Third-Trimester Discovery of a Placental Lesion – An Obstetric Challenge

SECTION 1 – QUIZ A 34-year-old pregnant woman, gravida 2 para 1, was referred to our outpatient clinic at 10 weeks of gestation for a personal history of chronic hypertension and preeclampsia in her previous pregnancy. She was medicated with low-dose aspirin after the 12th week, and no complications were described until the third trimester. At 32+3 weeks’ gestation, a previously unrecognized placental formation was detected during a routine third-trimester ultrasound examination [Figures 1-3]. The fetus presented in cephalic position, with an estimated growth at the 13th percentile, and no major structural anomalies were identified. The placenta was located anteriorly and exhibited abnormal thickening, measuring 63 mm. Amniotic fluid volume was within normal limits.Figure 1: Two-dimensional image showing a round formation in the placentaFigure 2: Image obtained using low-velocity blood flow Doppler scanningFigure 3: Image obtained using three-dimensional ultrasoundAdditionally, fetal growth decreased from the 53rd centile at 28 + 1 weeks to the 2nd centile at 36 + 2 weeks, prompting induction of labor at 37 weeks. This resulted in a spontaneous vaginal delivery of a healthy female newborn weighing 2110 g, with Apgar scores of 9, 10, and 10 at the 1st, 5th, and 10th min, respectively. Photographs of the placenta were obtained after birth, displaying the abovementioned mass [Figures 4 and 5].Figure 4: Macroscopic view of the placenta – decidua basalisFigure 5: Macroscopic view of the placenta – chorionic plate (arrow indicating location of the formation)What is your suggested diagnosis, based on these findings? Ethics statement This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki and its amendments. The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.