, and may be fatal or cause disease after birth. They may include aneuploidies, structural abnormalities, or neoplasms. * Acardiac twin * Achon ...

. *

Low birth weight Low birth weight (LBW) is defined by the World Health Organization as a birth weight of an infant of or less, regardless of gestational age. Infants born with LBW have added health risks which require close management, often in a neonatal intens ...

: Lack of proper

nutrition Nutrition is the biochemical and physiological process by which an organism uses food to support its life. It provides organisms with nutrients, which can be metabolized to create energy and chemical structures. Failure to obtain sufficien ...

and blood flow to the

during

often results in decreased weight of the baby at

birth Birth is the act or process of bearing or bringing forth offspring, also referred to in technical contexts as parturition. In mammals, the process is initiated by hormones which cause the muscular walls of the uterus to contract, expelling the ...

. * Placenta abruption: Placenta abruption, in which the

divides from the wall of the

uterus The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The ...

prior to

, can have severe outcomes for a mother and her baby. Such consequences include

, decreased birth weight,

, and

stillbirth Stillbirth is typically defined as fetal death at or after 20 or 28 weeks of pregnancy, depending on the source. It results in a baby born without signs of life. A stillbirth can result in the feeling of guilt or grief in the mother. The ter ...

. Significant

can induce

maternal ] A mother is the female parent of a child. A woman may be considered a mother by virtue of having given birth, by raising a child who may or may not be her biological offspring, or by supplying her ovum for fertilisation in the case of ges ...

Anemia in pregnancy, anemia and dangerously

low blood pressure Hypotension is low blood pressure. Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps out blood. Blood pressure is indicated by two numbers, the systolic blood pressure (the top number) and the dia ...

. *

Oligohydramnios Oligohydramnios is a medical condition in pregnancy characterized by a deficiency of amniotic fluid, the fluid that surrounds the fetus in the abdomen, in the amniotic sac. It is typically diagnosed by ultrasound when the amniotic fluid index (A ...

: Insufficiency of proper volumes of

amniotic fluid The amniotic fluid is the protective liquid contained by the amniotic sac of a gravid amniote. This fluid serves as a cushion for the growing fetus, but also serves to facilitate the exchange of nutrients, water, and biochemical products betwe ...

, a condition called

oligohydramnios Oligohydramnios is a medical condition in pregnancy characterized by a deficiency of amniotic fluid, the fluid that surrounds the fetus in the abdomen, in the amniotic sac. It is typically diagnosed by ultrasound when the amniotic fluid index (A ...

, can also occur as a result of a circumvallate placenta.

Amniotic fluid The amniotic fluid is the protective liquid contained by the amniotic sac of a gravid amniote. This fluid serves as a cushion for the growing fetus, but also serves to facilitate the exchange of nutrients, water, and biochemical products betwe ...

is essential to normal

fetal movement Fetal movement refers to motion of a fetus caused by its own muscle activity. Locomotor activity begins during the late embryological stage and changes in nature throughout development. Muscles begin to move as soon as they are innervated. These ...

, fetal organ development, and cushioning of the

within the mother's

. It is also imperative in preventing

umbilical cord compression Umbilical cord compression is the obstruction of blood flow through the umbilical cord secondary to pressure from an external object or misalignment of the cord itself. Cord compression happens in about one in 10 deliveries. ...

so that the

is able to obtain

nourishment Nutrition is the biochemical and physiological process by which an organism uses food to support its life. It provides organisms with nutrients, which can be metabolized to create energy and chemical structures. Failure to obtain sufficient nu ...

and

oxygenation Oxygenation may refer to: * Oxygenation (environmental), a measurement of dissolved oxygen concentration in soil or water * Oxygen saturation (medicine), the process by which concentrations of oxygen increase within a tissue * Water oxygenation, t ...

from its mother. *

Premature delivery Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is between 2 ...

Premature birth Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is betwee ...

of the

occurs at less than 37 weeks of gestation, compared to full-term delivery at about 40 weeks. *

Miscarriage Miscarriage, also known in medical terms as a spontaneous abortion and pregnancy loss, is the death of an embryo or fetus before it is able to survive independently. Miscarriage before 6 weeks of gestation is defined by ESHRE as biochemical ...

: Loss of a

prior to

via

miscarriage Miscarriage, also known in medical terms as a spontaneous abortion and pregnancy loss, is the death of an embryo or fetus before it is able to survive independently. Miscarriage before 6 weeks of gestation is defined by ESHRE as biochemical ...

can transpire if any of the above complications occur without prompt intervention and treatment.

Cause

Unfortunately, there is no known cause of circumvallate placenta and no major

preventative measures Preventive healthcare, or prophylaxis, consists of measures taken for the purposes of disease prevention.Hugh R. Leavell and E. Gurney Clark as "the science and art of preventing disease, prolonging life, and promoting physical and mental hea ...

that can be taken to minimize the risk of developing a circumvallate placenta. Circumvallate placenta is not a genetic disorder. Some potential causes of circumvallate placenta include reduced amniotic fluid pressure, circumferential

hemorrhage Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vag ...

, and

superficial Superficial may refer to: *Superficial anatomy, is the study of the external features of the body *Superficiality, the discourses in philosophy regarding social relation *Superficial charm, the tendency to be smooth, engaging, charming, slick and ...

deep Deep or The Deep may refer to: Places United States * Deep Creek (Appomattox River tributary), Virginia * Deep Creek (Great Salt Lake), Idaho and Utah * Deep Creek (Mahantango Creek tributary), Pennsylvania * Deep Creek (Mojave River tributary), ...

implantation of the embryo within the

uterine wall The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The ute ...

, although these potential causes are still not well-understood in terms of their relation to circumvallate placenta. High-risk pregnancies are described as

in which a mother, the

, or both are put at a higher risk for developing

pregnancy complications Complications of pregnancy are health problems that are related to pregnancy. Complications that occur primarily during childbirth are termed obstetric labor complications, and problems that occur primarily after childbirth are termed puerperal di ...

before, during, or after

Risk factor In epidemiology, a risk factor or determinant is a variable associated with an increased risk of disease or infection. Due to a lack of harmonization across disciplines, determinant, in its more widely accepted scientific meaning, is often us ...

s such as hypertensive medical conditions,

maternal age Advanced maternal age, in a broad sense, is the instance of a woman being of an older age at a stage of reproduction, although there are various definitions of specific age and stage of reproduction.substance use are just some of the things that can put a woman at an increased risk for developing circumvallate placenta and/or any other complications.

Risk factors

Hypertensive disorders

Women entering a

with hypertension are considered to be put at a higher risk for

preeclampsia Pre-eclampsia is a disorder of pregnancy characterized by the onset of high blood pressure and often a significant amount of protein in the urine. When it arises, the condition begins after 20 weeks of pregnancy. In severe cases of the disease ...

eclampsia Eclampsia is the onset of seizures (convulsions) in a woman with pre-eclampsia. Pre-eclampsia is one of the hypertensive disorders of pregnancy that presents with three main features: new onset of high blood pressure, large amounts of protein in ...

during the course of their

. Hypertensive disorders, like hypertension, have been found to affect about 10% of

in the United States and have resulted in about 6.8% of

maternal death Maternal death or maternal mortality is defined in slightly different ways by several different health organizations. The World Health Organization (WHO) defines maternal death as the death of a pregnant mother due to complications related to pre ...

s from 2011 to 2015.

High blood pressure Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. Long-term high b ...

during

can potentially damage maternal

organ system An organ system is a biological system consisting of a group of organs that work together to perform one or more functions. Each organ has a specialized role in a plant or animal body, and is made up of distinct tissues. Plants Plants have ...

s such as the

liver The liver is a major organ only found in vertebrates which performs many essential biological functions such as detoxification of the organism, and the synthesis of proteins and biochemicals necessary for digestion and growth. In humans, it ...

or the

kidney The kidneys are two reddish-brown bean-shaped organs found in vertebrates. They are located on the left and right in the retroperitoneal space, and in adult humans are about in length. They receive blood from the paired renal arteries; bloo ...

s, which can be life-threatening. To prevent

from developing in

, women with hypertension can be prescribed anti-hypertensive medications during

and are advised to monitor their

blood pressure Blood pressure (BP) is the pressure of circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term "blood pressur ...

throughout the course of

Maternal age

Another

for developing any

maternal age Advanced maternal age, in a broad sense, is the instance of a woman being of an older age at a stage of reproduction, although there are various definitions of specific age and stage of reproduction.Advanced maternal age Advanced maternal age, in a broad sense, is the instance of a woman being of an older age at a stage of reproduction, although there are various definitions of specific age and stage of reproduction.pregnancy Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but ...

at age 35 or above, has also been linked to increased risk of

maternal mortality Maternal death or maternal mortality is defined in slightly different ways by several different health organizations. The World Health Organization (WHO) defines maternal death as the death of a pregnant mother due to complications related to pre ...

, restricted fetal growth,

fetal distress Fetal distress, also known as non-reassuring fetal status, is a condition during pregnancy or labor in which the fetus shows signs of inadequate oxygenation. Due to its imprecision, the term "fetal distress" has fallen out of use in American obstetr ...

, and a variety of other

. Conversely,

teenage pregnancy Teenage pregnancy, also known as adolescent pregnancy, is pregnancy in a female adolescent or young adult under the age of 20. This includes those who are legally considered adults in their country. The WHO defines adolescence as the period bet ...

is also associated with increased risk of

endometriosis Endometriosis is a disease of the female reproductive system in which cells similar to those in the endometrium, the layer of tissue that normally covers the inside of the uterus, grow outside the uterus. Most often this is on the ovaries, ...

postpartum hemorrhage Postpartum bleeding or postpartum hemorrhage (PPH) is often defined as the loss of more than 500 ml or 1,000 ml of blood following childbirth. Some have added the requirement that there also be signs or symptoms of low blood volume fo ...

, and mild preeclampsia, when compared with pregnant mothers in their 20s.

Genetically Genetics is the study of genes, genetic variation, and heredity in organisms.Hartl D, Jones E (2005) It is an important branch in biology because heredity is vital to organisms' evolution. Gregor Mendel, a Moravian Augustinian friar working i ...

, the long period of time between meiotic arrest of the egg gamete as a

and each

ovulation cycle The menstrual cycle is a series of natural changes in hormone production and the structures of the uterus and ovaries of the female reproductive system that make pregnancy possible. The ovarian cycle controls the production and release of eggs a ...

occurring after the

of female puberty in teenage years can potentially contribute to the increased risk for

in mothers who are age 35 or older at time of

Substance use

Further, yet another factor inducing adverse complications in pregnancy is substance use status. Nicotine,

alcohol Alcohol most commonly refers to: * Alcohol (chemistry), an organic compound in which a hydroxyl group is bound to a carbon atom * Alcohol (drug), an intoxicant found in alcoholic drinks Alcohol may also refer to: Chemicals * Ethanol, one of sev ...

, and

marijuana Cannabis, also known as marijuana among other names, is a psychoactive drug from the cannabis plant. Native to Central or South Asia, the cannabis plant has been used as a drug for both recreational and entheogenic purposes and in variou ...

are the most common

substances Substance may refer to: * Matter, anything that has mass and takes up space Chemistry * Chemical substance, a material with a definite chemical composition * Drug substance ** Substance abuse, drug-related healthcare and social policy diagnosis o ...

used during

. Substance use in

is concerning because of its alarming association with other risk factors, such as

mental illness A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitt ...

. Depression alone has been associated within increased risk for

gestational diabetes Gestational diabetes is a condition in which a woman without diabetes develops high blood sugar levels during pregnancy. Gestational diabetes generally results in few symptoms; however, it increases the risk of pre-eclampsia, depression, and o ...

, hypertension,

premature birth Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is betwee ...

, and

. Women with

substance use disorder Substance use disorder (SUD) is the persistent use of drugs (including alcohol) despite substantial harm and adverse consequences as a result of their use. Substance use disorders are characterized by an array of mental/emotional, physical, and b ...

s tend to live in areas that are unable to provide quality

prenatal care Prenatal care, also known as antenatal care, is a type of preventive healthcare. It is provided in the form of medical checkups, consisting of recommendations on managing a healthy lifestyle and the provision of medical information such as matern ...

or proper management of their psychiatric conditions. As a result of improper management of psychiatric illnesses, substances are abused during

, potentially causing harm to both the mother and the

. Some

that can occur as a result of substance use in

are fetal alcohol syndrome and neonatal abstinence disorder. Women with these risk factors are recommended additional surveillance during

to monitor

fetal development Prenatal development () includes the development of the embryo and of the fetus during a viviparous animal's gestation. Prenatal development starts with fertilization, in the germinal stage of embryonic development, and continues in fetal devel ...

and to be able to detect

fetal A fetus or foetus (; plural fetuses, feti, foetuses, or foeti) is the unborn offspring that develops from an animal embryo. Following embryonic development the fetal stage of development takes place. In human prenatal development, fetal develo ...

l, or

abnormalities as early as possible.

Pathophysiology/Mechanism

The

is a transient organ developed during

that facilitates nutrient, gas, and waste exchange between a mother and a developing

. Placental abnormalities, such as circumvallate placenta, can harm a developing

, as normal exchange of materials between a mother and a developing

is impaired. With placental abnormalities, a developing

is unable to receive the vital materials that it needs for proper development, resulting in the possibility of

birth defect A birth defect, also known as a congenital disorder, is an abnormal condition that is present at birth regardless of its cause. Birth defects may result in disabilities that may be physical, intellectual, or developmental. The disabilities c ...

s, and/or death of the fetus. In a normal

, there is a smooth transition from the

parenchyma Parenchyma () is the bulk of functional substance in an animal organ or structure such as a tumour. In zoology it is the name for the tissue that fills the interior of flatworms. Etymology The term ''parenchyma'' is New Latin from the word π ...

l villous

to the membranous chorion at the border of the placental plate. Fetal blood vessels subdivide from the

and spread diagonally throughout the

towards the edge of the placental plate. In a circumvallate placenta, the

membranes A membrane is a selective barrier; it allows some things to pass through but stops others. Such things may be molecules, ions, or other small particles. Membranes can be generally classified into synthetic membranes and biological membranes. Bi ...

often become restrained due to marginal infarct,

, or

depositing. This results in the reduction in size of the chorionic plate of the

, further causing the

on the fetal side to fold backward on themselves. The

l villous

continues to proliferate beyond the tethered

and appears to protrude outward. The fetal blood vessels are directed downward and then horizontally in order to provide blood flow to the most peripheral parts of the placental plate extending beyond the tethered

. Since a portion of the

tends to become exposed in a circumvallate placenta, due to the reduced size of the chorionic plate,

is more likely to occur at this site of exposure. Likewise, inhibited fetal growth can also ensue due to the decreased exchange of nutrients and waste between mother and

, since the

is unable to sustain necessary nutritional demands for proper fetal development.

often occurs as a result of

infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable d ...

in the

, which can be caused by the occurrence

. Therefore, placental abnormalities such as circumvallate placenta can be extremely detrimental in causing the onset of associated conditions.

Diagnosis

In some cases, a

may be able to

a circumvallate placenta via

during one of many routine ultrasound screenings. In most cases, a circumvallate placenta is not discovered until

physical examination In a physical examination, medical examination, or clinical examination, a medical practitioner examines a patient for any possible medical signs or symptoms of a medical condition. It generally consists of a series of questions about the patie ...

of the

after delivery of the

. For this reason, circumvallate placenta is very difficult to diagnose during

. On

, a normal

should appear complete and uniform, with the fetal surface of the

appearing slightly shiny and translucent. The appearance of a circumvallate placenta on ultrasound may present with irregular edges, uplifted margins, or placental sheets. In a study conducted in 1994, 62 healthy

pregnant Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but ...

women were examined with placental sonography for detection of circumvallate placenta. Of the five experienced sonologists who interpreted the placental ultrasounds, all were unable to properly detect and diagnose circumvallate placenta, revealing the difficult nature of circumvallate placenta recognition. Further, these findings indicate that prenatal sonographic criteria used for detection of circumvallate placenta are not reliable enough for screening purposes. Complete circumvallate placenta involves morphological abnormality of the entire dimension of the

, while partial circumvallate placenta does not involve the entire

but rather a portion of the

. Complete circumvallate placenta is very rare, occurring within about 1% of

, and has been noted to increase the risks of associated complications such as

, premature childbirth,

, and

congenital abnormalities A birth defect, also known as a congenital disorder, is an abnormal condition that is present at birth regardless of its cause. Birth defects may result in disabilities that may be physical, intellectual, or developmental. The disabilities can ...

. Partial circumvallate placenta is more common but is not found to be as

clinically significant In medicine and psychology, clinical significance is the practical importance of a treatment effect—whether it has a real genuine, palpable, noticeable effect on daily life. Types of significance Statistical significance Statistical significance ...

as complete circumvallate placenta. The accurate diagnosis of circumvallate placenta during

can have significant implications in the recognition of

patient A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health ...

s who are at risk of complications. Although the ability of

sonography Medical ultrasound includes diagnostic techniques (mainly imaging techniques) using ultrasound, as well as therapeutic applications of ultrasound. In diagnosis, it is used to create an image of internal body structures such as tendons, muscles ...

to accurately diagnosis circumvallate placenta during

is quite limited, research studies continue to emerge at the possibility of doing so.

Treatment/Management

Although there is no

cure A cure is a substance or procedure that ends a medical condition, such as a medication, a surgical operation, a change in lifestyle or even a philosophical mindset that helps end a person's sufferings; or the state of being healed, or cured. The m ...

or specific treatment for restoration of the circumvallate placenta, there are ways to decrease the risks of possible complications prior to

or attempt to manage complications if they develop. If circumvallate placenta is diagnosed during

s may offer recommendations to reduce the risks of associated complications such as

lower birth weight Low birth weight (LBW) is defined by the World Health Organization as a birth weight of an infant of or less, regardless of gestational age. Infants born with LBW have added health risks which require close management, often in a neonatal intensi ...

and

. Decreased birth weight is a major concern associated with circumvallate placenta.

Infant An infant or baby is the very young offspring of human beings. ''Infant'' (from the Latin word ''infans'', meaning 'unable to speak' or 'speechless') is a formal or specialised synonym for the common term ''baby''. The terms may also be used t ...

s born with birth weights that are lower than expected per their

gestational age In obstetrics, gestational age is a measure of the age of a pregnancy which is taken from the beginning of the woman's last menstrual period (LMP), or the corresponding age of the gestation as estimated by a more accurate method if available. Su ...

oftentimes end up requiring extra support in the

neonatal intensive care unit A neonatal intensive care unit (NICU), also known as an intensive care nursery (ICN), is an intensive care unit (ICU) specializing in the care of ill or premature newborn infants. Neonatal refers to the first 28 days of life. Neonatal care, as k ...

(NICU). To assist in the monitoring of appropriate

fetal growth Prenatal development () includes the development of the embryo and of the fetus during a viviparous animal's gestation. Prenatal development starts with fertilization, in the germinal stage of embryonic development, and continues in fetal devel ...

, a

may recommend more frequent growth checks during

if circumvallate placenta is suspected. If a

is not growing satisfactorily,

, via

vaginal delivery A vaginal delivery is the birth of offspring in mammals ( babies in humans) through the vagina (also called the "birth canal"). It is the most common method of childbirth worldwide. It is considered the preferred method of delivery, with lower ...

, may be recommended, with

C-section Caesarean section, also known as C-section or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen, often performed because vaginal delivery would put the baby or ...

being more favorable compared to

. In women experiencing a

associated with circumvallate placenta,

s will normally advocate for frequent growth checks, hospital

bed rest Bed rest, also referred to as the rest-cure, is a medical treatment in which a person lies in bed for most of the time to try to cure an illness. Bed rest refers to voluntarily lying in bed as a treatment and not being confined to bed because of ...

, early delivery, and, if necessary,

. Likewise,

IV fluids Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrie ...

and

blood transfusion Blood transfusion is the process of transferring blood products into a person's circulation intravenously. Transfusions are used for various medical conditions to replace lost components of the blood. Early transfusions used whole blood, but m ...

s can also be given to

s with a

in attempts to increase

and minimize the effects of severe blood loss. If

occurs as a result of a circumvallate placenta, a treatment called

amnioinfusion Amnioinfusion is a method in which isotonic fluid is instilled into the uterine cavity. It was introduced in the 1960s as a means of terminating pregnancy and inducing labor in intrauterine death, but is currently used as a treatment in order to c ...

may be considered to replenish the amount of lost

within the

Amnioinfusion Amnioinfusion is a method in which isotonic fluid is instilled into the uterine cavity. It was introduced in the 1960s as a means of terminating pregnancy and inducing labor in intrauterine death, but is currently used as a treatment in order to c ...

may help in preventing underdevelopment of the lungs. If diagnosed with a circumvallate placenta, consistent fetal monitoring by a licensed

can help to prevent and/or reduce the effects of associated complications that may occur. Additionally, healthy

lifestyle choice Lifestyle is the interests, opinions, behaviours, and behavioural orientations of an individual, group, or culture. The term was introduced by Austrian psychologist Alfred Adler in his 1929 book, ''The Case of Miss R.'', with the meaning of "a per ...

s, a well-balanced and nutritious diet, adequate rest, and cessation of alcohol and tobacco products can also help to prevent the incidence of a circumvallate placenta and its associated complications. If diagnosed with a circumvallate placenta, in association with other threatening pregnancies complications,

will most likely be suggested by a

Prognosis

Unfortunately, there is currently not a

available for circumvallate placenta. While some evidence suggests that a circumvallate placenta can increase the risk of complication during pregnancy, other

suggests this increased risk is marginal. Sadly, circumvallate placenta can occasionally result in

infant death Infant mortality is the death of young children under the age of 1. This death toll is measured by the infant mortality rate (IMR), which is the probability of deaths of children under one year of age per 1000 live births. The under-five morta ...

depending on the severity of the complications encountered. In other cases, circumvallate placenta can result in

infant An infant or baby is the very young offspring of human beings. ''Infant'' (from the Latin word ''infans'', meaning 'unable to speak' or 'speechless') is a formal or specialised synonym for the common term ''baby''. The terms may also be used t ...

s who are otherwise healthy after being monitored in the

for a period of time after

. Therefore, proper medical care and

monitoring Monitoring may refer to: Science and technology Biology and healthcare * Monitoring (medicine), the observation of a disease, condition or one or several medical parameters over time * Baby monitoring * Biomonitoring, of toxic chemical compounds, ...

are crucial in attempting to minimize the likelihood of complications. In other cases,

s diagnosed with circumvallate placenta are able to carry their babies until term or near-term.

Epidemiology

Circumvallate placenta is a very rare condition affecting

women. This condition is a placental morphological abnormality, with the

being formed during the early periods of

. Women are able to become

with the

ovulation Ovulation is the release of eggs from the ovaries. In women, this event occurs when the ovarian follicles rupture and release the secondary oocyte ovarian cells. After ovulation, during the luteal phase, the egg will be available to be fertilize ...

and

menstruation Menstruation (also known as a period, among other colloquial terms) is the regular discharge of blood and mucosal tissue from the inner lining of the uterus through the vagina. The menstrual cycle is characterized by the rise and fall of ...

in early

adolescence Adolescence () is a transitional stage of physical and psychological development that generally occurs during the period from puberty to adulthood (typically corresponding to the age of majority). Adolescence is usually associated with t ...

, with most women becoming

during adulthood. Circumvallate placenta is currently known to affect about 1-2% of pregnancies. It is not virally transmissible to other individuals, nor can it be transferred through contact or respiration. There are no specific racial or ethnic groups that are more predisposed to acquiring a circumvallate placenta during

, however, as with all

, there are general risks factors that can put a pregnant woman at risk for complications, including circumvallate placenta. Notably, certain

, such as

, tend to be almost three times as

fatal Fatal may refer to: * ''Fatal'' (album), by Hussein Fatal, 2002 * ''Fatal'' (film), a 2010 French film starring Michaël Youn and Stéphane Rousseau * '' F.A.T.A.L.'', a tabletop role-playing game released in 2003 * Fatal Recordings, a record la ...

in African American women compared to non-Hispanic white women, even though both groups tend to experience

at almost the same rates. This is partially thought to be due to

inequalities Inequality may refer to: Economics * Attention inequality, unequal distribution of attention across users, groups of people, issues in etc. in attention economy * Economic inequality, difference in economic well-being between population groups * ...

in accessing quality

in lower

socioeconomic Socioeconomics (also known as social economics) is the social science that studies how economic activity affects and is shaped by social processes. In general it analyzes how modern societies progress, stagnate, or regress because of their l ...

neighborhoods and the effect of

structural racism A structure is an arrangement and organization of interrelated elements in a material object or system, or the object or system so organized. Material structures include man-made objects such as buildings and machines and natural objects such a ...

within

healthcare systems Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health profess ...

. Any woman residing in an area with a lower

status, regardless of

race Race, RACE or "The Race" may refer to: * Race (biology), an informal taxonomic classification within a species, generally within a sub-species * Race (human categorization), classification of humans into groups based on physical traits, and/or s ...

or age, is predisposed to developing

like circumvallate placenta if quality

is not available. Women with significant obstetric histories can also be at higher risk for developing any type of

pregnancy complication Complications of pregnancy are health problems that are related to pregnancy. Complications that occur primarily during childbirth are termed obstetric labor complications, and problems that occur primarily after childbirth are termed puerperal di ...

, including circumvallate placenta, and are recommended to be screened for placental abnormalities within their second trimester of pregnancy.

Research Directions

The

plays a dominant role in being responsible for a variety of complications within pregnancy and labor. Placental pathological studies have significantly contributed to recent obstetric literature. Many studies have examined the

clinical significance In medicine and psychology, clinical significance is the practical importance of a treatment effect—whether it has a real genuine, palpable, noticeable effect on daily life. Types of significance Statistical significance Statistical significance ...

s with circumvallate placenta compared to

s with a normal

. They have revealed that incidences of

preterm birth Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is betwee ...

, and

fetal death Perinatal mortality (PNM) refers to the death of a fetus or neonate and is the basis to calculate the perinatal mortality rate. Variations in the precise definition of the perinatal mortality exist, specifically concerning the issue of inclusion o ...

were present in significantly higher rates than when compared to control patients with normal

s. Because circumvallate placenta is such a rare condition, it is difficult to gain significant evidence and

data In the pursuit of knowledge, data (; ) is a collection of discrete values that convey information, describing quantity, quality, fact, statistics, other basic units of meaning, or simply sequences of symbols that may be further interpret ...

. A

case study A case study is an in-depth, detailed examination of a particular case (or cases) within a real-world context. For example, case studies in medicine may focus on an individual patient or ailment; case studies in business Business is the pract ...

reported in 2020 observed the

correlation In statistics, correlation or dependence is any statistical relationship, whether causal or not, between two random variables or bivariate data. Although in the broadest sense, "correlation" may indicate any type of association, in statisti ...

between circumvallate placenta and the occurrence of obstetric complications such as battledore insertion. Battledore insertion, abnormal insertion of the

into the

, occurs in about 7% of

and can also result in many of the same

as circumvallate placenta;

intrauterine growth restriction Intrauterine growth restriction (IUGR), or fetal growth restriction, refers to poor growth of a fetus while in the womb during pregnancy. IUGR is defined by clinical features of malnutrition and evidence of reduced growth regardless of an infant's ...

, and

. This abnormal insertion of the

into the

can result in a loss of adequate blood flow to the developing

due to restriction. The

is unable to obtain normal amounts of required oxygen and

through the

, and this can further cause other severe complications. In the study, a 22-year-old woman at 28 weeks and 2 days of gestation, presented for a routine third trimester screening. She was noted to have had 2 prior

s at 17 and 20 weeks. A previous normal

second trimester Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but ...

routine screening at 21 weeks of gestation did not identify any structural abnormalities within the

, decreased fetal size, or abnormally-appearing

insertion. The

also did not have any episodes of

during the current

. Upon presenting for routine screening at 28 weeks and 2 days of gestation, the

was not exhibiting any

of active contractions and a

cardiotocography Cardiotocography (CTG) is a technique used to monitor the fetal heartbeat and the uterine contractions during pregnancy and labour. The machine used to perform the monitoring is called a cardiotocograph. Fetal heart sounds was described as ear ...

was performed as part of routine screening.

Cardiotocography Cardiotocography (CTG) is a technique used to monitor the fetal heartbeat and the uterine contractions during pregnancy and labour. The machine used to perform the monitoring is called a cardiotocograph. Fetal heart sounds was described as ear ...

is a

diagnostic tool Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine "cause and effect". In systems engineer ...

used during the

third trimester of pregnancy Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but ca ...

to observe

fetal heart rate A fetus or foetus (; plural fetuses, feti, foetuses, or foeti) is the unborn offspring that develops from an animal embryo. Following embryonic development the fetal stage of development takes place. In human prenatal development, fetal develo ...

s and presence of

uterine contraction Uterine contractions are muscle contractions of the uterine smooth muscle that occur during the menstrual cycle and labour. Uterine contractions occur throughout the menstrual cycle in the non-pregnant state and throughout gestation. Throughout ...

s. It can also be used to detect

of any sort of

. In interpreting the

that the 22-year-old pregnant woman had completed, it was noted that the

appeared to be much smaller than expected and was exhibiting concerns of decreased

volume,

, and restricted blood flow through the

. Cardiotocographic monitoring also noted decreases in

every 25 minutes without contractions. Fetal motion was present, with the

appearing enlarged and spherical. Decreases in the fetus' heart rate, in addition to the other findings of the

, ultimately prompted

s to deliver the baby via

without major complications. The

newborn An infant or baby is the very young offspring of human beings. ''Infant'' (from the Latin word ''infans'', meaning 'unable to speak' or 'speechless') is a formal or specialised synonym for the common term ''baby''. The terms may also be used to ...

, with normal

APGAR scores The Apgar score is a quick way for doctors to evaluate the health of all newborns at 1 and 5 minutes after birth and in response to resuscitation. It was originally developed in 1952 by an anesthesiologist at Columbia University, Virginia Apgar ...

and umbilical cord arterial pH levels, was admitted to the

. Upon examining the

after delivery, it was noted that the

demonstrated the appearance of a circumvallate placenta, and also showed evidence of abnormal

insertion into the

Postpartum The postpartum (or postnatal) period begins after childbirth and is typically considered to end within 6 weeks as the mother's body, including hormone levels and uterus size, returns to a non-pregnant state. The terms puerperium, puerperal perio ...

, the mother had a good recovery and the

was discharged from the

105 days post-birth. This case study discussed the association of circumvallate placenta and abnormal battledore cord insertion in producing

. Restriction of

blood flow from the

to the

and placental abnormalities like circumvallate placenta may work in conjunction to generate

. Decreased levels of oxygenation and nutrient absorption resulted in decelerations of fetal heart rate and the decision to deliver the

via

to prevent

by hypoxia. Routine monitoring of fetal growth and development, placental structure, and placental function are recommended with high-risk pregnancies. In

s diagnosed with circumvallate placenta during

, monthly fetal growth assessments are also recommended.

Patient A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health ...

s found to have blood flow restrictions to or from the

are recommended to undergo weekly

ultrasounds Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies f ...

with consistent monitoring of

. In a separate

reported in 2017, a woman at about 35 weeks of gestation presented with

and

intrauterine fetal demise Stillbirth is typically defined as fetal death at or after 20 or 28 weeks of pregnancy, depending on the source. It results in a baby born without signs of life. A stillbirth can result in the feeling of guilt or grief in the mother. The term ...

, or more commonly known as

. After delivery of the stillborn fetus, examination of the

revealed a circumvallate placenta with battledore insertion of the umbilical cord. It was speculated that the combination of circumvallate placenta and battledore insertion had led to the loss of the fetus prior to delivery, as there was no other discernible cause for the

. While circumvallate placenta and battledore insertion are individually very rare conditions that can result in multiple

, the coexistence of these abnormalities likely resulted in the loss of the fetus. The diminished blood flow and circulation from the

to the

, as caused by battledore insertion, in combination with the impaired exchange of nutrients and wastes between mother and

, as caused by circumvallate placenta, likely contributed to the

and this loss of fetal life. Thus, it is highly recommended that if

l or

abnormalities, such as circumvallate placental and battledore insertion, are suspected or detected prior to

, that the

should be considered high-risk. High-risk pregnancies significantly benefit from f requent follow-ups using ultransonography to monitor fetal developmental and placental and umbilical cord structure and function.

Research Research is "creative and systematic work undertaken to increase the stock of knowledge". It involves the collection, organization and analysis of evidence to increase understanding of a topic, characterized by a particular attentiveness t ...

directions continue to investigate methods in which circumvallate placenta may be more commonly diagnosed during

before complications can transpire.

Biomarker In biomedical contexts, a biomarker, or biological marker, is a measurable indicator of some biological state or condition. Biomarkers are often measured and evaluated using blood, urine, or soft tissues to examine normal biological processes, p ...

s such as Sflt/PlGF can be used to predict severe

in high-risk pregnancies. Circumvallate placenta appears to be correlated with reduced placental efficacy due to increased placental thickness and abnormal villi function, affecting the Sflt/PlGF ratio. It is thought that obtaining Sflt/PlGF ratios can be used to determine deficiencies in placental function in cases of placental abnormalities. Future

analyzing the contribution of

biomarker In biomedical contexts, a biomarker, or biological marker, is a measurable indicator of some biological state or condition. Biomarkers are often measured and evaluated using blood, urine, or soft tissues to examine normal biological processes, p ...

s like Sflt/PlGF to predict placental abnormalities would be influential to our understanding of many placental deformities, including circumvallate placenta. Due to the rare occurrences of circumvallate placenta, more extensive

trials are unavailable, resulting in

limitations. Therefore, the clinical importance of circumvallate placenta remains uncertain.

References

External links

{{Pathology of pregnancy, childbirth and the puerperium Pathology of pregnancy, childbirth and the puerperium

Signs & Symptoms

Complications

Cause

Risk factors

Hypertensive disorders

Maternal age

Substance use

Pathophysiology/Mechanism

Diagnosis

Treatment/Management

Prognosis

Epidemiology

Research Directions

See also

References

External links