The pathologies of the placenta cover a large spectrum of diverse diseases that range from anomalies of the form and the implantation, over fetal (fetal erythroblastosis) and maternal (diabetes, pregnancy toxaemia, eclampsia) complications, and all the way to tumors and infections. In this chapter, the pathologies are not explained in depth and should be studied in more detail in obstetrics handbooks.

Implantation and form anomalies

The placenta previa is characterized by a low-lying insertion location in the uterus (close to the cervix). The natural birth canal can be partially or completely plugged up thereby and represent a mechanical obstacle during delivery through the vagina. This pathology affects 0,5% of all pregnant women. The placenta previa is life-threatening to the fetus and also for the mother. The latter risks hemorrhages due to a detachment of the placenta that occurs too early during uterine contractions or cervix dilatation. The precise causes for a placenta previa are as yet unknown, but multiparity and preceding miscarriages create favorable conditions for it to happen. In addition, it has been established that scarring and uterine abnormalities, fibroma and twin pregnancies also represent risk factors.

Ectopic pregnancie (tube)
© Prof. Dr. med. Michel Müller, Frauenklinik Inselspital, Bern

Ectopic, i.e., extra-uterine pregnancies occur in approximately one woman in 300. They arise through an implantation of the embryo at another location than in the uterine cavity. The most frequent location is that of the fallopian tube roughly 85%). Implantations in the ovary, in the abdominal cavity or in the intra-uterine pars of the fallopian tube can ensue. Possible explanations for these ectopic implantations could be a delayed taking up of the oocyte or the slowed emigration through the fallopian tube. Anatomic reasons also exist such as fallopian tube abnormalities and stenosis that can arise following infections of the fallopian tube. Functional factors can also be mentioned (surgical reconstruction of the fallopian tube, intrauterine devices).

The form anomalies affect mainly the insertion point of the umbilical cord. These can be velamentous, marginal or eccentric (see umbilical cord). In addition, abnormalities of the placenta itself exist, e.g., a placenta with several lobes (placenta multilobata), doubly or triply lobed, or possessing accessorial lobes (a second or third). Finally, the placenta succenturia (placenta with lobes of various sizes) exhibit small accessorial placental lobes that are fully separated from the main body of the placenta.