or specific treatment for restoration of the circumvallate placenta, there are ways to decrease the risks of possible complications prior to birth or attempt to manage complications if they develop. if circumvallate placenta is diagnosed during pregnancy, physicians may offer recommendations to reduce the risks of associated complications such as lower birth weight and placental abruption. decreased birth weight is a major concern associated with circumvallate placenta. infants born with birth weights that are lower than expected per their gestational age oftentimes end up requiring extra support in the neonatal intensive care unit (nicu). to assist in the monitoring of appropriate fetal growth, a physician may recommend more frequent growth checks during pregnancy if circumvallate placenta is suspected. if a fetus is not growing satisfactorily, premature delivery, via vaginal delivery or caesarean section, may be recommended, with c-section being more favorable compared to vaginal delivery. in women experiencing a placental abruption associated with circumvallate placenta, physicians will normally advocate for frequent growth checks, hospital bed rest, early delivery, and, if necessary, emergency c-section. likewise, iv fluids and blood transfusions can also be given to patients with a placental abruption in attempts to increase blood pressure and minimize the effects of severe blood loss. if oligohydramnios occurs as a result of a circumvallate placenta, a treatment called amnioinfusion may be considered to replenish the amount of lost amniotic fluid within the amniotic sac. amnioinfusion may help in preventing underdevelopment of the lungs. if diagnosed with a circumvallate placenta, consistent fetal monitoring by a licensed physician can help to prevent and/or reduce the effects of associated complications that may occur. additionally, healthy lifestyle choices, a well-balanced and nutritious diet, adequate rest, and cessation of alcohol and tobacco products can also help to prevent the incidence of a circumvallate placenta and its associated complications. if diagnosed with a circumvallate placenta, in association with other threatening pregnancies complications, emergency cesarean section will most likely be suggested by a physician. prognosis unfortunately, there is currently not a cure available for circumvallate placenta. while some evidence suggests that a circumvallate placenta can increase the risk of complication during pregnancy, other research suggests this increased risk is marginal. sadly, circumvallate placenta can occasionally result in infant death depending on the severity of the complications encountered. in other cases, circumvallate placenta can result in premature birth of infants who are otherwise healthy after being monitored in the neonatal intensive care unit for a period of time after birth. therefore, proper medical care and monitoring are crucial in attempting to minimize the likelihood of complications. in other cases, patients diagnosed with circumvallate placenta are able to carry their babies until term or near-term. epidemiology circumvallate placenta is a very rare condition affecting pregnant women. this condition is a placental morphological abnormality, with the placenta being formed during the early periods of pregnancy. women are able to become pregnant with the onset of ovulation and menstruation in early adolescence, with most women becoming pregnant during adulthood. circumvallate placenta is currently known to affect about 1-2% of pregnancies. it is not virally transmissible to other individuals, nor can it be transferred through contact or respiration. there are no specific racial or ethnic groups that are more predisposed to acquiring a circumvallate placenta during pregnancy, however, as with all pregnancies, there are general risks factors that can put a pregnant woman at risk for complications, including circumvallate placenta. notably, certain pregnancy complications, such as preeclampsia, tend to be almost three times as fatal in african american women compared to non-hispanic white women, even though both groups tend to experience preeclampsia at almost the same rates. this is partially thought to be due to inequalities in accessing quality prenatal care in lower socioeconomic neighborhoods and the effect of structural racism within healthcare systems. any woman residing in an area with a lower socioeconomic status, regardless of race or age, is predisposed to developing pregnancy complications like circumvallate placenta if quality prenatal care is not available. women with significant obstetric histories can also be at higher risk for developing any type of pregnancy complication, including circumvallate placenta, and are recommended to be screened for placental abnormalities within their second trimester of pregnancy. research directions the placenta plays a dominant role in being responsible for a variety of complications within pregnancy and labor. placental pathological studies have significantly contributed to recent obstetric literature. many studies have examined the clinical significance of patients with circumvallate placenta compared to patients with a normal placenta. they have revealed that incidences of preterm birth, oligohydramnios, placental abruption, low birth weight, and fetal death were present in significantly higher rates than when compared to control patients with normal placentas. because circumvallate placenta is such a rare condition, it is difficult to gain significant evidence and data. a case study reported in 2020 observed the correlation between circumvallate placenta and the occurrence of obstetric complications such as battledore insertion. battledore insertion, abnormal insertion of the umbilical cord into the placenta, occurs in about 7% of pregnancies and can also result in many of the same pregnancy complications as circumvallate placenta; intrauterine growth restriction, fetal distress, and fetal death. this abnormal insertion of the umbilical cord into the placenta can result in a loss of adequate blood flow to the developing fetus due to restriction. the fetus is unable to obtain normal amounts of required oxygen and nutrition through the placenta, and this can further cause other severe complications. in the study, a 22-year-old woman at 28 weeks and 2 days of gestation, presented for a routine third trimester screening. she was noted to have had 2 prior miscarriages at 17 and 20 weeks. a previous normal second trimester routine screening at 21 weeks of gestation did not identify any structural abnormalities within the placenta, decreased fetal size, or abnormally-appearing umbilical cord insertion. the patient also did not have any episodes of vaginal bleeding during the current pregnancy. upon presenting for routine screening at 28 weeks and 2 days of gestation, the patient was not exhibiting any signs of active contractions and a cardiotocography was performed as part of routine screening. cardiotocography is a diagnostic tool used during the third trimester of pregnancy to observe fetal heart rates and presence of uterine contractions. it can also be used to detect signs of any sort of fetal distress. in interpreting the cardiotocography that the 22-year-old pregnant woman had completed, it was noted that the fetus appeared to be much smaller than expected and was exhibiting concerns of decreased amniotic fluid volume, oligohydramnios, and restricted blood flow through the umbilical cord. cardiotocographic monitoring also noted decreases in fetal heart rate every 25 minutes without contractions. fetal motion was present, with the placenta appearing enlarged and spherical. decreases in the fetus' heart rate, in addition to the other findings of the cardiotocography, ultimately prompted physicians to deliver the baby via emergency cesarean section without major complications. the newborn, with normal apgar scores and umbilical cord arterial ph levels, was admitted to the neonatal intensive care unit. upon examining the placenta after delivery, it was noted that the placenta demonstrated the appearance of a circumvallate placenta, and also showed evidence of abnormal umbilical cord insertion into the placenta. postpartum, the mother had a good recovery and the newborn was discharged from the neonatal intensive care unit 105 days post-birth. this case study discussed the association of circumvallate placenta and abnormal battledore cord insertion in producing pregnancy complications. restriction of umbilical cord blood flow from the placenta to the fetus and placental abnormalities like circumvallate placenta may work in conjunction to generate fetal distress. decreased levels of oxygenation and nutrient absorption resulted in decelerations of fetal heart rate and the decision to deliver the fetus via cesarean section to prevent fetal death by hypoxia. routine monitoring of fetal growth and development, placental structure, and placental function are recommended with high-risk pregnancies. in patients diagnosed with circumvallate placenta during pregnancy, monthly fetal growth assessments are also recommended. patients found to have blood flow restrictions to or from the placenta are recommended to undergo weekly ultrasounds with consistent monitoring of fetal heart rate. in a separate case study reported in 2017, a woman at about 35 weeks of gestation presented with preeclampsia and intrauterine fetal demise, or more commonly known as stillbirth. after delivery of the stillborn fetus, examination of the placenta revealed a circumvallate placenta with battledore insertion of the umbilical cord. it was speculated that the combination of circumvallate placenta and battledore insertion had led to the loss of the fetus prior to delivery, as there was no other discernible cause for the stillbirth. while circumvallate placenta and battledore insertion are individually very rare conditions that can result in multiple pregnancy complications, the coexistence of these abnormalities likely resulted in the loss of the fetus. the diminished blood flow and circulation from the placenta to the fetus, as caused by battledore insertion, in combination with the impaired exchange of nutrients and wastes between mother and fetus, as caused by circumvallate placenta, likely contributed to the preeclampsia and this loss of fetal life. thus, it is highly recommended that if placental or umbilical cord abnormalities, such as circumvallate placental and battledore insertion, are suspected or detected prior to birth, that the pregnancy should be considered high-risk. high-risk pregnancies significantly benefit from frequent follow-ups using ultrasonography to monitor fetal developmental and placental and umbilical cord structure and function. research directions continue to investigate methods in which circumvallate placenta may be more commonly diagnosed during pregnancy before complications can transpire. biomarkers such as sflt/plgf can be used to predict severe pregnancy complications in high-risk pregnancies. circumvallate placenta appears to be correlated with reduced placental efficacy due to increased placental thickness and abnormal villi function, affecting the sflt/plgf ratio. it is thought that obtaining sflt/plgf ratios can be used to determine deficiencies in placental function in cases of placental abnormalities. future research analyzing the contribution of biomarkers like sflt/plgf to predict placental abnormalities would be influential to our understanding of many placental deformities, including circumvallate placenta. due to the rare occurrences of circumvallate placenta, more extensive research trials are unavailable, resulting in data limitations. therefore, the clinical importance of circumvallate placenta remains uncertain.