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.
ElchalalUEzraYLeviY, et al.
Sonographically thick placenta: a marker for increased perinatal risk–a prospective cross-sectional study.Placenta2000;
21:268–272.
2.
HoddickWKMahonyBSCallenPW, et al.
Placental thickness.J Ultrasound Med1985;
4:479–482.
3.
Fadl S, Moshiri M, Fligner CL, et al. Placental imaging: normal appearance with review of pathologic findings. RadioGraphics 2017;37:979–998.
4.
HabibFA.Prediction of low birth weight infants from ultrasound measurement of placental diameter and placental thickness.Ann Saudi Med2002;
22:312–314.
5.
DamodaramMStoryLEixarchE, et al.
Placental MRI in intrauterine fetal growth restriction.Placenta2010;
31:491–498.
6.
GizzoSNoventaMVitaglianoA, et al.
Sonographic assessment of placental location: a mere notional description or an important key to improve both pregnancy and perinatal obstetrical care? A large cohort study.Int J ClinExp Med2015;
8:13056–13066.
7.
BenirschkeK.Placental shape aberrations. In: BenirschkeKKaufmannP, editors. Pathology of the Human Placenta.
New York, NY:
Springer‐Verlag, 1990:367–397.
8.
GallagherPFaganCJBediDG, et al.
Potential placenta previa: definition, frequency, and significance.Am J Radiol1987;
149:1013–1015.
9.
CastroLCHobelCJWallaC, et al.
Placental migratory patterns and birth weight.Am J Obstet Gynecol1995;
172:346.
10.
ShippTD.Sonographic evaluation of the placenta. In: RumackCMWilsonSRCharboneauJW, editors. Diagnostic Ultrasound.
St. Louis, MO:
Elsevier Mosby, 2005:1510–1512.
11.
OppenheimerLWFarineDRitchieJW, et al.
What is a low-lying placenta?Am J Obstet Gynecol1991;
165:1036–1038.
12.
BhideAPrefumoFMooreJ, et al.
Placental edge to internal os distance in the late third trimester and mode of delivery in placenta praevia.BJOG2003;
110:860–864.
13.
Timor-TritschIEYunisRA.Confirming the safety of transvaginal sonography in patients suspected of placenta previa.Obstet Gynecol1993;
81:742–744.
14.
ShukunamiKNishijimaKKurokawaT, et al.
A small-angled thin edge of the placenta predicts abnormal placentation at delivery.J Ultrasound Med2005;
24:331–335.
15.
GhourabS.Third-trimester transvaginal ultrasonography in placenta previa: does the shape of the lower placental edge predict clinical outcome?Ultrasound Obstet Gynecol2001;
18:103–108.
16.
TorpinRBarfieldWE.Placenta duplex. J Med Assoc Ga1968;
57:78–80.
17.
ElsayesKMTroutATFriedkinAM, et al.
Imaging of the placenta: a multimodality pictorial review.Radiographics2009;
29:1371–1391.
18.
GrannumPABerkowitzRLHobbinsJC.The ultrasonic changes in the maturing placenta and their relation to fetal pulmonic maturity.Am J Obstet Gynecol1979;
133:915–922.
19.
KazziGMGrossTLSokolR, et al.
Detection of intrauterine growth retardation: A new use for sonographic placental grading.Am J Obstet Gynecol1983;
145:733–737.
20.
BlaicherWBruggerPCMittermayerC, et al.
Magnetic resonance imaging of the normal placenta.Eur J Radiol2006;
57:256–260.
21.
ShipleyCFNelsonGH.Prenatal diagnosis of a placental cyst: comparison of postnatal biochemical analyses of cyst fluid, amniotic fluid, cord serum, and maternal serum.Am J Obstet Gynecol1993;
168:211–213.
22.
FeldsteinVAHarrisRDMachinGA.Ultrasound evaluation of the placenta and umbilical cord. In: CallenP, editor. Ultrasonography in Obstetrics and Gynecology. 5th ed.
Philadelphia, PA:
Saunders, 2007:721–724.
23.
DekanSLinduskaNKasprianG, et al.
MRI of the placenta - a short review.Wien Med Wochenschr2012;
162:225–228.
24.
LinduskaNDekanSMesserschmidtA, et al.
Placental pathologies in fetal MRI with pathohistological correlation.Placenta2009;
30:555–559.
25.
MesserschmidtABaschatALinduskaN, et al.
Magnetic resonance imaging of the placenta identifies placental vascular abnormalities independently of Doppler ultrasound.Ultrasound Obstet Gynecol2011;
37:717–722.
26.
KirkpatrickADPodbereskyDJGrayAE, et al.
Best cases from the AFIP: Placental chorioangioma.Radiographics 2007;27:1187–1190.
27.
AbdallaNBachanekMTrojanowskiS, et al.
Placental tumor (chorioangioma) as a cause of polyhydramnios: a case report. Int J Womens Health2014;
6:955–959.
28.
ChhabraMDaverR.Live second trimester intrauterine pregnancy with invasive mole: a rare case report.Int J Reprod Contracept Obstet Gynecol2018;
7:1657–1659.
29.
ImafukuHMiyaharaYEbinaY, et al.
Ultrasound and MRI findings of twin pregnancies with complete hydatidiform mole and coexisting normal fetus: two case reports.Kobe J Med Sci2018;
64:E1–E5.
30.
SheikSAl-RiyamiNMathewNR, et al.
Twin pregnancy with a complete hydatidiform mole and a coexisting live fetus: rare entity.Sultan Qaboos Univ Med J2015;
15:e550–e553.
31.
HimotoYKidoAMinamiguchiS, et al.
Prenatal differential diagnosis of complete hydatidiform mole with a twin live fetus and placental mesenchymal dysplasia by magnetic resonance imaging.J Obstet Gynaecol Res2014;
40:1894–1900.
32.
CallenPWFillyRA.The placental-subplacental complex: a specific indicator of placental position on ultrasound.J Clin Ultrasound1980;
8:21–26.
33.
CheungCSChanBC.The sonographic appearance and obstetric management of placenta accreta.Int J Wom Health2012;
4:587–594.
ComstockCHLoveJJBronsteenRA, et al.
Sonographic detection of placenta accreta in the second and third trimesters of pregnancy.Am J Obstet Gynecol2004;
190:1135–1140.
36.
Castellucci M, Kaufmann P. Basic structure of the villous trees. In: Benirschke K and Kaufmann P (eds) Pathology of the Human Placenta. 3rd edn. New York: Springer Verlag, 1995, pp. 57--115.
37.
BenirschkeKBurtonGJBaergenRN.Anatomy and pathology of the umbilical cord. In: Benirschke K, Kaufmann P and Baergen RN (eds) Pathology of the Human Placenta.
Berlin, Heidelberg:
Springer, 2012, pp. 380--435.
38.
Kumar I, Verma A, Ojha R, et al. Invasive placental disorders: A prospective US and MRI comparative analysis. Acta Radiol 2017;58:121–128.
39.
FinbergHJWilliamsJW.Placenta accreta: Prospective sonographic diagnosis in patients with placenta previa and prior cesarean section.J Ultrasound Med1992;
11:333–343.
40.
YangJILimYKKimHS, et al.
Sonographic findings of placental lacunae and the prediction of adherent placenta in women with placenta previa totalis and prior Cesarean section.Ultrasound Obstet Gynecol2006;
28:178–182.
41.
TwicklerDMLucasMJBalisAB, et al.
Color flow mapping for myometrial invasion in women with a prior cesarean delivery.J Matern Fetal Med2000;
9:330–335.
42.
LernerJPDeaneSTimor-TritschIE.Characterization of placenta accreta using transvaginal sonography and color Doppler imaging.Ultrasound Obstet Gynecol1995;
5:198–201.
43.
ShihJCPalacios JaraquemadaJMSuYN, et al.
Role of three-dimensional power Doppler in the antenatal diagnosis of placenta accreta: comparison with gray-scale and color Doppler techniques.Ultrasound Obstet Gynecol2009;
33:193–203.
44.
ChouMMHoESCLeeYH.Prenatal diagnosis of placenta previa accreta by transabdominal color Doppler ultrasound.Ultrasound Obstet Gynecol2000;
15:28–35.
45.
BaughmanWCCortevilleJEShahRR.Placenta accreta: Spectrum of US and MR imaging findings.Radiographics2008;
28:1905–1916.
46.
LevineDHulkaCALudmirJ, et al.
Placenta accreta: evaluation with color Doppler US, power Doppler US, and MR imaging.Radiology1997;
205:773–776.
47.
LaxAPrinceMRMennittKW, et al.
The value of specific MRI features in the evaluation of suspected placental invasion.Magn Reson Imaging2007;
25:87–93.
48.
LamGKullerJMcMahonM.Use of magnetic resonance imaging and ultrasound in the antenatal diagnosis of placenta accreta.J Soc Gynecol Investig2002;
9:37–40.
49.
DwyerBKBelogolovkinVTranL, et al.
Prenatal diagnosis of placenta accreta: sonography or magnetic resonance imaging?J Ultrasound Med2008;
27:1275–1281.
50.
MaldjianCAdamRPelosiM, et al.
MRI appearance of placenta percreta and placenta accreta.Magn Reson Imaging1999;
17:965–971.
51.
MasselliGBrunelliRCascianiE, et al.
Magnetic resonance imaging in the evaluation of placental adhesive disorders: correlation with color Doppler ultrasound.Eur Radiol2008;
18:1292–1299.
52.
Kumar I, Verma A, Jain S, et al. Chemical shift artifact on steady-state MRI sequences for detection of vesical wall invasion in placenta percreta. J Obstet Gynecol India 2016;66:101–106.
53.
UenoYKitajimaKKawakamiF, et al.
Novel MRI finding for diagnosis of invasive placenta praevia: evaluation of findings for 65 patients using clinical and histopathological correlations.Eur Radiol2014;
24:881–888.
54.
AlamoLAnayeAReyJ, et al.
Detection of suspected placental invasion by MRI: do the results depend on observer’s experience?Eur J Radiol2013;
82:e51–57.
55.
MorikawaMChoKKataokaS, et al.
Magnetic resonance image findings of placental lake: report of two cases.Prenat Diagn2005;
25:250–252.
56.
DermanAYNikacVHabermanS, et al.
MRI of placenta accreta: A new imaging perspective.Am J Roentgenol2011;
197:1514–1521.
57.
GuptaRBajajSKKumarN, et al.
Magnetic resonance imaging - A troubleshooter in obstetric emergencies: A pictorial review.Indian J Radiol Imaging2016;
26:44–51.
58.
NotelvitzM.BottomsSFDaseDF, et al.
Painless abruptio placentae.Obstetr Gynecol1979;
53:270–272.
59.
JaffeMHSchoenWCSilverTM, et al.
Sonography of abruptio placentae.Am J Roentgenol1981;
137:1049–1054.
60.
NybergDAMackLABenedettiTJ, et al.
Placental abruption and placental hemorrhage: correlation of sonographic findings with fetal outcome.Radiology1987;
164:357–361.
61.
FadlSALinnauKFDigheMK.Placental abruption and hemorrhage—review of imaging appearance.Emerg Radiol2019;
25:729–731.
62.
MasselliGBrunelliRDi TolaM, et al.
MR imaging in the evaluation of placental abruption: Correlation with sonographic findings.Radiology2011;
259:222–230.
63.
ElsasserDAAnanthCVPrasadV, et al.
Diagnosis of placental abruption: relationship between clinical and histopathological findings. Eur J Obstet Gynecol Reprod Biol2009;
148:125–130.
64.
SaphierNBKopelmanTR.Traumatic Abruptio Placenta Scale (TAPS): a proposed grading system of computed tomography evaluation of placental abruption in the trauma patient.Emerg Radiol2014;
21:17–22.
65.
SiddiqiTABendonRSchultzDM, et al.
Umbilical artery aneurysm: Prenatal diagnosis and management. Obstet Gynecol1992;
80:530–533.
66.
LeinzingerE.Varixthrombose der Nabelschnur.Z Geburtsh Gynäkol1969;
171:82–87.
67.
HallSP.The thin cord syndrome. A review with a report of two cases.Obstet Gynecol1961;
18:507–509.
68.
RaioLGhezziFDi NaroE, et al.
The clinical significance of antenatal detection of discordant umbilical arteries.Obstet Gynecol1998;
91:86–91.
69.
PrimanJ.A note on the anastomosis of the umbilical arteries.Anat Rec1959;
134:1–5.
70.
RaioLGhezziFDi NaroE, et al.
In-utero characterization of the blood flow in the Hyrtl anastomosis.Placenta2001;
22:597–601.
71.
DolkartLAReimersFTKuonenCA.Discordant umbilical arteries: ultrasonographic and Doppler analysis.Obstet Gynecol1992;
79:59–63.
72.
PredanicMKolliJYousefzadehP, et al.
Disparate blood flow patterns in parallel umbilical arteries.Obstet Gynecol1998;
91:757–760.
73.
DeganiSLewinskyRM.Sonographic estimation of umbilical coiling index and correlation with Doppler flow characteristics.Obstet Gynecol1995;
86:990– 993.
74.
StrongTHElliottJPRadinTR.Non-coiled umbilical blood vessels: A new marker for the fetus at risk.Obstet Gynecol1993;
81:409–411.
75.
MurphyAPlattLD.First-trimester diagnosis of body stalk anomaly using 2- and 3-dimensional sonography.J Ultrasound Med2011;
30:1739–1743.
76.
BosselmannSMielkeG.Sonographic assessment of the umbilical cord.Geburtshilfe Frauenheilkd2015;
75:808–818.
77.
CollinsJH.Ultrasound measurement of umbilical cord length.J Ultrasound Med1994;
13:854–854.
78.
RanziniACWaltersCAVintzileosAM.Ultrasound diagnosis of nuchal cord: the gray‐scale divot sign.Obstet Gynecol1999;
93:854.
79.
PiluGFalcoPGuazzariniM, et al.
Sonographic demonstration of nuchal cord and abnormal umbilical artery waveform heralding fetal distress.Ultrasound Obstet Gynecol1998;
12:125–127.
80.
AIUM practice guideline for the performance of obstetric ultrasound examinations.
J Ultrasound Med2013;
32:1083–1101.
81.
IsmailKIHanniganAO’DonoghueK, et al.
Abnormal placental cord insertion and adverse pregnancy outcomes: a systematic review and meta-analysis.Syst Rev2017;
6:242.
82.
CandaMTDemirNDoganayL.Velamentous and furcate cord insertion with placenta accreta in an IVF pregnancy with unicornuate uterus.Case Rep Obstet Gynecol2013;
53:937–939.
83.
MoshiriMZaidiSFRobinsonTJ, et al.
Comprehensive imaging review of abnormalities of the umbilical cord.Radiographics2014;
34:179–196.
84.
MarrSAshtonLStemmA, et al.
Vasa praevia: ultrasound diagnosis at the mid-trimester scan.Australas J Ultrasound Med. 2015;
16:8–15.
WinnHNGabrielliSReeceEA, et al.
Ultrasonographic criteria for the prenatal diagnosis of placental chorionicity in twin gestations.Am J Obstet Gynecol1989;
161:1540–1542.
87.
TaylorMJTalbertDGFiskNM.Mapping the monochorionic equator – the new frontier.Ultrasound Obstet Gynecol1999;
14:372–374.
88.
TaylorMJODenbowMLTanawattanacharoenS, et al.
Doppler detection of arterio-arterial anastomoses in monochorionic twins: feasibility and clinical application.Hum Reprod2000;
15:1632–1636.
89.
LinduskaNMesserschmidtADekanS, et al.Placental magnetic resonance imaging in monochorionic twin pregnancies. J Matern Fetal Neonatal Med2012;
25:1419–1422.
90.
LuoJAbaci TurkEBibboC, et al.
In vivo quantification of placental insufficiency by BOLD MRI: a human study.Sci Rep2017;
7:371–373.
91.
BonelHMStolzBDiedrichsenL, et al.
Diffusion-weighted MR imaging of the placenta in fetuses with placental insufficiency.Radiology2010;
257:810–818.
92.
OhgiyaYNobusawaHSeinoN, et al.
MR imaging of fetuses to evaluate placental insufficiency.Magn Reson Med Sci2015;
15:212–219.
93.
MesserschmidtABaschatALinduskaN, et al.
Magnetic resonance imaging of the placenta identifies placental vascular abnormalities independent of Doppler ultrasound.Ultrasound Obstet Gynecol2010;
37:717–722.
94.
JavorDNaselCSchweimT, et al.
In vivo assessment of putative functional placental tissue volume in placental intrauterine growth restriction (IUGR) in human fetuses using diffusion tensor magnetic resonance imaging.Placenta2013;
34:676–680.
95.
SiauveNChalouhiGEDeloisonB, et al.
Functional imaging of the human placenta with magnetic resonance.Am J Obstet Gynecol2015;
213:S103–114.
