Placental grading

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Placental grading

  1. 1. GRANNUM CLASSIFICATION PLACENTAL GRADING <br />MERCURY IMAGING INSTITUTE <br />SCO 172-173 SEC 9C CHANDIGARH<br />MERCURY IMAGING CENTRE <br />SCO 16-17 SEC 20D CHANDIGARH<br />PLACENTA MEANS FLAT CAKE ( Greek –plakuos)<br />
  2. 2. USG APPEARANCE <br /> DECIDUA BASALIS – REGION OF THE BASAL PLATE ( HYPOECHOIC APPEARANCE).<br />FETAL SURFACE – ( CHORIOAMNIOTIC MEMBERANE ) ( BRIGHT SPECULAR REFLECTOR)<br />
  3. 3. GRADE O<br />LATE FIRST TRIMESTER TO EARLY SECOND TRIMESTER<br />SMOOTH ECHOPATTERN OF THE PLACENTAL PARENCHYMA . NO CALCIFICATION IN THE CHORIONIC / BASAL PLATE . NO INDENTATIONS OF THE CHORIONIC PLATE. ( SMOOTH CHORIONIC PLATE ).<br />
  4. 4. GRADE 1<br />MID SECOND TRIMESTER TO EARLY THIRD TRIMESTER. ( 18 TO 29 WKS)<br />SMALL DIFFUSE CALCIFICATIONS ( HYPERECHOIC AREAS ) ( 2mm to 4mm ) RANDOMLY DISTRIBUTED IN PLACENTA. SUBTLE INDENTATIONS OF THE CHORIONIC PLATE. <br />
  5. 5. GRADE 2<br />LATE THIRD TRIMESTER TILL DELIVERY ( 30WKS TILL DELIVERY)<br />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. <br />
  6. 6. GRADE 3<br />LATE THIRD TRIMESTER TILL DELIVERY ( 39 WKS – POST DATES)<br />Irregular calcifications with significant shadowing<br />Complete indentation of the chorionic plate through to the basilar plate creating cotyledons.<br />
  7. 7. BRIEF ABOUT PLACENTA<br />GRADE THREE MATURITY<br /><ul><li>MAY SIGNIFY PLACENTAL DYSMATURITY ( CAN LEAD TO IUGR)
  8. 8. ASSOCIATED WITH -CHRONIC SMOKING ,HYPERTENSION DIABETES, SLE</li></ul> TWO VESSESL FROM THE FETAL SIDE ( UMBILICAL ARTERIES) SUPPLY THE PLACENTA ( FET AL HYPOGASTRIC ARTERIES).<br />ONE UMBILICL VEIN CARRIES BLOOD BACK TO FETUS TO JOIN LEFT FETAL PORTAL VEIN.<br />MATERAL SIDE ARTERIES CROSSING MYOMETRIUM ( ARCUTAE ARTERIES) , THROUGH BASILAR ARTERY ( SPIRAL ARTERIES).<br />MATERANL VENOUS CHANNELS IN THE PLACENTA ARE CALLED AS MATERNAL LAKES. <br />THICKNESS OF PLACENTA IN THE MID POSITION / CORD INSERTION IS 2 TO 4CM.<br />
  9. 9. SUBJECTIVE FACTOR<br />CALCIFICATION associations with………….<br />Fetal distress in labor <br />Poor perinatal outcome,<br /> Maternal smoking <br />First-time mothers <br />Preeclampsia,<br />PLANE OF THE VIEW.<br />GAIN FACTORS<br />SETTINGS<br />EXPERIENCE OF THE OBSERVER.<br />TEXTURE OF PLACENTA<br />INEDNTATIONS OF THE CHORIONIC PLATE<br />CALFICATION INTERPRETATION.<br />
  10. 10. Normal placenta.<br />NORMAL PLACENTA <br />PLACENTAL SIZE<br /><ul><li>Expressed In terms of thickness in the Midportion of organ ( 2 to 4cm).
  11. 11. Thinning : systemic vascular / haematological disorder
  12. 12. Thickening : Fetal hydrops , antepartum infections , maternal diabetes , maternal anemia</li></ul>©2009 by Radiological Society of North America<br />
  13. 13. CIRCUMVALLATE PLACENTA. BASAL PLATE SMALLER THAN CHORIONIC PLATE<br />©2009 by Radiological Society of North America<br />
  14. 14. SUCCENTURATE LOBE PLACENTA<br />SMALL LOBE SEPARATED FROM THE MAIN PLACENTAL MASS.<br />©2009 by Radiological Society of North America<br />
  15. 15. PLACENTA MEMBRANACEA. THIN MEMBERANOUS PLACENTA<br />©2009 by Radiological Society of North America<br />
  16. 16. TWINNING- SOME RULES………..<br />TWO YOLK SACS <br />TWO AMNION<br />TWO PLACENTA <br />TWO CHORION<br />T SIGN – MONOCHORIONIC DIAMNIOTIC<br />TWIN BEAK SIGN- DIAMNIOTIC / DICHORIONIC<br />INTERTWIN MEMBERANE<br />>2 MM ( DIAMNIOTIC / DICHORIONIC)<br /><2 MM ( DIAMNIOTIC)<br />
  17. 17. TWIN PEAK SIGN DICHORIONIC-DIAMNIOTIC TWIN GESTATIONS.<br />©2009 by Radiological Society of North America<br />
  18. 18. T SIGN IN A MONOCHORIONIC-DIAMNIOTIC TWIN GESTATION.<br />©2009 by Radiological Society of North America<br />
  19. 19. BILOBED PLACENTA.<br />©2009 by Radiological Society of North America<br />
  20. 20. CHORIOAMNIOTIC SEPARATION.<br />PLACENTAL MEMBERANE (CHORION), <br />FETAL MEMBERANE <br /> (AMNION )<br />REMAIN SEPRATE AT GESTATION FUSE AT 14WKS .<br /> SEPARATION LATER THAN THIS – CHORIOAMNION SEPARATION. FOCAL , DIFFUSE . <br />SEQUAEL TO PRIOR INTERVENTION / AMNIOCENTESIS. CAN BE ASSOCIATED WITH CHROMOSOMAL / DEVELOPMENTAL ABNORMALITIES <br />©2009 by Radiological Society of North America<br />
  21. 21. PLACENTAL HAEMATOMA SITE<br />PREPLACENTAL ( FETAL)<br />( SUBCHORIONIC)<br />INTRAPLACENTAL<br />RETROPLACENTAL ( MATERNAL).<br />

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