The placenta plays an essential role in fetal growth. As a result, placental abnormalities are one of the most common causes for which women seek the advice of a maternal-fetal medicine specialist.
This is the case for circumvallate placenta, a rare condition that affects only 1-2% of pregnant women. This condition has very few specific symptoms, which makes it difficult to diagnose. Once detected, constant monitoring and decisive actions can help prevent complications for both the woman and her future baby.
What is a circumvallate placenta?
Circumvallate placenta (also called placenta circumvallate) is a condition involving the placenta — the sac responsible for sending oxygen and nutrients to the baby, and for keeping the mom’s and baby’s blood supply separate.
In circumvallate placenta, the chorionic plate, which is the part of the placenta that’s on the side of the fetus, is too small. That causes the fetal membranes to double back on the fetal side and around the edge of the placenta, and it keeps the chorionic plate from aligning with the basal plate (the side that faces the rest of the mother’s body).
When this happens, the chorionic plate can bend into a raised ring or ridge, constricting the umbilical cord and reducing the baby’s supply of nutrients and blood. In addition, these “folds” can increase the risk of several complications, both before and after delivery. These include:
- Placental abruption, where the placenta separates from the uterine wall prematurely.
- Low birth weight, which in turn increases the risk of future health problems for the baby.
- Oligohydramnios, or insufficient amniotic fluid around the baby.
- Vaginal bleeding during the second trimester.
- Pre-term births and miscarriage.
In addition, women with circumvallate placenta during pregnancy are more likely to need an emergency C-section, and their babies have a higher chance of requiring a stay in the neonatal intensive care unit before going home.
The management of circumvallate placenta depends on the specific circumstances of each pregnancy. To minimize risks, we often need a team of healthcare professionals to closely monitor and manage the pregnancy as it progresses.
What causes circumvallate placenta?
Unfortunately, we haven’t been able to pinpoint a single or definitive cause behind circumvallate placenta. The condition “starts” because of the abnormal implantation of the placenta in the uterus during the first trimester — and this may happen to women of all ages, ethnic backgrounds and lifestyles.
Something we always stress to mothers is that, in many cases, issues with placental implantation come down to a dice roll. It’s not caused by doing something or skipping something, during early pregnancy.
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Can we prevent circumvallate placenta?
With no definite cause, we also can’t talk with any certainty about preventing circumvallate placenta. In addition, the risk factors for this condition seem to be the same as those for other complications, such as placenta previa or pre-eclampsia.
Instead, we have general guidelines that will increase our chances of maintaining a healthy pregnancy, or that will prevent complications even if a problem does arise.
The following behaviors will increase a woman’s chances of carrying their pregnancy to term:
- A healthy lifestyle before and during pregnancy, combining a balanced diet, physical activity, and appropriate stress management.
- Avoiding harmful substances, such as tobacco or excessive alcohol consumption.
- For women who have a family history of placental abnormalities, genetic counseling may be useful.
- Regular and comprehensive pre-natal care (check-ups, ultrasounds, prenatal testing) can help detect circumvallate placenta, and keep its impact contained.
Even with the best prenatal care and healthy lifestyle practices, some conditions, including circumvallate placenta, may still occur. But once this happens, our team’s intervention can still have a major impact on the way the pregnancy develops.
How does circumvallate placenta affect pregnancy?
A circumvallate placenta can have a deep impact on overall pregnancy outcomes. It ramps up the incidence of several serious perinatal complications — but it doesn’t make any of them unavoidable.
Left unmonitored, or through poor interventions, circumvallate placenta can result in serious conditions that place both the mother and baby at risk.
Placental insufficiency
This condition is characterized by reduced blood flow to the placenta. In turn, this limits the amount of oxygen and nutrients that the fetus receives, creating a condition known as “intrauterine growth restriction” (IUGR).
Unchecked, placental insufficiency can result in low birth weight, or a baby born too small for their gestational age. Babies who are born below this weight have an increased risk (but no guarantee) of the following:
- Neonatal mortality
- Longer stays in the neonatal ICU
- Issues with cognitive development
- Chronic health issues later in life
Placental abruption
This is when the placental separates from the uterine wall before delivery. This is a serious medical emergency. Depending on when it happens, and how it’s treated, it may lead to:
- The mother hemorrhaging, as the placenta is extensively connected to the mom’s circulatory system
- A preterm delivery
- Miscarriage and neonatal death (stillbirth)
Oligohydramnios
Within the placenta, the fetus is floating in amniotic fluid. This liquid acts as cushioning for the baby, while also allowing them room to move, and creating space for the umbilical cord.
As circumvallate placenta restricts the amount of space available in the placenta, it can also reduce the volume of amniotic fluid. This is known as oligohydramnios, and it can give way to further problems such as umbilical cord compression, or further worsen any existing intrauterine growth restrictions.
Preterm premature rupture of membranes (PPROM)
This is when the membranes of the amniotic sac, which hold the amniotic fluid, break before the 37th week of pregnancy. PPROM can occur due to a variety of factors, from infections to general poor health.
Depending on when it happens, PPROM may result in anything from a slightly preterm delivery to severe vaginal bleeding or a life-threatening infection of the placental tissues.
A circumvallate placenta essentially makes all amniotic membranes smaller and frailer. This can heighten the risk of PPROM, especially during the second trimester, when the baby is less ready to survive outside the uterus.
How is circumvallate placenta treated?
Not every case of circumvallate placenta leads to complications. Many pregnancies with this condition progress into a natural vaginal delivery without significant issues. Additionally, the impact of circumvallate placenta can vary from one pregnancy to another.
Our doctors’ treatment approach for a diagnosis of circumvallate placenta depends on the specific circumstances of each pregnancy and whether complications are present. In many cases, circumvallate placenta is managed through close monitoring and medical interventions.
Frequent and detailed antenatal monitoring can help us assess fetal growth, amniotic fluid levels, and the overall well-being of the baby. It can also help our team spot oligohydramnios promptly, spurring us into more proactive alternatives.
In some cases, we can compensate for uterine growth restriction through bed rest, a carefully monitored diet, or reduced physical activity.
Thorough and frequent check-ups can also help us spot whether an early delivery may be necessary. Here, gestational age can make all the difference: in some cases, we can simply induce labor or perform an emergency cesarean section (C-section).
Left unmonitored, or through poor interventions, circumvallate placenta can result in serious conditions that place both the mother and baby at risk.
If it occurs earlier in the pregnancy, we can also prepare for a preterm birth. Medications such as corticosteroids can help the baby’s lungs mature faster, increasing their chances of survival.
Once diagnosed, prompt action and access to the best available technology can help us land a safe delivery, with a healthy baby and a happy mom in tow. For example, high-definition scans that let us “see” exactly how the baby is doing made all the difference for Angelica, a patient from the Philippines who was diagnosed with circumvallate placenta while vacationing in the U.S.
After seeking Dr. Rad’s help, she became the proud mother of a baby girl.
Why trust Dr. Rad with your pregnancy?
Did you know that all pregnancies in the United States are in danger of becoming high-risk? Even a pregnancy that begins “low risk” can become a high-risk obstetrics case.
That is no secret to double-board certified Dr. Steve Rad, an obstetrician-gynecologist with sub-specialty training in perinatal maternal-fetal medicine.
Dr. Rad has been named a top maternal-fetal medicine specialist in Los Angeles by Los Angeles Magazine for six years in a row.
Our offices are conveniently located throughout Southern California and the Los Angeles area at locations in or near Beverly Hills, Santa Monica, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, Newport Beach, Irvine, and downtown Los Angeles.
We also offer in-home prenatal care and an obstetrics and gynecology fly-in program for out-of-town and international patients. Dr. Rad even travels to patients who need him throughout the U.S. and around the world.
If you can’t make it to Dr. Rad, he also offers virtual consultations worldwide.
Book your appointment online or call us anytime at (844) 473-6100.
Call (844) 473-6100 or click here to schedule online
Sources
HDlive imaging of circumvallate placenta – AboEllail – 2015 – Ultrasound in Obstetrics & Gynecology – Wiley Online Library
https://doi.org/10.1002/uog.14839
Circumvallate Placenta: Associated Clinical Manifestations and Complications—A Retrospective Study
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4248327/
Premature Rupture of Membranes
https://www.ncbi.nlm.nih.gov/books/NBK532888/
Restriction (IUGR): etiology and diagnosis. Curr Obstet Gynecol Rep 2013; 2:102–111.Dukatz R, Henrich W, Entezami M, Nasser S, Siedentopf
https://www.degruyter.com/document/doi/10.1515/crpm-2020-0020/html
