What disorders can affect the placenta during pregnancy?

What disorders can affect the placenta during pregnancy?

The placenta and its health are vital to the health of a woman's pregnancy and fetal development. This organ provides oxygen, nutrients, and filters fetal waste during pregnancy.

It also plays an important role in hormone production and protects the fetus from bacteria and infections.

The blood-rich placenta is joined to the uterine wall and connects to the baby by way of the umbilical cord.

Most often the placenta attaches itself to the top or side of the uterine wall. At times, however, it may grow or attach to the uterus in a way that can cause health problems.

Risk factors for placental disorders

Many factors influence the health of the placenta, including:

The risk of placental disorders is affected by ethnicity, lifestyle and medical history.

  • Ethnicity
  • History of smoking cigarettes
  • High blood pressure
  • Multiple gestation pregnancy
  • Maternal blood-clotting disorders
  • History of uterine surgery such as a cesarean delivery
  • History of placental problems
  • Maternal substance abuse, such as cocaine use
  • Abdominal trauma, such as from a fall or blunt trauma
  • Maternal age - women over the age of 40 area at a higher risk for developing placental problems
  • Premature rupture of membranes - the risk of placental problems increases when the amniotic sac ruptures prematurely.

There are many complications that can affect the placenta. The most common disorders are discussed below.

Placenta previa

Placenta previa is a condition in which the placenta attaches to the wall of the uterus very low down. In doing so, the placenta partially or completely covers the cervix.

This condition occurs in 0.5-1% of pregnancies. The condition may resolve as the pregnancy progresses, however.

Placenta previa is most common in women who are:

  • Black and of other minority races
  • Older
  • Smokers
  • Have a history of abortion, cesarean delivery or other uterine surgery
  • Carrying a multiple gestation pregnancy.

There are two types of placenta previa: marginal and complete. Marginal placenta previa is when the placenta only partially covers the cervix. Complete placenta previa fully covers the cervix.

Placenta previa can cause vaginal bleeding both before and during birth. This bleeding can be severe at times.

Placenta previa can cause the following complications during pregnancy:

  • Placental tear
  • Increased risk for fetal infection
  • Bleeding
  • Contractions
  • Preterm labor.

Most often, a cesarean delivery will be required to deliver the baby safely.

Placental abruption

Placental abruption occurs when the placenta separates from the uterus during pregnancy. Abruption can be either partial or complete.

High blood pressure can raise the risk of placental abruption.

The condition occurs most commonly in the third trimester. It is the most common placental disorder and occurs in up to 1 out of every 100 pregnancies.

Placental abruption is the leading cause of fetal and newborn death. It also causes high rates of premature delivery and fetal growth restriction.

The risk of placental abruption can be increased by:

  • Trauma to the abdomen
  • Premature membrane rupture
  • Smoking
  • Use of cocaine
  • History of a prior placental abruption
  • Defects of the uterus
  • Maternal high blood pressure or pregnancy-induced high blood pressure
  • Circumvallate placenta.

Expectant mothers with placental abruption may experience vaginal bleeding, uterine or abdominal pain, continuous contractions, and fetal heart rate abnormalities.

A diagnosis of placental abruption will be based on symptoms, and treated according to their severity.

Due to the role that the placenta plays in oxygen and nutrient delivery, placental abruption can cause deprivation of these vital nutrients.

This deprivation can lead to abnormal fetal development, premature delivery, fetal growth restriction, and stillbirth.

Placental insufficiency

As previously discussed, the placenta plays a vital role in fetal development by providing a growing baby with nutrients and oxygen and filtering their waste products. At times, however, the placenta may not function properly. When this happens, it can fail to deliver adequate quantities of nutrition, causing placental insufficiency.

This placental abnormality will often result in fetal growth restriction and a low birth weight in infants.

Women with placental insufficiency may notice less fetal movement and a smaller uterus size than before.

There can be both maternal and fetal consequences related to placental insufficiency. Maternal risks increase in the presence of diabetes and high blood pressure.

Many expectant mothers experience symptoms of placental insufficiency such as:

  • Placental abruption (see above)
  • Preterm labor and delivery
  • Preeclampsia.

Preeclampsia is characterized by high blood pressure and the presence of protein in the urine. Symptoms of preeclampsia include excessive weight gain, edema, headaches, and high blood pressure.

Fetal and infant risks in the presence of placental insufficiency include:

  • Oxygen deprivation at birth, which can cause conditions such as cerebral palsy
  • Learning disabilities
  • Hypothermia (low body temperature)
  • Hypoglycemia (low blood sugar levels)
  • Polycythemia (excessive levels of red blood cells)
  • Premature labor
  • Need for a cesarean delivery
  • Stillbirth or death.

The presence of placental insufficiency early in pregnancy worsens the problems that are experienced by the baby.

While there is no cure for placental insufficiency, receiving recommended follow-up and prenatal care is vital.

Healthcare providers may evaluate your pregnancy regularly by recommending:

  • More frequent office exams
  • Kick count records
  • Education on self-monitoring for symptoms of preeclampsia
  • Bed rest
  • Steroid injections before 32 weeks if preterm labor is a risk
  • Evaluation with high-risk maternal fetal medicine specialists.

In severe cases, expectant mothers may require an inpatient hospital stay.

Placental infarcts

Placental infarcts are areas of dead tissue found within the placenta, typically caused by blood vessel complications.

This placental abnormality decreases blood flow to the affected areas, which at times can cause fetal growth restriction or death. Placental infarcts are more commonly experienced by women with severe high blood pressure.

Placenta accreta

Having a cesarean section could increase the risk of placenta accreta in the future.

Placenta accreta is a condition that occurs in 1 in 2,500 pregnancies. The placenta and its blood vessels attach and grow deeply into the wall of the uterus.

This serious medical condition has three forms:

  • Placenta accreta: the placenta is attached to the uterine wall muscle
  • Placenta increta: the placenta is attached through the uterine wall muscle
  • Placenta percreta: the placenta grows through the entire uterine wall and attaches to other surrounding organs.

Risk factors for developing placenta accreta are mainly unknown but are thought to include a history of placenta previa and previous cesarean sections.

Complications of this condition can include third trimester vaginal bleeding, severe postpartum hemorrhage, cesarean delivery, and subsequent hysterectomy.

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Speak with your healthcare provider to discuss your personal risk for developing placental abnormalities and for recommendations about prevention and treatment.

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