Presentation
Para three gravida four woman for second-trimester fetal anomaly scan.
Patient Data
The superior placental plate edge portion circumferentially curls downwards into the chorionic space with its retro-placental basal margin, maintaining a clear anechoic fluid. The naked portion of the placental parenchyma exhibits heterogeneous reflectivity riddled with echogenic and hypoechoic fluid areas suggesting multiple infarcts. The rest of the placental parenchyma is homogeneous and intact.
A focal fundal-posterior uterine myometrial thickening (measuring 4.6 cm in diameter) noted is consistent with a Braxton hick contraction.
Case Discussion
Extrachoriol circummarginate placenta (a.k.a placenta extra-chorioalis or circumvallate placenta) can easily be confused with uterine synechia or placental abruption. When placental abruption is involved, the patient may present with per vaginal bleeding or spotting, and also hematoma content may be visualized within the intra-uterine or retro-placental spaces, which were not in this particular illustration.
Such circumferential folds may be partial (if <360° of the placental circumference is involved) or complete (if 360° of the placental circumference is involved). They may present with infarcts thus contributing to intrauterine fetal growth restriction, small for gestational babies ,and/or preterm labor.
Some literature posits that where uterine contractions, hydrorrhea or intermittent bleeding occurs in the late second or early third trimesters, circumvallate placentas should be considered1-3.
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