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Maternal bonds
THE nine-month physical connection between a mother and her child is called placenta. It is through this membrane that the fetus gets its nourishment when resting in the mother’s womb.
The knowledge of placenta in the embryological books gives no idea about placental statistics in Pakistani child-bearing women, which in turn helped one realize the necessity of conducting a survey.
Thus, under the supervision of Dr Shoaib Tauheed, chairperson of a local medical university, performas were designed and distributed at eight hospitals in Karachi, Lahore and Multan including Civil Hospital (Karachi), Abbasi Shaheed Hospital (Karachi), PAF Hospital (Masroor Base), Nishtar Hospital, (Multan), Mue Hospital (Lahore). In this way, 381 deliver cases were studied.
The objective of the study was to analyze placental Statistics in Pakistani child-bearing women, the influence of physiological factors and the impact of pathological conditions on placental measurements.
This included various placental statistics, along with duration of gestation, nature of delivery and complications during the pregnancy and delivery. The weight of the mother and infant, length and sex of the infant along with the number of previous pregnancies (including the unsuccessful ones) were also recorded.
The average placental weight is around 500g and is affected by the duration of gestation. When the mother is pregnant for almost nine months, the placenta usually weighs less than 500g and when it exceeds beyond nine months, it weighs more than 500g. Where the mother has hypertension, the weight gain and placental weight tends to be more than 500g. This is comparatively more in cases with female infants than male infants.
The average placental diameter is around 15-25 centimetre. It is influenced by an increase or decrease in the duration of gestation. In cases with hypertension, weight gain and diabetes mellitus, the diameter tends to be less than 15 centimetre. Female infants tend to have a diameter lesser than 15 centimetre. Meanwhile, male infants generally have a diameter between 15-25 centimetre.
The shape of the placenta is a major factor which determines the nature of delivery and can cause complications during parturition. It is normally discoid (in 95 per cent of the cases). The rest of the 5 per cent cases have non-discoid placenta which includes Placenta Abruptio. The duration of gestation isn’t greatly affected by the shape of the placenta, but in cases with non-discoid placenta, the duration of gestation usually remains lesser than nine months. The reason might be Placenta Abruptio which causes early parturition. C-section deliveries have a relatively higher occurrence of non-discoid placenta. No cases of non-discoid placenta were observed in cases of forceps delivery
Placental position is yet another characteristic which determines the nature of delivery. The position of the placenta is fundal in 82.4 per cent of the cases, anterior in 3.9 per cent, posterior in 5.8 per cent, lower uterine segment in 1.3 per cent and lateral in 1.8 per cent. Placenta Previa was seen in 4.7 per cent of the cases.
All cases with Placenta Previa are delivered through C-section. The cases with forceps delivery had the placenta in fundal position. Post-partum hemorrhage is one of the major complications that occur. No complications were observed in cases with placenta in the lower uterine segment.
The average length of the umbilical cord is 50-60 centimetres. When the duration of gestation is lower than nine months, the length of the cord remains less than 50 centimetre. Weight gain is one of the major complications of pregnancy in which the length of the cord is lower than usual. The average thickness of the placenta is between 2-3 centimetre. Another noteworthy observation was the nature of delivery in the Pakistani population. 74 per cent had normal vaginal delivery. 25 per cent experienced Caesarean sections and 4 cases were that of forcep delivery. According to the survey, 59 per cent of the population were male infants and 41 per cent were females.
The writer
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