What's a "calcified" placenta?

[aran]

I had an "emergency" c/s almost 2 years ago. Before I TTC #2 I am trying to wrap my brain around why it happened and whether it was necessary or could have been prevented.

I had a cervidil/pit induced labor at 41 weeks, which went nowhere and resulted in ds having some prolonged decels. Also, a u/s the previous day indicated that the amniotic fluid was a little bit low. So, I consented to a c/s.

When the OB had the placenta in hand in the OR, she said it was "extremely calcified" and indicated that was probably the cause of the problems (the decels, I suppose).

So my question is - what exactly does it mean to have a "calcified" placenta? Is it just another way to say that it was aging and shutting down? Or do you think she literally meant it was encrusted (yuck) with calcium deposits? (I know I could just ask the OB, but I have not been to see her again since my post-partum visit... she didn't do a particularly bad job for an OB... I just don't want to go back)

My initial reaction when I was on the operating table was that I had caused the problem by eating too many calcium-based antacid tablets during my pregnancy (I seriously ate A LOT). That's probably silly, but I just don't know. (Please, no flames... I was totally uninformed until ds came along and indicated his preference for an AP lifestyle )

Thanks!

[mama3peanuts]

Originally Posted by aran

My initial reaction when I was on the operating table was that I had caused the problem by eating too many calcium-based antacid tablets during my pregnancy (I seriously ate A LOT). That's probably silly, but I just don't know. (Please, no flames... I was totally uninformed until ds came along and indicated his preference for an AP lifestyle )

Thanks!

Actually, that's not silly at all. The calcium in antacid tablets (like Tums, Rolaids...) is calcium carbonate-or CHALK!!!!!! If you ate a ton of those, that could very well be the reason your placenta was calcified. If you think of your placenta like a filter (which it is ), you can see how, in doing its job, it could become encrusted with the calcium. And a clogged filter doesn't work as well as a clean one, YK?

You know what worked for me with heartburn last time around? Dehydrated papaya. Seriously. It wasn't the instant "ahhhhh" sort of relief you get from tums, but if you eat it several times a day, it might help prevent the heartburn in the first place. Weird, I know. If it makes you feel any better, I also downed the antacid tabs throughout my first pregnancy...but my OB didn't say anything about anything (let alone the placenta), so who knows if the same thing happened to me?! And as for the last one, I have that placenta in my freezer, and have examined it as a project for our midwifery study group. I stayed the hell away from Tums, and there was ONE tiny spot that MAY have been calcium, but could have been fatty something, or nothing at all.

[mwherbs]

it is a frequent event that induction produces decels and a c-section-- this is the direction your research should take-- this is the primary cause for your c-section.
(or maybe a secondary cause, primary being your doc's fear of being sued)



I believe that the calcification in your child's case is an incidental finding-- this stuff is still being studied and there are no conclusions
smoker's babies tend to have more calcified placentas as well as smaller babies but not all smoker's placentas are calcified
women with hypertension may have more calcified placentas but not all
some calcification is normal- the placenta is considered to be a calcium pump...
here is one small study- remember this is all in the study phase and not much written in stone--- get a complete copy of your records (not just the doc's summary- but the copies the hospital keeps)

here is the web address where this abstract can be read

http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_DocSum

Am J Epidemiol. 1998 Jan 15;147(2):127-35.

Relations of cigarette smoking and dietary antioxidants with placental
calcification.

Klesges LM, Murray DM, Brown JE, Cliver SP, Goldenberg RL.

Department of Preventive Medicine, University of Tennessee, Memphis 38105, USA.
-------clipped for copyright-----------------------------
The authors' findings confirm a pathologic relation between smoking and
placental calcification and suggest that dietary antioxidants may reduce villus
calcification.

Publication Types:
Review

PMID: 9457001 [PubMed - indexed for MEDLINE]

the antioxidants mentioned in the article vitamin C and vitamin E-

[erin_brycesmom]

I know nothing about calcification but just wanted to add that I didn't find out until the end of my pregnancy that Tums are a class C med. I thought they were B at most. Most people I know take Tums without thought throughout pregnancy but learning it was a class C made me 2nd guess. I am on Rx meds for Reflux and the ones I take are class B and I felt much better taking that during pregnancy.

[channelofpeace]

Oh, can you remind me what class C is again?

[aran]

Thanks for your replies!!

I appreciate the recommendation for the papaya. I was actually amazingly careful about what I put into my body (other than antacids, I guess), and went thru the whole pregnancy without so much as a sniffle. But, the heartburn was so awful. I remember leading meetings at work and I would suddenly go silent... no-one knew what was wrong, but I was just dealing with stabbing heartburn, and couldn't bear to speak! I would pop rolaids for the instant relief. I will definitely be doing anything and everything to avoid tums/rolaids next time, though. Even if that may not have been the cause, it certainly didn't help.

The study you cite, mwherbs, suggests antioxidants could help avoid this next time. I have never smoked in my life, so that risk factor for calcification is taken care of! I'll go search Medline and see what else I find.

The OB definitely wanted to c/s... she had been talking about it for weeks, even though everything looked OK. She said she thought I might need one because DS was measuring big for gestational age. I thought that was hooey, because between my mom and two sisters, they pushed out 9 babies, most 9-10 lbs, and I have a larger bone structure than they do, so I thoought I'd have no problem. Ultimately, DS was 8 lb 11.5 oz... good sized, but not huge. I had no doubts that I could birth him naturally and thought I would despite the OB (I think I was too confident, and not well-read enough to know how to avoid the chain of interventions). I already have interviewed and lined up a VBAC midwife for the next pregnancy! I know better now!

Regarding the safety classes, here's what I googled (from intellihealth.com)

"Medications are graded by classes A through D to indicate their level of safety if used during pregnancy:

Class A is safest. These medications have been proven to be safe in pregnant women.
Class B medications are considered safe during pregnancy, although definitive study evidence in humans is lacking.
Class C medications are potentially harmful according to animal studies, although no studies in humans are available.
Class D medications have been shown to be harmful to human fetuses."

I recall reading that Rolaids/Tums were ok in moderation. In retrospect, my idea of moderation was warped because of the terrible heartburn! I popped way too many of those!

Thanks for your replies, mamas!

[aran]

OK, I am back...

I think this abstract (I am too cheap to order the article) suggests that too much calcium in the diet can cause calcification of the placenta. I think. Not totally sure. Because it seems to say that calcium deposits in the placenta look chemically like the way calcium solids do when they form in a super-saturated solution. (I bolded the most relevant parts)



Placental Calcification: A Metastatic Process?
Placenta. 2001 Jul;22(6):591-6.
S. H. Poggia, f1, K. I. Bostromb, L. L. Demerb, H. C. Skinnerc and B. J. Koosa

Abstract
Placental calcification commonly increases with gestational age. The mechanism of apatite mineralization probably involves one of three known mechanisms of tissue calcification: physiological (like bone), dystrophic (ischaemia-related) or metastatic (mineralization in a supersaturated environment). This study was designed to determine the mechanism of calcification by examining (1) the mineral content of placental calcifications in comparison to other physiological and pathological apatites, and (2) the expression of bone morphogenetic proteins (BMPs), which are important in physiological calcification, across gestational age. By energy-dispersive x-ray analysis (EDXA), the Ca/P weight ratio for apatitic mineral from mature calcifications was 2.00±0.05 (s.e.), which is similar to that for stones formed in a metastatic, supersaturated environment and lower than that observed in physiological calcification. Biologically active BMP, which was determined by bioassay, was demonstrated in mature and postmature placentae. The BMPs PLAB, PDF and related protein INSL-4 were identified by semiquantitative reverse transcriptase polymerase chain reaction (RT-PCR), but their mRNA expression was independent of gestational age (7–41 weeks of gestation). We conclude that (1) the identified BMPs were not related directly to placental calcification, which argues against physiological calcification, and (2) the chemical composition of the apatitic mineral was suggestive of rapid formation in a supersaturated environment, which is consistent with a metastatic mechanism of calcification.

[aran]

I keep reading abstracts and articles, and found this one that is really interesting... (most of the articles, by the way, indicate that calcification of the placenta is not correlated to (and thus unlikely the cause of) any problems with the fetus!)

This one says that the whole idea that a placenta is aging and dying late in pregnancy is false...

http://fn.bmjjournals.com/cgi/content/full/77/3/F171

[mwherbs]

[QUOTE=aran]OK, I am back...

I think this abstract (I am too cheap to order the article) suggests that too much calcium in the diet can cause calcification of the placenta. I think. Not totally sure. Because it seems to say that calcium deposits in the placenta look chemically like the way calcium solids do when they form in a super-saturated solution. (I bolded the most relevant parts)



Placental Calcification: A Metastatic Process?
Placenta. 2001 Jul;22(6):591-6.
S. H. Poggia, f1, K. I. Bostromb, L. L. Demerb, H. C. Skinnerc and B. J. Koosa


I am not getting anything from this abstract that leads me to believe that too much dietary calcium will = placental calcification.
what I do think that they liken it to is less than how bones are laid down and more like a metastatic process that occurs in supersaturation

[aran]

[QUOTE=mwherbs]

Originally Posted by aran

OK, I am back...

I think this abstract (I am too cheap to order the article) suggests that too much calcium in the diet can cause calcification of the placenta. I think. Not totally sure. Because it seems to say that calcium deposits in the placenta look chemically like the way calcium solids do when they form in a super-saturated solution. (I bolded the most relevant parts)



Placental Calcification: A Metastatic Process?
Placenta. 2001 Jul;22(6):591-6.
S. H. Poggia, f1, K. I. Bostromb, L. L. Demerb, H. C. Skinnerc and B. J. Koosa


I am not getting anything from this abstract that leads me to believe that too much dietary calcium will = placental calcification.
what I do think that they liken it to is less than how bones are laid down and more like a metastatic process that occurs in supersaturation

Fair enough... but what then do you think the source of Ca supersaturation would be, then? (I am a scientist, but clearly not a biologist... ) Is it just cell senescence leading to poor Ca regulation around the dying cells?

[mwherbs]

what are some things that are known-
smokers have an increase rate of placental calcification - but I doubt that they have excess dietary calcium- so will look and see if there is any info about blood calcium levels of smokers and see if there is a correlation.
women with hypertension also have increased placental calcification-
some things that regulate calcium and prevent soft tissue calcification in other parts of the body- vitamin K, an magnesium

other things related to soft tissue calcification
venous insufficiency
some infections
trauma
autoimmune disease
tumors
precipitation as in kidney stones ( in the old days they limited calcium in stone formers, but they found that it had more to do with oxalate and uric acid as well as lower than normal levels of citrate, and magnesium)

looking further I found that metastatic calcification out side of the placenta almost exclusively in people with end-stage renal disease and secondary hyperparathyroidism --- what this all means I am not sure - probably is an indicator that things are not functioning loosing ability to transport nutrients and waste properly...
I have seen parts of placentas that were calcified infarctions that lost circulation- one in particular the gal had some 20 week bleeding that did not lead to a loss- at birth there was a round soup bone looking calcified part in the placenta. Many placentas I have looked at and felt have had fine grittiness on the maternal side-

[mwherbs]

looked at the calcium in smokers nope no increase- but some down regulation in the parathyroid
also much more calcium in the arteries and a direct quote
"cigarette smoking-induced vasoconstriction is a calcium-mediated process"

now I know that you are not a smoker- I am just looking at the smoking and hypertension groups because they are more widely studied so we can find out different components and see if we can find out more

find out if your baby's placenta was sent to pathology- and if so get the report.

[sevenkids]

Calcifications can occur anywhere in the body as a form of protection from an irritant, the way an oyster makes a pearl around a grain of sand. There are so many environmental toxins that we have to deal with on an every day basis, it makes sense, the placenta, the filter to and from the baby, might try to protect itself by calcifying.

I seen a placenta in a primip, non-smoker, that looked and sounded like a rock. I mean, it was almost completely white and hard. When you rubbed it it felt like sandpaper, and had almost no flexibility. Strangest thing I ever seen.

[crazy_eights]

A mw friend tells me that her clients that eat a lot of tums have very calcified placentas so you might be on to something there. The bigger question to me is 'and therefore.....what?'

[mamaverdi]

Have also read about the Tums/Calcification issue. But I agree with mwherbs that is more likely, an OB wanting to do a c/s issue.

[aran]

Hey! Thanks for all the replies! I went away for a week and forgot to come back and check the thread till now.

mom2seven: The day that I started this thread and spent the day procrastinating on work, and instead looked at articles on placental calcification, I recall seeing that some researchers did indicate that calcification was not correlated with problems. But my OB presented that information as though it were evidence that the c/s was warranted. I am now thinking that was an assumption on her part.

mwherbs: I think the placenta was sent to pathology, b/c I vaguely remember hearing that there was no cancer in it and thinking "what a weird thing to check for"

My bottom line for the next pregnancy (TTC #2 starting in my next cycle : ) is to chill out on the antacids as a precautionary measure even if that wasn't the cause of placental calcification, and even if calcification had no influence on the outcome of the pregnancy. But I do feel better having thought it out more and now feeling as though it was my OB's "excuse" more than a legitimate concern (but I will request the hospital records to confirm this, too).

THANKS ALL.

[liawbh]

Just a quick note on the heartburn:
antacids can actually have an exacerbating effect, almost addictive. When the stomach fluid gets too alkaline it interferes with the function of the sphincters that are supposed to keep stuff from coming back up. So, while it sounds backwards, you actually may need to increase the acidity of the stomach. Drinking a little apple cider vinegar daily can really help. It's not an immediate effect, but will help over time.

[crazy_eights]

bump

[AutumnMama]

Originally Posted by liawbh

Just a quick note on the heartburn:
antacids can actually have an exacerbating effect, almost addictive. When the stomach fluid gets too alkaline it interferes with the function of the sphincters that are supposed to keep stuff from coming back up. So, while it sounds backwards, you actually may need to increase the acidity of the stomach. Drinking a little apple cider vinegar daily can really help. It's not an immediate effect, but will help over time.

Yep, as strange as this may sound, it works!
I've tried it (even when pg) and it worked great for me (it actually helped immediately, I diluded it with water).
Another thing that seems to work well are Papaya enzyme tablets to help with digestion after meals

[happydoulamama]

I have a friend who was pushed into an induction with her second baby because she was 41 weeks and by u/s the doctor scared her because her placenta was becoming calcified. He mentioned that it was because the placenta was deteriorating because of the baby's "prolonged gestation".
Anyway, she was convinced because she "saw the calcifications herself" and induced. All ended well, but she really didn't want to be induced. I'm guessing (and did from the get-go) that this was all scare tactic- I never heard of this calcification thing again until this thread.