Diagnosis of Placental Position by Early First-Trimester Ultrasound: A Pilot Study
- PDF / 495,831 Bytes
- 7 Pages / 602.986 x 782.986 pts Page_size
- 107 Downloads / 193 Views
Diagnosis of Placental Position by Early First-Trimester Ultrasound: A Pilot Study
Reproductive Sciences 1-7 ª The Author(s) 2019 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1933719119831778 journals.sagepub.com/home/rsx
Laura Detti, MD1 , Jennifer C. Gordon, MD1, Mary E. Christiansen, MD1, Nicole A. Van de Velde, MD1, Ludwig Francillon, MD1, Irene Peregrin-Alvarez, MD1, Robert A. Roman, MD1, and Anna Joy G. Rogers, DrPH1
Abstract Objective: Conventional wisdom is that placental location cannot be identified before 8 weeks’ gestation when the placenta first becomes hyperechogenic on ultrasound. We sought to evaluate whether placental location could be reliably diagnosed between 5 and 6 weeks’ gestation. Materials and Methods: This was a retrospective analysis of prospectively acquired data. Early placental location was diagnosed by evaluation of the embryonal and yolk sac position inside the gestational sac on transvaginal ultrasound. Placental position was described as anterior, posterior, fundal, or lateral. Early and mid-pregnancy placental locations were compared and coded as being the same, having migrated to an adjacent surface, or being on an opposite surface. Results: A total of 111 patients met study criteria, providing 141 placental locations, comprising 85 singleton and reduced pregnancies and 28 dichorionic twin pregnancies. The most common placental location was anterior in both singleton and twin/ triplet pregnancies. Placental location at the mid-pregnancy ultrasound was consistent with early pregnancy location in 100% of cases, with 79.5% (112/141) being on the same surface and 20.5% (29/141) having expanded onto an adjacent surface. Placental location was not associated with pregnancy outcome, although our study may have been underpowered to detect a significant difference. Conclusions: Placental location diagnosed at 5 to 6 weeks’ gestation is consistent with the location on mid-pregnancy ultrasound. Excluding the presence of an ectopic, cornual, or cesarean section scar and uterine subseptation pregnancy in early first trimester would allow a more effective tailoring of pregnancy follow-up. Keywords early pregnancy, placenta, location, ultrasound
Introduction Early identification of placental location is crucial for clinical management of the pregnancy, such as to differentiate an ectopic from a cornual pregnancy,1 identify cesarean scar pregnancies, 2,3 or predict resolution of a cervical pregnancy.4,5 Placental location is traditionally identified by ultrasound after 8 weeks’ gestation, when the placenta forms by anchoring the chorion frondosum with the apposed amnion in the basal decidua.4 When this occurs, the circulation in the chorion frondosum starts becoming prominent, thus appearing hyperechogenic on ultrasound and allowing its localization in relationship to the uterine wall.6 Placental location has also been visualized using power Doppler by 10 weeks of gestation, at which point scattered vessels can be identified surrounding the gestational sac.7 Howeve
Data Loading...
