|Year : 2015 | Volume
| Issue : 2 | Page : 85-88
A morphological and morphometric study of placenta with its clinical implications
Chandni Gupta, Hemant Ashish Harode, Antony Sylvan D'souza, Ankur Sharma
Department of Anatomy, Kasturba Medical College, Manipal University, Manipal, Udupi, Karnataka, India
|Date of Web Publication||9-Jun-2015|
Dr. Chandni Gupta
Department of Anatomy, Kasturba Medical College, Manipal University, Manipal - 576 104, Udupi, Karnataka
Objective: In the idiopathic intrauterine growth restriction where there are no clear maternal or fetal causes, the placenta may hold the key to its etiology. So, this study was undertaken to look for any placental and umbilical cord abnormality and to establish the relationship of fetal birth weight with placental measurements. Materials and Methods: In this study, 100 freshly delivered placentae were collected. The placenta and the umbilical cord were examined to look for any abnormalities in the shape, cord insertion, and vessels in the cord; placenta weight, its circumference, diameter, volume, and thickness at the level of cord insertion were also noted. Baby's weight at birth and age in weeks, maternal history about diabetes and hypertension were also noted down. IBM SPSS Statistics for Windows version 20.0, USA was used to do statistical analysis of the measurements. Results: In the present study, placenta weight, volume, diameter, and circumference show a strong correlation with fetal weight. We found placenta of round and abnormal shapes in 89% and 11% of cases, respectively. In 76% of cases, we got normal cord insertion and in 24% of cases, abnormal cord insertion. Statistical analysis of all the parameters of the placenta was done. Conclusion: In our study, placenta weight, volume, diameter, and circumference showed a strong correlation with fetal weight. The knowledge of these measurements on the placenta and umbilical cord will be helpful to the pediatrician and obstetrician in clinical practice.
Keywords: Fetal weight, measurements, placenta, umbilical cord
|How to cite this article:|
Gupta C, Harode HA, D'souza AS, Sharma A. A morphological and morphometric study of placenta with its clinical implications. Trop J Med Res 2015;18:85-8
|How to cite this URL:|
Gupta C, Harode HA, D'souza AS, Sharma A. A morphological and morphometric study of placenta with its clinical implications. Trop J Med Res [serial online] 2015 [cited 2019 Jan 18];18:85-8. Available from: http://www.tjmrjournal.org/text.asp?2015/18/2/85/158400
| Introduction|| |
Human placenta is a discoid, deciduate, chorioallantoic, hemochorial, and villous organ. It is the most interesting organ; its function often holds the key to fetal growth. It is an organ which transfers vital nutrients from mother to embryo and the waste products from embryo to mother.  Its weight is approximately 1/6 th of the fetal weight.
Placenta is the principal cause of maternal and perinatal mortality if it is abnormal; and if there is a placental insufficiency, it can even lead to fetal growth retardation.  After delivery, if the placenta is inspected meticulously, it can provide much insight into the prenatal health of the baby and the mother. 
Pregnancy complications like hypertension or gestational diabetes are reflected in the placenta in a significant way. Majumdar et al. found that the fetal weight was significantly less in the hypertensive group than the control normotensive group and the morphometry of placenta, i.e., weight, surface area, and volume were also less in the hypertensive group than the control normotensive group.  Kishwara et al. found that the diameter and volume of the placenta were significantly reduced in preeclampsia patients.  Various anomalies of the placenta, umbilical cord, and membranes are connected with abnormal fetal development and perinatal morbidity. 
In case of idiopathic intrauterine growth restricted babies where there are no apparent maternal and fetal reasons, the placenta might hold the key to its etiology.  A 1-min inspection of the placenta, which was done in the delivery room, may provide information that is significant to the care of both the mother and the infant. 
So, this study was undertaken to quantitatively evaluate various dimensions of the placenta and analyze their relationship with fetal birth weight and to note the abnormalities in the placenta as well as the umbilical cord and their clinical significance.
| Materials and Methods|| |
The study was carried out on 100 full-term freshly delivered placentae that were obtained from all the delivery and cesarean sections of the Obstetrics and Gynaecology Department. The placenta and umbilical cord were inspected for any abnormality in the shape, cord insertion, and vessels in the cord; and various measurements of the placenta were done like weight, circumference, diameter, volume, and thickness at the level of cord insertion. The diameter of the cord was also measured [Figure 1]. Volume of the placenta was measured by the water displacement technique.
|Figure 1: ( a) Circumference of placenta, (b) Diameter of placenta, (c) Thickness at the level of cord insertion. (d) Diameter of cord|
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Statistical analyses of the measurements were done and the relationship between birth weight and placental measurement was investigated.
| Results|| |
In our study, the average fetal weight was 2863.3 g and the average cord diameter was 1.15 cm.
Mean and range of all the parameters of the placenta is shown in [Table 1].
In the present study, we got oval, round, irregular, triangular, and bilobed shape of the placenta in 7%, 89%, 1%, 1%, and 2% of cases, respectively [Figure 2], [Figure 3] and [Figure 4].
In the present study, placenta weight, volume, diameter, and circumference showed a strong correlation with the fetal weight with a P < 0.05, except the thickness of the placenta.
We got normal cord insertion in 76% of cases, marginal insertion in 22%, and velamentous insertion of the cord in 2% [Figure 5].
|Figure 5: (a) Normal insertion of the cord (b) Marginal insertion (c) Velamentous cord|
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In all the 100 cases, we got two arteries and one vein in the umbilical cord with no variations.
| Discussion|| |
The human placenta is the functional center of the maternal-fetal system. Since some clues for placental examination will not be obvious at the time of delivery, it may be wise to save the placenta (labeled and refrigerated or preserved in formalin) till the neonatal outcome is determined.  Comparision of our parameters with the parameters of other authors is shown in [Table 2].
Pathak et al. 2007 found the ratio between fetal birth weight and placental weight and fetal weight and placental circumference to be 7.2 and 64.57, respectively. These results are similar to our study and we found the values as 5.6 and 54.22.  This ratio is important as in our study we found that the placental weight significantly correlates with the fetal weight.
Kouvalainen et al. 1997 reported the average diameter of umbilical cord as 1.5 cm but in our study it was 1.16 cm. 
According to Yetter (1998), about 7% of umbilical cord insertions occur at the placental margin but in our study we found marginal insertion of cord in 22% of cases.  Londhe and Mane found that in 93% of the cases, there was central attachment of cord while the remaining 7% had marginal attachment.  Panuganti and Boddeti found that out of 50 placentae, central attachment was observed in 60% of the cases, eccentric attachment in 20%, and marginal attachment in 20% while velamentous attachment was not observed in their study.  In our study, central cord insertion was seen in 76% of cases and marginal insertion in 22% of cases.
In our study, we also found velamentous insertion of cord in 2% of cases. This velamentous insertion is important because these cases may lead to an increased risk of fetal hemorrhage due to the unprotected vessels as well as vascular compression and thrombosis. Velamentous cord insertion is also associated with advanced maternal age, diabetes mellitus, smoking, a single umbilical artery, and fetal malformations.  Kishwara et al. 2009 found placenta of oval, round, and irregular shape in 38.3%, 36.6%, and 25% of cases, respectively, but in our study we found that in 7%, 89%, and 1% of cases.  Raghunath et al. found that out of the 101 placentae, 94 were circular in shape and 7 were oval in shape.  Kulandaivelu et al. found that out of the 51 placentae, 48 were circular and 3 were oval in shape.  Irregular-shaped placentae are mostly seen in premature deliveries that occur due to toxemia. In our study, in 2% of the cases we got partial bilobed placenta; these extra placental lobes are important because they may lead to retained placental tissue.
Babies born with a disproportionately large placenta are at a higher risk of developing hypertension in their future life. 
Raghunath et al. and Kulandaivelu et al. found the mean thickness of the placenta to be 2.1 cm and 1.42 cm, respectively. , Panuganti and Boddeti found that the thickness of the placenta varied from 1.8 cm to 3.8 cm.  In our study, the thickness of the placenta was 2.03 cm, which was almost similar to the studies of Raghunath et al. and Panuganti and Boddeti.
Thin placenta less than 2 cm are usually associated with possible placental insufficiency with intrauterine growth retardation while thick placenta more than 4 cm are usually associated with maternal diabetes mellitus. 
Panuganti and Boddeti found that the diameter of the placenta varied from 12.2 cm to 15.8 cm.  Kulandaivelu et al. found the mean diameter of the placenta to be 14.65 cm.  But in our study, the diameter ranged 13-21 cm. Panuganti and Boddeti found that the weight of the placenta ranged 321-534 g, which was almost similar to our study and we found that the weight ranged 350-650 g. 
In the present study, we compared the fetal weight with the various placental dimensions and finally we found that placenta morphometry significantly correlates with the fetal weight. So this means that if there is any abnormality in the placenta, it will be strongly reflected in the fetus.
In our study, placenta weight, volume, diameter, and circumference show a strong correlation with fetal weight. The knowledge of these measurements on the placenta and the umbilical cord will be helpful to the pediatrician and obstetrician in clinical practice.
So, careful examination of the placenta can give information that is useful in the immediate and later management of mother and infant.
| References|| |
Biswas S, Chattopadhyay JC, Ghosh SK. Volume of placenta and chorionic villi as indicator of intra uterine growth restriction of fetuses. J Anat Soc India 2007;56:25-9.
Kishwara S, Ara S, Rayhan KA, Begum M. Morphological changes of placenta in preeclampsia. Bangladesh J Anat 2009;7:49-54.
Majumdar S, Dasgupta H, Bhattacharya K, Bhattacharya A. A study of placenta in normal and hypertensive pregnancies. J Anat Soc India 2005;54:1-9.
Yetter JF 3rd. Examination of the Placenta. Am Fam Physician 1998;57:1045-54.
Aherne W, Dunnil MS. Morphometry of the human placenta. Br Med Bull 1966;22:5-8.
Raghunath G, Vijayalakshmi, Shenoy V. A study on the morphology and the morphometry of the human placenta and its clinical relevance in a population in Tamil Nadu. J Clin Diagn Res 2011;5:282-6.
Pathak S, Jessop F, Hook L, Sebire NJ, Lees CC. Placental weight digitally derived placental dimensions at term and their relationship to birth weight. J Matern Fetal Neonatal Med 2010;23:1176-82.
Kouvalainen K, Pynnönen AL, Mäkäräinen M, Peltonen T. Weights of placenta, fetal membranes and umbilical cord. Duodecim 1971;87:1210-4.
Londhe PS, Mane AB. Morphometric study of placenta and its correlation in normal and hypertensive pregnancies. Int J Pharma Bio Sci 2011;2:B430-7.
Panuganti PK, Boddeti RK. Morphology and morphometric anatomy of placenta. Int J Biol Med Res 2012;3:2165-8.
Kulandaivelu AR, Srinivasamurthy BC, Murugan A, Mutharasu A. Morphology and Morphometric Study of Human Placenta in Rural Southern India. Br J Med Med Res 2014;4:295-308.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2]
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