Placenta bipartita/bilobata in singleton pregnancy: risk of complications (case report)

Placenta bipartita/bilobata (PB) in singleton pregnancy is a rare special variant of placentation, in which instead of one placental lobe, two placental lobes of approximately equal size are formed. The prevalence of this pathology is 2–8%, but the frequency of prenatally diagnosed PB is approximately 2% with a high frequency of complications during pregnancy and childbirth (premature birth, fetal distress, premature placental abruption, postpartum hemorrhage), which increases the frequency of cesarean section (CS).The objective: to present a rare, prenatally diagnosed case of placentation – PB with membranous attachment of umbilical cord vessels against the background of moderate preeclampsia, which was performed at the Vyshhorod Central District Hospital (VCDH).In the obstetrics department of the VCDH, which is the clinical base of the Department of Obstetrics and Gynecology No. 1, a primigravida woman with the term 37–38 weeks, with a clinical and laboratory manifestations of moderate preeclampsia was observed. Consultations of a therapist and ophthalmologist, ultrasound examination (US), electrocardiography, cardiotocography were conducted. Complex therapy of moderate preeclampsia was started.According to the US data, the diagnosis of placenta bipartita was confirmed. Placenta consisted of two identically sized lobes with the location of the placentas on the right and left uterine walls with a membranous location of the umbilical cord vessels, which passed between them and were not protected by Wharton’s gel.Despite intensive observation and therapy for three days, the pregnant woman’s condition deteriorated due to the progression of preeclampsia, clinical symptoms of premature placental abruption and fetal distress, which became an indication for delivery by urgent CS. A live, full-term boy with body weight 3,365 g and growth 53 cm, 6–7 points on the Apgar scale, was born. A bilobata placenta with a 4 × 5 cm detachment area in the left placental lobe was separated. Prevention of hemorrhagic, thromboembolic and purulent-inflammatory complications was carried out in accordance with the regulatory documents of the Ministry of Health of Ukraine.Conclusions. A presented case confirmed the high probability of developing complications of pregnancy and childbirth in this rare variant of placentation (moderate preeclampsia, placental abruption) with the need for delivery by urgent cesarean section. In addition, there is a high risk of rupture of the umbilical vessels that pass in the membranes between the two placentas with the development of fetal distress, which requires a planned abdominal delivery.The obtained results of the clinical case are consistent with publications in the available scientific literature, which confirm a significant number of complications of pregnancy and childbirth and a high frequency of delivery of pregnant women with placenta bipartita/bilobata by CS.