Placental Lesions: Is Growth a Predictor of Bad Outcome?

Abstract

Placental lesions are difficult to assess because there is often a discrepancy between the ultrasound findings, clinical diagnosis and pathology. Large placental lesions especially when solid and echogenic on ultrasound may be associated with a high maternal serum alpha-fetoprotein, intrauterine growth retardation or uteroplacental insufficiency. We report three cases in which mainly solid placental lesions were noted to increase in size during the second trimester and the placental weights at birth were relatively heavy when compared to the fetal weight. In all cases there were serious pregnancy complications. Pathological examination showed infarction, haematoma or both. We suggest that the growth of placental lesions during pregnancy may be an important sign related to the severity of the disease and therefore poor outcome.

Management of fetal growth restriction

“…8 Traditionally, causes of abnormal SGA have been subdivided into fetal, placental and maternal. 9 However, accurate prenatal assessment of fetal growth is not without difficulties. Although size is a physical parameter that can be measured at any gestational age, growth is a dynamic process that can be assessed only by repeated measurements.…”

Prenatal Diagnosis of a Subamniotic Hematoma

“…The rise in MSAFP may be caused by extravasation of fetal blood into the maternal circulation. A similar mechanism for abnormally high levels of MSAFP has been proposed in first trimester vaginal bleeding, placental infarction [9,10], placental cavities [3,4] or chorangiomas [6].…”

“…The differential diagnosis has to be considered with placental anomalies [1,2] (avillous spaces or 'placental lakes' [3,4], true placental cyst or cytotrophoblast cyst [5], circumvallate placenta, subchorionic hematomas or thrombi [6][7][8], chorangioma [6], Breus' mole [7], and infarction [9,10]), a cord cyst, and fetal anomalies ('vanishing twin', meningocele). Exact sonographic localization, shape and echogenicity of the lesion over time [1] and Doppler flow examination enable differentiation between a subamniotic hematoma and other lesions.…”

Three-Dimensional Sonographic Features of Placental Abnormalities

“…These tumors are well circumscribed and have a different echogenicity from the rest of the placental tissue [6]. Subchorionic hematomas are often asymptomatic, although these lesions, especially when massive, may be associated with IUGR and fetal death [23][24][25][26]. Prenatal differentiation of chorioangiomas from other solid placental masses using conventional 2D sonography is frequently difficult [7].…”