Placenta & Amniotic Fluid U/S

8/17/2019 Placenta & Amniotic Fluid U/S

1/19

PLACENTA &PLACENTA &

AMN.FL. AMN.FL.


2/19

PLACENTA &PLACENTA & AMNIOTIC AMNIOTIC

FLUIDFLUID..


3/19

PLACENTA PLACENTA • NUMBER NUMBER • SITESITE• GRADINGGRADING• THCKNESSTHCKNESS• RETROPLACENTALRETROPLACENTAL

SPACE.SPACE.


4/19

PLACENTAL SITEPLACENTAL SITE • Placental location Placental location : state on wh !h "te# ne: state on wh !h "te# ne

s $e & how %a# t es %#o' the nt.os.s $e & how %a# t es %#o' the nt.os.• Ant. ( Post. ( Rt ate#a ( o# Lt ate#a Ant. ( Post. ( Rt ate#a ( o# Lt ate#a

• Re at on to the %"n$"s & nt. os.Re at on to the %"n$"s & nt. os.• Placental migration Placental migration : the a))a#ent: the a))a#ent

!han*e n ) a!enta o!at on $"# n* )#e*.!han*e n ) a!enta o!at on $"# n* )#e*.on se# a s!ans $"e to $ +e#ent a *#owthon se# a s!ans $"e to $ +e#ent a *#owth

o% the owe# "t. se*'. #e at ,e to the #est o%o% the owe# "t. se*'. #e at ,e to the #est o%the "te#"s - t s the nt.os. that 'o,es notthe "te#"s - t s the nt.os. that 'o,es not) a!enta) a!enta


5/19

PLACENTA PRE/IA PLACENTA PRE/IA • D a*nos s 'a$e a%te# 012 34 , s"a 5at on o%D a*nos s 'a$e a%te# 012 34 , s"a 5at on o%

who e nt. os. not $ sto#te$ 34 the U BL o# who e nt. os. not $ sto#te$ 34 the U BL o#!ont#a!t ons.!ont#a!t ons.

• False positive : False positive :

0.0. P a!enta ' *#at onP a!enta ' *#at on66 .Lowe# "te# ne !ont#a!t ons.Lowe# "te# ne !ont#a!t ons

77 .O,e#$ sten$e$ U BL .!o')#ess n* ant. a*a nst.O,e#$ sten$e$ U BL .!o')#ess n* ant. a*a nst)ost. M4o'et .)ost. M4o'et .

• False negative : False negative :00 . nt.os.o3s!"#e$ 34 %eta hea$. nt.os.o3s!"#e$ 34 %eta hea$66 .) a!enta on ate#a "te# ne wa.) a!enta on ate#a "te# ne wa

77 .3 oo$ n #e* on o% nt os - oo8s 8e a'n ot !.3 oo$ n #e* on o% nt os - oo8s 8e a'n ot !9" $ .9" $ .


6/19

PLACENTAPLACENTA

ACCRETA ACCRETA • Ra#e 4 $ a*nose$ sono*#a)h !a 4Ra#e 4 $ a*nose$ sono*#a)h !a 4• S"s)e!te$ n ) . )#e, a & "te# neS"s)e!te$ n ) . )#e, a & "te# ne

s!a# e.*. )#e,. C.S.s!a# e.*. )#e,. C.S.• La!8 o% , s"a sat on o% h4)oe!ho !La!8 o% , s"a sat on o% h4)oe!ho !

'4o'et# "' & sono "!ent ,eno"s'4o'et# "' & sono "!ent ,eno"s!o') e "n$e# ) a!enta .!o') e "n$e# ) a!enta .

• 2 th n,as ,e t4)es -)e#!#eta 2 th n,as ,e t4)es -)e#!#etat ss"es seen e ten$ n* to a$;a!entt ss"es seen e ten$ n* to a$;a!ento#*ans e.*. U BL.o#*ans e.*. U BL.


7/19

PLACENTALPLACENTAL

GRADINGGRADING• GRADE < :GRADE < : ho'o*eno"s a th#o"*h .ho'o*eno"s a th#o"*h .• GRADE IGRADE I :: s'ooth !ho# on ! ) ate o# so'es'ooth !ho# on ! ) ate o# so'e"n$" at ons ( ho'o*eno"s s"3stan!e w th %ew"n$" at ons ( ho'o*eno"s s"3stan!e w th %ew3asa !a ! =!at ons3asa !a ! =!at ons

• GRADE II:GRADE II: 'a#8e$ n$entat ons o% the'a#8e$ n$entat ons o% the!ho# on ! ) ate 3"t these $on>t #ea!h the 3asa!ho# on ! ) ate 3"t these $on>t #ea!h the 3asa) ate ( 'o#e !a ! =!at ons o% the s"3stan!e .) ate ( 'o#e !a ! =!at ons o% the s"3stan!e .

• GRADE III:GRADE III: n$entat ons o% the !ho# on !n$entat ons o% the !ho# on !) ate #ea!h the 3asa ) ate) ate #ea!h the 3asa ) ate

- !o')a#te'enta 5at on o% the ) a!enta - !o')a#te'enta 5at on o% the ) a!enta w th n!#ease$ !a ! =!at ons & 'a4 3e w th n!#ease$ !a ! =!at ons & 'a4 3e%a o"ts- e!ho "!ent a#eas n the !ente# o% the%a o"ts- e!ho "!ent a#eas n the !ente# o% the!ot4 e$on .!ot4 e$on .


8/19

PLACENTALPLACENTAL

THICKNESSTHICKNESS• Th !8ness s 'eas"#e$ )e#)en$ !" a# toTh !8ness s 'eas"#e$ )e#)en$ !" a# tothe ) ane o% the ) a!enta .the ) ane o% the ) a!enta .

• Thickness (mm)=menstrual age (weeks)Thickness (mm)=menstrual age (weeks)•

No#'a 4 ?No#'a 4 ? @.1!'[email protected]!'.• Th !8 - Th !8 - 1!'1!' :: D M , hy rops,!h D M , hy rops,!hisoimm., "hronic .#ntra $terine in%ection,isoimm., "hronic .#ntra $terine in%ection,twins, anaemiatwins, anaemia ..

• Th nTh n -?-? 7!'7!' : : polyhy ramnios ,#$&!,polyhy ramnios ,#$&!,placental insu'iciency .placental insu'iciency .

• Pse"$oth !8nessPse"$oth !8ness :: retroplacental orretroplacental orintraplacental haematomaintraplacental haematoma


9/19

PERIPLACENTALPERIPLACENTAL

HEMORRHAGEHEMORRHAGE• Ret#o) a!entaRet#o) a!enta :: high pressure .bleedinghigh pressure .bleedingseparatingseparating basal plate from ut. wallbasal plate from ut. wall ..Related to spiral art. hmgeRelated to spiral art. hmge

Aet. Aet. maternal hypertention , rugmaternal hypertention , rug

a use.a use.• S"3!ho# on ! -'a#* naS"3!ho# on ! -'a#* na : low pressure: low pressurebleedingbleeding at periphery of placentaat periphery of placenta . Related to. Related tohmge of marginal veins which elevate edge ofhmge of marginal veins which elevate edge ofplacenta . Increased withplacenta . Increased with cigarettecigarettesmokingsmoking ..

• S"3a'n ot !S"3a'n ot ! :: on fetal surface of theon fetal surface of theplacentaplacenta . Caused by rupture of fetal. Caused by rupture of fetal

vessels on placental surface vessels on placental surface


10/19

PERIPLACENTALPERIPLACENTAL

HMGE U SHMGE U S• U S ) !t"#e $e)en$s on s te( a*e o% he'ato'a(U S ) !t"#e $e)en$s on s te( a*e o% he'ato'a(a'o"nt o% 3 ee$ n* &*estat ona a*e .The s!ana'o"nt o% 3 ee$ n* &*estat ona a*e .The s!an!an 3e no#'a .!an 3e no#'a .

• !etroplacental !etroplacental : h4)oe!ho ! a#ea se)a#at n*: h4)oe!ho ! a#ea se)a#at n*) a!enta %#o' '4o'et# "' .) a!enta %#o' '4o'et# "' .

• u chorionic ( marginal ):u chorionic ( marginal ): 'a#* na se)a#at on'a#* na se)a#at ono% ) a!enta. Me'3#ane e e,at on en$s ato% ) a!enta. Me'3#ane e e,at on en$s at) a!enta.) a!enta.

• D.D. D.D. *.+asal veins*.+asal veins : $on>t %o#' 'ass &ha,e 9ow: $on>t %o#' 'ass &ha,e 9ow . .

%ocal myometrial cont %ocal myometrial cont . o#. o# - roi - roi 3e ow ) a!enta .3e ow ) a!enta .


11/19

CHORIOANGIOMA CHORIOANGIOMA -HEMANGIOMA(HAMARTO-HEMANGIOMA(HAMARTO

MAMA• Ben *n t"'o# a# s n* %#o' ) a!entaBen *n t"'o# a# s n* %#o' ) a!enta!a) a# es!a) a# es

• Most !o''on ) a!enta t"'o#Most !o''on ) a!enta t"'o#• G#ows as a o3" ate$ so ta#4 no$" e nG#ows as a o3" ate$ so ta#4 no$" e n

) a!enta.) a!enta.• I% a#*e !an o3st#"!t %eta ! #!" at on !a"s n*I% a#*e !an o3st#"!t %eta ! #!" at on !a"s n*

#$&! , hy rops or %etal ano ia #$&! , hy rops or %etal ano ia ..• U SU S :: single or multiple iscrete soli massessingle or multiple iscrete soli masses

with comple echo on %etal sur%ace o%with comple echo on %etal sur%ace o%placentaplacenta .. Can 3e asso! ate$ w thCan 3e asso! ate$ w thpolyhy ramniospolyhy ramnios o# %etao# %eta anomaliesanomalies a#te# aa#te# a

Doppler Doppler 9ow n an* o'ato"s !ho# oan* o'a .9ow n an* o'ato"s !ho# oan* o'a .


12/19

INTRAPLACENTALINTRAPLACENTAL

SONOLUCENCIESSONOLUCENCIES• D/"#D$012"34!#45#" /PT01 "6 T D/"#D$012"34!#45#" /PT01 "6 T : at to) o%: at to) o%se)ta %#o' o3st#"!te$ ,eno"s $#a na*e ns *n =!ant (se)ta %#o' o3st#"!te$ ,eno"s $#a na*e ns *n =!ant (o!!"# at# n )#e*nan!4.o!!"# at# n )#e*nan!4.

• #5T/!7#114$ T3!4M+4 # #5T/!7#114$ T3!4M+4 # : 34 %eta 3 ee$ n*: 34 %eta 3 ee$ n*nto nte#, o"s s)a!es.nto nte#, o"s s)a!es.

• M0T/!501 7/54$ 108/ M0T/!501 7/54$ 108/ :!o e!t on o% ,eno"s 3 .:!o e!t on o% ,eno"s 3 ."n$e# !ho# on on %eta s $e ( ns *n =!ant ( wh #)oo"n$e# !ho# on on %eta s $e ( ns *n =!ant ( wh #)oo'ot on o% 9ow n* 3 oo$ on #ea t 'e o# ,eno"s 9ow'ot on o% 9ow n* 3 oo$ on #ea t 'e o# ,eno"s 9owon Do)) e#on Do)) e#

• P/!#7#14$ 9 $+"34!#45#" P/!#7#14$ 9 $+"34!#45#" F#+!#5 D/P4 #T F#+!#5 D/P4 #T ::stas s o% 'ate#na 3 . n nte#, o"sstas s o% 'ate#na 3 . n nte#, o"s & s"3!ho# on !& s"3!ho# on !

s)a!es & $e)os t on o% =3# n.9ow !an 3e seen n t .s)a!es & $e)os t on o% =3# n.9ow !an 3e seen n t .• P10"/5T01 #5F0!"T P10"/5T01 #5F0!"T : a,as!" a# t# an*" a# a#eas o%: a,as!" a# t# an*" a# a#eas o%$ +.s 5e on 'at .s $e$ +.s 5e on 'at .s $e

• $2$2 h4)oe!ho ! es ons n ) a!enta s"3st. %#o' 0 0


13/19

AMNIOTIC FLUID AMNIOTIC FLUID

SOURCESOURCE • ? 01 2 ? 01 2 : from the amnion , di usion: from the amnion , di usionof maternal plasma in ltrate throughof maternal plasma in ltrate throughchorionic plate , e!change of "uidschorionic plate , e!change of "uidsthrough fetomaternal circulation.through fetomaternal circulation.

• 01 7< 2 01 7< 2 :: renalrenal glomeruli lt.glomeruli lt.#$%%ml&day' ,#$%%ml&day' , skinskin di usion.di usion.

• 7


14/19

A'n ot ! 9" $ A'n ot ! 9" $ ,o "'e ,o "'e • 0< 2ee8s 7< ' .0< 2ee8s 7< ' .

• 6< 2ee8s 7


15/19

A'n ot ! 9" $ A'n ot ! 9" $

n$e n$e • D , $e "te#"s nto @ e "a "a$#ants .D , $e "te#"s nto @ e "a "a$#ants .• Meas"#e M/P- 'a '. ,e#t !a )o!8et Meas"#e M/P- 'a '. ,e#t !a )o!8et

n ea!h "a$#antn ea!h "a$#ant• A F I s"' o% @ "a$#ants M/Ps. A F I s"' o% @ "a$#ants M/Ps.• ?1 :?1 : o *oh4$#a'n os o *oh4$#a'n os

• 1 :1 : $e!#ease$ $e!#ease$• 0 :0 : no#'ano#'a• 0 6


16/19

POL H DRAMNIOSPOL H DRAMNIOSS"3;e!t ,e $ a*nos s:S"3;e!t ,e $ a*nos s:• 66 n$n$ t# 'este# :9" $ :%et"s #at o 0:0t# 'este# :9" $ :%et"s #at o 0:0• 77 #$#$ t# 'este# : e !ess ,e 4 a#*e )o!8ets o% 9" $t# 'este# : e !ess ,e 4 a#*e )o!8ets o% 9" $

Se' "ant tat ,e 'eas"#e'entSe' "ant tat ,e 'eas"#e'ent ::

• 0mniotic ui in e 0mniotic ui in e J J thth )e#!ent e -)e#!ent e - AFI AFI 6


17/19

POL H DRAMNIOSPOL H DRAMNIOS- AETIOLOG- AETIOLOG

(#nc. sec.o% 0.F. y large plac. , %etal(#nc. sec.o% 0.F. y large plac. , %etalmal%ormation. which inc rease urinemal%ormation. which inc rease urinee cretion.or prevent swallowing ,D M ,i iopathice cretion.or prevent swallowing ,D M ,i iopathic

). ).0.D M0.D M

6.GIT6.GIT ano'a es:ano'a es: At#es as At#es as .... O3st#"!t onO3st#"!t on : $ a)h.H: $ a)h.Ho')ha o!e e ( *ast#os!h s so')ha o!e e ( *ast#os!h s s7.CNS7.CNS ')a #e$ swa ow n*')a #e$ swa ow n* : h4$#o!e)h .: h4$#o!e)h .

' !#o!e)h. %a! a $e%e!ts -' !#o*nath a &' !#o!e)h. %a! a $e%e!ts -' !#o*nath a &Ne"#a T"3e De%e!tsNe"#a T"3e De%e!ts

@.H4$#o)[email protected]$#o)s ''"ne & non ''"ne . ''"ne & non ''"ne .1.Ca#$ a!:1.Ca#$ a!: a##h4th' as( Ht %. (ano'a esa##h4th' as( Ht %. (ano'a es

.Chest.Chest 'ass'ass

.Ch#o'oso'a.Ch#o'oso'a

.Tw n tw n t#ans%"s on.Tw n tw n t#ans%"s on

J.I$ o)ath ! .J.I$ o)ath ! .


18/19

OLIGOH DRAMNIOOLIGOH DRAMNIO

SS-? @


19/19

OLIGOH DRAMNIOLIGOH DRAMNIOSOS-AETIOLOG-AETIOLOG

• Feta $eathFeta $eath

• I U G RI U G R• P a!enta ns"+ ! en!4- PET (P a!enta ns"+ ! en!4- PET (

) a!enta n%a#!ts() a!enta n%a#!ts()ost'at"# t4 )ost'at"# t4

• Rena ano'a esRena ano'a es• PROMPROM

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Placenta & Amniotic Fluid U/S