Tuesday, January 18, 2011

Location of Placenta and risks associated with

Whilst on my latest search for calcification of the placenta, I came across an article. It outlined the risks that could be associated with the location of the placenta.

Now we all know that have a low-lying placenta is never such a great thing and we all freak out about placenta previa and early bleeding, and in SA, another out-right reason to do a c-section. But did you know:

According to http://www.ncbi.nlm.nih.gov/pubmed/20608801, Cooley SM et al.,

  • An anterior placenta was statistically associated with intrauterine growth restriction (IUGR) and preterm birth.
  • A placenta located in the upper part or the uterus (fundus), was associated with a significant increase in incidence of pregnancy-induced hypertension and infants with a birthweight less than the 9th centile.
I just thought that was interesting...

Calcified Placenta?

I had a patient who was asking me what a calcified placenta actually was and whether it was a danger to her child? It seems, here in South Africa, that the 'calcified placenta' is another reason to give to the mother that 'we need to get this child out through c-section before its time' excuse.

I agree that this is something to monitor, but, it turns out, that it depends on when the calcification is noted, how much and whether the child is growing are the all important factors to consider.

When searching google it seems to be something of a thing that is only really discussed in forums - of which usually poor quality, anecdotal evidence is given. Here I try to tell the truth and explain the medical evidence in lay terms:

A blog post with a very pretty ultrasound display explains a portion of the inside info on calcified placenta:
http://cochinblogs.blogspot.com/2009/08/placental-calcification.html
Turns out that calcification of the placenta, when in the third trimester is a normal part of the aging of the placenta. At this time of presentation it is not part of a pathology. If, however, the calcification is found to be in the second trimester, then further, closer, monitoring of the foetus is required.

On looking the medical journals, PubMed and the like, I found two current articles that seemed to explain further, the issue between whether this is a normal pregnancy occurence or something to worry about:

The first, http://www.ncbi.nlm.nih.gov/pubmed/20586039 an article by Chen, KH et al., in June 2010, showed that calcification found in the 'late pre-term' (32 weeks onwards) was to show no significance, and women at this stage are not at any greater risk for adverse pregnancy outcome. However, if the calcification was found prior to this time, classed as 'early pre-term' (28 weeks +), then these women were found to be in a higher risk category for postpartum hemorrhage, placental abruption, and in adverse foetal outcomes: pre-term birth, low birth weight and lower APGAR scores.

The second article, http://www.ncbi.nlm.nih.gov/pubmed/20608801, by Cooley, SM et al., in July 2010, also backed this up. They went further to say that they found that placental calcification, if found early (seemingly even from 22 weeks in ultrasound), showed a 40-fold increase in the likelihood of the foetus have intrauterine growth retardation (IUGR).

One other article to note, that seemed to just add a note of caution to all this, was http://www.ncbi.nlm.nih.gov/pubmed/11440548, by Poggi SH, et al., in July 2001. They found that the proteins that were responsible to causing calcification of the placenta, were not related to the age of the pregnancy/placenta. Therefore they suggested that this mechanism was not one of a normal physiological mechanism, but one more of a pathological.

So, I guess that the jury is still out and the debate will continue - behind doors.
Thanks Leigh-Anne :)