Prospective cohort study in relation of placental location and risk of developing preeclampsia in a tertiary care hospital

Raji C., Asha Sundaram, Shenbagam G.


Background: Preeclampsia is one of the leading and unpredictable causes of maternal morbidity and mortality. This study was done to find the association between location of placenta and the development of preeclampsia as well as its correlation with severity of preeclampsia.

Methods: This prospective cohort study was conducted in government medical college hospital, Pudukottai, Tamil Nadu, India between March 2021 to December 2021. The 150 pregnant women were registered in this study. The location of the placenta was determined by ultrasound at 18-24 weeks. The placenta was classified as central and lateral. The endpoint of the study was the development of hypertension or delivery.

Results: The incidence of preeclampsia was 32%. Primigravida was a significant high-risk factor. Preeclampsia was more common in 20-25 years (52.1%). Among 48 women who developed preeclampsia, 32 had lateral location of placenta and 16 had central location of placenta. Lateral location of placenta in predicting preeclampsia, p<0.0001, which is clinically significant. Lateral location of placenta has high incidence of both severe 66.7% and non-severe preeclampsia 67.6%. The sensitivity-66.6%, specificity-78.4%, positive predictive value-59.2%, negative predictive value-83.3% and the likelihood ratio of 3.09 of our study are significant.

Conclusions: This study shows that placental location determined by ultrasonogram between 18-24 weeks of gestation is an excellent screening tool for the prediction of pre-eclampsia. Lateral placentation helps to identify who are at greatest risk and those requiring careful obstetric management to achieve a more favourable outcome and to decrease the maternal and perinatal morbidity and mortality with preeclampsia.  


Preeclampsia, Placental laterality, Central placenta

Full Text:



Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM et al. Williams obstetrics, 25th edition; Hypertensive Disorders. McGraw-Hill Education. 2018;710-28.

Martin JN Jr, Owens MY, Keiser SD. Standardized Mississippi protocol treatment of 190 patients with HELLP syndrome: slowing disease progression and preventing new major maternal morbidity. Hypertension in pregnancy. 2012;31(1):79.

Walker JJ. Current thoughts on the pathophysiology of preeclampsia/eclampsia. In Studd J. Progress in obstetrics ang gynaecology. Edinburgh: Livingstone-Churchill. 1998;177-88.

Myatt L, Clifton RG, Roberts JM. First-trimester prediction of preeclampsia in nulliparous women at low risk. Obstet Gynecol. 2012;119(6):2012a.

Myatt L, Clifton RG, Roberts JM. The utility of uterine artery Doppler velocimetry in prediction of preeclampsia in a low-risk population. Obstet Gynecol. 2012;120(4):815.

Usha K, Sheriar NK. OBG in perspective, pregnancy induced hypertension. Orient longman Publications, Endocr Jr. 2009;56(8):921-34.

Dutta DC. Text book of obstetrics. 8th edition, Chapter 17; Hypertensive disorders in pregnancy. Central Publishers. 2016;221-42.

Thobbi VA, Anwar A. A study of maternal morbidity and mortality DUE to Pre-eclampsia and eclampsia. J Med Sci. 2017;10(3):174-9.

Arias F, Bhide AG. Arias’ practical guide to high-risk pregnancy and delivery, 4th edition; Hypertensive disorders in pregnancy. 2019;186-232.

Worley LC, Hnat MD, Cunningham FG. Advanced extrauterine pregnancy: diagnostic and therapeutic challenges. Am J Obstet Gynecol. 2018;198(3):297:e1.

Volhard F. Die doppelseitigen haematogenen Nierener krankungen. Berlin Springer. 1918.

Cunningham FG, Leveno KJ, Bloom SL. Williams obstetrics, 22nd ed. New York: McGraw-Hill. 2005;761-808.

Fleischer A, Schulman H, Farmakides G. Uterine artery Doppler velocimetry in pregnant women with hypertension. Am J Obstet Gynecol. 1986;154:806-13.

Schulman H, Winter D, Farmakides G. Pregnancy surveillance with Doppler velocimetry of uterine and umbilical arteries. Am J Obstet Gynecol.1989;160:192-6.

Campbell S, Bewbey S, Cohen-overbeek T. Investigation of the uteroplacental circulation by Doppler ultrasound. Semin Perinatol. 1987;11:362.

Beek VE, Peters LLH. Pathogenesis of preeclampsia. A comprehensive model. Obstet Gynaecol survey. 1998;53(4):233-9.

Mosimann B, Wagner M, Poon LC. Maternal serum cytokines at 30-33 weeks in the prediction of preeclampsia. Prenat Diagn. 2013;33(9):823.

Kofinas AD, Penry M, Swain M. Effect of placental laterality on uterine artery resistance and development of preeclampsia and intrauterine growth retardation. Am J Obstet Gynecol. 1989;161:153-69.

Sumathi N, Pavithra GR. Placental laterality-A simple yet reliable Predictor of Pre-Eclampsia an ultrasonic prospective study. J Dental Med Sci. 2016;15(10):116-21.

Chandra K, Maheshwari S. Placental laterality: As a predictor for the development of pre-eclampsia. J Dental Med Sci. 2016;15(06):06-10.

Kore SJ et al. Int J Reprod Contracept Obstet Gynecol. 2016;5(5):1433-7.

Pai Muralidhar V. Placental laterality by ultrasound- a simple yet reliable predictive test for preeclampsia. J Obstet Gynecol India. 2005;55:431-3.

Kakkar T, Singh V, Razdan R. Placental laterality as predictor of development of preeclampsia. J Obstet Gynaecol India. 2013;63(1):22-5.

Sandhya K, Madhavi GB, Chandramathi M. Placental laterality as predictor of development of preeclampsia. Am J Phytomed Clin Ther. 2015;3(3):231-6.