DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20195313

Comparison of placental grading at different periods of gestation in PIH patients and their outcome

Sneha S., Sreelatha S., Renuka Ramaiah

Abstract


Background: The current study follows grannum grading of placenta. It is well known that there is accelerated placental maturation in PIH patients and the ultrasonic appearance of grade 3 placenta before 37 weeks may signify placental dysfunction and is associated with development of low birth weight babies, IUGR meconium stained liquor, low APGAR score. Hence this study was conducted to emphasize on placental grading at different periods of gestation to predict and prevent increased obstetric and fetal compromise and to compare the outcomes.

Methods: Obstetric scans were performed in all PIH patients attending antenatal OPD and inpatients at ESIC and PGIMSR medical college, Bangalore to know the placental grading and biophysical profile. These women were followed till their delivery for obstetric and fetal outcomes.

Results: Grade 3 placenta is seen in 17 patients in group 1(50%) and 39 patients (59%) in group 2. For statistical analysis grade 1 and 2 were combined and compared with  grade 3. P-value 0.198 which was not statistically significant. There was no statistically significant difference in age and gravidity between two groups. The medical disorders were more in group 2 i.e., between 37 - 40 weeks. The complications of PIH were also more in group 2. There were more number of LSCS (n=19 versus 14) in 34-36 weeks group which was not statistically significant. Fetal outcomes like IUGR and IUD were more in group 2 which was not statistically significant. The mean birth weight in group 1 was 2 kg as compared to 2.7 kg in group 2. All associated medical disorders were more in group 2.

Conclusions: In hypertensive women there is accelerated placental maturation leading to maternal and fetal complications. Hence women with accelerated placental maturity in ultrasound should be closely monitored and appropriately managed. However, we recommend larger randomized studies are necessary.


Keywords


Grannums study, Gestational age, PIH, Ultrasound placental grading

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References


Palmer PES. Obstetrics. In: Palmer PES(ed) Manual of diagnostic ultrasound, WHO Library Catologuing in Publication Data. 2003:223-82.

Collins S, Arulkumaran S, Hayes S, Jackson S, Impey L. Normal pregnancy. In: Collins, Arulkumaran, Hayes, Jackson, Impey (eds .) Oxford Handbook of Obstetrics and Gynecology, 2nd edition, Oxford University Press. 2008:1-46.

Weinsberg F. Echographic changes with placental aging. J Clin Ultrasound. 1973;1:52-60.

Grannum PAT, Berkowitz RL, Hobbins JC. The ultrasonic changes in the maturating placenta and their relation to fetal pulmonic maturity. Am J Obstet Gynecol. 1979;133:915-22.

Petrucha RA, Piatt LD. Relationship of placental grade to gestational age. Am J Obstet and Gynecol. 1982;144:733-35.

Grannum PA, Hobbins JC. The placenta. Radiol Clin North Am. 1982;20:353-65.

Chudleigh T, Thilaganathan B. The placenta and amniotic fluid. In: Chudleigh, Thilaganathan(eds) Obstetric Ulrasound: How, Why and When, 3rd edition, Elsevier Churchill Livingstone. 2004:9137-47.

Carrol B. Ultrasonic features of preeclampsia. J Clic Ultrasound. 1980;8:483-88.

Mc Kenna D, Tharamarathnam S, Mahsud S, Dornan J. Ultrasounnic evidence of placental calcification at 36 weeks gestation: maternal and fetal outcomes. Acta Obstet Gynecol Scand. 2005;84:7-10.

Cooley SM, Donnelly JC, Walsh T, McMohan c, Gillan J, Geary MP. The impact of ultrasonographic placental architecture on antenatal course, labour and delivery in a low risk primigravid population. J Mater Fetal Neonatal Med. 2010;7:1-5.

Valenzuela BA, Méndez GA. Premature aging of the placenta, ultrasonic diagnosis. Ginecol Obstet Mex. 1995;63:287-92.

Middleton WD, Kurtz AB, Hertzberg BS. Fetal growth and wellbeing. In: Middleton, Kurtz, Hertzberg (eds) Ultrasound: The Requisites ,2ndedition. Mosby. 2004:330-41.

Brown HL, Miller JM, Khawli O, Gabert HA. Premature placental calcification in maternal cigarette smokers. Obstet Gynecol. 1988;71:914-17.

Kazzi GM, Gross TL, Sokol RJ, Kazzi NJ. Detection of intrauterine growth retardation : a new use for sonographic placental grading. Am J Obstet Gynecol. 1983;145:733-37.

Merz E. The placenta, umblical cord, and amniotic fluid. In: Merz E (ed). Ultrasound in Gynecology and Obstetrics: Textbook and atlas, Thieme Medical Publishers. 1991:232-248.

Alkazaleh F, Viero S kingdom JCP. Sonographic evaluation of the placenta. In: Rumack, Wilson, Charboneau, Johnson (eds.) Diagnostic ultrasound. 3rd edition. Obstetric and fetal sonography. Elsevier Mosby. 2005:1557-81.

Callan NA. Intrauterine growth retardation. In: Quilligan , Zuspan (eds) Current therapy in Obstetrics and Gynecology, 5th edition, Philadelphia: WB Saunders. 2000:307-310.