Placenta Membranacea

I love placentas. No really…I do! I love placentas and think they are the closest thing to magical that we have on this earth. That little organ that is capable of doing more for life support for that little baby than an entire building filled with most advanced equipment there is! I think it’s a thing of beauty.

There are times, however, when I come across a placenta that stand out from the rest…that placenta that comes out and makes you go, “WOW! Would ya look at that! That’s…interesting.”

I did a birth once with a WONDERFUL couple! They were going to be parents for the first time and wanted to do it at home and hired me to be their midwife. I was honored and grew to truly love this couple. The mom went into labor on my birthday (what a great gift!) and she proceeded to have one of the most peaceful yet powerful birth I’ve ever seen. She wanted ultimate quiet and privacy, and so I only saw her for a few moments out of every hour to monitor the baby (as quickly as quietly as I could) as she labored in the candlelit bathroom. Pushing occurred spontaneously and she quickly delivered her baby while she squatted in her bathtub.

She moved from the tub to her bed before we clamped or cut the umbilical cord, even before she birthed the placenta. Once on the bed she pushed her placenta out – a normal 3rd stage to a placenta that seemed average sized. No cord traction, mother birthed her own placenta.

That’s when she started to bleed. Not a bunch, not gushing…just trickling that was steady and wouldn’t go away. I felt her uterus and it was firm…yet she was bleeding…steadily, a small but steady bleed. I checked for tears and there weren’t any. Her fundus was still firm, but the bleeding kept coming. I watched, waiting for it to stop, checking her uterus, watching it ooze out onto the chux pad.  Despite the fact that her uterus felt firm, I made the call finally to give her a shot of Pitocin – and the bleeding stopped!

For about 5 minutes – then there it was again, the slow but steady bleeding. Uterus felt firm, fundal massage to make sure there weren’t any clots. Frustrated and confused, I gave her a second dosage of Pitocin as it was either that or take her to the hospital – and the bleeding stopped again. I watched and watched and waited…but this time it seemed to be staying away. Blood pressure was steady, everything was stable and mom was enjoying her baby.

When I felt safe stepping away from mom, we inspected the placenta to make sure that it had been birthed complete as I was still struggling to find a “source” of the bleed, looking for answers. My first words were, “Now THAT isn’t what we normally see…” My client had a very very rare condition called “Placenta Diffusa” (also know as “Placenta Membranacea”)…a condition in which the placenta grows very thin, but VERY large, possibly covering most of the uterine wall.  Here you can see the placenta the way it was inside the uterus (cord is hanging out the opening).  The placenta is on the bottom – but it goes all the way up both sides until it’s almost touching my hand on the right…and it IS touching my hand on the left.

Let me explain: An average placenta in a full term pregnancy is approximately 18cm in diameter (7 inches) and about 2-2.5cm in thickness. As I held this placenta in my hands, it was large enough to cover BOTH of my hands with some of it left to hang over. In fact, I couldn’t lay the placenta flat because there was more placenta surface than there was membranes! (this is not normally the case)

I would later take the placenta and cut the membranes so that I could lay the placenta flat and measure and take pictures of it.  As you can see, the long diameter of it was 30.5 cm!!  Wow….

Risks associated with this exceedingly rare condition:
1. placenta previa – with that much placenta, there’s a much bigger chance some of it could go over the cervix!
2. preterm labor – this mom delivered right near her due date
3. small for gestational age baby – this moms baby was seven and a half pounds
4. postpartum hemorrhage – with that much surface area covered by the placenta, she is much more likely to bleed.

We dodged every bullet except the fourth…and even that was managed successfully at home. I did give the mother Methergine (a pill that is very effective at keeping a uterus contracted) to take for the next few days…and it worked like a charm.

I still have her placenta – how do you take something so unique and just toss it away?

16 Comments

  1. Kewal wrote:

    Wow! Thanks for sharing!

    Sunday, February 21, 2010 at 11:02 am | Permalink
  2. That is *amazing*! I have never seen that and would have totally had to look it up to know what it was. Did you know what it was? I’ve never even seen that in placenta books. Just amazing. Thank you for taking such great pics.

    And I agree… how could you throw something like that away? (Although, it makes one think about ALL placentas being that holy, right?)

    Sunday, February 21, 2010 at 1:21 pm | Permalink
  3. elfanie wrote:

    I didn’t know what it was at the time…in fact, immediately after the birth I went home and started looking it up on the internet. If you do a search, you will find VERY little information on the internet on this condition – so I began calling physicians that I know in the area (OB’s, neonatologists..) and said, “I had a birth this morning which ended up having a condition called “Placenta Membranacea”…it’s also called “placenta diffusa”. Mom and baby both appear stable – but I am curious if this condition is limited to the placenta and possible results from that…or could there be something with the baby that could be hidden and needs to be watched or further investigated?” (as you know, some findings set off bells that we should make sure there aren’t chromosomal issues or whatnot)

    Not a single doctor that I called knew anything about the condition…and 2 days later I was in my office with a handful of physicians showing off my new find…heh. Not much information out there that I was even able to find on it! (which is why I’m hoping this blog post with pictures could assist someone somewhere if they run into this condition themselves)

    Sunday, February 21, 2010 at 1:27 pm | Permalink
  4. WOW!! Thank you for sharing this with us! I always love a learning opportunity.

    Sunday, February 21, 2010 at 1:55 pm | Permalink
  5. Reta SIM wrote:

    Please please, encapsulate this giant placenta for the mother. I firmly believe that if her placenta grew that large she needs the extra nutrients that come with the extra size.

    Sunday, February 21, 2010 at 5:45 pm | Permalink
  6. elfanie wrote:

    This baby is now a year and a half old…besides, it was so thin, almost entirely chorionic villi…..there wouldn’t have been enough meat to actually encapsulate.

    Sunday, February 21, 2010 at 5:47 pm | Permalink
  7. Amy wrote:

    Thank you SO much for sharing this. I, too, have an obsession with placentas. I always warn moms that I’m weird 🙂

    Sunday, February 21, 2010 at 6:41 pm | Permalink
  8. Thank you so much for sharing! I think placentas are so interesting!!

    Monday, February 22, 2010 at 1:40 am | Permalink
  9. Diana J. wrote:

    I’ve been waiting to see this puppy ever since you talked about it at BC! Awesome – thanks for sharing!

    Friday, February 26, 2010 at 4:48 pm | Permalink
  10. Nikki Davies wrote:

    Hi, thankyou for sharing this wonderful story. A colleage, wonderful student midwife (how passed on your wedsite to me) and myself were lucky enough to experience the exactly the same thing just the other day with a homebirthing woman. She had a 4.55kg baby and exactly the same placenta as you described. It was amazing and never had seem it myself, and sounds like never will again. She also did bleed after and required 2 doses of syntocinon, breastfeeding also helped. Thankyou for sharing, now I know a more about this, I will share it with my colleages and the woman!

    Friday, March 5, 2010 at 9:23 pm | Permalink
  11. Rebekah C wrote:

    I attended a UC a couple of years ago as a doula (for a friend). Her placenta looked JUST like that and she did, in fact, have a slow bleed (treated at home). I think I’ll send her this link! Thanks for answering a question I didn’t even realize I had!

    Is it common for this type of placenta to take a while to detach? Hers took close to an hour and she ended up having to manually release some membranes in the end.

    Tuesday, March 16, 2010 at 9:55 pm | Permalink
  12. Mercedes wrote:

    wow – I was so shocked to read this story and not because I had never heard of the condition. In fact I had the rare condition myself. It is extremely dangerous and I was suprised to read that your patient delivered vaginally. I was hospitalized for most of my third trimester and delivered at 33 weeks via c-section as the placenta was covering my cervix. I lost so much blood I needed two transfusions. Luckily my baby was born healthy. The scariest part about this rare condition is that there is very little information available about it and a woman going through it cannot take control of her own situation.

    Thursday, February 10, 2011 at 10:18 am | Permalink
  13. Laura wrote:

    Thanks so much for posting this. I had a birth a couple weeks ago with a very similar placenta and story. Looked everywhere and couldn’t find anything about it, especially photos!

    Thursday, May 5, 2011 at 10:58 pm | Permalink
  14. Samantha wrote:

    I was just diagnosed with this condition today. I would like to talk to anyone who has been through it. Thanks!

    Tuesday, October 30, 2012 at 8:54 pm | Permalink
  15. Samantha wrote:

    I should mention that I am 20 weeks along.

    Tuesday, October 30, 2012 at 8:54 pm | Permalink
  16. Meredith wrote:

    Thanks for the photos. With my third child I had the same condition but with the complete previa. I had to have a c-section for the first time. I am thankful every day for my wonderful doctor and her care. My son was delivered early but was 6 pounds 9 oz. Everything went well with the delivery and he is now a very active, wonderful three year old. Where is all of the info on placenta membranacea? Thanks again!

    Saturday, April 6, 2013 at 6:23 pm | Permalink

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