Definition/General
Introduction:
Battledore placenta is characterized by marginal cord insertion at the edge of placenta
The umbilical cord inserts at the placental margin rather than central location
It resembles a ping-pong paddle (battledore)
It represents an abnormal cord insertion site.
Origin:
Results from abnormal implantation or placental development
Uneven placental growth causing cord to appear marginal
Migration of cord insertion during development
Developmental anomaly of cord-placental interface
May be associated with uterine constraint.
Classification:
Classified as marginal cord insertion
True marginal: Cord at exact edge
Near-marginal: Cord within 2 cm of edge
May be complete or partial marginal insertion
Distinguished from velamentous insertion.
Epidemiology:
Incidence approximately 7-10% of pregnancies
More common than velamentous insertion
Higher incidence in multiple pregnancies
More frequent with placental abnormalities
Often incidental finding.
Clinical Features
Presentation:
Usually asymptomatic
May have intrauterine growth restriction
Preterm delivery (increased risk)
Fetal distress during labor
Abnormal fetal heart rate patterns
Generally benign condition.
Symptoms:
No specific maternal symptoms
Fetal growth may be affected
Labor complications possible
Cord compression during delivery
Variable fetal heart rate.
Risk Factors:
Multiple pregnancy
Advanced maternal age
Placental abnormalities
Uterine abnormalities
Previous battledore placenta
Small for gestational age placenta.
Screening:
Routine ultrasound can identify
Cord insertion assessment
Fetal growth monitoring
Doppler studies of umbilical vessels
Enhanced labor monitoring.
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Gross Description
Appearance:
Umbilical cord insertion at placental margin
Cord attached at edge of placental disc
Asymmetric appearance resembling paddle
Normal cord structure
Intact placental architecture.
Characteristics:
Marginal cord attachment
Three-vessel cord typically present
Normal cord length
Placental edge insertion
No membrane insertion (unlike velamentous)
Cord vessels enter placenta directly.
Size Location:
Cord inserts at or within 2 cm of placental edge
Any location around placental circumference
Normal cord diameter
Typical placental size
Marginal positioning.
Multifocality:
Single cord insertion site
Unilateral marginal position
No multiple insertions
Consistent location
Uniform cord structure.
Microscopic Description
Histological Features:
Normal cord histology
Two arteries and one vein
Wharton's jelly present
Normal placental architecture
Intact chorionic plate
No inflammatory changes typically.
Cellular Characteristics:
Normal umbilical vessels
Smooth muscle in vessel walls
Endothelial lining intact
Mucoid connective tissue (Wharton's jelly)
Normal trophoblast at insertion site.
Architectural Patterns:
Normal three-vessel cord
Appropriate vessel spiral
Normal placental interface
Intact chorionic plate connection
No structural abnormalities.
Grading Criteria:
Based on distance from placental edge
True marginal: 0-1 cm from edge
Near-marginal: 1-2 cm from edge
Vessel integrity assessment.
Immunohistochemistry
Positive Markers:
Smooth muscle actin (vessel walls)
CD34 (endothelium)
Factor VIII (endothelial cells)
Elastin (vessel walls)
Collagen (Wharton's jelly).
Negative Markers:
Inflammatory markers (typically absent)
Pathological markers
Infectious organism stains
Neoplastic markers.
Diagnostic Utility:
Confirms normal vessel structure
Rules out pathology
Demonstrates intact endothelium
Assesses vessel integrity
Normal tissue confirmation.
Molecular Subtypes:
Not applicable for routine classification
Morphological variant rather than pathological entity.
Molecular/Genetic
Genetic Mutations:
No specific genetic mutations identified
Developmental variant
Multifactorial inheritance possible
No chromosomal associations typically
Environmental factors may contribute.
Molecular Markers:
Normal vascular development markers
Appropriate angiogenesis factors
Normal extracellular matrix
Typical cord proteins
Standard placental markers.
Prognostic Significance:
Generally good prognosis
Slight increase in labor complications
Minimal impact on fetal outcomes
No long-term consequences
Monitoring during labor recommended.
Therapeutic Targets:
Enhanced fetal monitoring during labor
Careful cord handling during delivery
No specific treatment required
Standard obstetric care
Awareness of variant.
Differential Diagnosis
Similar Entities:
Velamentous cord insertion (cord in membranes)
Central cord insertion (normal)
Eccentric cord insertion (off-center but not marginal)
Furcate insertion (branching)
Cord abnormalities.
Distinguishing Features:
Battledore: Cord at placental edge
Battledore: Direct placental insertion
Velamentous: Cord in membranes
Velamentous: Vessel separation
Central: Central placental insertion.
Diagnostic Challenges:
Differentiation from velamentous insertion
Assessment of exact location
Clinical significance evaluation
Distance measurement from edge.
Rare Variants:
Partial marginal insertion
Combined with other anomalies
Multiple pregnancy variations
Placental shape abnormalities.
Sample Pathology Report
Template Format
Sample Pathology Report
Complete Report: This is an example of how the final pathology report should be structured for this condition.
Specimen Information
Placenta with umbilical cord insertion at [distance] from placental margin (battledore insertion)
Diagnosis
Battledore Placenta (Marginal Cord Insertion)
Classification
Classification: [True marginal/Near-marginal] cord insertion at [distance] cm from placental edge
Cord Characteristics
Three-vessel cord with normal structure inserting at placental margin
Histological Features
Shows normal umbilical cord histology with intact vessel structure and Wharton's jelly
Vessel Assessment
Umbilical vessels show normal structure with intact endothelium and smooth muscle
Clinical Significance
Marginal insertion may require enhanced fetal monitoring during labor but generally benign
Recommendations
Recommend enhanced fetal heart rate monitoring during labor due to marginal cord insertion
Final Diagnosis
Battledore Placenta with [classification] marginal cord insertion and [clinical significance]