BENDER, H. G.

HERBERGER, J.

KOZLOWSKI, P.

SCHMIDT, H.

TERINDE, R.

Journal of Perinatal Medicine

English

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Analysis of Placental Structures by Ultrasound in Normal and Complicated Pregnancies

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138Analysis of Placental Structures by Ultrasound in Normal andfComplicated PregnanciesP. KOZLOWSKI, R. TERINDE, H. SCHMIDT, J. HERBERGER, H.6. BENDERGrey scale echography allows to study the intrauterine dimensions of theplacenta äs it is possible to separate the chorionic plate, marginal areasand the basal plate from the surrounding structures. Subject of the presentstudy were the progress of placental -growth in the last third of pregnancyand the changes in placental tissue structure. 267 placentas of 157 gra-vidas were examined at various stages of gestation. 4372 longi tudinal andtransversal section scans were done - on an average 15 scans of one pla-centa. The anterior wal l placenta of a patient was scanned in steps of2 cms in longitudinal just äs in transverse direction ( Fig. l ).Abb. 1: Model of transverse (left) and longitudinal (r ight)section scans of a placentaThe scans were stored on a video tape and measured by means of a X-Y-di-gitizer, o u t l i n i n g the placenta on each scan. The Implanta t ion area,total surface and the placental volume were calculated.The sonographical tissue structure of each single section scan was dif-ferentiated by a scored scheme of five different signs in a four-stepgraduation ( Fig. 2 ). The degree of appeärance of each criterion in asection scan was brought in relation to its part of the whole placentalvolume.ResultsFig. 3 demonstrates the increase of placental volume during pregnancy bymeans of a mathematically fitted growth curve i n c l u d i n g the Standard de-viat ion. The gestational age was calculated not only by the term of thelast menstruation, but also by the progress of the fetal biparietal dia-meter. There is no growth of placental volume beyond the 34th w.o .g .The placental volumes of pregnancies complicated by diabetes B, C or .Daccording to the WHITE scheme are represented by the "D" letters, the"S" letters show the volumes of the placentae of small for gestationalage infants who f ina l ly had a birthwei'ght below 2700 g.0300-5577/81/0091-0040 $ 2.00Copyright by Walter de Gruyter & Co.139Maternal sideof placentaM a r g i n a lareasInternatstructuresAvi l lousspacesSinusoidesHomoganous'• ingle apotaup te50% t h ickinhomoganouaroughö -mora than50% t hick"gar l and"•choaaa p r « a < lAbb. 2: Scheme of the f ive criteriaof placental tissue structureIn 152 patients the last sonogra-phic examination was done two weeksor less before delivery. Analyzingthe five criteria .of placentalstructure we established a groupof inconspicious pregnancies withnon-pathological fetal outcome anda pathological one inc lud ing fetaldistress, operative delivery,small-for-date and s t i l lbir th .Three of the five criteria provedto be of small value under c l in i -cal aspects: The existence of mar-ked marginal areas, av i l lous spa-ces and sinusoids was not connec-ted with remarkable differencesconcerning the fetal outcome. Sig-nif icant differences between bothgroups were found, however, äs to"maternal side of placenta11 and"internal structures11. If 75 percent or more of the placental tis-sue are sonographically describedäs grossly inhomogenous or eveninterspersed with garland echoesa significant di'fference in fetaloutcome between the normal and thepathological groups was found. Si-mi la r differences between thosegroups could be demonstrated inthose cases in which besides theutero-placental borderline was ap-parently thicker.Ccm331200-830400SSWAbb. 3: Growth of placental volume with s ingle s. d.Dr.P.KozlowskiUniv.-FrauenklinikMoorenstr.5D-40OO Düsseldorf l /Germany

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Analysis of Placental Structures by Ultrasound in Normal and Complicated Pregnancies

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