Case Report Accepted: Received: ail.com Nalinisharma100@rediffm E-mail: India Meghalaya, Sciences, Shillong, Health and Medical Regional Instituteof Eastern Indira Gandhi North Sharma, Nalini * CorrespondingAuthor: could be because however,preva of its rarity; cumvallate placenta isnotdocumented which theprevalenceofcir- rareindividually; are very al insertionofumbilicalabnormalities cord.Both to the placentalmargin (1) also knownasmargin- Battledore placenta,theumbilical cordisattached Shillong, Meghalaya, India - Departmentof Obstetrics and Gynaecology, SharmaNalini Resulting inGraveObstetri Coexistent CircumvallatePl whitethickened ringattheperiphery a greyish by foetal surfacesurrounded tral depressiononthe cen- there isa placental shapewhere mality ofthe the placenta uncovered at the periphery the placentauncoveredat basal plate onthematernal side leavingapartof chorionic plate onthefoetal side smaller thanthe themselvesplacental margin atthe makingthe amnionupon Here thechorionand arefolded
outcome.abnor- Circumvallateis an placenta obstetric affectthe adversely been knownto arious placentalandcordabnormalitieshave Apr. 24, 2017Apr. 24, Aug. 27, 2017 Aug. 27,
, Rituparna Das,Sushila Salam, Roma Jethani, Ahanthem Santa Singh Introduction
ternal andfetaloutcome. ous intrapartum monitoring cat toavoidany womanmorefollo wouldrequire stringent the pregnanc ultrasonography, by antenatally 2017;18(4):390-392. Infertil. JReprod CaseReport. come: A late Placentaand BattledoreInsertion of Umb cite thisarticle:To Pregnancy outcome. Keywords: Conclusion: had nootheridentifiablecauseforIUFD. and ultimately IUFDinthiscaseasshe Battledore insertion ofumbilical cord.Thismight haveattributedtopreeclampsia examination After delivery, re vaginally. of Health andMedicalScience Shillong on tion withpreeclampsia withIUFDtoNort Case Presentation: outcome individually. of the umbilical cord are both rareand affect theobstetricoutcome.versely Ci Background: Abstract
Battledore insertion of umbilical cord,Circumvallate placenta,Preeclampsia, J Reprod Infertil. 2017;18(4):390-392 Infertil. 2017;18(4):390-392 Reprod J If such placental and cord abnormaplacental and Ifsuch North EasternIndira GandhiRegionalIns Various placental and cord abnormalities have been known to ad- cord abnormalitiesbeen knownto Variousplacentaland have c Outcome: ACaseReport acenta andBattledoreInse
Sharma N, Das R, AS.Coexistent Circumval- Salam R,Singh S,Jethani (1). In Inthis case report,the woman presentedat 8 months ofgesta-
(1). insertion of the cord has been reported only in one in been reported only insertion ofthecordhas Battledore bination ofcircumvallateplacenta with ty and congenitalmalformationsty tal heart ratepatterns, increased perinatalmortali- foe- tae, foetalgrowthrestriction,non-reassuring late abortions,pretermplacen- deliveries,abruptio vallate placentaisknowntobeassociatedwith reported as 7% in term pregnancies(2).Circum- lence of Battledore insertion of umbilical cordis cy LSCSandpoorneonataloutcomecy preterm increasedincidenceof emergen- delivery, centa previa, abruptioplacentae,preeclampsia, others havereportedincreasedincidenceofpla- 7), somestudies (6, by little clinicalsignificance of the umbilical cord isthough reported tohave mentioned.insertion Battledore clearly very is not tion ofcircumvallate preeclampsia placentaand rcumvallate placentaandBattledoreinsertion known to be associated with poorobstetric ilical CordResulting in vealed bothacircumvallate placentaand w up in the antenatal period and continu- period and the antenatal w upin h Easter Indira Gandhi Regional Institute h EasterIndiraGandhiRegional 22/7/16 and delivered amacerated fetus astrophe and to achieve a favorable ma-astrophe andtoachieveafavorable y shouldberegarded as highrisk.Such y titute of Health and Medical Sciences, lities are suspected or diagnosed suspected or lities are rtion ofUmbilicalCord Grave ObstetricOut-
(1, 3-5).Associa-
(8, 9).
Com-
Downloaded from http://www.jri.ir tion were all absent, temperature was98 tion wereallabsent, not pale,icterus,oedema Ongeneralexamination,was she surgical history. her LMP. Shehadnosignificantpastmedical or ments She since thelast could notrecall 2 days. months withabsentfoetalmove- of pregnancy and MedicalScienceShillongon22/02/2017at8 Easter Indira GandhiRegionalInstituteofHealth attended the Emergency Department ofNorth normal deliveries,referredfromhospital, adistrict uterine foetaldemise. intra- prognosis of normalitiesrather grave witha ab- these rare of both womena coexistence had mg/dl M6E2, platelet countwas3.3lacs/cumm, RBS77 Hb 10.6 positive, was B blood group done. Her tion was induc- formation ultrasound.Labor inthefetusby ultrasound andtherewasnocongenitalmal-by confirmedinvestigations weresentandIUFDwas relevant urine albuminon dipstick.All was2+ with intactmembranes andadequatepelvis.Her was 1.5 the cervix localized. Pervaginalexam presentation andfetalheartsoundcouldnotbe uterine tonewasnormalcephalic andfetusin height correspondedto34weeksofgestation, in normal limits. Onobstetricexamination, fundal tract CVS examinationand respiratory werewith- rate 88/ study U/L male baby of 1.8 male baby amacerated fe- active. Shedeliveredvaginally nonre- negative, HIV VDRL nonreactive,HbsAg thrombin time 15 secs, APTT40.1 secs, INR1.15, urea 28 ing for autopsy. ing forautopsy. will- were not her attendance patient and but the advised in themembranes. was ofbaby Autopsy detected abnormality was knots. No without any umbilicalnormalclot andthe length cordwas in the cord (Figure 1). Therewas no retroplacental cumvallate placentawithBattledore insertionof seen. Examination ofthe placenta revealedacir- Liquor was absentand no meconium stainwas did gross congenitalmalformation.not haveany events wereuneventful. third stage oflaborwasdoneandthereafter A 35 year old lady G5P4L4,with allprevious oldlady A 35year On clinical examination after delivery, the baby thebaby On clinicalexamination afterdelivery, , SGPT 24 , SGPT
, LFT- Totalbilirubin0.7 (10). This case has been reported as the (10). Thiscasehasbeenreportedas min g/dl mg/dl and B.P was160/90 , TLC10,600/cumm, DLCN76L16 U/L , Sr.creatinine1.0 Case Presentation kg , totalprotein6.2 cm . Active management. Active the of dilated and 50%effaced
, cyanosis anddehydra- , cyanosis ination revealed that ination revealed mmHg mg/dl
mg/dl mg/dl , SGOT23 . TheCNS, 0 F, pulse , blood , Pro- J Reprod Infertil, Vol 18, No 4, Oct-Dec 2017 Oct-Dec2017 4, No 18, Vol Infertil, Reprod J NaliniSh,etal. ery, cordprolapse,foetal ery, abruptio placentae,preeclampsia, pretermdeliv- have increasedassociation withplacentaprevia, even chroniclungdisease ean Section,NICUadmission, neonataldeathand ed with increasedincidence Caesar- of emergency al. statedthatcircumvallateassociat- placentawas complications,et tion tothese HanakoTaniguchi IUFD as compared tocontrols of reportedincreased incidence even astudy and patterns (4,5) reassuring foetalheartrate tae, preterm births,IUGR,oligohydramnios, non- with circumvallate placentalikeabruptioplacen- creased incidence of complications in patients (3). listedasthecause placenta, itwasrarely foetal demise wasassociatedwithcircumvallate of cumvallatehigh incidence placenta.Although cir- associated with to be been found rhage have abortions, preterm labors and maternal haemor- late Russelletal.,highincidence of studies by earlier have beenconductedandinoneofthe cal significance clini- without any anatomicof placenta variation a mereinteresting to be placenta wasconsidered noted. werealso angiosis suggestive ofchronichypoxia haemorrhagic infarction. Focalareasofchor- and sectionsfromof placentashowedlargeareas vein which werepatent and withinnormal limits reported thecordashavingtwoarteriesandone puerperium. of second day health onthe discharged ingood and circumvallate placenta Figure 1. Battledore insertion of cord was also found to Battledore insertionofcord wasalsofound Subsequently, other studieshavealsoshownin- Subsequently, In the past as stated by Williams,circumvallateIn thepastasstatedby Histopathological examinationplacenta ofthe was Postpartumuneventful andshe periodwas CoexistentBattledoreinsertionofumbilical cord
(3). Discussion
Since then, variousstudies
distress, increased inci- distress,increased (6).
(5). Also,inaddi-
JRI 391
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392 trimester bleeding pervaginum andpremature maternaland foetaloutcome. avoid such acatastropheandtoachievefavorable period and continuousintrapartum monitoring to quire moreantenatal stringentfollowupinthe regarded ashighriskandthewomen wouldre- ultrasonography, by tally antenna- abnormalitiesor diagnosed aresuspected cord if suchplacentaland quence ofIUFD.Thus, conse- more seriousuntoward ence leadstoa women,coexist- in these their and individually outcome affect thepregnancy known to adversely are rare and the umbilicalcord are sertion of outcome.nancy duetopossiblepoorpreg- as highriskpregnancy cord should beconsidered if detectedantenatally Women with suchabnormalities of placentaland predictors for circumvallate placenta as of99.9%whenbothareused and specificity 28.8% rupture ofmembranes of a sensitivity had malformations NICU admission,congenital lowbirthweightand LSCS,lowApgarscore, dence ofemergency 1. difficult with increasing gestational age increasing gestational difficult with becomeslocalization ofthesitecordinsertion possible and is better donein second trimester as is ultrasound diagnosis ofBattledoreplacentaby positive and high false negative rates positive andhighfalse ultrasound is diagnosis limitedby withhighfalse of difficult. is however natally The accuracy very grave prognosisofIUFD. have attributed topreeclampsia and ultimately the coexistence of both these abnormalities might same,cause forthe itmay identifiable patient hadanIUFDwithoutany JRI Authors declarenoconflict of interest. Both circumvallate placenta and Battledorein- The diagnosisofcircumvallate placentaante-
Cunningham FG, Leveno KJ, Bloom SL, Hauth JC,
Coexistent Circumvallate Placenta and Battledore Insertion of Umbilical Cord Insertionof Umbilical Battledore Placenta and Circumvallate Coexistent
Conflict ofInterest (8, 9). Keeping in view that this in viewthat (8, 9).Keeping Conclusion References J Reprod Infertil, Vol 18, No 4, Oct-Dec 2017 Oct-Dec2017 4, No 18, Vol Infertil, Reprod J
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(11).
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(12).
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