Repetitive circumvallate placenta as a cause for early preterm rupture of membranes? Presentation of a rare case

Purpose: Circumvallate placenta is a rare abnormality of placental development, which can cause severe perinatal complications. Prenatal diagnosis is difficult and includes sonographic and clinical features. Here we present a case of suspected repetitive circumvallate placenta.

Materials and methods: A 32year old patient IVG IP with a history of one spontaneous delivery and two cases of rupture of membranes in 18 weeks of gestation and consecutive loss of pregnancy presented at our department at 11 weeks of gestational age. Sonography revealed a massive retroamnial hematoma surrounding the amniotic sac with an otherwise unsuspicious fetus. In further course of pregnancy the hematoma disappeared slowly, mostly by vaginal bleeding. At 31 weeks of pregnancy PPROM and consecutive vaginal bleeding led to suspicion of placental abruption and cesarian section. Placental examination after birth revealed the diagnosis of circumvallate placenta.

Results: Reevaluation of the previous cases of loss of pregnancy in second trimester revealed similar sonographic findings of extensive hematoma in first trimester with consecutive loss of pregnancy due to rupture of membranes at 18 and 20 weeks of pregnancy. However reevaluation of the sonographic images of the most recent pregnancy did not show definite signs of the latter diagnosed circumvallate placenta. Parameters for hemostaseology were within normal limits.

Discussion: Though circumvallate placenta is a rare condition and prenatal diagnosis is demanding, anamnestic and clinical findings like early preterm rupture of membranes and first trimester vaginal bleeding must be suspicious for this diagnosis. So far only very few cases of repetitive circumvallate placenta have been described and further studies are necessary to elucidate the etiology of this suspected repetitive abnormal placenta development.

Fig. 1: Hematoma in first trimester