Bilobed placenta and management choices. Literature review and two cases studies

Objective. Bilobed placenta is a placental morphological variation with an estimated incidence of 4% of all pregnancies. It is associated with an increased risk of cord insertion anomalies and vasa previa. We searched the literature, focusing on the diagnosis, management, and particular aspects of cases of bilobed placenta. Moreover, we described our experience with two cases of bilobed placenta.
Materials and Methods. A literature search was conducted in Medline, Embase, Web of science,, Cochrane Library and Scopus, from January 2012 to January 2022. We selected all clinical studies in English, investigating the diagnosis and management of cases of bilobed placenta.
Moreover, we reported two cases of a bilobed placenta associated with anomalous cord insertion.
Results. Ten papers were included in the review: case reports (seven articles), cross-sectional study (one article), retrospective analysis (two article). Three articles referred to the bilobed placenta phenomenon in twin pregnancy. Based on the type of found articles, the quality of evidence is limited, mainly on the pathophysiology and etiology of this anomaly. Moreover, our search showed a significantly lower incidence compared to the literature. About our reported two cases of a bilobed placenta associated with anomalous cord insertion: case 1, characterized by a velamentous cord insertion and, case 2, with a marginal previa placenta associated with vasa previa.
Conclusions. A close ultrasound follow-up should be performed in case of suspicion of bilobed placenta to confirm the morphology and proximity to the cervix, assess the umbilical cord’s insertion and to identify other eventual associated anomalies. The management should be carried out by a dedicated team of specialists with experience with placenta abnormalities to reduce the risk of adverse fetal and maternal outcomes

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