Ultrasonographically Observed Grade III Placenta at 36 Weeks’ Gestation: Maternal and Fetal Outcomes

Abstract

ABSTRACT:BACKGROUND:Current ultrasound assessment of placental calcification relies on Grannum grading. The ultrasonographic appearance of grade III placental maturation, if it occurs before 37 weeks, may signify placental dysfunction and is found to be associated with development of pre-eclampsia and low birth weight.OBJECTIVE:To look at the prevalence of a grade III placenta at 36 weeks’ gestation in a low-risk obstetric population, and to explore the association between premature aging observed ultrasonographically and pregnancy outcome.METHODS:Scans were performed at 36 weeks’ gestation in 591 low-risk pregnant women to determine placental maturity. The prevalence of grade III placenta at 36 weeks’ gestation was determined. Follow-up was performed for the group of women demonstrating a grade III placenta in comparison to those not demonstrating a grade III placenta for determining pregnancy outcome.RESULTS:The prevalence of grade III placenta at 36 weeks’ gestation was 3.9%. A grade III placenta at 36 weeks’ gestation was significantly associated with young maternal age P = 0.01. The Grannum grade III of the placenta at 36 weeks’ gestation was statistically associated with increased risk for development of proteinuric pregnancy-induced hypertention (PIH) later in pregnancy (RR 4.94; 95% CI 1.15-21.26), P = 0.021. Women demonstrating a grade III placenta at 36 weeks’ gestation had a significant high risk of induction of labour for suspected fetal compromise (RR 4.7; 95% CI 1.76-12.59), P = 0.001. The risk for delivering a baby with a weight <10th centile at birth was significantly higher in women with grade III placentas in comparison to those with grades 0-II (RR 3.19; 95% CI 1.23-8.27), P = 0.017.CONCLUSION:In a low-risk obstetric population, ultrasound detection of Grannum grade III placenta at 36 weeks’ gestation helps to identify at risk pregnancy. It appears to predict subsequent development of proteinuric PIH and may help in identifying the growth-restricted baby