Fig 5 - uploaded by Robert Dunning Harris
Content may be subject to copyright.
-Pseudodilatatlon of cervix at 23 weeks' gestation (same patient as in Fig. 3). Longitudinal sonogram shows contraction of lower uterine segment (white arrow) mimicking cervical dilatation. Pseudodilated segment (asterisk) is cephalad relative to posterior angie of bladder. Black arrow = normal closed endocervical canal.
Source publication
Examination of the placenta and gravid uterus is an integral part of any obstetric sonographic study. Fetal well-being and growth depend on an intact uteroplacental vascular supply, and sonography can show most of the macroscopic abnormalities that may adversely affect the placenta or the gravid uterus, and thus compromise the fetus or affect the m...
Contexts in source publication
Context 1
... placentation site. Asterisk = placenta. During the latter part of pregnancy, transabdominal sonog- raphy frequently does not show the internal cervical os and endocervical canal because of acoustic interference result- ing from the low position of the fetal head and the mother's body habitus [6] (Fig. 3A). This technical limitation can easily be overcome by using translabial or transvaginal sonogra- phy and imaging the cervical canal and internal os via a sonographic window posterior and caudad to the fetal head (Fig. 3B) It has a reported prevalence of 1 % and may be responsible for as many as 20% of second-trimester miscar- riages ...
Context 2
... canal because of acoustic interference result- ing from the low position of the fetal head and the mother's body habitus [6] (Fig. 3A). This technical limitation can easily be overcome by using translabial or transvaginal sonogra- phy and imaging the cervical canal and internal os via a sonographic window posterior and caudad to the fetal head (Fig. 3B) It has a reported prevalence of 1 % and may be responsible for as many as 20% of second-trimester miscar- riages [14]. Incompetent cervix can be acquired, as a result of obstetric trauma or dilatation and curettage, or it can be congenital, usually associated with exposure to diethylstilbe- ...
Context 3
... translabial and transvaginal sonography have a potential role in evaluating the progression of labor and response to medical treatment; the length of the cervical canal can be measured, and dilata- tion of the endocervical canal can be observed. These tech- niques overcome the sonographic technical difficulties associated with a low fetal head ( Fig. 3) and avoid the errors associated with transabdominal measurement of the length of the cervical canal in the presence of a distended maternal ...
Context 4
... sonography (Fig. 12) 1'- (. ,,,'-.--. SONOGRAPHY OF GRAVID UTERUS AND PLACENTA 463 The sonographic findings in placental abruption may be normal or may show evidence of peniplacental hemorrhage. Sonographic classification of peniplacental hemorrhage is based on three anatomic locations: subchorionic, preplacen- tal, and retroplacental [63] (Fig. 13). Acute hemorrhage is hyperechoic or isoechoic relative to normal placenta, fre- quently becoming hypoechoic within the first week and anechoic by 2 weeks [63]. Peniplacental hemorrhage and fetal outcome have been correlated in several recent studies. Nybeng et al. [64] found that in 65 patients with abruption and peniplacental hemor- ...
Similar publications
Two placentas in singleton pregnancy with fused umbilical cord which has its own placental insertion site forming 3-vessel cord at fetal end is an extremely rare case. This present case describes two placentas with fused umbilical cord with an episode of vanishing twin syndrome and there seems to be a strong relationship between these two events. A...
Abstract The murine basic helix-loop-helix transcription (bHLH) factor mouse atonal homolog 6 (Math6) is expressed in numerous organs and supposed to be involved in several developmental processes. However, so far neither all aspects nor the molecular mechanisms of Math6 function have been explored exhaustively. To analyze the in vivo function of M...
Citations
... 2D imaging generally shows a well circumscribed, complex or hypoechoic round mass, separated from the rest of the placenta, located near the umbilical cord insertion site and protruding into the amniotic cavity [7]. Color Doppler demonstrates increased flow with a low resistance pulsatile flow within the hypoechoic area [11] and is the gold standard in differentiating chorioangioma from its other differential diagnoses such as teratoma, placental haemorrhage, degenerating myomas, partial hydatiform mole and chorioangiocarcinoma [12,13]. ...
Chorioangioma is a non-trophoblastic benign vascular tumour of the placenta affecting fetal outcome. It has no malignant potential. It is usually diagnosed during the 2nd trimester. These are usually found on the fetal side of the placenta, close to the umbilical cord insertion site protruding into the amniotic cavity. Chorioangiomas can be small or large. Small tumours (less than 5 cm) usually have favourable outcome. Large chorioangiomas (more than 5 cm) usually have an unfavourable outcome and may cause maternal complications like pre-eclampsia, preterm labour, placental abruption, placenta previa, polyhydramnios and post partum haemorrhage and fetal complications like anemia, thrombocytopenia, growth restriction, hydrops, cardiomegaly, congestive heart failure and intrauterine fetal demise. With the use of ultrasound and color Doppler, it has become possible to diagnose these early and provide timely intervention in order to prevent fatal complications. Here, we present a case of a large chorioangioma, 10 × 8.7 × 9.3 cm, with significant high vascularity and fetal anemia. There was a significant reduction in the size of tumour after interstitial laser coagulation. Following this, an intrauterine transfusion helped in correcting anemia. Other intervention options available for chorioangiomas are endoscopic surgical devascularization, alcoholic ablation and radiofrequency ablation. Polyhydramnios if present, is treated with therapeutic amniocentesis. Delivery is to be considered in case of complications after 34 weeks of gestation. Small chorioangiomas are usually favourable and require close fetal monitoring only.
... It can also result in release of prostaglandins and initiations of uterine contraction and there is requirement of special transducer. [6][7][8] Transperineal sonography is more convenient and safer means of imaging the cervix and lower uterine segment overcoming the short coming of transabdominal sonography and eliminating the risk associated with Transvaginal sonography. ...
... Although various studies using endovaginal sonography have been promising but endovaginal probe has to be inserted cautiously while directly visualizing the cervix on screen and further adjustments in the position of probe must be made with caution to minimize the possibility of inducing bleeding in patient with possible placenta previa. 8 Endovaginal sonography is not preferred by some patients and some time it may cause torrential haemorrhage. In 1992 Hertzberg et al reported the use of transperineal sonography for localization of placenta in case of APH, which seems to be convenient and safe route of imaging the cervix , lower uterine segment, its relation with placenta and as vaginal penetration is not needed virtually eliminating the potential for inducing bleeding which is associated with endovaginal sonography. ...
... Hertzberg et al in her series reported sensitivity of 100% specificity of 90% positive predictive value of 90% negative predictive value of 100%, false negative rate of 0% and false positive rate of 0.6% by transperineal sonography in cases of APH. 8 In 1999 Bukshee et al studied the role of transperineal sonography in localization of placenta. They published sensitivity, specificity, negative and positive predictive value of 100%. ...
Background: Haemorrhage is one of the leading causes of maternal mortality and morbidity in world in pregnant patients.Patients with antepartum haemorrhage confirmation of location of placenta by sonography is must for management. Transvaginal sonography(TVS) has main disadvantage of need of penetration of vagina and provoking vaginal haemorrhage It can also result in uterine contraction & requirement of special transducer. Transperineal sonography(TPS) is more convenient and safer means of imaging the cervix and lower uterine segment overcoming the short coming of transabdominal sonography and eliminating the risk associated with Transvaginal sonography. Thus present study was undertaken with a view to evulate patients of antepartum haemorrhage by Transvaginal as well as by transperineal sonography to compare accuracy of transperineal with Transvaginal sonography. Methods: Transvaginal probe was gently introduced for about 3-4 cm beyond the introitus. Distance between internal os and lower edge of placenta was measured. The diagnosis of placenta previa was made if placental edge was located within 5cm of internal os. Transperineal sonography was performed with convex transducer. Bladder was kept empty The transducer was positioned directly on perineum in sagittal orientation over the labia minora with center of transducer typically posterior to urethra and anterior to vaginal orifice and measurement taken. Results: TPS diagnosed placenta previa in 31 cases, 30 of which had placenta previa. TPS negated placenta previa in 19 cases, none of which had placenta previa. So false positive rate of TPS was found to 4.7%, false negative 0% sensitivity 100% specificity 95.2%. Positive predictive value of TPS was found to be 96.7% and negative predictive value of TVS was found to be 100%. Conclusions: So, to conclude transperineal sonography is easy to perform, well tolerated accurate diagnostic tool with high sensitivity specificity, positive and negative predictive values for localisation of placenta cases of APH. TVS can be replaced by TPS in cases of APH for localisation of placenta.
... Unfortunately, we could not do gray-scale or Doppler in earlier trimesters because our patient did not come on regular followup. Chorioangioma is often confused with placental teratoma, placental hematoma (intraplacental or subchorionic), partial hydatidiform mole, degenerated myoma, and metastases (8). ...
Chorioangiomas are the most common benign tumors of placenta with reported prevalence of approximately 0.5% -1%. Large tumors are rare but those exceeding 5 cm in diameter may be associated with adverse effects on both mother and fetus. The larger the size of the tumor the more is the chance of developing complications. However, it is not necessary that complications would always ensue. Here, we present a case with a large asymptomatic placental chorioangioma that was found incidentally at term and led to a successful outcome. Despite the large size, it was not associated with the maternal or fetal complications expected with a chorioangioma of that size.
... They are more seen in multiple pregnancies and in female babies. The differential diagnosis of placental masses includes teratoma, placental hemorrhage, metastasis from a primary maternal tumor (very rare), degenerate myoma and partial hydatidiform mole [1,2]. ...
... early diagnosis of preeclampsia is very important to control of this problem. [1][2][3][4][5][6][7][8][9][10] Intrauterine growth restriction (IUGR), defined most commonly as a sonographic estimation fetus weight, below the 10th percentile for gestational age. 2,11 The aimed of this study was to fine association between placental location at second trimester and pregnancy outcomes. ...
The aimed of this study was to find association between location of placental at second trimester and pregnancy outcomes. It was a descriptive -analytic epidemiological study which has performed on 250 pregnant women by simple random sampling in Razi hospital and Imam Khomeini hospital during July 2011 – October 2012 in Ahvaz city, Iran. Placental location was determined by sonography at 18 - 22 weeks of gestation, and it was classified to high / low category and anterior / posterior category. In this study has been assessed placental location with incidence of preeclampsia, intrauterine growth restriction and preterm birth. The incidence of preeclampsia and intrauterine growth restriction was 5.6%, 1.6% respectively, these parameters were not associated with placental location (p=0.84, p=0.69). The incidence of preterm birth was 7.2% and it was associated with low placental location (p=0.01).There was no significant difference between anterior and posterior placenta in all of outcomes. Low placental location was associated with increased risk of preterm labor and preterm delivery.
... early diagnosis of preeclampsia is very important to control of this problem. [1][2][3][4][5][6][7][8][9][10] Intrauterine growth restriction (IUGR), defined most commonly as a sonographic estimation fetus weight, below the 10th percentile for gestational age. 2,11 The aimed of this study was to fine association between placental location at second trimester and pregnancy outcomes. ...
The aimed of this study was to find association between location of placental at second trimester and pregnancy outcomes. It was a descriptive -analytic epidemiological study which has performed on 250 pregnant women by simple random sampling in Razi hospital and Imam Khomeini hospital during July 2011 – October 2012 in Ahvaz city, Iran. Placental location was determined by sonography at 18 -22 weeks of gestation, and it was classified to high / low category and anterior / posterior category. In this study has been assessed placental location with incidence of preeclampsia, intrauterine growth restriction and preterm birth. The incidence of preeclampsia and intrauterine growth restriction was 5.6%, 1.6% respectively, these parameters were not associated with placental location (p=0.84, p=0.69). The incidence of preterm birth was 7.2% and it was associated with low placental location (p=0.01).There was no significant difference between anterior and posterior placenta in all of outcomes. Low placental location was associated with increased risk of preterm labor and preterm delivery. INTRODUCTION Placenta is an important connecting Organ between mother and fetus, a lot of fetus problems, even the pathology of preeclampsia, related with placenta. Evaluation of the placenta should be a part of every pregnancy sonography; location, shape and size of the placenta should be considered .The placenta size is related to the fetus size, the small placenta is usually accompanied with small fetus. Preeclampsia is one of the important complications of pregnancy, and may be lead to maternal mortality, which is defined as blood pressure more then 140 / 190 mmhg, with proteinuria. Preeclampsia is more common in primiparus, with prevalence of 6% -7% as compare with multiparus (3% -4%). early diagnosis of preeclampsia is very important to control of this problem. 1-10 Intrauterine growth restriction (IUGR), defined most commonly as a sonographic estimation fetus weight, below the 10th percentile for gestational age. 2,11 The aimed of this study was to fine association between placental location at second trimester and pregnancy outcomes.
... Placental infarction, occurring in 25% of all pregnancies, is most common at the margin of the placenta and, usually is not significant. 15 Central infarcts are rare and usually represent generalized uteroplacental vascular disease (Fig. 6). The amount of placenta that can be infarcted without clinical significance depends on the status of the placenta. ...
... 14 One third of all cases of small-for-gestational age infants are caused solely by uteroplacental vascular disease. 14,15 The positive predictive value of a hypoechoic lesion for diagnosing an infarct is only around 12%, probably because most placental infarcts tend to have isoechoic echogenicity. Only those that had central bleeding in utero can be detected by prenatal ultrasound because of the different echogenicity in the blood clot and the placenta. ...
... Only those that had central bleeding in utero can be detected by prenatal ultrasound because of the different echogenicity in the blood clot and the placenta. 15 Placental lakes are believed to contain purely maternal blood and appear as homogenous sonolucent lesions with turbulent low-velocity flow seen on color Doppler studies. 16 Trauma from normal fetal movements at the fetoplacental interface, incomplete invasion of the spiral arteries, and other abnormalities of implantation leading to intervillous circulatory dysfunction and an abnormally low local vascular resistance in the placental bed during the ''second wave'' of trophoblastic invasion have been implicated as potential etiologic mechanisms. ...
Placental imaging allows prenatal diagnosis of many important complications of pregnancy and delivery. Sonographic assessment of placental location and structure to rule out placenta previa, succenturiate lobes, and placenta accreta as well as evaluation for lesions including infarctions and abruptions can allow appropriate pregnancy follow-up and delivery planning. Diagnosis of these placental complications prenatally can allow optimal pregnancy management and prevent adverse outcomes for mother and infant.
... At gray-scale US examination, chorioangioma is a hypo-or hyperechoic circumscribed mass that is distinctly different from the placenta and contains anechoic cystic areas (6,12,13). Large lesions may or may not contain fibrous septa, which create the appearance of a complex mass (12,13). The tumor classically protrudes into the amniotic cavity from the fetal surface near the cord insertion. ...
... At gray-scale US examination, chorioangioma is a hypo-or hyperechoic circumscribed mass that is distinctly different from the placenta and contains anechoic cystic areas (6,12,13). Large lesions may or may not contain fibrous septa, which create the appearance of a complex mass (12,13). The tumor classically protrudes into the amniotic cavity from the fetal surface near the cord insertion. ...
A 29-year-old gravida 3, para 2 woman was referred to maternal fetal medicine for clinical follow-up and serial ultrasonographic (US) surveillance. The patient had an unremarkable prenatal course until a placental mass was noted at a routine second trimester obstetric US examination. Given its imaging characteristics, the mass was thought to be most consistent with a chorioangioma. The remainder of the pregnancy passed without complications, and at 39 weeks the patient underwent an elective induction with intravenous oxytocin (Pitocin; Parke-Davis, New York, NY).
... In this scheme, central retroplacental hemorrhages were found to have a later onset and a worse prognosis than the other 2 entities, which usually began at the margin of the placenta during the first half of pregnancy. 3 Although not proved, 1 hypothesis that helps to explain some of the ambiguities is that retroplacental hemorrhages fall into 2 broad categories: arterial and venous. 20 In this scenario, arterial bleeding leads to abruptio placentae, while marginal, terminal, and chronic abruptions represent venous hemorrhage. ...
... 1 Sonographic findings in CAOS may include preplacental (peripheral) and subchorionic (retromembranous) collections of blood. [3][4][5] Many cases of CAOS have premature rupture of membranes, although in some cases, membrane rupture is simulated by organization of peripheral blood clots with clot retraction and subsequent passage of serum through the vagina. 2 Placental circumvallation was the most common pathologic feature associated with DCH. ...
Diffuse nonmeconium-related pigment was observed in the chorioamnion of 36 of 1,023 placentas over 4 years and evaluated by iron staining. Stains were negative in 13 cases and positive in chorionic plate and membranes (diffuse chorioamnionic hemosiderosis [DCH]) in 23 cases (3/1,000 deliveries; 25/1,000 placentas). Gestational age at delivery was lower in DCH and was inversely proportional to the magnitude of iron staining. Placentas with DCH were more likely to show circumvallation, old peripheral blood clots, increased chorionic-villous macrophages, and green discoloration. To evaluate demographic, obstetric, and perinatal factors associated with DCH, 2 gestational age-matched controls were selected for each DCH case. Multiparity, smoking, and chronic vaginal bleeding all were increased significantly with DCH, while intrauterine growth retardation and oligohydramnios were increased but did not achieve statistical significance. Gestational hypertension and advanced maternal age were significantly decreased with DCH, and cocaine abuse was uncommon (3 cases). Long-term neurologic sequelae of DCH were evaluated in a separate series of gestational age-matched very-low-birth-weight infants with and without neurologic impairment at 2 years of age. No increased risk of neurologic impairment was found in patients with DCH.
... The results of this study showed that this was not effective in predicting embryo demise. A quick placental measurement in this way is possible in the recurrent miscarriage clinic, but the effect of the placenta on fetal growth is complex, as discussed by Harris and Barth (1993). A more in-depth study of placental structure and function is therefore necessary. ...
In this study, the potential prognostic value of serial ultrasonographic, endocrinological and biochemical measurements in
the early pregnancy of women with a history of unexplained recurrent miscarriage was examined. A total of 113 pregnancies
among 93 women were studied, of which 77 (68%) resulted in live birth, whereas 36 (32%) ended in a miscarriage. The normal
range (5-95th centile) of various measurements was derived from pregnancies which resulted in a live birth. Among the 36 failed
pregnancies, 42% had one or more human chorionic gonadotrophin (HCG) measurements, 35% had one or more gestation-sac diameter
measurements, 33% had one or more embryonic heart rate measurements, 20% had one or more crown-rump length measurements and
9% had one or more placental protein 14 measurements below the normal range, a week or more prior to the confirmation of miscarriage.
Altogether, 22/36 = 61% of the failed pregnancies could have been predicted on the basis of one or more of the measurements
below the normal range.
