North American Registry of Midwives (NARM) Practice Exam

What could the presence of a larger and heavier than normal placenta indicate?

1. Excessive maternal weight gain

2. Development of a blighted twin

3. Diseases caused by maternal hypertension

4. Potential fetal conditions such as syphilis or erythroblastosis

The correct answer is: Potential fetal conditions such as syphilis or erythroblastosis

The presence of a larger and heavier than normal placenta can indeed indicate potential fetal conditions such as syphilis or erythroblastosis. In cases where there are underlying fetal conditions, the placenta often compensates by enlarging to support the fetus’s needs, especially if there are issues such as hemolytic disease of the newborn (like erythroblastosis fetalis). This is due to the placenta attempting to provide adequate nutrients and oxygen when the fetus is experiencing stress or is affected by infections or blood incompatibility. While excessive maternal weight gain might contribute to placenta size, it does not address the specific implications of direct fetal conditions. The development of a blighted twin refers more to the absence or loss of a twin, which would generally not contribute to an enlarged placenta in a singleton pregnancy. Maternal hypertension does lead to some placental changes, but it tends to be associated with different placental characteristics rather than simply a larger size. Thus, the link between certain fetal conditions and an increased size of the placenta provides a clear rationale for why the presence of an unusually large placenta might be a concern and warrants further investigation into fetal health.