PLACENTA &

AMN.FL.

PLACENTA &
AMNIOTIC
FLUID
.

PLACENTA
NUMBER
SITE
GRADING
THCKNESS
RETROPLACENTAL
SPACE.

PLACENTAL SITE
Placental location: state on which uterine
side & how far it lies from the int.os.
Ant. , Post. , Rt lateral , or Lt lateral
Relation to the fundus & int. os.

Placental migration : the apparent

change in placental location during preg.

on serial scans due to differential growth
of the lower ut. segm. relative to the rest of
the uterus (it is the int.os. that moves not
placenta)

PLACENTA PREVIA
Diagnosis made after 15W by visualization of
whole int. os. not distorted by the U BL or
contractions.
False positive :
1. Placental migration
2.Lower uterine contractions
3.Overdistended U BL .compressing ant. against
post. Myomet .
False negative :
1.int.os.obscured by fetal head
2.placenta on lateral uterine wall
3.blood in region of int os ( looks like amniotic
fluid ).

PLACENTA
ACCRETA
Rarely diagnosed
sonographically
Suspected in pl. previa & uterine
scar e.g. prev. C.S.
Lack of visualisation of hypoechoic
myometrium & sonolucent venous
complex under placenta .
With invasive types (percreta)
tissues seen extending to adjacent
organs e.g. U BL.

PLACENTAL
GRADE 0 GRADING
: homogenous all through .

GRADE I : smooth chorionic plate or some

undulations , homogenous substance with few

basal calcifications
GRADE II: marked indentations of the
chorionic plate but these dont reach the basal
plate , more calcifications of the substance .
GRADE III: indentations of the chorionic
plate reach the basal plate
( compartementalization of the placenta )
with increased calcifications & may be
fallouts( echolucent areas in the center of the
cotyledon).

PLACENTAL
THICKNESS
Thickness is measured perpendicular to

the plane of the placenta .

Thickness (mm)=menstrual age (weeks)
Normally < 4.5cm.
Thick ( > 5cm): D M , hydrops,Rh
isoimm., Chronic .Intra Uterine infection,
twins, anaemia.
Thin (< 3cm) : polyhydramnios ,IUGR,
placental insufficiency .
Pseudothickness : retroplacental or
intraplacental haematoma

PERIPLACENTAL
HEMORRHAGE

Retroplacental : high pressure .bleeding

separating basal plate from ut. wall.
Related to spiral art. hmge
Aet. maternal hypertention , drug
abuse.
Subchorionic (marginal) : low pressure
bleeding at periphery of placenta . Related to
hmge of marginal veins which elevate edge of
placenta . Increased with cigarette
smoking .
Subamniotic : on fetal surface of the
placenta .
Caused by rupture of fetal
vessels on placental surface

PERIPLACENTAL
HMGE U/S

U/S picture depends on site, age of hematoma,

amount of bleeding &gestational age .The scan
can be normal .

Retroplacental : hypoechoic area separating

placenta from myometrium .

Subchorionic ( marginal ): marginal separation

of placenta. Membrane elevation ends at
placenta.

D.D. 1.Basal veins: dont form mass &have flow

2.
focal myometrial cont. or fibroid below placenta .

CHORIOANGIOMA
(HEMANGIOMA,HAMARTO
Benign tumor arising
from placental
MA)
capillaries
Most common placental tumor
Grows as a lobulated solitary nodule in
placenta.
If large can obstruct fetal circulation causing
IUGR , hydrops or fetal anoxia .
U/S :single or multiple discrete solid masses
with complex echo on fetal surface of
placenta. Can be associated with
polyhydramnios or fetal anomalies arterial
Doppler flow in angiomatous chorioangioma .

INTRAPLACENTAL
SONOLUCENCIES

DECIDUAL/CHORIONIC SEPTAL CYSTS: at top of

septa from obstructed venous drainage insignificant ,
occur latr in pregnancy.
INTERVILLOUS THROMBOSIS: by fetal bleeding
into intervillous spaces.
MATERNAL VENOUS LAKES :collection of venous bl.
under chorion on fetal side ,insignificant , whirpool
motion of flowing blood on realtime or venous flow
on Doppler
PERIVILOUS&SUBCHORIONIC FIBRIN DEPOSITS:
stasis of maternal bl.in intervillous & subchorionic
spaces & deposition of fibrin.flow can be seen in it .
PLACENTAL INFARCT: avascular triangular areas of
diff.size on mat .side
U/S hypoechoic lesions in placental subst. from 1-10
cm .

AMNIOTIC FLUID
SOURCE

< 15 W : from the amnion , diffusion

of maternal plasma infiltrate through
chorionic plate , exchange of fluids
through fetomaternal circulation.

15 30 W : renal glomeruli filt.

(500ml/day) ,skin diffusion.
>30W :decrease in skin diffusion
with increased in urine output .

Amniotic fluid
volume30 ml .
10 Weeks
20 Weeks
30 Weeks
36 Weeks
38-42 Weeks

300 ml .
600 ml .
1000 ml.
600 ml .

Amniotic fluid
index

Divide uterus into 4 equal quadrants .

Measure MVP( maxim. vertical pocket )
in each quadrant
A F I = sum of 4 quadrants MVPs.
<5 : oligohydramnios
5-8 : decreased
8-18 : normal
18-20 : increased
>20 : polyhydramnios
N.B. 1 cm = 30 ml

POLYHYDRAMNIOS
Subjective diagnosis:

2nd trimester :fluid :fetus ratio>1:1

3rd trimester : excessively large pockets of fluid

Semiquantitative measurement :
Amniotic fluid index > 97th percentile (AFI >20 /24
near term)

Largest pocket of fluid (max. vertical pocket) MVP

> 8 (identify largest pocket measure depth of fluid
avoid fetal parts & cord may use Doppler to avoid
cord ) .
2 diameter pocket (TDP): identify MVP , also
measure width of same pocket
TDP= MVP x width .
(polyhydramnios if TDP>50cm2 )
More than 2000 ml of fluid at term .

POLYHYDRAMNIOS
( AETIOLOGY)
(Inc. sec.of A.F. by large plac. , fetal
malformation. which inc rease urine
excretion.or prevent swallowing ,D M ,idiopathic
).
1.D M
2.GIT anomalies: Atresias .. Obstruction : diaph.H
omphalocele , gastroschisis
3.CNS impaired swallowing : hydroceph .
microceph. facial defects (micrognathia) &
Neural Tube Defects
4.Hydrops ; immune & nonimmune .
5.Cardiac: arrhythmias, Ht f. ,anomalies
6.Chest mass
7.Chromosomal
8.Twin twin transfusion
9.Idiopathic .

OLIGOHYDRAMNIO
(< 400-500 ml at term
)
S
Subjective diagnosis :
2nd trimester : fetus > uterine volume
3rd trimester : diminished pockets of
fluid
Fetal crowding

Semiquantitative :
MVP < 2cm
AFI < 5 or < 5th percentile .
TPD < 15 cm2

OLIGOHYDRAMNI
OS
(AETIOLOGY)
Fetal death
IUGR
Placental insufficiency( PET ,
placental infarcts,
postmaturity )
Renal anomalies
PROM