This document provides information on placental grading and ultrasound appearance of the placenta. It describes the four grades of placental maturity based on ultrasound findings. Grade 0 is seen in the first trimester and is characterized by a smooth echopattern. Grades 1-3 are seen later in pregnancy and are distinguished by the presence and pattern of calcifications. Abnormal placenta features like circumvallate, succenturiate lobe, and membranous placentas are also described. The document concludes with descriptions of twinning ultrasound signs and examples of placental hematomas.

1. GRANNUM CLASSIFICATION PLACENTAL GRADING MERCURY IMAGING INSTITUTE SCO 172-173 SEC 9C CHANDIGARHMERCURY IMAGING CENTRE SCO 16-17 SEC 20D CHANDIGARHPLACENTA 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 OLATE FIRST TRIMESTER TO EARLY SECOND TRIMESTERSMOOTH ECHOPATTERN OF THE PLACENTAL PARENCHYMA . NO CALCIFICATION IN THE CHORIONIC / BASAL PLATE . NO INDENTATIONS OF THE CHORIONIC PLATE. ( SMOOTH CHORIONIC PLATE ).

4. GRADE 1MID 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 2LATE 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 3LATE 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.

7. BRIEF ABOUT PLACENTAGRADE THREE MATURITYMAY SIGNIFY PLACENTAL DYSMATURITY ( CAN LEAD TO IUGR)

8. 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.

9. SUBJECTIVE FACTORCALCIFICATION associations with………….Fetal distress in labor Poor perinatal outcome, Maternal smoking First-time mothers Preeclampsia,PLANE OF THE VIEW.GAIN FACTORSSETTINGSEXPERIENCE OF THE OBSERVER.TEXTURE OF PLACENTAINEDNTATIONS OF THE CHORIONIC PLATECALFICATION INTERPRETATION.

10. Normal placenta.NORMAL PLACENTA PLACENTAL SIZEExpressed In terms of thickness in the Midportion of organ ( 2 to 4cm).

11. Thinning : systemic vascular / haematological disorder

12. Thickening : Fetal hydrops , antepartum infections , maternal diabetes , maternal anemia©2009 by Radiological Society of North America

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

14. SUCCENTURATE LOBE PLACENTASMALL LOBE SEPARATED FROM THE MAIN PLACENTAL MASS.©2009 by Radiological Society of North America

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

16. TWINNING- SOME RULES………..TWO YOLK SACS TWO AMNIONTWO PLACENTA TWO CHORIONT SIGN – MONOCHORIONIC DIAMNIOTICTWIN BEAK SIGN- DIAMNIOTIC / DICHORIONICINTERTWIN MEMBERANE>2 MM ( DIAMNIOTIC / DICHORIONIC)<2 MM ( DIAMNIOTIC)

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

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

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

20. CHORIOAMNIOTIC SEPARATION.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 ©2009 by Radiological Society of North America

21. PLACENTAL HAEMATOMA SITEPREPLACENTAL ( FETAL)( SUBCHORIONIC)INTRAPLACENTALRETROPLACENTAL ( MATERNAL).