IJCRR

IJCRR - 4(14), July, 2012

Pages: 122-130

Date of Publication: 31-Jul-2012

THE STUDY OF MORPHOLOGY AND VASCULAR PATTERNOF PLACENTA AND UMBILICAL CORD WITH CLINICAL CORRELATION IN ANDHRA POPULATION

Author: Sirisha Bandi, Raju Sugavasi, M .Sujatha, B .Indira Devi

Category: Healthcare

Abstract:Abstract: Placenta plays a role exactly similar to that of bridge between the mother and child. Placenta is
responsible for protective, nutritional, respiratory, and an excretory orgon for the growing foetus. Examination of placenta immediately after delivery, gives much idea of prenatal health of baby and the mother. Umbilical cord embedded in the jelly of warton and consists of two Umbilical arteries and one Umbilical vein. Objectives: To compare and contrast the finding of the study with those previous literatures, with a view to analyze the morphology and vascular pattern of placenta and umbilical cord in 100 placentae and to clinically correlate this analysis with the foetal parameters. Materials and Methods: A total of 100 placentae were collected for this study (46 from uncomplicated deliveries and 54
from various factors which complicated pregnancy).The placenta parameters were collected, analyzed and clinically correlated. Results and Conclusion: Out of 100 placentae which were collected, 81 were circular, 15 were oval and 4 were triangular in shape. In the preset study the average diameter of placenta was 15.84 cm, the average thickness was 3.2 cm and the average weight of placenta was in male baby 506.30 gm and female baby 390.27 gm. The average diameter of umbilical cord for male 1.5 cm and female 1.3 cm. The average length of umbilical cord for male baby was 26 cm and female baby was 22 cm. This study shows eccentric insertion of umbilical cord in 70 %, central 7%, battledore 22%, and velamentous was 1%.

Full Text:

INTRODUCTION
The placenta is a unique orgon in its development and function. The placenta begins to meet the demands of embryo at an early part of intrauterine life. This is the only orgon in the body which is derived from two separate individuals the mother and foetus. Placenta is a flattened discoid mass with circular or oval in shape. It has an average volume of 500 ml, a weight of 470 gm, a diameter of 185 mm, a thickness of 23 mm and a surface area of 30000mm. The umbilical cord is attached near the center of foetal surface [1]. The examination of the placenta in utero and postpartum gives idea about the state of foetal well being [2]. The umbilical cord is about 50 cm long and 1.5 to 2 cm in diameter, embedded in the jelly of warton is two umbilical arteries and one umbilical vein. The placenta is main characteristic feature of mammals which connects between uterus and foetus by the umbilical cord.

MATERIALS AND METHODS
A total of 100 placentae (FIGURE: 01) were collected (90 full term babies and 10 premature babies) for this study from DR. PSIMS and Research Foundation Hospital, Chinoutapalli, Vijayawada, Krishna district, Andhra Pradesh. The placentae were collected both from normal deliveries and caesarean sections. The collected placentae were washed under tap water. The specimens were kept in 10 % of formalin. In all collected placentae, the following parameters were studied

1. Weight – Rerecorded by weighing scale

2. Shape – By observation

3. Thickness – Measured by divider

4. Number of cotyledons - Counted visually

5. Diameter - By measuring tape

Also examined for abnormal placental charecterists

1. Accessory placental lobes

2. Placental calcification

Placentae were collected from

1. Normal un complicated prima gravid and multi gravid

2. Full term and pre maturity

3. Normal and caesarean delivery

4. Pathological factors which complicated pregnancy includes

a. Pregnancy induced hypertension (PIH)

b. Diabetes mellitus

c. Anaemia

d. Intra uterine death (IUD)

e. Abnormal presentation: Breach delivery

The babies whose placenta were obtained were also examined for the following factors

1. Sex of the baby

2. Weight of the baby

3. Any visible anomalies of the baby

In each case a preliminary history was elicited from the mother regarding

1. Age

2. Parity

3. Period of amenorrhea

4. Previous obstetric history

5. History of hypertension, diabetes mellitus, and toxemia of pregnancy

Techniques done in the present study are as follows

1. Study of placental vasculature by eosin and haematoxylin staining (FIGURE: 02)

2. Contrast study of placental vasculature by injecting barium sulphate dye

3. Study of placental vasculature by dissection

Umbilical cords were examined by: Length and Diameter of umbilical cords were measured by measuring tape All the parameters which were studied were tabulated and analyzed in (TABLE – 01)

RESULTS
Shape
In the present study out of 100 cases 81 were circular (FIGURE: 03), 15 were oval in shape and 4 were triangular in shape placentae were seen.

Diameter and thickness of placentae
In the present study the average diameter of placenta was 15.84 cm (Range 10 – 12 cm), and average thickness was 3.2 cm (Range 2.2 – 3.3 cm).

Weight of Placentae
This study shows the placental weight ranged from 225 to 725 gm and average being 469.35 gm

The correlation of weight of placenta with foetal weight of the baby The ratio between the foetal weight and placental weight (Foeto–placental ratio, which is normally 6:1) of Andhra population as shown by the present study is Both sexes considered is – 5.89:1 In Males – 6.20:1, In Females – 5.78:1

Placenta succenturiata (Figure: 04) is seen in one case and a case of omphalocele with short umbilical cord (Figure: 05) also seen in present study. The amniotic membrane was translucent in 98 % of the cases and 2% of cases were opaque membranes. The average number of cotyledons in maternal surface was 18 in number.

The present study shows eccentric insertion of umbilical cord in 70 %, central insertion 7%, battledore insertion 22%, and velamentous insertion was 1% (FIGURE: 06).True knots were observed in 4 cases. The types of insertion of umbilical cord to the placenta in various cases were reported in TABLE: 05.

DISCUSSION
A total number of 100 cases were studied and their morphological observations have been summarized and discussed with special references to the diagnosis. The data obtained in this present study were correlated with the data of previous workers in the field. In the shape of placenta, According to Kurt Benirschke (2000) [3] studies shows 94 placentae were normal circular in shape and 7 were oval in shape. In the weight of placenta Armtiage (1967) [4] reported the average weight of placenta was 508 gm. According to Yousonszai and Haworth (1969) [5] placental weight and size were directly proportional to birth weight of babies. Thomson AM (1969) [6] and Saigal (1970) [7] reported that placental weight and birth weight were below average, but their ratio was slightly increased in case of pregnancy induced hypertension. According to previous studies there are some Factors which complicate the pregnancy, were reported by many authors, Naeye RL and friedman EA (1979) [8] observed that 70 % of foetal deaths in women with hypertension are large due to large placental infarcts. According to Zeek PM and Assali NS (1950) [9] placental infarction as an ischaemic necrosis of a group of villi, due to complete interference wih their blood supply in the deciduas or by the thrombosis of a spiral arteriole. Fox H (1967) [10] and Udainia A (2004) [11] observed placental infarcts in cases of pregnancy induced hypertension. Gernot Desoye (2007) [12] reported that one of the characteristic feature of placenta in maternal diabetes mellitus is its increase in weight. Nordenvall M (1988) [13]

reported paucity of cotyledons seen in cases of PIH, prematurity and low birth weight babies. According to Siegler SL and sacks JJ (1941) [14] placenta succenturiata were associated with ante partum hemorrhage. Pretorius DH (1966) [15] observed 42% of cases of marginal insertion of placenta in pregnancy induced hypertension.

CONCLUSION
The study of morphology and vascular pattern of placenta and umbilical cord with clinical correlation in Andhra population Give a lot of information about the early assessment of the foetal well being. The observations of normal and abnormal placentae and umbilical cord gain greater importance in the specialties of obstetrics and neonatology, where this information are of great significance in the early diagnosis of condition is also useful in the congenital fetal malformations. Accurate study of fetal anomalies is possible with ultrasonography.

AKNOWLEDGEMENTS
I express my deep sense of gratitude to Dr. P. Vithal Kumari, Proff and Hod, Department of Anatomy, Dr PSIMS and RF for her constant support and guidance. My special thanks to Dr. Chudamani, Proff and Hod, Department of Obstetrics and Gynecology. I am thankful to my parents and friends. The authors are also thanks to authors, editors, publishers, journals and books from where the literature for this article has been reviewed and discussed.

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