The placenta - odds and sods

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all about ultrasound and pregnancy and placentae Basic to intermediate level

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The placenta - odds and sods

  1. 1. Placentae Chris Griffin Consultant Maternal Fetal Medicine King Edward Memorial Hospital Perth Western Australia
  2. 2. Development of placenta • Process of cellular changes – Cellular Division – Cellular hypertrophy – Cellular apoptosis • Implantation – Upper part of post wall of uterine body near midsagital plan
  3. 3. Early Ultrasound Findings • 5 to 12 weeks Online essay Vitelline duct at 6weeks+ Yolk sac at 5 weeks Retro amniotic 11 weeks
  4. 4. Placental Lakes
  5. 5. Lakes
  6. 6. Hydatidiform mole
  7. 7. Placenta Praevia • Risk factors – Previous CS • 5% only fundal cf 15% no CS • Lower implantaion site • Multiple pregnancy • IVF • Smoking • Placenta Praevia – Second trimester TA • 20% incidence of low lying • 1 to 2% major incidence • 50% resolve – First Trimester TVS • 6% incidence • 1% incidence at 15 – 20 weeks • If placenta overlying internal os by 1 cm then 100% sensitivity for PP with 85% specificity
  8. 8. TVS for placenta praevia
  9. 9. Morbidly Adherent Placenta • Loss of echolucent area between bladder and uterus • Bladder line: thinning or interruption of hyperechoic interface between uterine serosa and bladder wall • Placental Lacuna with turbulent high velocity flow
  10. 10. Loss of echolucent area
  11. 11. Succenturiate Lobe
  12. 12. Two placental masses
  13. 13. Use colour flow
  14. 14. Succenturiate lobe Vasa Praevia
  15. 15. Velamentous cord insertion
  16. 16. Mangrove Sign
  17. 17. Placenta membranacea (placenta diffusa):  all the membranes are covered by functioning villi & placental tissue forms on all pheripheral chorion. Sonographically the placenta appears to cover most or the entire uterine wall. Often associated with placental anomalies such as; accreta, increta, percreta & vasa previa.
  18. 18. Vasa Praevia: • Complication in which fetal blood vessels cross over or come in close proximity to the internal os. Associated with velementous cord insertion or placental morphological anomalies ie. Succinuate or bilobate ??Failure of rotation of the embryonic pole to the endometrium
  19. 19. Placenta teddy bear • London-based designer Alex Green (2008) The placenta must first be cured with salt to kill bacteria and remove water. Green then softens the dried organ with a mixture of eggs and tannins. Once he cuts and sews the bears, Green fills them with brown rice. Most end up to be 5 inches tall.
  20. 20. Other placental concerns ? ? ?
  21. 21. ?
  22. 22. ?
  23. 23. Chorionicity
  24. 24. Placenta Grannum Grade 0 Uniform moderate echogenicity Smooth chorionic plate without indentations
  25. 25. 1 • Grade 1 • Mid 2nd trimester –early 3rd trimester (~18-29 wks) • Subtle indentations of chorionic plate • Small, diffuse calcifications (hyperechoic) randomly dispersed in placenta
  26. 26. 2 • Grade 2 • Late 3rd trimester (~30 wks to delivery) • Larger indentations along chorionic plate • Larger calcifications in a “dot-dash” configuration along the basilar plate
  27. 27. 3 • Grade 3 • 39 wks – post dates • Complete indentations of chorionic plate through to the basilar plate creating “cotyledons” (portions of placenta separated by the indentations) • More irregular calcifications with significant shadowing • May signify placental dysmaturity which can cause IUGR • Associated with smoking, chronic hypertension, SLE, diabetes
  28. 28. Unusual stuff • CVS using uterine manipulation with TVS probe

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