Placental grading
Citation, DOI, disclosures and article data
Citation:
Weerakkody Y, Jones J, Elfeky M, et al. Placental grading. Reference article, Radiopaedia.org (Accessed on 05 Nov 2024) https://doi.org/10.53347/rID-13909
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rID:
13909
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Disclosures:
At the time the article was created Yuranga Weerakkody had no recorded disclosures.
View Yuranga Weerakkody's current disclosures
Last revised:
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At the time the article was last revised Jeremy Jones had no recorded disclosures.
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Synonyms:
- Placental sonographic grading
- Placental ultrasound grading
- Placental maturity grading
- Grannum classification
Placental grading (Grannum classification) refers to an ultrasound grading system of the placenta based on its maturity. This primarily affects the extent of calcifications. In some countries, the use of placental grading has fallen out of obstetric practice due to a weak correlation with adverse perinatal outcome 5.
Mismatched grades for gestational age are considered abnormal. Grading is however still based on visual appearance of the placenta.
The grading system is as follows:
-
grade 0: <18 weeks
- uniform echogenicity
- smooth chorionic plate
-
grade I: 18-29 weeks
- occasional parenchymal calcification/hyperechoic areas
- subtle indentations of chorionic plate
-
grade II: 30-38 weeks
- occasional basal calcification/hyperechoic areas
- deeper indentations of the chorionic plate (does not reach up to the basal plate)
- seen as comma type densities at the chorionic plate
-
grade III: ≥ 39 weeks
- significant basal plate calcification
- chorionic plate interrupted by indentations (frequently calcified) that reach up to the basal plate: cotyledons
- an early progression to a grade III placenta is concerning and is termed as hyper mature placenta and sometimes associated with placental insufficiency
- associated with smoking, chronic hypertension, SLE, diabetes.
References
- 1. Hills D, Irwin GA, Tuck S et-al. Distribution of placental grade in high-risk gravidas. AJR Am J Roentgenol. 1984;143 (5): 1011-3. AJR Am J Roentgenol (abstract) - Pubmed citation
- 2. Ragozzino MW, Hill LM, Breckle R et-al. The relationship of placental grade by ultrasound to markers of fetal lung maturity. Radiology. 1983;148 (3): 805-7. Radiology (abstract) - Pubmed citation
- 3. Dudley NJ, Fagan DG, Lamb MP. Short communication: ultrasonographic placental grade and thickness: associations with early delivery and low birthweight. Br J Radiol. 1993;66 (782): 175-7. doi:10.1259/0007-1285-66-782-175 - Pubmed citation
- 4. Merz E, Bahlmann F. Ultrasound in obstetrics and gynecology. Thieme Medical Publishers. (2005) ISBN:1588901475. Read it at Google Books - Find it at Amazon
- 5. Fadl S, Moshiri M, Fligner CL, Katz DS, Dighe M. Placental Imaging: Normal Appearance with Review of Pathologic Findings. Radiographics : a review publication of the Radiological Society of North America, Inc. 37 (3): 979-998. doi:10.1148/rg.2017160155 - Pubmed
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