Placenta ultrasound

1. PLACENTA PLACENTA Dr.DOAA IRAQIDr.DOAA IRAQI

2. Normal placentaNormal placenta
US image shows a US image shows a
placenta that is placenta that is
relatively relatively
homogeneous in homogeneous in
echo-texture.echo-texture.

The retroplacental The retroplacental
clear space is clear space is
hypoechoichypoechoic
(arrowheads). (arrowheads).

3. Normal placentaNormal placenta
Normal placentaNormal placenta. . ((aa)) US US
image shows a placentaimage shows a placenta ((PP))
that is relatively homogeneous that is relatively homogeneous
in echoin echo--texturetexture..
 TheThe retroplacental clear spaceretroplacental clear space
is hypoechoic is hypoechoic ((arrowheadsarrowheads). ).
((bb)) Sagittal singleSagittal single--shot fast shot fast
spinspin--echo echo ((SSFSESSFSE) ) T2-T2-
weighted MR image shows a weighted MR image shows a
placentaplacenta ((PP)) with intermediate with intermediate
signal intensitysignal intensity. . The dark line The dark line
represents the retroplacental represents the retroplacental
clear space clear space ((arrowheadsarrowheads).).

4. subchorionic cyst of the placentasubchorionic cyst of the placenta. . Also Also
known as membranous cyst, chorionic known as membranous cyst, chorionic
cystcyst
cystic lesion of the cystic lesion of the
placenta, just below placenta, just below
the placental the placental
surfacesurface.. Few mobile Few mobile
echoes were seen echoes were seen
within the lesionwithin the lesion. .
This finding is This finding is
generally considered generally considered
to be clinically of to be clinically of
little significancelittle significance. .

5. Velamentous insertion of umbilical Velamentous insertion of umbilical
cord into placentacord into placenta
These color doppler These color doppler
images show images show the the
umbilical cord umbilical cord
inserting into the inserting into the
placental membranesplacental membranes
before reaching the before reaching the
placental tissue placental tissue
properproper. .

6. Vesicular mole Vesicular mole ((also called Molar also called Molar
pregnancy or Hydatidiform molepregnancy or Hydatidiform mole) ) in 1st in 1st
trimestertrimester
Sonography of the uterus was Sonography of the uterus was
done in this 1st trimester done in this 1st trimester
pregnancypregnancy. . aa) ) Hyperechoic Hyperechoic
mass in the uterine cavity mass in the uterine cavity
with multiple cystic with multiple cystic
spaces within itspaces within it.. bb) ) Uterus Uterus
is enlarged is enlarged ((bulkybulky) ) cc) ) The The
myometrium is hypoechoic myometrium is hypoechoic
compared to the contents of compared to the contents of
the uterine cavitythe uterine cavity. . These These
appearances can be likened to appearances can be likened to
a a ""snowstormsnowstorm""

7. Vesicular moleVesicular mole

8. Vesicular moleVesicular mole
CT image of a patient with a CT image of a patient with a ββ--
hCG level of 620,000 mIUhCG level of 620,000 mIU//mL mL
shows :shows :
a predominantly a predominantly lowlow--
attenuation mass in the uterus attenuation mass in the uterus
with heterogeneous foci of with heterogeneous foci of
internal enhancementinternal enhancement..
Pathologic examination Pathologic examination
demonstrated a complete mole demonstrated a complete mole
without myometrial invasionwithout myometrial invasion. .
enlarged ovary with theca enlarged ovary with theca
lutein cystslutein cysts.. CT can be used to CT can be used to
assess for invasion by assess for invasion by
gestational trophoblastic gestational trophoblastic
diseasedisease. .

9. Placental calcificationPlacental calcification
This 3rd trimester This 3rd trimester
pregnancy shows pregnancy shows
extensive calcification of extensive calcification of
the basal plate the basal plate ((uterine or uterine or
maternal surfacematernal surface) ) of the of the
placentaplacenta. . Clinically and Clinically and
pathologically, calcific pathologically, calcific
changes of placenta have changes of placenta have
no significanceno significance. .

10. Placenta-GradingPlacenta-Grading

Grade 0Grade 0
Late 1st trimester-Late 1st trimester-
early 2nd trimesterearly 2nd trimester
UniformUniform moderate moderate
echogenicityechogenicity
SmoothSmooth chorionic chorionic
plate without plate without
indentationsindentations

11. Grade 1Grade 1
Grade 1Grade 1
Mid 2nd trimester –early Mid 2nd trimester –early
3rd trimester (~18-29 3rd trimester (~18-29
wks)wks)
Subtle (thin) indentationsSubtle (thin) indentations
of chorionic plate.of chorionic plate.
Small, diffuse Small, diffuse
calcificationscalcifications
(hyperechoic) randomly (hyperechoic) randomly
dispersed in placentadispersed in placenta

12. Grade 2Grade 2
Grade 2Grade 2
Late 3rd trimester (~30 Late 3rd trimester (~30
wks to delivery)wks to delivery)
Larger indentationsLarger indentations along along
chorionic platechorionic plate
Larger calcificationsLarger calcifications in a in a
“dot-dash” configuration “dot-dash” configuration
along the basilar platealong the basilar plate

13. Grade 3Grade 3
Grade 3Grade 3
39 wks – post dates39 wks – post dates
Complete indentations of Complete indentations of
chorionicchorionic plate through to the plate through to the
basilar plate creating basilar plate creating
“cotyledons” (portions of “cotyledons” (portions of
placenta separated by the placenta separated by the
indentations)indentations)
More irregular calcificationsMore irregular calcifications with with
significant shadowingsignificant shadowing
May signify placental May signify placental
dysmaturity which can cause dysmaturity which can cause
IUGRIUGR
Associated with smoking, Associated with smoking,
chronic hypertension, SLE, chronic hypertension, SLE,
diabetesdiabetes

15. placental chorioangiomaplacental chorioangioma
Sonography of the placenta in Sonography of the placenta in
this 16 week pregnancy shows this 16 week pregnancy shows
a large, solid mass, that is non a large, solid mass, that is non
calcific and shows mild calcific and shows mild
vascularity (vascular) and vascularity (vascular) and
excludes placental hematomaexcludes placental hematoma. .
and shows many cystic spaces and shows many cystic spaces
within itwithin it.. This tumor of the This tumor of the
placenta lies close to the cord placenta lies close to the cord
insertion siteinsertion site. . Ultrasound Ultrasound
images of this type of placental images of this type of placental
mass are highly suggestive of mass are highly suggestive of
placental chorioangiomaplacental chorioangioma..

16. placental chorioangiomaplacental chorioangioma

17. Succenturiate placentaSuccenturiate placenta

18. Succenturiate placentaSuccenturiate placenta

19. Succenturiate placentaSuccenturiate placenta
This was a 3rd trimester pregnancy This was a 3rd trimester pregnancy
showing part of the placenta along the showing part of the placenta along the
anterior wall of the uterus (SUCCENT PL), anterior wall of the uterus (SUCCENT PL),
and the main part of the placenta along and the main part of the placenta along
the posterior wall (PL). the posterior wall (PL). The sucenturiate The sucenturiate
lobe of placenta is connected to the main lobe of placenta is connected to the main
placenta by a string of blood vessels.placenta by a string of blood vessels.

20. Circumvallate placentaCircumvallate placenta
Circumvallate placentaCircumvallate placenta

21. Circumvallate placentaCircumvallate placenta
Infolding of the margins of the placentaInfolding of the margins of the placenta..
This condition is a normal variant and is produced due to the fact This condition is a normal variant and is produced due to the fact
that in this case, the chorionic plate that in this case, the chorionic plate ((fetal surfacefetal surface) ) of the placenta is of the placenta is
smaller than the basal plate smaller than the basal plate ((surface in contact with the uterine wall surface in contact with the uterine wall
or deciduaor decidua) ) of the placenta with resultant shouldering or infoldingof the placenta with resultant shouldering or infolding/ /
rolling of the placental marginsrolling of the placental margins.. This condition is This condition is
called circumvallate placenta and usually called circumvallate placenta and usually
causes causes no harm to the fetusno harm to the fetus. . However, it However, it
can can sometimes be associated with sometimes be associated with
increased chances of placental abruption increased chances of placental abruption
and hemorrhage.and hemorrhage.

22. Circumvallate placentaCircumvallate placenta

23. Placental venous lakePlacental venous lake

24. Placental venous lakePlacental venous lake
This placenta, in a 28 week pregnancy shows a This placenta, in a 28 week pregnancy shows a
large hypoechoic large hypoechoic ((almost anechoicalmost anechoic)), measuring , measuring
5 x 3.5 cms5 x 3.5 cms. . in sizein size. . Some particulate matter Some particulate matter
was seen flowing through this area, which was was seen flowing through this area, which was
closer to the fetal surface of the placentacloser to the fetal surface of the placenta. . These These
ultrasound images suggest a typical appearance ultrasound images suggest a typical appearance
of a large venous lake in the placentaof a large venous lake in the placenta.. Color Color
Doppler image showed no major flow pattern Doppler image showed no major flow pattern
within this placental lakewithin this placental lake. . The fine, echogenic The fine, echogenic
strands within the lesion appear to be nothing strands within the lesion appear to be nothing
more than artefacts produced by slow flowing more than artefacts produced by slow flowing
blood within the lesionblood within the lesion. .

25. Placenta previaPlacenta previa

26. Placenta previaPlacenta previa

27. The above ultrasound and color Doppler images show the The above ultrasound and color Doppler images show the
lower margin of the placenta partially covering the internal lower margin of the placenta partially covering the internal
os, suggesting os, suggesting partial placenta previapartial placenta previa..

28. Placenta previaPlacenta previa
One point to be noted is that placenta previa is One point to be noted is that placenta previa is
diagnosed in the 2nd and 3rd trimester of diagnosed in the 2nd and 3rd trimester of
pregnancy, and that normal uterine contractions pregnancy, and that normal uterine contractions
can cause the placenta to be can cause the placenta to be ""pushedpushed" " lower lower
down its normal position, creating an down its normal position, creating an
appearance of placenta previa appearance of placenta previa ((a false positive a false positive
diagnosis of placenta previadiagnosis of placenta previa).). Hence it is Hence it is
advisable to repeat the ultrasound scan after 30 advisable to repeat the ultrasound scan after 30
minutes to exclude a false diagnosis of this minutes to exclude a false diagnosis of this
conditioncondition..

29. Placenta previaPlacenta previa
This ultrasound image shows This ultrasound image shows
the placenta completely the placenta completely
covering the internal os , thus covering the internal os , thus
diagnostic of diagnostic of complete complete
placenta previaplacenta previa..
Follow up ultrasonography is Follow up ultrasonography is
advisable in all cases of placenta advisable in all cases of placenta
previa, to look for ascent of the previa, to look for ascent of the
placenta to a higher position due placenta to a higher position due
to the growth of the uterusto the growth of the uterus.. Such Such
cases of placenta previa cases of placenta previa ((both both
partial and completepartial and complete) ) are are in in
danger of hemorrhage danger of hemorrhage
((antepartumantepartum) ) and are advised and are advised
rest to prevent thisrest to prevent this..

30. ????????

31. placental abruptionplacental abruption . .
Crescent of Crescent of avascularavascular
low echogenicity low echogenicity
between placenta and between placenta and
uterine wall consistent uterine wall consistent
withwith placental placental
abruptionabruption. .

32. placental abruptionplacental abruption

33. Retained products of conceptionRetained products of conception/ /
retained placentaretained placenta

34. Retained products of conceptionRetained products of conception/ /
retained placentaretained placenta

The above ultrasound images show The above ultrasound images show a post partum uterus on a post partum uterus on
transabdominal sonographytransabdominal sonography. . There is a hyperechoic There is a hyperechoic
mass within the endometrial cavity measuring 8 x 5 cmsmass within the endometrial cavity measuring 8 x 5 cms..
The color Doppler ultrasound image shows poor vascularity of the The color Doppler ultrasound image shows poor vascularity of the
mass and the endometriummass and the endometrium..
note that the endometrial mass is eccentric within the cavitynote that the endometrial mass is eccentric within the cavity- - the the
anterior myometrium is thicker whilst the posterior wall of the uterus anterior myometrium is thicker whilst the posterior wall of the uterus
is thinneris thinner. . The placenta was not expelled at the time of deliveryThe placenta was not expelled at the time of delivery..
Absence of vascularity or poor flow does not rule out Absence of vascularity or poor flow does not rule out
retained products of conceptionretained products of conception/ / retained placentaretained placenta..
The single most important sign of retained products of The single most important sign of retained products of
conception is the large endometrialconception is the large endometrial massmass. . Other signs of Other signs of
retained placenta or products include complex fluid or retained placenta or products include complex fluid or
thickened endometrium thickened endometrium ((more than 10 mmmore than 10 mm..((..

35. Bilobed placentaBilobed placenta: (: (bilobate placentabilobate placenta((

36. Bilobed placentaBilobed placenta: : bilobate placentabilobate placenta

37. Bilobed placentaBilobed placenta: (: (bilobate placentabilobate placenta((
This is a 3rd trimester pregnancy with This is a 3rd trimester pregnancy with
ultrasound images showing ultrasound images showing two parts of two parts of
the placenta along the anterior and the placenta along the anterior and
posterior walls of the uterus, connected posterior walls of the uterus, connected
by a thin bridge of placental tissueby a thin bridge of placental tissue.. This This
kind of sonographic appearance is kind of sonographic appearance is
typical of bilobed placentatypical of bilobed placenta. .

38. Twin gestationsTwin gestations
T sign in a T sign in a
MonochorionicMonochorionic--diamniotic diamniotic
Twin GestationTwin Gestation
Twin peak sign in Twin peak sign in
DICHORIONICDICHORIONIC--DIAMNIOTIC DIAMNIOTIC
TWIN GESTATIONSTWIN GESTATIONS..

39. Twin gestationsTwin gestations

40. Placental hematomaPlacental hematoma
aa)) US image shows a US image shows a
rounded collection of rounded collection of
mixedmixed--echogenicityechogenicity
material material ((arrowheadsarrowheads) )
deep to the chorion along deep to the chorion along
the lateral margin of the the lateral margin of the
placentaplacenta. .
There is There is no internal no internal
Doppler signal to suggest Doppler signal to suggest
blood flowblood flow.. This This
appearance is consistent appearance is consistent
with a subchorionic with a subchorionic
hematomahematoma. . ((bb

41. placenta accretaplacenta accreta
)) US images show US images show disruption of the disruption of the
normal hypoechoic normal hypoechoic
myometrium myometrium ((black black
arrowheadsarrowheads) ) by invading by invading
placental tissue placental tissue ((white white
arrowheadsarrowheads). ). BB = = bladderbladder, , PP = =
placentaplacenta. . ((bb)) Sagittal SSFSE MR Sagittal SSFSE MR
image shows intermediateimage shows intermediate--signalsignal--
intensity placental tissue intensity placental tissue
((arrowheadarrowhead) ) invading the normal invading the normal
dark myometriumdark myometrium ((MM)) in the lower in the lower
uterine segment, findings uterine segment, findings
consistent with placenta accretaconsistent with placenta accreta. .
((cc)) Sagittal SSFSE MR image Sagittal SSFSE MR image
shows obliteration of the normal shows obliteration of the normal
dark myometriumdark myometrium ((MM)) posteriorly, posteriorly,
with placental tissue of with placental tissue of
heterogeneous signal intensity heterogeneous signal intensity
((arrowheadsarrowheads) ) penetrating the full penetrating the full
thickness of the uterine wallthickness of the uterine wall. . This This
appearance is indicative of appearance is indicative of
placenta percretaplacenta percreta. .

42. placenta accretaplacenta accreta
US images show disruption of the US images show disruption of the
normal hypoechoic myometrium normal hypoechoic myometrium
((black arrowheadsblack arrowheads) ) by invading by invading
placental tissue placental tissue ((white white
arrowheadsarrowheads). ). BB = = bladderbladder, , PP = =
placentaplacenta. . ((bb)) Sagittal SSFSE MR Sagittal SSFSE MR
image shows intermediateimage shows intermediate--signalsignal--
intensity placental tissue intensity placental tissue
((arrowheadarrowhead) ) invading the normal invading the normal
dark myometriumdark myometrium ((MM)) in the lower in the lower
uterine segment, findings uterine segment, findings
consistent with placenta accretaconsistent with placenta accreta. .
((cc)) Sagittal SSFSE MR image Sagittal SSFSE MR image
shows obliteration of the normal shows obliteration of the normal
dark myometriumdark myometrium ((MM)) posteriorly, posteriorly,
with placental tissue of with placental tissue of
heterogeneous signal intensity heterogeneous signal intensity
((arrowheadsarrowheads) ) penetrating the full penetrating the full
thickness of the uterine wallthickness of the uterine wall. . This This
appearance is indicative of appearance is indicative of
placenta percretaplacenta percreta. .

43. placenta accretaplacenta accreta
US images show disruption of the US images show disruption of the
normal hypoechoic myometrium normal hypoechoic myometrium
((black arrowheadsblack arrowheads) ) by invading by invading
placental tissue placental tissue ((white white
arrowheadsarrowheads). ). BB = = bladderbladder, , PP = =
placentaplacenta. . ((bb)) Sagittal SSFSE MR Sagittal SSFSE MR
image shows intermediateimage shows intermediate--signalsignal--
intensity placental tissue intensity placental tissue
((arrowheadarrowhead) ) invading the normal invading the normal
dark myometriumdark myometrium ((MM)) in the lower in the lower
uterine segment, findings uterine segment, findings
consistent with placenta accretaconsistent with placenta accreta. .
((cc)) Sagittal SSFSE MR image Sagittal SSFSE MR image
shows obliteration of the normal shows obliteration of the normal
dark myometriumdark myometrium ((MM)) posteriorly, posteriorly,
with placental tissue of with placental tissue of
heterogeneous signal intensity heterogeneous signal intensity
((arrowheadsarrowheads) ) penetrating the full penetrating the full
thickness of the uterine wallthickness of the uterine wall. . This This
appearance is indicative of appearance is indicative of
placenta percretaplacenta percreta. .