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?