This document discusses various ultrasound findings related to the placenta: - Images show a normal placenta that is relatively homogeneous in texture with a hypoechoic retroplacental clear space. - Other findings discussed include subchorionic cysts, velamentous cord insertion, vesicular mole, placental calcification, grading of the placenta, chorioangioma, succenturiate placenta, circumvallate placenta, venous lakes, and placenta previa. These images provide examples of ultrasound appearances of various normal and abnormal placental conditions.

1. PLACENTAPLACENTA Dr.DOAA IRAQIDr.DOAA IRAQI

2. Normal placentaNormal placenta
 US image shows aUS image shows a
placenta that isplacenta that is
relativelyrelatively
homogeneous inhomogeneous in
echo-texture.echo-texture.
 The retroplacentalThe retroplacental
clear space isclear space is
hypoechoichypoechoic
(arrowheads).(arrowheads).

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

4. subchorionic cyst of the placentasubchorionic cyst of the placenta.. AlsoAlso
known as membranous cyst, chorionicknown as membranous cyst, chorionic
cystcyst
cystic lesion of thecystic lesion of the
placenta, just belowplacenta, just below
the placentalthe placental
surfacesurface.. Few mobileFew mobile
echoes were seenechoes were seen
within the lesionwithin the lesion..
This finding isThis finding is
generally consideredgenerally considered
to be clinically ofto be clinically of
little significancelittle significance..

5. Velamentous insertion of umbilicalVelamentous insertion of umbilical
cord into placentacord into placenta
 These color dopplerThese color doppler
images showimages show thethe
umbilical cordumbilical cord
inserting into theinserting into the
placental membranesplacental membranes
before reaching thebefore reaching the
placental tissueplacental tissue
properproper..

6. Vesicular moleVesicular mole ((also called Molaralso called Molar
pregnancy or Hydatidiform molepregnancy or Hydatidiform mole)) in 1stin 1st
trimestertrimester
 Sonography of the uterus wasSonography of the uterus was
done in this 1st trimesterdone in this 1st trimester
pregnancypregnancy.. aa)) HyperechoicHyperechoic
mass in the uterine cavitymass in the uterine cavity
with multiple cysticwith multiple cystic
spaces within itspaces within it.. bb)) UterusUterus
is enlargedis enlarged ((bulkybulky)) cc)) TheThe
myometrium is hypoechoicmyometrium is hypoechoic
compared to the contents ofcompared to the contents of
the uterine cavitythe uterine cavity.. TheseThese
appearances can be likened toappearances can be likened to
aa ""snowstormsnowstorm""

7. Vesicular moleVesicular mole

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

9. Placental calcificationPlacental calcification
 This 3rd trimesterThis 3rd trimester
pregnancy showspregnancy shows
extensive calcification ofextensive calcification of
the basal platethe basal plate ((uterine oruterine or
maternal surfacematernal surface)) of theof the
placentaplacenta.. Clinically andClinically and
pathologically, calcificpathologically, calcific
changes of placenta havechanges 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 moderatemoderate
echogenicityechogenicity
SmoothSmooth chorionicchorionic
plate withoutplate without
indentationsindentations

11. Grade 1Grade 1
Grade 1Grade 1
 Mid 2nd trimester –earlyMid 2nd trimester –early
3rd trimester (~18-293rd trimester (~18-29
wks)wks)
 Subtle (thin) indentationsSubtle (thin) indentations
of chorionic plate.of chorionic plate.
 Small, diffuseSmall, diffuse
calcificationscalcifications
(hyperechoic) randomly(hyperechoic) randomly
dispersed in placentadispersed in placenta

12. Grade 2Grade 2
Grade 2Grade 2
 Late 3rd trimester (~30Late 3rd trimester (~30
wks to delivery)wks to delivery)
 Larger indentationsLarger indentations alongalong
chorionic platechorionic plate
 Larger calcificationsLarger calcifications in ain 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 ofComplete indentations of
chorionicchorionic plate through to theplate through to the
basilar plate creatingbasilar plate creating
“cotyledons” (portions of“cotyledons” (portions of
placenta separated by theplacenta separated by the
indentations)indentations)
 More irregular calcificationsMore irregular calcifications withwith
significant shadowingsignificant shadowing
 May signify placentalMay signify placental
dysmaturity which can causedysmaturity 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 inSonography of the placenta in
this 16 week pregnancy showsthis 16 week pregnancy shows
a large, solid mass, that is nona large, solid mass, that is non
calcific and shows mildcalcific and shows mild
vascularity (vascular) andvascularity (vascular) and
excludes placental hematomaexcludes placental hematoma..
and shows many cystic spacesand shows many cystic spaces
within itwithin it.. This tumor of theThis tumor of the
placenta lies close to the cordplacenta lies close to the cord
insertion siteinsertion site.. UltrasoundUltrasound
images of this type of placentalimages of this type of placental
mass are highly suggestive ofmass 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 pregnancyThis was a 3rd trimester pregnancy
showing part of the placenta along theshowing 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 alongand the main part of the placenta along
the posterior wall (PL).the posterior wall (PL). The sucenturiateThe sucenturiate
lobe of placenta is connected to the mainlobe 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 factThis condition is a normal variant and is produced due to the fact
that in this case, the chorionic platethat in this case, the chorionic plate ((fetal surfacefetal surface)) of the placenta isof the placenta is
smaller than the basal platesmaller than the basal plate ((surface in contact with the uterine wallsurface 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 isThis condition is
called circumvallate placenta and usuallycalled circumvallate placenta and usually
causescauses no harm to the fetusno harm to the fetus.. However, itHowever, it
cancan sometimes be associated withsometimes be associated with
increased chances of placental abruptionincreased 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 aThis placenta, in a 28 week pregnancy shows a
large hypoechoiclarge hypoechoic ((almost anechoicalmost anechoic)), measuring, measuring
5 x 3.5 cms5 x 3.5 cms.. in sizein size.. Some particulate matterSome particulate matter
was seen flowing through this area, which waswas seen flowing through this area, which was
closer to the fetal surface of the placentacloser to the fetal surface of the placenta.. TheseThese
ultrasound images suggest a typical appearanceultrasound images suggest a typical appearance
of a large venous lake in the placentaof a large venous lake in the placenta.. ColorColor
Doppler image showed no major flow patternDoppler image showed no major flow pattern
within this placental lakewithin this placental lake.. The fine, echogenicThe fine, echogenic
strands within the lesion appear to be nothingstrands within the lesion appear to be nothing
more than artefacts produced by slow flowingmore 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 theThe above ultrasound and color Doppler images show the
lower margin of the placenta partially covering the internallower margin of the placenta partially covering the internal
os, suggestingos, suggesting partial placenta previapartial placenta previa..

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

29. Placenta previaPlacenta previa
 This ultrasound image showsThis ultrasound image shows
the placenta completelythe placenta completely
covering the internal os , thuscovering the internal os , thus
diagnostic ofdiagnostic of completecomplete
placenta previaplacenta previa..
 Follow up ultrasonography isFollow up ultrasonography is
advisable in all cases of placentaadvisable in all cases of placenta
previa, to look for ascent of theprevia, to look for ascent of the
placenta to a higher position dueplacenta to a higher position due
to the growth of the uterusto the growth of the uterus.. SuchSuch
cases of placenta previacases of placenta previa ((bothboth
partial and completepartial and complete)) areare inin
danger of hemorrhagedanger of hemorrhage
((antepartumantepartum)) and are advisedand are advised
rest to prevent thisrest to prevent this..

30. ????????

31. placental abruptionplacental abruption..
Crescent ofCrescent of avascularavascular
low echogenicitylow echogenicity
between placenta andbetween placenta and
uterine wall consistentuterine wall consistent
withwith placentalplacental
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 showThe above ultrasound images show a post partum uterus ona post partum uterus on
transabdominal sonographytransabdominal sonography.. There is a hyperechoicThere 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 theThe 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-- thethe
anterior myometrium is thicker whilst the posterior wall of the uterusanterior 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 outAbsence 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 ofThe single most important sign of retained products of
conception is the large endometrialconception is the large endometrial massmass.. Other signs ofOther signs of
retained placenta or products include complex fluid orretained placenta or products include complex fluid or
thickened endometriumthickened 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 withThis is a 3rd trimester pregnancy with
ultrasound images showingultrasound images showing two parts oftwo parts of
the placenta along the anterior andthe placenta along the anterior and
posterior walls of the uterus, connectedposterior walls of the uterus, connected
by a thin bridge of placental tissueby a thin bridge of placental tissue.. ThisThis
kind of sonographic appearance iskind of sonographic appearance is
typical of bilobed placentatypical of bilobed placenta..

38. Twin gestationsTwin gestations
 T sign in aT sign in a
MonochorionicMonochorionic--diamnioticdiamniotic
Twin GestationTwin Gestation
 Twin peak sign inTwin peak sign in
DICHORIONICDICHORIONIC--DIAMNIOTICDIAMNIOTIC
TWIN GESTATIONSTWIN GESTATIONS..

39. Twin gestationsTwin gestations

40. Placental hematomaPlacental hematoma
 aa)) US image shows aUS image shows a
rounded collection ofrounded collection of
mixedmixed--echogenicityechogenicity
materialmaterial ((arrowheadsarrowheads))
deep to the chorion alongdeep to the chorion along
the lateral margin of thethe lateral margin of the
placentaplacenta..
 There isThere is no internalno internal
Doppler signal to suggestDoppler signal to suggest
blood flowblood flow.. ThisThis
appearance is consistentappearance is consistent
with a subchorionicwith a subchorionic
hematomahematoma.. ((bb

41. placenta accretaplacenta accreta
)) US images showUS images show disruption of thedisruption of the
normal hypoechoicnormal hypoechoic
myometriummyometrium ((blackblack
arrowheadsarrowheads)) by invadingby invading
placental tissueplacental tissue ((whitewhite
arrowheadsarrowheads).). BB == bladderbladder,, PP ==
placentaplacenta.. ((bb)) Sagittal SSFSE MRSagittal SSFSE MR
image shows intermediateimage shows intermediate--signalsignal--
intensity placental tissueintensity placental tissue
((arrowheadarrowhead)) invading the normalinvading the normal
dark myometriumdark myometrium ((MM)) in the lowerin the lower
uterine segment, findingsuterine segment, findings
consistent with placenta accretaconsistent with placenta accreta..
((cc)) Sagittal SSFSE MR imageSagittal SSFSE MR image
shows obliteration of the normalshows obliteration of the normal
dark myometriumdark myometrium ((MM)) posteriorly,posteriorly,
with placental tissue ofwith placental tissue of
heterogeneous signal intensityheterogeneous signal intensity
((arrowheadsarrowheads)) penetrating the fullpenetrating the full
thickness of the uterine wallthickness of the uterine wall.. ThisThis
appearance is indicative ofappearance is indicative of
placenta percretaplacenta percreta..

42. placenta accretaplacenta accreta
US images show disruption of theUS images show disruption of the
normal hypoechoic myometriumnormal hypoechoic myometrium
((black arrowheadsblack arrowheads)) by invadingby invading
placental tissueplacental tissue ((whitewhite
arrowheadsarrowheads).). BB == bladderbladder,, PP ==
placentaplacenta.. ((bb)) Sagittal SSFSE MRSagittal SSFSE MR
image shows intermediateimage shows intermediate--signalsignal--
intensity placental tissueintensity placental tissue
((arrowheadarrowhead)) invading the normalinvading the normal
dark myometriumdark myometrium ((MM)) in the lowerin the lower
uterine segment, findingsuterine segment, findings
consistent with placenta accretaconsistent with placenta accreta..
((cc)) Sagittal SSFSE MR imageSagittal SSFSE MR image
shows obliteration of the normalshows obliteration of the normal
dark myometriumdark myometrium ((MM)) posteriorly,posteriorly,
with placental tissue ofwith placental tissue of
heterogeneous signal intensityheterogeneous signal intensity
((arrowheadsarrowheads)) penetrating the fullpenetrating the full
thickness of the uterine wallthickness of the uterine wall.. ThisThis
appearance is indicative ofappearance is indicative of
placenta percretaplacenta percreta..

43. placenta accretaplacenta accreta
 US images show disruption of theUS images show disruption of the
normal hypoechoic myometriumnormal hypoechoic myometrium
((black arrowheadsblack arrowheads)) by invadingby invading
placental tissueplacental tissue ((whitewhite
arrowheadsarrowheads).). BB == bladderbladder,, PP ==
placentaplacenta.. ((bb)) Sagittal SSFSE MRSagittal SSFSE MR
image shows intermediateimage shows intermediate--signalsignal--
intensity placental tissueintensity placental tissue
((arrowheadarrowhead)) invading the normalinvading the normal
dark myometriumdark myometrium ((MM)) in the lowerin the lower
uterine segment, findingsuterine segment, findings
consistent with placenta accretaconsistent with placenta accreta..
((cc)) Sagittal SSFSE MR imageSagittal SSFSE MR image
shows obliteration of the normalshows obliteration of the normal
dark myometriumdark myometrium ((MM)) posteriorly,posteriorly,
with placental tissue ofwith placental tissue of
heterogeneous signal intensityheterogeneous signal intensity
((arrowheadsarrowheads)) penetrating the fullpenetrating the full
thickness of the uterine wallthickness of the uterine wall.. ThisThis
appearance is indicative ofappearance is indicative of
placenta percretaplacenta percreta..