Placental grading

1. 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 )

2. USG APPEARANCE DECIDUA BASALIS – REGION OF THE BASAL PLATE ( HYPOECHOIC APPEARANCE). FETAL SURFACE – ( CHORIOAMNIOTIC MEMBERANE ) ( BRIGHT SPECULAR REFLECTOR)

3. 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 ).

4. 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.

5. 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.

6. GRADE 3 LATE THIRD TRIMESTER TILL DELIVERY ( 39 WKS – POST DATES) Irregular calcifications with significant shadowing Complete indentation of the chorionic plate through to the basilar plate creating cotyledons .

7. 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.

8. SUBJECTIVE FACTOR CALCIFICATION associations with…………. Fetal distress in labor Poor perinatal outcome, Maternal smoking First-time mothers Preeclampsia, PLANE OF THE VIEW. GAIN FACTORS SETTINGS EXPERIENCE OF THE OBSERVER. TEXTURE OF PLACENTA INEDNTATIONS OF THE CHORIONIC PLATE CALFICATION INTERPRETATION.

9. 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

10. CIRCUMVALLATE PLACENTA. BASAL PLATE SMALLER THAN CHORIONIC PLATE ©2009 by Radiological Society of North America

11. SUCCENTURATE LOBE PLACENTA SMALL LOBE SEPARATED FROM THE MAIN PLACENTAL MASS . ©2009 by Radiological Society of North America

12. PLACENTA MEMBRANACEA. THIN MEMBERANOUS PLACENTA ©2009 by Radiological Society of North America

13. 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)

14. TWIN PEAK SIGN DICHORIONIC-DIAMNIOTIC TWIN GESTATIONS . ©2009 by Radiological Society of North America

15. T SIGN IN A MONOCHORIONIC-DIAMNIOTIC TWIN GESTATION . ©2009 by Radiological Society of North America

16. BILOBED PLACENTA . ©2009 by Radiological Society of North America

17. 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

18. PLACENTAL HAEMATOMA SITE PREPLACENTAL ( FETAL) ( SUBCHORIONIC) INTRAPLACENTAL RETROPLACENTAL ( MATERNAL).