The document discusses various ultrasound findings related to the placenta. It describes normal placenta appearance and grading. It also describes various placental pathologies like subchorionic cyst, velamentous cord insertion, molar pregnancy, placental chorioangioma, succenturiate and circumvallate placenta, venous lake, and placenta previa. It also discusses placental abruption and retained products of conception. In summary, the document provides an overview of ultrasound evaluation of the placenta with descriptions of normal variants and various placental abnormalities.

1. PLACENTA
PLACENTA Dr.DOAA IRAQI
Dr.DOAA IRAQI

2. Normal placenta
Normal placenta
 US image shows a
US image shows a
placenta that is
placenta that is
relatively
relatively
homogeneous in
homogeneous in
echo-texture.
echo-texture.
 The retroplacental
The retroplacental
clear space is
clear space is
hypoechoic
hypoechoic
(arrowheads).
(arrowheads).

3. Normal placenta
Normal placenta
 Normal placenta
Normal placenta.
. (
(a
a)
) US
US
image shows a placenta
image shows a placenta (
(P
P)
)
that is relatively homogeneous
that is relatively homogeneous
in echo
in echo-
-texture
texture.
.
 The
The retroplacental clear space
retroplacental clear space
is hypoechoic
is hypoechoic (
(arrowheads
arrowheads).
).
(
(b
b)
) Sagittal single
Sagittal single-
-shot fast
shot fast
spin
spin-
-echo
echo (
(SSFSE
SSFSE)
) T2-
T2-
weighted MR image shows a
weighted MR image shows a
placenta
placenta (
(P
P)
) with intermediate
with intermediate
signal intensity
signal intensity.
. The dark line
The dark line
represents the retroplacental
represents the retroplacental
clear space
clear space (
(arrowheads
arrowheads).
).

4. subchorionic cyst of the placenta
subchorionic cyst of the placenta.
. Also
Also
known as membranous cyst, chorionic
known as membranous cyst, chorionic
cyst
cyst
cystic lesion of the
cystic lesion of the
placenta, just below
placenta, just below
the placental
the placental
surface
surface.
. Few mobile
Few mobile
echoes were seen
echoes were seen
within the lesion
within the lesion.
.
This finding is
This finding is
generally considered
generally considered
to be clinically of
to be clinically of
little significance
little significance.
.

5. Velamentous insertion of umbilical
Velamentous insertion of umbilical
cord into placenta
cord into placenta
 These color doppler
These color doppler
images show
images show the
the
umbilical cord
umbilical cord
inserting into the
inserting into the
placental membranes
placental membranes
before reaching the
before reaching the
placental tissue
placental tissue
proper
proper.
.

6. Vesicular mole
Vesicular mole (
(also called Molar
also called Molar
pregnancy or Hydatidiform mole
pregnancy or Hydatidiform mole)
) in 1st
in 1st
trimester
trimester
 Sonography of the uterus was
Sonography of the uterus was
done in this 1st trimester
done in this 1st trimester
pregnancy
pregnancy.
. a
a)
) Hyperechoic
Hyperechoic
mass in the uterine cavity
mass in the uterine cavity
with multiple cystic
with multiple cystic
spaces within it
spaces within it.
. b
b)
) Uterus
Uterus
is enlarged
is enlarged (
(bulky
bulky)
) c
c)
) The
The
myometrium is hypoechoic
myometrium is hypoechoic
compared to the contents of
compared to the contents of
the uterine cavity
the uterine cavity.
. These
These
appearances can be likened to
appearances can be likened to
a
a "
"snowstorm
snowstorm"
"

7. Vesicular mole
Vesicular mole

8. Vesicular mole
Vesicular mole
CT image of a patient with a
CT image of a patient with a β
β-
-
hCG level of 620,000 mIU
hCG level of 620,000 mIU/
/mL
mL
shows :
shows :
 a predominantly
a predominantly low
low-
-
attenuation mass in the uterus
attenuation mass in the uterus
with heterogeneous foci of
with heterogeneous foci of
internal enhancement
internal enhancement.
.
 Pathologic examination
Pathologic examination
demonstrated a complete mole
demonstrated a complete mole
without myometrial invasion
without myometrial invasion.
.
 enlarged ovary with theca
enlarged ovary with theca
lutein cysts
lutein cysts.
. CT can be used to
CT can be used to
assess for invasion by
assess for invasion by
gestational trophoblastic
gestational trophoblastic
disease
disease.
.

9. Placental calcification
Placental calcification
 This 3rd trimester
This 3rd trimester
pregnancy shows
pregnancy shows
extensive calcification of
extensive calcification of
the basal plate
the basal plate (
(uterine or
uterine or
maternal surface
maternal surface)
) of the
of the
placenta
placenta.
. Clinically and
Clinically and
pathologically, calcific
pathologically, calcific
changes of placenta have
changes of placenta have
no significance
no significance.
.

10. Placenta-Grading
Placenta-Grading

Grade 0
Grade 0
Late 1st trimester-
Late 1st trimester-
early 2nd trimester
early 2nd trimester
Uniform
Uniform moderate
moderate
echogenicity
echogenicity
Smooth
Smooth chorionic
chorionic
plate without
plate without
indentations
indentations

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

12. Grade 2
Grade 2
Grade 2
Grade 2
 Late 3rd trimester (~30
Late 3rd trimester (~30
wks to delivery)
wks to delivery)
 Larger indentations
Larger indentations along
along
chorionic plate
chorionic plate
 Larger calcifications
Larger calcifications in a
in a
“dot-dash” configuration
“dot-dash” configuration
along the basilar plate
along the basilar plate

13. Grade 3
Grade 3
Grade 3
Grade 3
 39 wks – post dates
39 wks – post dates
 Complete indentations of
Complete indentations of
chorionic
chorionic plate through to the
plate through to the
basilar plate creating
basilar plate creating
“cotyledons” (portions of
“cotyledons” (portions of
placenta separated by the
placenta separated by the
indentations)
indentations)
 More irregular calcifications
More irregular calcifications with
with
significant shadowing
significant shadowing
 May signify placental
May signify placental
dysmaturity which can cause
dysmaturity which can cause
IUGR
IUGR
 Associated with smoking,
Associated with smoking,
chronic hypertension, SLE,
chronic hypertension, SLE,
diabetes
diabetes

15. placental chorioangioma
placental chorioangioma
 Sonography of the placenta in
Sonography of the placenta in
this 16 week pregnancy shows
this 16 week pregnancy shows
a large, solid mass, that is non
a large, solid mass, that is non
calcific and shows mild
calcific and shows mild
vascularity (vascular) and
vascularity (vascular) and
excludes placental hematoma
excludes placental hematoma.
.
and shows many cystic spaces
and shows many cystic spaces
within it
within it.
. This tumor of the
This tumor of the
placenta lies close to the cord
placenta lies close to the cord
insertion site
insertion site.
. Ultrasound
Ultrasound
images of this type of placental
images of this type of placental
mass are highly suggestive of
mass are highly suggestive of
placental chorioangioma
placental chorioangioma.
.

16. placental chorioangioma
placental chorioangioma

17. Succenturiate placenta
Succenturiate placenta

18. Succenturiate placenta
Succenturiate placenta

19. Succenturiate placenta
Succenturiate placenta
This was a 3rd trimester pregnancy
This was a 3rd trimester pregnancy
showing part of the placenta along the
showing 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 along
and the main part of the placenta along
the posterior wall (PL).
the posterior wall (PL). The sucenturiate
The sucenturiate
lobe of placenta is connected to the main
lobe of placenta is connected to the main
placenta by a string of blood vessels.
placenta by a string of blood vessels.

20. Circumvallate placenta
Circumvallate placenta
Circumvallate placenta
Circumvallate placenta

21. Circumvallate placenta
Circumvallate placenta
Infolding of the margins of the placenta
Infolding of the margins of the placenta.
.
This condition is a normal variant and is produced due to the fact
This condition is a normal variant and is produced due to the fact
that in this case, the chorionic plate
that in this case, the chorionic plate (
(fetal surface
fetal surface)
) of the placenta is
of the placenta is
smaller than the basal plate
smaller than the basal plate (
(surface in contact with the uterine wall
surface in contact with the uterine wall
or decidua
or decidua)
) of the placenta with resultant shouldering or infolding
of the placenta with resultant shouldering or infolding/
/
rolling of the placental margins
rolling of the placental margins.
. This condition is
This condition is
called circumvallate placenta and usually
called circumvallate placenta and usually
causes
causes no harm to the fetus
no harm to the fetus.
. However, it
However, it
can
can sometimes be associated with
sometimes be associated with
increased chances of placental abruption
increased chances of placental abruption
and hemorrhage.
and hemorrhage.

22. Circumvallate placenta
Circumvallate placenta

23. Placental venous lake
Placental venous lake

24. Placental venous lake
Placental venous lake
This placenta, in a 28 week pregnancy shows a
This placenta, in a 28 week pregnancy shows a
large hypoechoic
large hypoechoic (
(almost anechoic
almost anechoic)
), measuring
, measuring
5 x 3.5 cms
5 x 3.5 cms.
. in size
in size.
. Some particulate matter
Some particulate matter
was seen flowing through this area, which was
was seen flowing through this area, which was
closer to the fetal surface of the placenta
closer to the fetal surface of the placenta.
. These
These
ultrasound images suggest a typical appearance
ultrasound images suggest a typical appearance
of a large venous lake in the placenta
of a large venous lake in the placenta.
. Color
Color
Doppler image showed no major flow pattern
Doppler image showed no major flow pattern
within this placental lake
within this placental lake.
. The fine, echogenic
The fine, echogenic
strands within the lesion appear to be nothing
strands within the lesion appear to be nothing
more than artefacts produced by slow flowing
more than artefacts produced by slow flowing
blood within the lesion
blood within the lesion.
.

25. Placenta previa
Placenta previa

26. Placenta previa
Placenta previa

27. The above ultrasound and color Doppler images show the
The above ultrasound and color Doppler images show the
lower margin of the placenta partially covering the internal
lower margin of the placenta partially covering the internal
os, suggesting
os, suggesting partial placenta previa
partial placenta previa
.
.

28. Placenta previa
Placenta previa
 One point to be noted is that placenta previa is
One point to be noted is that placenta previa is
diagnosed in the 2nd and 3rd trimester of
diagnosed in the 2nd and 3rd trimester of
pregnancy, and that normal uterine contractions
pregnancy, and that normal uterine contractions
can cause the placenta to be
can cause the placenta to be "
"pushed
pushed"
" lower
lower
down its normal position, creating an
down its normal position, creating an
appearance of placenta previa
appearance of placenta previa (
(a false positive
a false positive
diagnosis of placenta previa
diagnosis of placenta previa).
). Hence it is
Hence it is
advisable to repeat the ultrasound scan after 30
advisable to repeat the ultrasound scan after 30
minutes to exclude a false diagnosis of this
minutes to exclude a false diagnosis of this
condition
condition.
.

29. Placenta previa
Placenta previa
 This ultrasound image shows
This ultrasound image shows
the placenta completely
the placenta completely
covering the internal os , thus
covering the internal os , thus
diagnostic of
diagnostic of complete
complete
placenta previa
placenta previa.
.
 Follow up ultrasonography is
Follow up ultrasonography is
advisable in all cases of placenta
advisable in all cases of placenta
previa, to look for ascent of the
previa, to look for ascent of the
placenta to a higher position due
placenta to a higher position due
to the growth of the uterus
to the growth of the uterus.
. Such
Such
cases of placenta previa
cases of placenta previa (
(both
both
partial and complete
partial and complete)
) are
are in
in
danger of hemorrhage
danger of hemorrhage
(
(antepartum
antepartum)
) and are advised
and are advised
rest to prevent this
rest to prevent this.
.

30. ????
????

31. placental abruption
placental abruption
.
.
Crescent of
Crescent of avascular
avascular
low echogenicity
low echogenicity
between placenta and
between placenta and
uterine wall consistent
uterine wall consistent
with
with placental
placental
abruption
abruption.
.

32. placental abruption
placental abruption

33. Retained products of conception
Retained products of conception/
/
retained placenta
retained placenta

34. Retained products of conception
Retained products of conception/
/
retained placenta
retained placenta
 The above ultrasound images show
The above ultrasound images show a post partum uterus on
a post partum uterus on
transabdominal sonography
transabdominal sonography.
. There is a hyperechoic
There is a hyperechoic
mass within the endometrial cavity measuring 8 x 5 cms
mass within the endometrial cavity measuring 8 x 5 cms.
.
The color Doppler ultrasound image shows poor vascularity of the
The color Doppler ultrasound image shows poor vascularity of the
mass and the endometrium
mass and the endometrium.
.
 note that the endometrial mass is eccentric within the cavity
note that the endometrial mass is eccentric within the cavity-
- the
the
anterior myometrium is thicker whilst the posterior wall of the uterus
anterior myometrium is thicker whilst the posterior wall of the uterus
is thinner
is thinner.
. The placenta was not expelled at the time of delivery
The placenta was not expelled at the time of delivery.
.
 Absence of vascularity or poor flow does not rule out
Absence of vascularity or poor flow does not rule out
retained products of conception
retained products of conception/
/ retained placenta
retained placenta.
.
 The single most important sign of retained products of
The single most important sign of retained products of
conception is the large endometrial
conception is the large endometrial mass
mass.
. Other signs of
Other signs of
retained placenta or products include complex fluid or
retained placenta or products include complex fluid or
thickened endometrium
thickened endometrium (
(more than 10 mm
more than 10 mm.
.(
(.
.

35. Bilobed placenta
Bilobed placenta: (
: (bilobate placenta
bilobate placenta
(
(

36. Bilobed placenta
Bilobed placenta:
: bilobate placenta
bilobate placenta

37. Bilobed placenta
Bilobed placenta: (
: (bilobate placenta
bilobate placenta
(
(
This is a 3rd trimester pregnancy with
This is a 3rd trimester pregnancy with
ultrasound images showing
ultrasound images showing two parts of
two parts of
the placenta along the anterior and
the placenta along the anterior and
posterior walls of the uterus, connected
posterior walls of the uterus, connected
by a thin bridge of placental tissue
by a thin bridge of placental tissue.
. This
This
kind of sonographic appearance is
kind of sonographic appearance is
typical of bilobed placenta
typical of bilobed placenta.
.

38. Twin gestations
Twin gestations
 T sign in a
T sign in a
Monochorionic
Monochorionic-
-diamniotic
diamniotic
Twin Gestation
Twin Gestation
 Twin peak sign in
Twin peak sign in
DICHORIONIC
DICHORIONIC-
-DIAMNIOTIC
DIAMNIOTIC
TWIN GESTATIONS
TWIN GESTATIONS.
.

39. Twin gestations
Twin gestations

40. Placental hematoma
Placental hematoma
 a
a)
) US image shows a
US image shows a
rounded collection of
rounded collection of
mixed
mixed-
-echogenicity
echogenicity
material
material (
(arrowheads
arrowheads)
)
deep to the chorion along
deep to the chorion along
the lateral margin of the
the lateral margin of the
placenta
placenta.
.
 There is
There is no internal
no internal
Doppler signal to suggest
Doppler signal to suggest
blood flow
blood flow.
. This
This
appearance is consistent
appearance is consistent
with a subchorionic
with a subchorionic
hematoma
hematoma.
. (
(b
b

41. placenta accreta
placenta accreta
)
) US images show
US images show disruption of the
disruption of the
normal hypoechoic
normal hypoechoic
myometrium
myometrium (
(black
black
arrowheads
arrowheads)
) by invading
by invading
placental tissue
placental tissue (
(white
white
arrowheads
arrowheads).
). B
B =
= bladder
bladder,
, P
P =
=
placenta
placenta.
. (
(b
b)
) Sagittal SSFSE MR
Sagittal SSFSE MR
image shows intermediate
image shows intermediate-
-signal
signal-
-
intensity placental tissue
intensity placental tissue
(
(arrowhead
arrowhead)
) invading the normal
invading the normal
dark myometrium
dark myometrium (
(M
M)
) in the lower
in the lower
uterine segment, findings
uterine segment, findings
consistent with placenta accreta
consistent with placenta accreta.
.
(
(c
c)
) Sagittal SSFSE MR image
Sagittal SSFSE MR image
shows obliteration of the normal
shows obliteration of the normal
dark myometrium
dark myometrium (
(M
M)
) posteriorly,
posteriorly,
with placental tissue of
with placental tissue of
heterogeneous signal intensity
heterogeneous signal intensity
(
(arrowheads
arrowheads)
) penetrating the full
penetrating the full
thickness of the uterine wall
thickness of the uterine wall.
. This
This
appearance is indicative of
appearance is indicative of
placenta percreta
placenta percreta.
.

42. placenta accreta
placenta accreta
US images show disruption of the
US images show disruption of the
normal hypoechoic myometrium
normal hypoechoic myometrium
(
(black arrowheads
black arrowheads)
) by invading
by invading
placental tissue
placental tissue (
(white
white
arrowheads
arrowheads).
). B
B =
= bladder
bladder,
, P
P =
=
placenta
placenta.
. (
(b
b)
) Sagittal SSFSE MR
Sagittal SSFSE MR
image shows intermediate
image shows intermediate-
-signal
signal-
-
intensity placental tissue
intensity placental tissue
(
(arrowhead
arrowhead)
) invading the normal
invading the normal
dark myometrium
dark myometrium (
(M
M)
) in the lower
in the lower
uterine segment, findings
uterine segment, findings
consistent with placenta accreta
consistent with placenta accreta.
.
(
(c
c)
) Sagittal SSFSE MR image
Sagittal SSFSE MR image
shows obliteration of the normal
shows obliteration of the normal
dark myometrium
dark myometrium (
(M
M)
) posteriorly,
posteriorly,
with placental tissue of
with placental tissue of
heterogeneous signal intensity
heterogeneous signal intensity
(
(arrowheads
arrowheads)
) penetrating the full
penetrating the full
thickness of the uterine wall
thickness of the uterine wall.
. This
This
appearance is indicative of
appearance is indicative of
placenta percreta
placenta percreta.
.

43. placenta accreta
placenta accreta
 US images show disruption of the
US images show disruption of the
normal hypoechoic myometrium
normal hypoechoic myometrium
(
(black arrowheads
black arrowheads)
) by invading
by invading
placental tissue
placental tissue (
(white
white
arrowheads
arrowheads).
). B
B =
= bladder
bladder,
, P
P =
=
placenta
placenta.
. (
(b
b)
) Sagittal SSFSE MR
Sagittal SSFSE MR
image shows intermediate
image shows intermediate-
-signal
signal-
-
intensity placental tissue
intensity placental tissue
(
(arrowhead
arrowhead)
) invading the normal
invading the normal
dark myometrium
dark myometrium (
(M
M)
) in the lower
in the lower
uterine segment, findings
uterine segment, findings
consistent with placenta accreta
consistent with placenta accreta.
.
(
(c
c)
) Sagittal SSFSE MR image
Sagittal SSFSE MR image
shows obliteration of the normal
shows obliteration of the normal
dark myometrium
dark myometrium (
(M
M)
) posteriorly,
posteriorly,
with placental tissue of
with placental tissue of
heterogeneous signal intensity
heterogeneous signal intensity
(
(arrowheads
arrowheads)
) penetrating the full
penetrating the full
thickness of the uterine wall
thickness of the uterine wall.
. This
This
appearance is indicative of
appearance is indicative of
placenta percreta
placenta percreta.
.