Structured evaluation and reporting in imaging of placenta and umbilical cord

Abstract

The human placenta plays a pivotal role in development and growth of the fetus. Disorder of this multifunctional organ is central to various fetal disorders. Doppler sonography and MRI provide excellent diagnostic evaluation of the placental morphology and umbilical cord. Decades of experience in obstetric imaging have highlighted the need of careful prenatal assessment of placenta. However, in most of the routine obstetric scans, the evaluation and reporting of the placental examination is limited to the location and grade of the placenta. The purpose of this article is to review the existing literature and facilitate step-by-step evaluation of the placenta and umbilical cord by the radiologists.

Furcate umbilical cord insertion with a bilobed placenta identified on prenatal ultrasonography

“…7 In our case, the furcate cord insertion was isolated with no further fetal anomalies detected. A bilobed placenta 17 was identified in our case. Bilobed placentas and lobes have been associated with furcord insertions in the literature.…”

“…However, by 2019, 98% of placental cord insertions were able to be assessed with colour Doppler, in less than one minute in most cases. 19 Some 17,20 have recommended a comprehensive evaluation of the placenta and the length of the umbilical cord, facilitated by modern sonographic technology, but this is not yet routine. In our case, the cord insertion was evaluated at every second-and third-trimester scan.…”

Current Perspectives of Prenatal Sonography of Umbilical Cord Morphology

“…Specific MR imaging criteria for utilization of detailed depiction of umbilical cord entanglement (nuchal, true knots and complex entanglement) remain to be determined. 282 …”

Placental magnetic resonance imaging: normal appearance, anatomical variations, and pathological findings

“…The radiologist should include this information in the report in a descriptive manner, avoiding the terms marginal, partial, complete, and central (total) PP. The diagnosis of PP should be made only in the third trimester (around 30 weeks), given that placental migration can still occur prior to that time ( 4 , 6 ) . The main risk factors for PP are as follows ( 5 ) : anterior cesarean section or uterine scarring; advanced maternal age; multiparity; curettage; twinning; a history of placenta previa (recurrence in 4-8%); smoking; and the use of illicit drugs, such as cocaine.…”