Grade That Placenta
This grade of placenta is classified during the late first trimester and early second trimester, with uniform moderate echogenicity and a smooth chorionic plate without indentations
Grade 0 placenta
This type of cord insertion is present when the insertion of the umbilical cord is within <2 cm from the placental margin
Marginal cord insertion
If the placenta is within this many centimeters of the internal cervical os, then it is known as a low-lying placenta
2cm
This is a morphological variation of a placenta where one or more smaller accessory placental lobes develop separately from the main placental disc, usually connected by fetal vessels
A succenturiate placenta
This grade of placenta has occasional parenchymal calcification/hyperechoic areas, and subtle indentations of chorionic plate
Grade I placenta
Velamentous cord insertion is a pregnancy complication where the umbilical cord inserts into the membranes surrounding the placenta, which causes the blood vessels in the cord to not fully be protected by this, which is a gelatin-like substance.
Wharton's jelly
There are multiple factors that can increase the incidence of placenta previa, name three
- Number of previous cesarean sections
- Number of previous spontaneous deliveries
- the number of elective terminations
- prior uterine surgery
- maternal parity
- maternal age
- smoking
- cocaine use
- multiple gestations
- prior placenta previa
Placental abruption refers to a premature separation of the normally implanted placenta, and is a significant cause of third-trimester bleeding/antepartum hemorrhage. Name two risk factors for placental abruption.
- pre-eclampsia and maternal hypertension: up to 50% of cases
- previous placental abruption (recurrence rate 19-25%)
- prolonged rupture of membranes
- maternal age: pregnant women who are younger than 20 years or older than 35 years are at greater risk
- maternal trauma
- cigarette smoking
- cocaine or other amphetamine use
- thrombophilia
- multiparity
- multifetal pregnancies
This grade of placenta is classified by significant basal plate calcification, and an early progression to this is concerning and sometimes associated with placental insufficiency
Grade III placenta
This cord insertion, a rare umbilical cord abnormality, is when the vessels branch before reaching the placenta.
Furcate cord insertion
There are multiple ultrasound findings that can be visualized with placenta accreta, name two
- Loss of Retroplacental Space
- Myometrial Thinning
- Placental Lacunae
- Loss of Bladder Wall-Uterine Interface:
- Abnormal Vascularity:
This is a benign tumor in the placenta, which may sequester platelets, leading to thrombocytopenia
This grade of placenta has occasional basal calcification/hyperechoic areas with deeper indentations of the chorionic plate seen as comma type densities
Grade II placenta
This is a rare congenital abnormality in the cord where a fluid-filled sac, originating from the structure that develops into the umbilical cord and bladder, fails to fully disappear during fetal development
Allantoic cyst
Vasa previa can be classified as type 1, 2, or 3. Describe a type 1 vasa previa
This type is associated with a velamentous cord insertion, where the umbilical cord attaches to the edge of the placenta instead of the center. Unprotected fetal vessels then run over the cervix.
This is a convex, irregular bulge that can be seen on a first-trimester ultrasound in the gestational sac, protruding from the choriodecidual surface, and have been linked to an increased risk of miscarriage in some cases
Chorionic bump
Placental grading is also called this classification, named after the person who classified placental maturity into four grades 0 - III, based on the changes occurring in three zones of placenta: chorionic plate, placental substance and basal layer, as the pregnancy advances
Grannum classification
Umbilical vein varix refers to a focal dilatation of the umbilical vein, and is diagnosed when when the caliber is greater than this many mm or with a ratio of more than 50% between the dilated and a more distal normal intra-abdominal portion of the vein
9 mm
Vasa previa can be classified as type 1, 2, or 3. Describe a type 2 vasa previa
This type is linked to a bilobed or succenturiate placenta, where the blood vessels connecting the different lobes of the placenta lie over the cervix.
Subchorionic hematoma is characterized as small, medium, and large based on their size in relation to the gestational sac. Describe these
Small (under 20%), medium (20-50%), and large (over 50%)
Per ACOG, placenta accreta spectrum occurs in this percentage of women diagnosed with placenta previa and no prior cesarean deliveries
3%