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Odedra D, Mellnick VM, Patlas MN. Imaging of Trauma in Pregnancy. Radiol Clin North Am 2023; 61:129-139. [DOI: 10.1016/j.rcl.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Fadl SA, Linnau KF, Dighe MK. Placental abruption and hemorrhage-review of imaging appearance. Emerg Radiol 2018; 26:87-97. [PMID: 30159815 DOI: 10.1007/s10140-018-1638-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/22/2018] [Indexed: 12/16/2022]
Abstract
Placental and periplacental bleeding are common etiologies for antepartum bleeding. Placental abruption complicates approximately 1% of pregnancies and is associated with increased maternal, fetal, and neonatal morbidity and mortality. This article reviews the normal placental appearance on ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) and then discusses the different morphological appearance of placental and periplacental hematomas along with their mimics. Hematomas are classified based on the location as retroplacental, marginal subchorionic, preplacental (subamniotic), or intraplacental. Placenta-related bleeding is a common finding during first trimester ultrasound and its detection can help triage the pregnant females into low- and high-risk groups. This article reviews placenta related bleeding in the setting of trauma. Trauma can complicate pregnancy with potential severe maternal and fetal outcomes. CT is usually performed as part of the trauma workup and it can be challenging for placental evaluation. MRI can characterize the age of the hematomas and can differentiate hematomas from tumors.
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Affiliation(s)
- Shaimaa A Fadl
- Department of Radiology, University of Washington Medical Center, 1959 NE pacific St., Seattle, WA, 98195, USA.
| | - Ken F Linnau
- Department of Radiology, Harborview Medical Center, University of Washington, 325, 9th Avenue, Harborview Medical Center, Seattle, WA, 98104, USA
| | - Manjiri K Dighe
- Department of Radiology, University of Washington Medical Center, 1959 NE pacific St., Seattle, WA, 98195, USA
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Fadl S, Moshiri M, Fligner CL, Katz DS, Dighe M. Placental Imaging: Normal Appearance with Review of Pathologic Findings. Radiographics 2017; 37:979-998. [PMID: 28493802 DOI: 10.1148/rg.2017160155] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The placenta plays a crucial role throughout pregnancy, and its importance may be overlooked during routine antenatal imaging evaluation. Detailed systematic assessment of the placenta at ultrasonography (US), the standard imaging examination during pregnancy, is important. Familiarity with the normal and abnormal imaging appearance of the placenta along with the multimodality and methodical approach for evaluation of its related abnormalities is necessary, so that radiologists can alert clinicians regarding appropriate prompt management decisions. This will potentially decrease fetal and maternal morbidity and mortality. This article reviews early placental formation and the expected imaging appearance of the placenta during pregnancy, as well as variations in its morphology. It also discusses various placental diseases and their potential clinical consequences. Placental pathologic conditions include abnormalities of placental size, cord insertion, placental and cord location, and placental adherence. Other conditions such as bleeding in and around the placenta, as well as trophoblastic and nontrophoblastic tumors of the placenta, are also discussed. US with Doppler imaging is the initial imaging modality of choice for placental evaluation. Magnetic resonance (MR) imaging is reserved for equivocal cases or when additional information is needed. Computed tomography (CT) has a limited role in evaluation of placental abnormalities because of the ionizing radiation exposure and the relatively limited assessment of the placenta; however, CT can provide important information in specific circumstances, particularly evaluation of trauma and staging of choriocarcinoma. This article also addresses recent techniques and updates in placental imaging, including elastography, diffusion-weighted MR imaging, and blood oxygen level-dependent (BOLD) MR imaging. These advanced imaging techniques may provide additional information in evaluation of abnormal placental adherence and new insights into placental pathophysiology in selected patients. Online supplemental material is available for this article. ©RSNA, 2017.
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Affiliation(s)
- Shaimaa Fadl
- From the Departments of Radiology (S.F., M.M., M.D.) and Pathology (C.L.F.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; and Department of Radiology, Winthrop Radiology Associates, Mineola, NY (D.S.K.)
| | - Mariam Moshiri
- From the Departments of Radiology (S.F., M.M., M.D.) and Pathology (C.L.F.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; and Department of Radiology, Winthrop Radiology Associates, Mineola, NY (D.S.K.)
| | - Corinne L Fligner
- From the Departments of Radiology (S.F., M.M., M.D.) and Pathology (C.L.F.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; and Department of Radiology, Winthrop Radiology Associates, Mineola, NY (D.S.K.)
| | - Douglas S Katz
- From the Departments of Radiology (S.F., M.M., M.D.) and Pathology (C.L.F.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; and Department of Radiology, Winthrop Radiology Associates, Mineola, NY (D.S.K.)
| | - Manjiri Dighe
- From the Departments of Radiology (S.F., M.M., M.D.) and Pathology (C.L.F.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; and Department of Radiology, Winthrop Radiology Associates, Mineola, NY (D.S.K.)
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Rheinboldt M, Delproposto Z. Sonography of placental abnormalities: a pictorial review. Emerg Radiol 2015; 22:401-8. [PMID: 25933509 DOI: 10.1007/s10140-015-1320-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/16/2015] [Indexed: 10/23/2022]
Abstract
Often overlooked during routine ultrasound evaluation of a normal pregnancy, the placenta forms the biologic interface between the mother and fetus and is critical to fetal growth and development. Malformations in development, positioning, and vascularity can have profound implications for both maternal and fetal well-being. As such, a judicious inspection of the placenta is warranted as an integral part of every screening or emergent prenatal ultrasound. Herein, we present a pictorial review of a variety of placental pathologic conditions including abnormalities in positioning, adherence, vascularity, and hemorrhage as well as potential peri-placental masses and gestational trophoblastic disease, all of which are readily encountered in a busy emergency radiology practice.
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Affiliation(s)
- Matt Rheinboldt
- Department of Emergency Radiology, Henry Ford Hospital, Detroit, MI, USA,
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Bowman ZS, Kennedy AM. Sonographic Appearance of the Placenta. Curr Probl Diagn Radiol 2014; 43:356-73. [DOI: 10.1067/j.cpradiol.2014.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 05/16/2014] [Accepted: 05/16/2014] [Indexed: 11/22/2022]
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Placental vascularity and resorption delay after conservative management of invasive placenta: MR imaging evaluation. Eur Radiol 2012; 23:262-71. [PMID: 22760345 DOI: 10.1007/s00330-012-2573-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 05/29/2012] [Accepted: 06/01/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To assess the potential of magnetic resonance (MR) imaging in evaluating placental vascularity and predicting placental resorption delay after conservative management of invasive placenta. METHODS MR examinations of 23 women with conservative management of invasive placenta were reviewed. Twelve women had pelvic embolisation because of postpartum haemorrhage (Group 1) and 11 had no embolisation (Group 2). Comparisons between the two groups were made with respect to the delay for complete placental resorption at follow-up MR imaging and degree of placental vascularity 24 h after delivery on early (30s) and late (180 s) phase of dynamic gadolinium chelate-enhanced MR imaging. RESULTS The median delay for complete placental resorption in the cohort study was 21.1 weeks (range, 1-111 weeks). In Group 1, the median delay for complete placental resorption was shorter than in Group 2 (17 vs 32 weeks) (P = 0.036). Decreased placental vascularity on the early phase was observed in Group 1 by comparison with Group 2 (P = 0.003). Significant correlation was found between the degree of vascularity on early phase of dynamic MR imaging and the delay for complete placental resorption (r = 0.693; P < 0.001). CONCLUSIONS MR imaging provides useful information after conservative management of invasive placenta and may help predict delay for complete placental resorption.
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Nguyen D, Nguyen C, Yacobozzi M, Bsat F, Rakita D. Imaging of the Placenta with Pathologic Correlation. Semin Ultrasound CT MR 2012; 33:65-77. [DOI: 10.1053/j.sult.2011.10.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Elsayes KM, Trout AT, Friedkin AM, Liu PS, Bude RO, Platt JF, Menias CO. Imaging of the Placenta: A Multimodality Pictorial Review. Radiographics 2009; 29:1371-91. [DOI: 10.1148/rg.295085242] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ethier-Chiasson M, Forest JC, Giguère Y, Masse A, Marseille-Tremblay C, Lévy E, Lafond J. Modulation of placental protein expression of OLR1: implication in pregnancy-related disorders or pathologies. Reproduction 2008; 136:491-502. [PMID: 18599643 DOI: 10.1530/rep-08-0082] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The lectin-like oxidized low-density lipoprotein (LDL) receptor-1 (OLR1) is a newly described receptor for oxidatively modified LDL. The human pregnancy is associated with hyperlipidemia and oxidative stress. It has been reported that modification in maternal lipid profile can induce disturbance during pregnancy. In this study, we have evaluated the expression protein level of OLR1 in human term placenta of women having plasma cholesterol level lower to 7 mM or higher to 8 mM and women of gestational diabetes mellitus (GDM) by western blot analysis. The present study demonstrates that the maternal lipid profile is associated with placental protein expression of OLR1. A significant increase in the protein expression of OLR1 was observed in placenta of women with elevated plasmatic total cholesterol level (>8 mM). In addition, the placental protein expression of OLR1 is increased in mothers having the highest pre-pregnancy body mass index (BMI) and low (<7 mM) plasmatic total cholesterol level at term. Interestingly, the placental protein expression of OLR1 is increased in the presence of GDM pregnancies compared with normal lipids level pregnancies, without the modification of mRNA expression. In conclusion, placental OLR1 protein expression is associated with maternal lipid profile, pre-pregnancy BMI, and pathology of GDM.
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Affiliation(s)
- M Ethier-Chiasson
- Laboratoire de Physiologie Materno-Foetale, Département des Sciences Biologiques, Université du Québec à Montréal, Montréal, Québec, Canada
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Gordijn SJ, Dahlstrom JE, Khong TY, Ellwood DA. Histopathological examination of the placenta: key issues for pathologists and obstetricians. Pathology 2008; 40:176-9. [PMID: 18203039 DOI: 10.1080/00313020701813750] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The placenta is often not submitted for histopathological examination and obstetricians may be sceptical of the value of the examination. This article looks at the reasons for histopathological assessment of the placenta, examines what clinical information should be provided to pathologists and reviews what information can be gained from this 'diary of the pregnancy', especially for explaining adverse outcomes and potentially guiding the management of future pregnancies.
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Affiliation(s)
- S J Gordijn
- Department of Obstetrics and Gynecology, University Medical Centre, Groningen, The Netherlands
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Abramowicz JS, Sheiner E. Ultrasound of the placenta: a systematic approach. Part I: Imaging. Placenta 2008; 29:225-40. [PMID: 18262643 DOI: 10.1016/j.placenta.2007.12.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Revised: 12/17/2007] [Accepted: 12/20/2007] [Indexed: 11/28/2022]
Abstract
Diagnostic ultrasound has been in use in clinical obstetrics for close to half-a-century. However, in the literature, examination of the placenta appears to be treated with less attention than the fetus or the pregnant uterus. This is somewhat unexpected, given the obvious major functions this organ performs during the entire pregnancy. Examination of the placenta plays a foremost role in the assessment of normal and abnormal pregnancies. A methodical sonographic evaluation of the placenta should include: location, visual estimation of the size (and, if appearing abnormal, measurement of thickness and/or volume), implantation, morphology, anatomy, as well as a search for anomalies, such as additional lobes and tumors. Additional assessment for multiple gestations consists of examining the intervening membranes (if present). The current review considers the various placental characteristics, as they can be evaluated by ultrasound, and the clinical significance of abnormalities of these features. Numerous and varied pathologies of the placenta can be detected by routine ultrasound. It is incumbent on the clinician performing obstetrical ultrasound to examine the placenta in details and in a methodical fashion because of the far reaching clinical significance and potentially avoidable severe consequences of many of these abnormalities.
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Affiliation(s)
- J S Abramowicz
- Department of Obstetrics and Gynecology, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA.
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Abramowicz JS, Sheiner E. In utero imaging of the placenta: importance for diseases of pregnancy. Placenta 2007; 28 Suppl A:S14-22. [PMID: 17383721 DOI: 10.1016/j.placenta.2007.02.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2006] [Revised: 02/08/2007] [Accepted: 02/09/2007] [Indexed: 11/15/2022]
Abstract
Maurice Panigel demonstrated by X-rays, almost 40 years ago, placental maternal blood jets in non-human primates. Although to researchers the importance of the placenta is evident, in clinical obstetrical imaging, the fetus takes precedence. The placenta is imaged almost as an after thought and mostly to determine its location in the uterus. In animal species, the placenta was imaged with techniques which would be considered too invasive (or too costly for routine use) in humans, many pioneered by Panigel: radioangiography, radioisotopes scintigraphy, thermography, magnetic resonance imaging (MRI) and spectroscopy, positive emission tomography (PET) and single photon emission computed tomography (SPECT). Ultrasound allows for detailed, and, as far as is known, safe analyses of not only placental structure in the human but also its function. Earlier, only 2-dimensional grey-scale was available and more than 20 years ago, placental grading was popular. Later, colour imaging and spectral Doppler analysis of blood velocity both in the umbilical artery and within the placenta as well as the uterus and fetal vessels became essential and, more recently, the use of ultrasound contrast agents has been described, albeit not yet in a clinical setting. Three-dimensional ultrasound permits evaluation of the placenta in several planes, more precise depiction of internal vasculature as well as more accurate volume assessment. Several medical disorders of the pregnant woman or her fetus begin or end in the placenta, and ultrasound is the optimal investigation method. Obvious examples include pre-eclampsia and other forms of hypertension in pregnancy, less than optimal fetal growth (i.e. intrauterine growth restriction), triploidy (and its placental manifestation: partial mole), non-immune hydrops as well as several infectious processes. Ultrasound is also particularly suited to evaluate specific placental conditions, such as abnormal placentation (placenta previa and accrete for instance), gestational trophoblastic disease and placental tumors (e.g. chorioangioma).
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Affiliation(s)
- J S Abramowicz
- Department of Obstetrics and Gynecology, Rush University, 1653 West Congress Parkway, Chicago, IL 60612, USA.
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