By Alison Carameros, Jideka Nwosu, Akshata Gailot, Prathyusha Pinnamaneni, Geniqua Dorsainvil, Cadecia James
A 33-year-old G2P1001 female presented at 37 weeks with an accessory placenta on transabdominal ultrasound. The pregnancy was complicated by supraventricular tachycardia, maternal syringomyelia, HSV-1 infection, hypertension, and irregular mild contractions. At 39 weeks and 3 days, the patient visited the OB/GYN with a chief complaint of decreased fetal movements. The fetus was found to have lagging fetal growth that decreased from 23rd percentile to 16th percentile over 2 weeks. Decreased fetal movement was confirmed and oligohydramnios was present. Due to these findings, the patient was admitted for induction of labor. Although the patient’s syringomyelia was of concern for epidural anesthesia placement, consultation with neurology cleared the patient for epidural. This was due to the necessity of thorough evaluation of the placenta with accessory lobe and of the uterus for remaining tissue at the time of delivery and the need for pain management during exploration. Labor was induced at 39 weeks and 4 days with vaginal delivery of a 2610-gram baby girl with Apgar scores of 8 and 9. The placenta was removed intact with no evidence of retained tissue, and bleeding was minimal following placenta removal. Surgical pathology showed a singleton discoid placenta with an accessory lobe measuring 6.0 x 6.0 x 1.6 cm. Tachycardia and hypertension resolved postpartum.
The incidence of placenta succenturiate is between 1-5%. The only known risk factors for placenta succenturiate are advanced maternal age and in vitro fertilization. The patient presented at age 33 with nearly all associated factors of placenta succenturiate which include increased risks for impaired fetal growth, prematurity, infection, and preeclampsia.