A prospective observational study to determine the utility of placental laterality for prediction of preeclampsia in pregnancy


  • Anshul Rana Department of Obstetrics and Gynecology, Kamla Nehru State Hospital for Mother and Child, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
  • Rama Thakur Department of Obstetrics and Gynecology, Kamla Nehru State Hospital for Mother and Child, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
  • Rohini Rao Department of Obstetrics and Gynecology, Kamla Nehru State Hospital for Mother and Child, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India




Doppler, Hypertension, Placenta laterality, Pregnancy


Background: Preeclampsia is a multisystem disorder of unknown aetiology and recently its link with placental laterality has been explored. The objective of this study was to find the association of placental laterality with maternal and fetal outcomes in pregnancy. Study also determined the predictive ability of placenta laterality for the development of hypertension in pregnancy.

Methods: A prospective observational cohort study was conducted on 200 pregnant women. Routine investigations and doppler analysis were done. Placenta position was categorized into central and lateral. Maternal and fetal outcomes were recorded. The data was entered in MS excel spreadsheet and analysis was done using statistical package for social sciences (SPSS) version 21.0. A p value of < 0.05 was considered statistically significant.

Results: Study found no significant association of placental laterality with hypertension in pregnancy. Various fetal complications, birth weight, Apgar scores and NICU admission were comparable among women with central or lateral placenta (p > 0.05). Even the maternal outcomes like mode of delivery, onset of labor, indication of labor induction and caesarean deliveries were comparable among women with central or lateral placenta (p > 0.05). On applying univariate logistic regression analysis, previous history of hypertension in pregnancy was a significant risk factor for development of preeclampsia with odds ratio of 168.43 (p < 0.05).

Conclusions: It can be concluded that the maternal and fetal outcomes are independent of the placenta laterality. The doppler characteristics and placenta laterality did not show any increased risk for hypertension in pregnancy. However future studies are recommended with large sample size including more women with diagnosed hypertension in the pregnancy so that a better association can be derived with placenta laterality and doppler characteristics.


Magee LA, Dadelszen P von, Stones W, Mathai M. The FIGO textbook of pregnancy hypertension: an evidence-based guide to monitoring, prevention and Management; 2016.

Rastogi A. Preeclampsia. National Health Portal of India, 2016. Available at: https://www.nhp.gov.in/disease/gynecology-and-obstetrics/preeclampsia. Accessed on 12th August 2019.

World Health Organization. WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia, 2011. Available at: http://whqlibdoc.who.int/publications/2011/9789241548335_eng.pdf. Accessed on 12th August 2019.

Munge A, Satia M. Urinary calcium to creatinine ratio to predict preeclampsia and use of calcium supplementation to prevent preeclampsia. Int J Reprod Contracept Obstet Gynecol. 2016;104:1380-5.

Wallace AE, Whitley GS, Thilaganathan B, Cartwright JE. Decidual natural killer cell receptor expression is altered in pregnancies with impaired vascular remodeling and a higher risk of pre-eclampsia. J Leukoc Biol. 2015;97(1):79-86.

North RA, Ferrier C, Long D, Townend K, Kincaid-Smith P. Uterine artery Doppler flow velocity waveforms in the second trimester for the prediction of preeclampsia and fetal growth retardation. Obstet Gynecol. 1994;83(3):378-86.

Pedroso M, Palmer K, Hodges R, Costa F, Rolnik D. Uterine artery Doppler in screening for preeclampsia and fetal growth restriction. Rev Bras Ginecol Obstet. 2018;40(05):287-93.

Yu CKH, Khouri O, Onwudiwe N, Spiliopoulos Y, Nicolaides KH. For the fetal medicine foundation second-trimester screening group. Prediction of pre-eclampsia by uterine artery Doppler imaging: relationship to gestational age at delivery and small-for-gestational age. Ultrasound Obstet Gynecol. 2008;31(3):310-3.

Yousuf S, Ahmad A, Qadir S, Gul S, Tali SH, Shaheen F, et al. Utility of placental laterality and uterine artery Doppler abnormalities for prediction of preeclampsia. J Obstet Gynecol India. 2016;66(S1):212-6.

Kofinas D, Penry M, Swain M, Hatjis CG. Effect of placental laterality on uterine artery resistance and development of preeclampsia and intrauterine growth retardation. Am J Obstet Gynecol. 1989;161(6):1536-9.

Liberati M, Rotmensch S, Zannolli P, Perrino S, Celentano C, Tiboni GM, et al. Uterine artery Doppler velocimetry in pregnant women with lateral placentas. J Perinat Med. 1997;25(2):133-8.

Preety A, Phalguni K, Nounenuo T. Study on relation between placental laterality in second trimester ultrasound and development of preeclampsia at term. J Evol Med Dent Sci. 2015;4(104):16926-8.

Devarajan K, Kives S, Ray JG. Placental location and newborn weight. J Obstet Gynaecol Can. 2012;34(4):325-9.

Seckin KD, Cakmak B, Karsli MF, Yeral MI, Gultekin IB, Oz M, et al. Is lateral localisation of placenta a risk factor for adverse perinatal outcomes? J Obstet Gynaecol. 2015;35(7):696-8.

Magann EF, Doherty DA, Turner K, Lanneau GS, Morrison JC, Newnham JP. Second trimester placental location as a predictor of an adverse pregnancy outcome. J Perinatol. 2007;27:9-14.

Contro E, Maroni E, Cera E, Youssef A, Bellussi F, Pilu G, et al. Unilaterally increased uterine artery resistance, placental location and pregnancy outcome. Eur J Obstet Gynecol Reprod Biol. 2010;153(2):143-7.

Vaillant P, Best MC, Cynober E, Devulder G. Pathological uterine readings when the placenta is laterally situated. J Gynecol Obstet Biol Reprod. 1993;22:301-7.

Jaiswal J, Jaiswal A, Nagaria T, Ramteke A. Prediction of pregnancy induced hypertension by USG guided placental localization. J Evol Med Dent Sci. 2015;4(81):14163-72.






Original Research Articles