Thick Placenta Research Articles

Rare pathologic Placenta Ultrasound Findings

Rare ultrasound placenta findings, such as avascular cystic lesions, hyperechogenic and thick placenta, and enlarged placenta, are associated with infarcts, perivillous fibrin deposition, and mesenchymal dysplasia. These lesions can be present in 20% of normal pregnancies but are more frequent in pregnant women with pre-eclampsia (PE) and/or fetal growth restriction, autoimmune diseases, and infections, and can increase the risk of perinatal complications, including fetal death. Evaluation of the placental surface may also identify cases with circumvallate placenta and chorioangiomas. These rare placental findings require close clinical follow-up and serial fetal evaluations to identify those at a higher risk of abnormal perinatal outcomes.

Transuterine relocation of pregnant uterine horn segment in an exploratory rat model with implications for tubal ectopic pregnancy

Ectopic pregnancy affects ~ 2% of pregnancies annually in the United States, with no current treatments allowing for the continuation of the pregnancy. Thus, this study sought to initiate an investigation into the potential design of a surgical technique, in an animal model, that could serve as a foundation for future research into the potential of relocating an ectopic embryo into the uterus at the human level. Female Long-Evans rats were randomly assigned to one of two groups: Embryo Relocation (ER; n = 12; underwent embryo relocation surgery) and Normal Pregnancy (NP; n = 12; carried a normal pregnancy; no surgery). Eight rats/group were allowed to carry their pregnancy to term and deliver, while four had their uteri collected at the end of gestation. Briefly, for the ER group, a uterine horn containing 1–2 embryos was translocated to the contralateral horn, which had been incised and cleared of its contents, prior to being wrapped around the relocated horn. Rat weight, food consumption and vaginal impedance of the mothers were measured throughout the experiment. Ultrasounds were performed and fetal heart rates measured on day 20–21 of gestation. Additionally, rat weight of all offspring was measured at adulthood. Our findings indicate that, in the ER group, 15/15 (100%) of the relocated embryos had detectable heart rates at the end of gestation (within the normal range), 14/15 (93%) were delivered vaginally, and 12/14 (86%) survived until adulthood. A significant decrease in rat weight and food consumption was observed only on the day following surgery. Fertility, as measured by vaginal impedance, was minimally impacted by surgery. Moreover, there was no significant difference between groups in average body weight of offspring at adulthood. Histological analysis indicated a thicker placenta in the ER group, attributable to the fetal part of the placenta, potentially indicating compensatory mechanisms. Our findings reflect a successful transuterine embryo relocation followed by vaginal birth and survival of offspring to adulthood, in a rat model. Such findings lay the foundation for future preclinical research in higher animals, with potential implications on a procedure relevant to human ectopic embryo relocation.

Correlation Between Ultrasonographic Placental Thickness and Adverse Fetal and Neonatal Outcomes.

Introduction The placenta is often overlooked in the routine evaluation of normal gestations, receiving attention only when abnormalities are detected. Placental thickness can serve as a good predictor of fetal growth and birth weight, especially in the second trimester.In this prospective study, we measured placental thickness in the second and third trimesters of singleton pregnancies and identified an association between placental thickness and adverse outcomes such as congenital anomalies, fetal growth restriction (FGR), prematurity, low birth weight, stillbirth, and hydrops fetalis. Methodology A total of 298 patients aged 20 to 33 yearswith a singleton pregnancy and regular cycles, who were sure of the date of their last menstrual period, were observed. Placental thickness was measured by ultrasound at 18-20 and 30-32 weeks, and patients were divided into three groups. Group A consisted of patients with normal placental thickness. Group B included patients with a thin placenta (below the 10th percentile). Group C consisted of patients with a thick placenta (above the 95th percentile). The correlation between placental thickness andthe fetal and neonatal outcome was observed. Results Out of 298 patients, 82 (27.5%) were primigravida and 216 (72.4%) were multigravida. At 18-20 weeks, premature birth was observed in one patient (7.69%) in Group C and six patients (20%) in Group B, compared with eight patients (3.14%) in Group A. At 30-32 weeks, premature birth was seen in two patients (16.67%) in Group C and 11 patients (36.67%) in Group B, compared with two patients (0.78%) in Group A. At 18-20 weeks of gestation, low birth weight was observed for three patients (23.08%) in Group C and 16 patients (53.33%) in Group B, compared with 15 patients (5.88%) in Group A. At 30-32 weeks, low birth weight was observed for four patients (33.33%) in Group C and 19 patients (63.33%) in Group B compared with 11 patients (4.30%) in Group A. A significant association was found between a thin placenta and low birth weight and prematurity at both 18-20 and 30-32 weeks of gestation. Two patients (13.33%) had major congenital abnormalities and a thick placenta at 18-20 weeks. In Group C, hydrops were observed in two patients (15.38%) at 18-20 weeks and two patients (16.67%) at 30-32 weeks. A significant association was found between a thick placenta and hydrops. At 30-32 weeks, 13 patients (43.33%) in Group B had developed FGR compared with six patients (2.34%) with a normal placenta. A significant association was found between a thin placenta and FGR. One patient (7.69%) with a thick placenta had a stillbirth, indicating a nonsignificant association. Conclusions A positive correlation was observed between congenital anomalies and hydrops and a thick placenta, whereas FGR, preterm labor, prematurity, and low birth weight were associated with a thin placenta. Subnormal placental thickness for a particular gestational age may be the earliest sign of FGR. A sonographically identified abnormal placenta should alert clinicians to the possibility of a compromised perinatal outcome and the need for evaluation and close follow-up.

Mid-trimester sonographic placenta previa thickness and persistence at delivery

ObjectiveIncreasing placental thickness is associated with adverse outcomes including earlier gestational age at delivery, lower birthweight, and lower umbilical artery pH. We aim to determine whether mid-trimester placenta previa thickness is associated with persistence of previa at time of delivery. Study designSingle-center retrospective cohort study of singleton gestations with previa diagnosed at 18–24 weeks delivering between 2015 and 2019. The thickest portion of the placenta was measured in a longitudinal plane on transabdominal imaging to determine placental thickness. We defined three cohorts: 1) thick placenta (>1 standard deviation above the mean), 2) thin placenta (>1 standard deviation below the mean), and 3) average placenta (within 1 standard deviation above or below the mean). Primary outcome was previa persistence at time of delivery. Secondary outcomes included postpartum hemorrhage, cesarean delivery, placenta accreta spectrum, and maternal morbidity composite (use of Bakri balloon, B-lynch, or O’Leary, peripartum hysterectomy, blood transfusion, ICU admission, or death). In all analyses, average thickness was used as the base comparator. ResultsOf 239 pregnancies with mid-trimester previa there were 34 thin, 166 average, and 39 thick placentas. Patients with thick placenta were older, more likely to have prior cesarean delivery, fibroid uterus, and delivery at an earlier gestational age. After adjusting for confounders, thick placenta was associated with persistent previa (aOR 6.85 [3.13–15.00]) and cesarean delivery (aOR 2.76 [1.26–6.08]). ConclusionAt diagnosis of mid-trimester previa, thick placenta is associated with persistence at time of delivery and delivery by cesarean section. This suggests placental thickness may assist with risk stratification and coordination of care.

Relationships between Ultrasonographic Placental Thickness in the Third Trimester and Foetal Outcomes

Poor neonatal outcomes, including low birth weight (LBW), poor APGAR scores, more NICU hospitalizations, and a higher chance to develop Pre-Eclampsia, IUGR, and Oligo Hydramnios, are all linked to thin placental thickness. While both thin and thick placentae are connected to a greater prevalence of C-sections, thick placentae are linked with a greater possibility of developing GDM and an increase in NICU hospitalizations. Objective of this research was to investigate the association between placental thickness as measured by ultrasonography in the third trimester and foetal outcome, including the relationship between placental histopathology and placental thickness. investigate the link among placental thickness, foetal outcome, and placental histology. Most newborns had fibrinoid necrosis and calcifications. Babies with Macrosomia and IUGR, respectively, were more likely to develop Syncytial knots and thickening of the vessel wall. Patients with normal placenta thickness at 36 weeks' gestation experienced fewer difficulties than those with thin or thick placentas at the same time. The study emphasizes the value of evaluating placental thickness using ultrasound in the third trimester to detect high-risk pregnancies. The study also shows that aberrant foetal and neonatal events are linked to certain placental histological characteristics, like artery wall thickening and infarctions.

Midtrimester sonographic placenta previa thickness is associated with persistence at delivery

Studies suggest placental thickness on 2D ultrasound in midtrimester placenta previa correlates with placenta accreta spectrum. Studies have yet to determine if midtrimester placental thickness is associated with persistent previa at delivery. Single-center retrospective cohort of singleton gestations with previa diagnosed at 18-24 weeks delivering between 2015-2019. The thickest portion of the placenta was measured three times in a longitudinal plane on transabdominal imaging to determine placental thickness. We defined three cohorts: 1) thick placenta (>1 standard deviation above the mean), 2) thin placenta (>1 standard deviation below the mean), and 3) average placenta (within 1 standard deviation above or below the mean). Primary outcome was placenta previa persistence at time of delivery. Secondary outcomes included placenta previa resolution, postpartum hemorrhage, cesarean delivery (CD), placenta accreta spectrum, and composite for maternal morbidity (use of Bakri balloon, B-lynch, or O’Leary, peripartum hysterectomy, dilation & curettage, blood transfusion, ICU admission, or death). In all analyses, average placental thickness was used as the base comparator. Of 239 pregnancies with midtrimester previa, 34 had thin, 166 had average, and 39 had thick placentas. Patients with thick placenta were older, more likely to have prior CD, chronic hypertension, fibroid uterus, and delivery at an earlier gestational age (Table1). After adjusting for confounders, thick placenta was associated with persistent previa at delivery (aOR 6.60, 95%CI 3.02-14.40) and thin placenta was associated with resolved previa at delivery (aOR 2.40, 95%CI 1.23-4.71) (Table 2). Placental thickness was not associated with the remainder of the outcomes. At diagnosis of midtrimester previa, thick and thin placenta are associated with persistent and resolved previa at time of delivery, respectively. This suggests placental thickness may assist with risk stratification. Future studies are needed to determine the normal distribution of placental thickness percentiles by gestational age.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The Multifaceted Clinical Characteristics of Congenital Cytomegalovirus Infection: From Pregnancy to Long-Term Outcomes.

The aim of this study was to capture multifaceted clinical characteristics of congenital cytomegalovirus (CMV) infection from diagnosis to treatment using a multidisciplinary approach including obstetrics, pediatrics, pathology, and otorhinolaryngology-head and neck surgery. This is a retrospective study including 30 consecutive cases of congenital CMV infection that were diagnosed at a single tertiary hospital located in Seoul, Korea from January 2009 to December 2020. Congenital CMV infection was defined as a positive result by polymerase chain reaction from urine, saliva or cerebrospinal fluid or positive CMV IgM from neonatal blood sampled within 3 weeks after birth. All cases were analyzed with respect to whole clinical characteristics from diagnosis to treatment of congenital CMV by a multidisciplinary approach including prenatal sonographic findings, maternal immune status regarding CMV infection, detailed placental pathology, neonatal clinical manifestation, auditory brainstem response test, and antiviral treatment (ganciclovir or valganciclovir). Long-term outcomes including developmental delay and hearing loss were also investigated. The total number of births during the study period in our institution was 19,385, with the prevalence of congenital infection estimated to be 0.15%. Among 30 cases of congenital CMV, the median gestational age at delivery was 32.2 weeks [range, 22.6-40.0] and 66.7% of these infants were delivered preterm at less than 37 weeks. Suspected fetal growth restriction was the most common prenatal ultrasound finding (50%) followed by ventriculomegaly (17.9%) and abnormal placenta (17.9%), defined as thick placenta with calcification. No abnormal findings on ultrasound examination were observed in one-third of births. Maternal CMV serology tests were conducted in only 8 cases, and one case each of positive and equivocal IgM were found. The most common placental pathologic findings were chronic villitis (66.7%) and calcification (63.0%), whereas viral inclusions were identified in only 22.2%. The most common neonatal manifestations were jaundice (58.6%) followed by elevation of aspartate aminotransferase (55.2%) and thrombocytopenia (51.7%). After excluding cases for which long-term outcomes were unavailable due to death (n = 4) or subsequent follow up loss (n = 3), developmental delay was confirmed in 43.5% of infants (10/23), and hearing loss was confirmed in 42.9% (9/21) during the follow-up period. In our cohort, 56.7% (17/30) of neonates were treated for congenital CMV with ganciclovir or valganciclovir. Our data show that prenatal findings including maternal serologic tests and ultrasound have limited ability to detect congenital CMV in Korea. Given that CMV is associated with high rates of developmental delay and hearing loss in infants, there is an urgent need to develop specific strategies for the definite diagnosis of congenital CMV infection during the perinatal period by a multidisciplinary approach to decrease the risks of neurologic impairment and hearing loss through early antiviral treatment.

Reviewing placental volumetry and thickness and its correlation with adverse feto maternal outcome - A cross sectional study in Western India

BACKGROUND: Placenta performs several functions including respiration, nutrition, and excretion for the fetus when playing a central role in regulating metabolic, endocrinological, and immunological functions during pregnancy. OBJECTIVE: To analyze the putative correlation of placental parameters including volume and thickness with adverse maternofetal outcomes. METHODOLOGY: A longitudinal observational study was undertaken for 2 years. The sample size was calculated, which was 140. Data were collected, and fetomaternal outcomes of gestational diabetes mellitus (GDM), gestational hypertension (HTN), preeclampsia, and intrauterine growth retardation (IUGR) were derived. A correlation was studied between placental volume (PV) and placental thickness (PT) with fetomaternal outcomes. RESULTS: Approximately half (42.85%) of the study population were primigravida, with overall mean age being 22.67 ± 2.94 years. 46 subjects had adverse fetomaternal outcomes in the form of gestational HTN, preeclampsia, GDM, and IUGR. The most frequent adverse outcome noted was IUGR in 19 cases (41.29%). Among the study population, 90% were term deliveries and 10% were preterm. Spontaneous vertex delivery was seen in 74.29% of the cases. 24.29% of the cases underwent lower segment cesarean section and 1.43% underwent vacuum-assisted delivery. The PV and PT (mm) were compared in healthy subjects with HTN, GDM, and IUGR pregnancies in all three trimesters. A strong correlation (R = 0.96, 95% confidence interval = 0.95–0.98) between birth weight with placental weight was noted. The difference between the means of PV during the first, second, and third trimester and hypertensive disorders in pregnancy was not statistically significant; among GDM and non-GDM patients, was statistically significant in the first and second trimester; and among IUGR and non-IUGR patients, was seen during the third trimester. Similarly, the difference between the means of PT in all trimesters and hypertensive disorders in pregnancy was not statistically significant; among GDM and non-GDM patients, a statistically significant association was seen during the second trimester; and among IUGR and non-IUGR patients, a statistically significant association was seen during the third trimester. CONCLUSIONS: PV in the 1st, 2nd, and 3rd trimesters is significantly less in patients with HTN and IUGR. PV is a predictor of adverse fetomaternal outcomes. Hypertensive subjects had thin placenta with low PV. Hypertensive subjects had thin placenta with low PV. IUGR subjects had thin placenta with low PV. Diabetic subjects had thick placenta. PT is also a predictor of adverse fetomaternal outcomes. Placental weight is known to correlate with fetal weight at term.

Thick Placenta in Pregnancy: A Review.

A thickened placenta is easily identified on ultrasound and provides insight into maternal and fetal wellbeing as well as underlying structural and physiologic anomalies. The aim of this study was to review the literature to clarify what classifies a placenta as "thickened" and to review the associated incidence, maternal and fetal comorbidities, and management during pregnancy. Electronic databases (PubMed and Web of Science) were searched from 2000 to 2020 in the English language. Studies were selected that examined associations between placental thickness, potential etiologies, and obstetric outcomes. There were 140 abstracts identified. After reviewing the articles, 60 were used in this review. Routine assessment of the placenta in the prenatal period is an easy and inexpensive way to assess the maternal and fetal patients. The criteria for a "thickened placenta" vary between studies based on gestational age, placental location, measurement technique, and maternal or fetal factors. Whereas most suggest thickness exceeding 4 cm is pathologic, a review had a threshold of 6 cm in the third trimester to classify placentomegaly. Several maternal and fetal conditions have been associated with a thickened placenta, such as obesity, parity, anemia, diabetes, preeclampsia, cardiac dysfunction, infection, assisted reproductive technology, multiple pregnancy, sacrococcygeal teratomas, and Beckwith-Wiedemann syndrome. A thickened placenta in pregnancy is associated with a higher incidence of adverse pregnancy outcomes and neonatal morbidity and mortality. The literature is clear that early evaluation of the placenta using ultrasound should be a standard practice. A thickened placenta found on routine imaging should prompt a more thorough investigation to determine the etiology of the placentomegaly. At the time of this literature review, there are no recommendations regarding modality or frequency of antenatal surveillance in pregnancies complicated by a thickened placenta. However, serial ultrasounds and weekly antenatal testing in the third trimester should be considered. A thickened placenta has been associated with a variety of maternal and fetal conditions and increases the risk of adverse pregnancy outcomes and neonatal morbidity and mortality.

Maternal urogenital infection and fetal heart functional assessment - what is the missing link?

Maternal urogenital infections during pregnancy are worldwide frequent problem. The aim was to analyze influence of maternal genitourinary infection on fetal cardiac function, pregnancy development and obstetrical outcomes. This was a single-center cohort study on fetuses (average at 28th week) in two groups: with maternal urogenital infections (study group n=49) and control group with no infections (n=59). Parvovirus B19, toxoplasmosis, cytomegalovirus, herpes simplex infections, congenital malformations, fetal growth restriction, chronic maternal diseases, as well as patients with body mass index (BMI) >25kg/m2 were excluded. We analyzed: maternal age, time of delivery, neonatal birth weight, Apgar scores, average time of hospitalization of newborns after birth and several fetal echocardiographic parameters. The only statistical differences was found for shorter isovolumetric relaxation time (IRT) (40±10 vs. 45±9; p=0.03) and longer ejection time (ET) [ms] for right ventricle (RV) (176±24 vs. 164±18; p=0.01). Thick placenta was observed more frequent in study group than in controls (36.7 vs. 16.9%; p= 0.02). The missing link for explanation of these findings was coincidence with thick placenta. This is probably the first observation suggesting that thick placenta (>5cm) may affect fetal RV function in normal heart anatomy: prolongation of right ventricular ET and shortening of fetal right ventricular IVRT.

Diffuse myometrium thinning and placenta accreta spectrum in a patient with systemic lupus erythematosus (SLE): a case report and review of the literature

BackgroundCases of uterine wall thinning and placental abnormalities complicated with systemic lupus erythematosus (SLE) during pregnancy have been reported in Asian countries for ten years. Long-term steroid use can cause muscle degeneration, but the mechanism of myometrium thinning was not known. Through the review of published articles, this report is the first review of cases to discuss the pathogenesis and clinical features of thinned myometrium and placenta accreta spectrum (PAS) in pregnant patients with SLE.Case presentationA twenty-nine-year-old primigravida with a history of lupus enteritis and paralytic ileus had a natural conception after less than two years of steroid treatment. An ultrasonographic study showed a thin uterine wall with a widespread thick placenta on the entire surface of the uterine cavity in the third trimester. At the 39th gestational week, she underwent a cesarean section due to the failure of the uterus to contract, even though the injection of oxytocin. There were several engorged vessels on the surface of the anterior uterine wall at the time of laparotomy. We decided to perform a hysterectomy because diffuse PAS replaced her uterus.ConclusionA review of reported cases and our case shows an unusual complication of SLE that might be related to the particular condition of the estrogen-mediated immune system. Clinicians should always pay attention to the possibility of uterine wall thinning as uterine atony and the structural abnormality of the placenta for SLE patients with the unscarred uterus.

FIGO (international Federation of Gynecology and obstetrics) initiative on fetal growth: best practice advice for screening, diagnosis, and management of fetal growth restriction.

Fetal growth restriction (FGR) is defined as the failure of the fetus to meet its growth potential due to a pathological factor, most commonly placental dysfunction. Worldwide, FGR is a leading cause of stillbirth, neonatal mortality, and short- and long-term morbidity. Ongoing advances in clinical care, especially in definitions, diagnosis, and management of FGR, require efforts to effectively translate these changes to the wide range of obstetric care providers. This article highlights agreements based on current research in the diagnosis and management of FGR, and the areas that need more research to provide further clarification of recommendations. The purpose of this article is to provide a comprehensive summary of available evidence along with practical recommendations concerning the care of pregnancies at risk of or complicated by FGR, with the overall goal to decrease the risk of stillbirth and neonatal mortality and morbidity associated with this condition. To achieve these goals, FIGO (the International Federation of Gynecology and Obstetrics) brought together international experts to review and summarize current knowledge of FGR. This summary is directed at multiple stakeholders, including healthcare providers, healthcare delivery organizations and providers, FIGO member societies, and professional organizations. Recognizing the variation in the resources and expertise available for the management of FGR in different countries or regions, this article attempts to take into consideration the unique aspects of antenatal care in low-resource settings (labelled “LRS” in the recommendations). This was achieved by collaboration with authors and FIGO member societies from low-resource settings such as India, Sub-Saharan Africa, the Middle East, and Latin America.

Ultrasonographic placental thickness versus fetal outcome: A prospective study in Southern India.

Background:Variations in placental thickness are associated with increased perinatal morbidity and mortality. However, only very few studies have been established on the correlation between placental thickness with birth outcomes. This study correlated placental thickness in 2nd and 3rd trimesters with neonatal outcome, maternal weight gain, and body mass index (BMI).Methods:A total of 116 patients aged between 20 to 50 years with singleton pregnancy and regular menstrual history (and sure about their last menstrual period) were included. Placental thickness was measured at 24 and 36 weeks by ultrasound and was divided into three groups: Group A (normal placenta), Group B (thin placenta), and Group C (thick placenta); and correlated with neonatal outcome, maternal weight gain, and BMI.Results: Out of the 116 pregnant women, 55 (47.4%) were primigravida and 61 (52.6%) were multigravida. Six patients (3.6%) delivered pre-term before 36 weeks. In the 2nd and 3rd trimesters, most cases had normal placental thickness (Group A; 93.1% and 92.7%), followed by thin placenta (Group B; 5.2% and 7.3%) and thick placenta (Group C; 1.7% and 0), respectively. Two patients with thin placenta had neonatal death. A significant positive correlation was found between birth weight and placental thickness (at 24 weeks; 0.516r, P<0.00001 and at 36 weeks; 0.669r, P<0.00001) and maternal weight gain and birth weight (0.563r, P<0.00001).Conclusion:Placental thickness on ultrasonography demonstrated well the correlation between birth weight in 2nd and 3rd trimesters and increased incidence of antenatal and postpartum complications resulting from thin placenta.

Exploring the impact of HIV infection and antiretroviral therapy on placenta morphology

IntroductionWomen living with HIV experience more adverse birth outcomes; the mechanisms are not fully understood. We examined placenta morphology and associations with birth outcomes in a Canadian cohort of women living with HIV (HIV+) on antiretroviral therapy (ART) from conception and HIV-uninfected (HIV−) women. MethodsTerm placentas from 94 women (40 HIV−, 54 HIV+) were studied. Trimmed placenta weight was collected. Placenta digital photos were used to compute morphometric parameters. Regression models investigated associations between log-transformed placenta parameters and birth outcomes. ResultsWe observed a trend towards lower placenta weight and smaller placenta area in the HIV+ group, both of which were significantly associated with small for gestational age births. HIV+ serostatus was associated with 6-fold (95%CI 2–20) greater odds of having placenta area in the lowest quartile (<236 cm2). Cord marginality (distance from the edge) was significantly lower in the HIV+ group (p = 0.004), with 35% of placenta having an abnormal (marginal or velamentous) cord insertion vs. 12.5% in the HIV− group (p = 0.01). Velamentous cord insertion was seen in 13% of placentas in the HIV+ vs. 0% in HIV− group (p = 0.02). A significant correlation between cord marginality and placenta thickness was observed in the HIV− group, with a more marginal cord being associated with a thicker placenta. This correlation was not observed in the HIV+ group. HIV+ placentas exposed to protease inhibitors were significantly less circular compared to the HIV− group (p = 0.03). ConclusionOur data suggest that HIV/ART exposure affects placenta morphology and is associated with higher rates of abnormal cord insertion.

Correlation of Maternal Anemia with Sonographic Placental Thickness

Anemia is a condition in which hemoglobin (Hb) concentration and/or red blood cell (RBC) numbers are lower than normal and insufficient to meet an individual’s physiological needs, it affects roughly one-third of the world’s population. Objective: To correlate the maternal anemia with placental thickness ultrasonographically . Methodology: Toshiba Nemio17 with Convex array transducer 3-5 MHz frequency was used. Patient were in spine position. Measurements of placental thickness were performed in the mid portion of the placenta, perpendicular to its long axis. The study was conducted at Gillani Ultrasound Centre and Mansoorah Teaching Hospital Lahore. Data of 110 patients was collected through cross-sectional, analytical study. Convenient Sampling Technique was used to analyze data. Statistical software for social sciences (SPSS version 22.0) is used for the analysis of data. Results: Out of 110 patients 44.5% patients were in 2 nd trimester and 55.5% patients were in their 3 rd trimester. In our study 26.4% patients had normal hemoglobin, 43.6% patients were diagnosed with moderate anemia and 30% patients were diagnosed with mild anemia. Hemoglobin rates varied between 7 g/dL to 15.40 g/dL. Placental thickness varied between 10.50mm and to 56.50mm. 9 patients had normal placental thickness, 89 had thick placenta and 12 had thin placenta. In 2 nd trimester minimum placental thickness was noted 15.7 mm and maximum placental thickness was 47.2 mm. In 3 rd trimester minimum placental thickness was noted as 10.5 mm and maximum thickness 56.5 mm. In normal placental thickness minimum hemoglobin was noted as 7 g/dL and maximum was 15.5 g/dL. In thick placenta minimum hemoglobin noted was; 7.8 g/dL and maximum hemoglobin was 15.4 g/dL. In thin placental thickness minimum hemoglobin was 8.9 g/dL and maximum was 11.2 g/dl. Majority patients came with hemoglobin rates between 8 to 11 (g/dL) and less than 5 patients came with hemoglobin 7 g/dL. In patients with mild anemia mean placental thickness was 30.57 mm. In patients with moderate anemia had mean placental thickness of 33.72 mm and in patients with normal anemia had mean placental thickness of 30.39 mm. Out of 110 patients, 29 had no anemia and from these 3 patients were found with normal placental thickness 4 with thick placenta and 2 were with thin. 81 patients who were diagnosed with anemia had normal placental thickness in 6 patients, 65 had thick placenta and 10 patients were found with thick placenta. Conclusion: We concluded that, maternal anemia has adverse effects on placental thickness and gestational age. In the present study we found that morphological and histological changes in placenta of anemic mother is undertaken, to study the effects of anemia on morphology of placenta and fetal outcomes. Keywords: Ultrasound (US), anemia, placenta, placental thickness DOI: 10.7176/JHMN/81-02 Publication date: October 31 st 2020

The prevalence of sonographically thick placenta and its effect on the fetal and maternal outcome

Abstract Background: The placenta, is responsible for the nutritive, respiratory and excretory functions of the fetus. It is often overlooked in the routine evaluation of the normal gestation, receiving attention only when an abnormality is detected. Aim of work: to determine the prevalence of sonographically thick placenta and the relation of thick placenta to fetal & maternal outcome. Patients and methods: prospective study included 25 pregnant women with thick placenta, attending to El-Hussein Obstetric outpatient clinics, as group A. 25 pregnant women with normal placental thickness were included as group B. US examination was recorded at 2nd and 3rd trimesters. After delivery, the placenta was weighted in grams. Results: There was statistically significant higher incidence of HTN, IUGR and NICU admission in group A rather than group B. There was statistically significant lower GA, birth weight and Apgar score in group A compared to group B. There was statistically significant higher placental weight in group A compared to group B. There was statistically significant increase in placental thickness in patients with maternal HTN, DM and thyroid disease. Conclusion: Increased placental thickness is not diagnostic of any specific disorder but may contribute to the management of a fetus at risk. Measurement of Placental Thickness is a good predictor tool for estimating the fetal weight. Thick placenta is associated with higher incidence of low GA and low birth weight. A thick placenta should be regarded as a risk factor and needs good follow up.

Ultrasound prenatal diagnosis of a de novo 14q distal duplication associated with foetal anomalies: a case report

Abstract Objectives Partial trisomy 14q is a rare chromosomal abnormality with an extremely variable phenotype ranging from mild to severe forms of malformation. Most of the cases described in literature are postnatal clinical findings although few prenatal cases have been reported. Case presentation A 33-year-old woman at 21+6 weeks’ gestation was referred to our hospital for a detailed foetal ultrasound with suspected partial agenesis of corpus callosum and ureterocele. On examination, we found a short corpus callosum and ureterocele with a duplicated right renal collecting system. Moreover, there was an intrarotation of left foot with a prominent part departing from the ankle, both thighs appeared thicker, a thickening of the nuchal fold, a mild hypertelorism and a thick heterogeneous placenta. The patient underwent magnetic resonance imaging (MRI), which confirmed the foetal anomalies. The couple opted for a termination of pregnancy. Chromosome analysis and molecular karyotyping of amniocytes revealed a de novo rearrangement of chromosome 14 with an interstitial gain 14q31.1–14q32.22 and a terminal deletion 14q32.33. Conclusions The majority of partial trisomy 14q reporter are postnatal diagnoses. Improvement in the quality of foetal imaging and molecular techniques have made possible to identify many genetic syndromes prenatally. In our opinion, anomalies of the brain, urinary system and limbs may be the core findings of trisomy 14q. To our knowledge, no such case has ever been described previously.

Ultrasound Assessment of Placental Thickness in The Last Two Trimesters of Normal Pregnancy and Its Relation with Fetal Outcome

Abstract:Background: The placenta is a vital organ which plays an important role in the normal fetal growth and development process. The aim of work: Is to assess the relation between thickness of the placenta during the 2nd and 3rd trimesters and fetal birth weight and placental weight .Patients & Methods: 50 cases of uncomplicated pregnant women who were attended the outpatient clinic at Zagazig University Maternity Hospital were involved in this cohort study from the period between June 2018 to March 2019;, The thickness of the placenta was measured by trans abdominal ultrasound during second and third trimester .The relation between thickness of the placenta and fetal outcome was examined by Pearson’s correlation. Results: according to our study there was positive relation between thickness of the placenta at the 2ndtrimester and 3rdtrimester with fetal birth weight, placental weight and APGAR score. The fetal outcome was better with normal placental thickness (10th- 90th) in comparison to that with thin (90th) &the incidence of NICU admission increased in thick placenta and thin placenta.Conclusions: The thickness of the placenta by ultrasound can be used beside other biometric parameters in predicting neonatal outcome and measurement of placental parameters should be involved in all routine antenatal ultrasounds.

Rediscovery and amended descriptions of Begonia kingdon-wardii (Begoniaceae) from North Myanmar.

Begonia kingdon-wardii Tebbitt was rediscovered in 2014 from Myanmar after 67 years based on its last collection in 1937. Its previously unknown female flower and inaccurate morphology of leaf and ovary have been additionally described. This species belongs to Begonia sect. Sphenanthera (Hassk.) Warb. due to its dioecious habit, 3-locular ovary, berry fruits and thick placenta segments. Morphologically, it is similar to Begonia gulinqingensis S. H. Huang & Y. M. Shui in the leaf shape, placentation and fruit shape, but different in its dioecious plants, pliciform leaves, two-petalled female flowers and berry fruits. The rediscovery of this amazing living species will attract significant interest for scientific research and horticultural application.

Role of Ultrasonographic Placental Thickness in Prediction of Fetal Outcome: A Prospective Indian Study.

Placenta is the connecting organ between the mother and the fetus. It supplies oxygen and all the necessary elements for the growth and development of the fetus. In normal pregnancy, the growth of the placenta remains concordant with the growth of the fetus. The sonographic assessment of placenta can give information about the nutritional status of the fetus. It is known that normal placental thickness approximately equals gestational age. It is historically documented that placental weight is one-fifth of the fetal weight and abnormally thin or thick placenta is associated with increased incidence of perinatal morbidity and mortality. However, there are very few studies correlating placental thickness with Neonatal outcome. To correlate ultrasonographic placental thickness at 32 and 36 weeks pregnancy with neonatal outcome. To propose placental thickness as a simple test for prediction of neonatal outcome. Placental thickness at 32 and 36weeks was measured by ultrasound, in 130 pregnant mothers with confirmed dates and uncomplicated singleton pregnancy. Placental thickness was categorized as normal (10th-95th percentile), thin (<10th percentile) and thick (>95th percentile) at each stage and was correlated with birth weight and neonatal outcome. Neonatal outcome was good in women with normal placental thickness (10th-95th percentile) at 32 and 36weeks and was compromised in women with thin (<10th percentile) and thick (>95th percentile) placentae. Placental thickness at 32 and 36weeks corresponds well with gestational age and is a good prognostic factor in assessing neonatal outcome. Therefore, placental thickness should be measured in addition to biometric parameters in antenatal women undergoing ultrasound.