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Placental Ultrasound NORMAL ANATOMY AND POSITION Maternal surface - Termed basal plate - Lie congruous with the

deciduas basalis - Irregular Fetal Surface - Termed chorionic plate - Smooth - Covered by amniotic membrane Placental Circulation - Intervillous spaces located within placental lobules - Oxygenated maternal blood enters the intervillous spaces via spiral arteries - From intervillous spaces, blood flows around and over surface of villi. This process permits exchange of oxygen and nutrients with fetal blood flowing in villous capillaries Placental Size - Placental thickness usually does not exceed 5cm Ap dimension - Large placenta may be associated with 1. maternal diabetes 2. Rh sensitization 3. congenital neoplasm 4. Non-immune hydrops - Small placenta may be associated with 1. IUGR 2. Placental insufficiency Placental Position - Placenta position in uterus can be categorized as: 1. posterior 2. anterior 3. RT lateral or LT lateral 4. fundal 5. combination Placental Migration - It is the impression of placental ascension from the cervical os during the last trimester of pregnancy, due to differential growth of lower uterine segment. Placental Number - Singleton - Dizygotic twin – 2 placentas (may be fused)

homogenous echotexture of substance of placenta.. PLACENTAL GRADING NORMAL PLACENTAL GRADES Grade 0 .Small intraplacental calcification randomly dispersed within the substance of a placenta. Monochoriotic / Monoamniotic – 1 placenta SONOGRAPHIC APPEARANCE OF PLACENTA 1. Grade III . and is most common until 34 weeks. May appear as early as 14 weeks.Calcified indentation of placenta extending from the basal plate to the chorionic plate ( placental cotyledons ). Basal plate cannot be identified sonographically unless it becomes calcified near term. Dichoriotic / Diamniotic – 2 placentas (may be fused) 2. ABNORMAL PLACENTAL GRADES . More than 50% of the placentas show some idegrees of calcification after 33 weeks. 3. 4. Found in 30% of term placentas. 2. Grade II .Calcification iof basal plate. In 8 weeks. diffuse granular texture of the placenta is clearly apparent sonographically. Grade I . Monochoriotic / Diamniotic – 1 placenta 3. 10-12 weeks. Does not usually appear until after 30 weeks.Monozygotic twin 1. Usually not seen until 35 weeks. The incidence of placental calcification increases exponentially with increasing gestational age. Most common in 1st trimester and early 2nd trimester (8-20weeks).Smooth chorionic plate. Chorionic plate is usually seen as an echogenic line in the fetal surface of placenta. beginning at about 29 weeks. the early placenta is visible sonographically as a generalized thickening around the gestational sac.

IUGR 3. Marginal Previa . it should be reevaluated pprior to term to confirm or deny persistence of a previa. Complete Previa .internal os partially covered by placenta (also called incomplete previa) 3.Delayed placental calcification may be associated with 1. Rh sensitization .When any type of previa is visualized.93% of women with placenta previa experience significant vaginal bleeding. The clinical hallmark of placenta previa is painless vaginal bleeding.Accerated placental calcification may be associated with 1. . Partial Previa . Types of Previa 1.placenta covers entire area of internal os ( also called total previa) ABRUPTION . . . .implants low in uterus with lower segment approaching but not encroaching on the internal cervical os. cigarette smoking PLACENTA PREVIA .A significant retroplacental or marginal haematoma will appear as a hypoechoic or complex mass beneath the elevated placental membranes on sonography. . and fetal demise. hypertension 2. a tense or painful uterus.Overly distended urinary bladder and focal uterine contractions are the two most common technical factors responsible for a false positive diagnosis by ultraound.Low-lying placenta .small edge or segment of placenta extends to the margin of internal cervical os 2.Clinical symptoms: vaginal bleeding.Premature placental detachment . . maternal DM 2..Two types: retroplacental and marginal . which usually occurs in the third trimester but can occur as early as 20 weeks. and possible shock.Prognosis: associated with premature labour and delivery.

Amnion covers the umbilical cord except near the fetal insertion.Hydatidiform mole • multiple diffuse iintraplacental sonolucent lesions (vesicular pattern). sonographically appear a swellcircumscribed intraplacental mass lesions with complex echo pattern .Teratoma and metastatic neoplasm • exceedingly rare .Complete mole • hydatidiform swelling of all villi and absence of an embryo. Sonographic anatomy of umbilical cord . A fetus may be present and is often triploid (69 chromosomes) • clinically present early onset or pre-eclampsia in second trimester. The arteries wind around the umbilical vein in a spiral fashion and. . .The umbilical stalk may occasionally be seen in the late first trimester.Partial mole • showing areas of molar changes alternating with normal villi.MASS AND LESIONS . adjacent to the anterior abdominal wall of the fetus.The Wharton jelly protects the vessels from undue torsion and compression. . where an epithelial covering is substituted.In the longitudinal section. and two umbilical arteries supported in Wharton jelly. a portion of cord will be seen as as series of parallel lines and sometimes the spiral . there are a number of foldings or tortuorties producing protusions or false knots on the cord surface.Umbilical cord is covered by amnion and contains a single umbilical vein. .Chorioangioma • vascular malformation. or • a viable fetus may coexist with a true mole in case of twin pregnancy with on twin surviving . the cord is much more readily visualized. because the vessels are longer the cord itself. In the second and third trimesters. UMBILICAL CORD Structure and function of umbilical cord .

Cord Position .By scanning near the center of placenta.cuhk.Haematoma .Omphalocele and gastroschisis http://www. . and shoulder loopins.A single umbilical artery may be seen in approximately 1% of all singleton births.course of umbilical arteries can be demonstrated.Allantoic duct cyst . . and 2. In the transverse section. knots.The most important umbilical cord malpositions include prolapses. In a number of instances. Single Umbilical Artery (SUA) . 5% of twins. Umbilical Cord Masses .On sonography.droid.Neoplasm .False knots . loops of cord may lie between the fetal presentation part and the lower uterine segment (funic presentation). the arteries and veins will be seen as three separately circular lucencies.Funic presentation is more common with malpresentations such as breech or transverse lie. it is diagnosed by demonstrating a complete parallel course of umbilical artery and vein in longitudinal section. and neck. .htm .Umbilical hernia . there may be loopings of cord around fetal neck or limbs or alternatively. body. the insertion site of the cord may be demonstrated as sonolucent area adjacent to the chorionic plate. the origin of umbilical vein and hypogastric arteries may be seen. At the insertion of the cord into the anterior abdominal wall of the loops of umbilical cord lie anterior to the fetal abdominal wall and adjacent to the limbs.5% of and by demonstrating only two circular lucencies in the transverse section.True knots . .

but can be large) Anatomy on US o Inner border of placenta against the uterine wall has the combined hypoechoic myometrium and interposed basilar layer = hypoechoic band called the decidua basalis (contains maternal blood vessels) o Outer surface abutting the amniotic fluid = chorionic plate (chorioamniotic membrane) = bright specular reflector Placental thickness judged subjectively o But if measure at midposition or cord insertion 2-4 cm = normal Grade 0 Late 1st trimesterearly 2nd trimester  Uniform moderate echogenicity  Smooth chorionic plate without indentations  .    Vascularity o Very vascular – has 2 blood supplies  Blood from fetus through 2 (sometimes 1) umbilical arteries through umbilical cord from fetal hypogastric arteries to placenta  1 umbilical vein carries blood back to fetal left portal vein  Blood from mom through branches of uterine arteries through the myometrium (arcuate arteries) through the basilar plate (spiral arteries) into the placenta The two circulations intertwine in the placenta but do not mix o Exchange of oxygen and nutrients occurs over the large vascular surface area o Maternal venous channels in the placenta are hypoechoic or anechoic spaces called venous lakes (usually small.

diffuse calcifications (hyperechoic) randomly dispersed in placenta  Grade 2 Late 3rd trimester (~30 wks to delivery)  Larger indentations along chorionic plate  Larger calcifications in a “dot-dash” configuration along the basilar plate  .Grade 1 Mid 2nd trimester – early 3rd trimester (~18-29 wks)  Subtle indentations of chorionic plate  Small.

SLE. diabetes   http://www.learningradiology.Grade 3 39 wks – post dates Complete indentations of chorionic plate through to the basilar plate creating “cotyledons” (portions of placenta separated by the indentations)  More irregular calcifications with significant shadowing  May signify placental dysmaturity which can cause IUGR  Associated with . chronic hypertension.