Ultrasonographic assessment of placental abnormalities

Article Abstract:

A review is presented of placental abnormalities that can be detected with ultrasonography; correct identification of such disorders can prompt effective clinical intervention. An ultrasonographic grading scale for rating placental maturity has been developed, but its application has generated controversy. This is partly a result of variability in interpretation of the scans and in scanning technique. Categories of placental lesions, as seen with ultrasonography, are listed in tabular form and described fully in this article. Abnormal location of the placenta, hematomas (regions of pooled blood), cysts, tumors, caverns, blood clots (thromboses), infarcts (blockage of circulation to the placenta), and hydatidiform transformation (a common type of placental tumor), can all be identified with ultrasonography. Accurate determination of placental abnormalities often requires repeated ultrasonographic examination, since changes can take place over very short periods. Data gathered in this way can be combined with other findings in prenatal testing, such as levels of maternal hormones, to predict complications of pregnancy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Diagnosis

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Ultrasonographic diagnosis of a large placental intervillous thrombosis associated with elevated maternal serum alpha-fetoprotein level

Article Abstract:

The concentration of alpha-fetoprotein (AFP) in maternal blood is commonly measured between the 16th and 20th weeks of gestation to detect several kinds of fetal abnormalities. The case history is presented of a woman with elevated AFP levels but a fetus that appeared normal with ultrasound imaging at 18 weeks' gestation. Studies later in pregnancy identified the abnormality as a hematoma (mass of blood in an enclosed space) located in the placenta. After 29 weeks' gestation, fetal growth was noted to be slower than normal, and the volume of amniotic fluid (in which the fetus floats) had decreased. A cesarean section was performed, leading to the delivery of a healthy infant. The placenta contained a large fibrotic lesion, about 36 cubic centimeters. Cases where AFP levels are elevated in the presence of certain other diagnostic signs should be evaluated by ultrasonography of the placenta. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Abnormalities, Placenta

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The origin of alpha-fetoprotein in first-trimester anembryonic pregnancies

Article Abstract:

Many anembryonic pregnancies may be a result of early embryo death. Researchers measured alpha-fetoprotein (AFP) in the maternal blood and in embryonic fluid in nine women with an empty gestational sac and 27 women with normal pregnancies. Women with an empty gestational sac had higher AFP levels in maternal blood but lower levels in embryonic fluid compared to the women with normal pregnancies. In eight of the women with an empty gestational sac, 50% of the AFP from embryonic fluid was nonreactive to concanavalin A, indicating that it was from the embryonic yolk sac. The higher maternal blood AFP levels in women with an empty gestational sac indicates that AFP is being produced by the breakdown of the placenta. These data lend further evidence to support the fact that many anembryonic pregnancies are characterized by an embryo that survives long enough produce a yolk sac.

Physiological aspects, Fetal death

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