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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.
©2009 by Radiological Society of North America
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).