New Directions: What is New in Placental Studies?

  • Kurt Benirschke


The answer to the question in the chapter subtitle depends very much on the knowledge of the examiner of placentas. From my perspective, perhaps the most interesting aspects have been the placental changes that are now being observed in multiple gestations and that result from the different practices of assisted reproductive technology (ART), in-vitro fertilization (IVF), and, especially, intracytoplasmic sperm injection (ICSI). The increased frequency with which excessive numbers of multiples are produced has been widely commented upon, and in recent publications it has been recommended that only single ovum transfers be practiced in ART, rather than the more frequent method of multiple blastocyst transfer. The attending prematurity rate and the frequently serious sequelae of marked prematurity have been the principal reasons for this recommendation. Additionally, because of uterine space limitations when multiple blastocysts compete for implantation sites, some placentas may become “squeezed” by the other placenta(s) and thus acquire less room for their expansion. This may then lead to fetal growth restriction and the more frequent and abnormal (velamentous) cord insertion seen in the placentas of multiples. We recently studied 127 sets of triplet placentas that had more single umbilical arteries (SUAs), more circumvallation, more chorangiomas, and, interestingly, more placentas with increased syncytial knots. More recently we saw a normal-appearing newborn with SUA who had a major contribution of cells that were mosaic for an 18q deletion. Thus one may ask, How normal are children with SUA?


Assisted Reproductive Technology Ethylene Diamine Tetraacetic Acid Ethylene Diamine Tetraacetic Acid Fetal Growth Restriction Placenta Accreta 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Kurt Benirschke
    • 1
  1. 1.University of HamburgHamburgGermany

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