GRANNUM CLASSIFICATION PLACENTAL GRADING

MERCURY IMAGING INSTITUTE SCO 172-173 SEC 9C CHANDIGARH

MERCURY IMAGING CENTRE SCO 16-17 SEC 20D CHANDIGARH

PLACENTA MEANS FLAT CAKE ( Greek –plakuos)

USG APPEARANCE

• DECIDUA BASALIS – REGION OF THE BASAL PLATE ( HYPOECHOIC APPEARANCE).

• FETAL SURFACE – ( CHORIOAMNIOTIC MEMBERANE ) ( BRIGHT SPECULAR REFLECTOR)

GRADE O

LATE FIRST TRIMESTER TO EARLY SECOND TRIMESTER

SMOOTH ECHOPATTERN OF THE PLACENTAL PARENCHYMA . NO CALCIFICATION IN THE CHORIONIC / BASAL PLATE . NO INDENTATIONS OF THE CHORIONIC PLATE. ( SMOOTH CHORIONIC PLATE ).

GRADE 1

MID SECOND TRIMESTER TO EARLY THIRD TRIMESTER. ( 18 TO 29 WKS)

SMALL DIFFUSE CALCIFICATIONS ( HYPERECHOIC AREAS ) ( 2mm to 4mm ) RANDOMLY DISTRIBUTED IN PLACENTA. SUBTLE INDENTATIONS OF THE CHORIONIC PLATE.

GRADE 2

LATE THIRD TRIMESTER TILL DELIVERY ( 30WKS TILL DELIVERY)

DOT DASH CALCIFICATIONS PATTERN ALONG THE BASAL PLATE . CALCIFICATION PATTERN IS PARALLEL TO THE LONG AXIS OF THE BASAL PLATE. LARGER INDENTATIONS OF THE CHORIONIC PLATE NOT REACHING THE BASAL PLATE.

GRADE 3

LATE THIRD TRIMESTER TILL DELIVERY ( 39 WKS – POST DATES)

Irregular calcifications with significant shadowingComplete indentation of the chorionic plate through to the basilar plate creating cotyledons.

BRIEF ABOUT PLACENTA

• GRADE THREE MATURITY

MAY SIGNIFY PLACENTAL DYSMATURITY ( CAN LEAD TO IUGR)

ASSOCIATED WITH -CHRONIC SMOKING ,HYPERTENSION DIABETES, SLE

TWO VESSESL FROM THE FETAL SIDE ( UMBILICAL ARTERIES) SUPPLY THE PLACENTA ( FET AL HYPOGASTRIC ARTERIES).

ONE UMBILICL VEIN CARRIES BLOOD BACK TO FETUS TO JOIN LEFT FETAL PORTAL VEIN.

MATERAL SIDE ARTERIES CROSSING MYOMETRIUM ( ARCUTAE ARTERIES) , THROUGH BASILAR ARTERY ( SPIRAL ARTERIES).

MATERANL VENOUS CHANNELS IN THE PLACENTA ARE CALLED AS MATERNAL LAKES.

THICKNESS OF PLACENTA IN THE MID POSITION / CORD INSERTION IS 2 TO 4CM.

SUBJECTIVE FACTOR

CALCIFICATION associations with………….

1. Fetal distress in labor 2. Poor perinatal outcome,3. Maternal smoking 4. First-time mothers 5. Preeclampsia,

PLANE OF THE VIEW.GAIN FACTORSSETTINGSEXPERIENCE OF THE OBSERVER.

TEXTURE OF PLACENTAINEDNTATIONS OF THE CHORIONIC PLATECALFICATION INTERPRETATION.

Normal placenta.

©2009 by Radiological Society of North America

NORMAL PLACENTA

• Expressed In terms of thickness in the Midportion of organ ( 2 to 4cm).

• Thinning : systemic vascular / haematological disorder

• Thickening : Fetal hydrops , antepartum infections , maternal diabetes , maternal anemia

PLACENTAL SIZE

CIRCUMVALLATE PLACENTA. BASAL PLATE SMALLER THAN

CHORIONIC PLATE

©2009 by Radiological Society of North America

SUCCENTURATE LOBE PLACENTASMALL LOBE SEPARATED FROM THE MAIN PLACENTAL MASS.

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PLACENTA MEMBRANACEA. THIN MEMBERANOUS

PLACENTA

©2009 by Radiological Society of North America

TWINNING- SOME RULES………..

• TWO YOLK SACS • TWO AMNION

• TWO PLACENTA • TWO CHORION

• T SIGN – MONOCHORIONIC DIAMNIOTIC

• TWIN BEAK SIGN- DIAMNIOTIC / DICHORIONIC

• INTERTWIN MEMBERANE• >2 MM ( DIAMNIOTIC /

DICHORIONIC)• <2 MM ( DIAMNIOTIC)

TWIN PEAK SIGN DICHORIONIC-DIAMNIOTIC TWIN GESTATIONS.

©2009 by Radiological Society of North America

T SIGN IN A MONOCHORIONIC-DIAMNIOTIC TWIN GESTATION.

©2009 by Radiological Society of North America

BILOBED PLACENTA.

©2009 by Radiological Society of North America

CHORIOAMNIOTIC SEPARATION.

©2009 by Radiological Society of North America

PLACENTAL MEMBERANE (CHORION), FETAL MEMBERANE (AMNION )REMAIN SEPRATE AT GESTATION FUSE AT 14WKS . SEPARATION LATER THAN THIS – CHORIOAMNION SEPARATION. FOCAL , DIFFUSE . SEQUAEL TO PRIOR INTERVENTION / AMNIOCENTESIS. CAN BE ASSOCIATED WITH CHROMOSOMAL / DEVELOPMENTAL ABNORMALITIES

PLACENTAL HAEMATOMA SITE

PREPLACENTAL ( FETAL)( SUBCHORIONIC)INTRAPLACENTALRETROPLACENTAL ( MATERNAL).