The placenta is the most valuable organ female body during pregnancy. Its main functions are delivery to the fetus required amount nutrients and providing it with oxygen. The normal course of pregnancy, as well as childbirth, directly depends on the state of development of the child's place. In addition, the embryonic organ performs protective functions, preventing various infections from reaching the child, and monitors the supply of a sufficient amount of hormones to the child, which allows the fetus to grow and develop.

Diagnosis of the condition of the placenta is extremely important and should be carried out throughout pregnancy using ultrasound (ultrasound).

This method allows you to timely detect any deviations in the development of the embryonic organ. And the sooner pathologies are detected, the greater the chances of successful treatment. With the help of an ultrasound scan, doctors determine its structure, location,. In the course of such a study, the expectant mother can be diagnosed with a heterogeneous structure of the placenta.

Causes of heterogeneity

In most cases, the heterogeneous structure of the embryonic organ should not be a cause for concern, because is the norm. The final formation of the placenta falls on, after which, up to the thirtieth week, its structure should be unchanged. And if at this time any changes occur in the structure of the child's place (the doctor can detect echo-negative areas, or other inclusions), then these changes can become a reason for serious disruption of the functioning of the placenta.

The main reasons for such violations can be the presence in the body of a woman in labor of any infection or the consequences of drinking alcohol, anemia, smoking, etc. The inhomogeneous structure of the placenta can provoke a violation of blood flow between the pregnant woman and the fetus, resulting in a slowdown in the intrauterine development of the child, difficult labor... If, during the ultrasound, after changes in the structure of the child's place are detected, then there is nothing to worry about, and the pregnancy is proceeding normally. Sometimes changes in the placenta that are identified on are considered the norm, this is provided that the child continues to develop fully and according to its term. When examining with ultrasound, the following phenomena associated with a violation of the structure of a child's place can be detected:

• The structure of the placenta with the expansion of the MEP (intervillous spaces). The MEP is the place in the embryonic organ where metabolism takes place between the woman in labor and the fetus. As pregnancy progresses, the baby requires more and more nutrients to grow and support vital functions. To meet his needs, the profit center increases. The expansion of this space does not lead to, but does not exclude it. Additional studies are not carried out when you expand the profit center.
• Heterogeneous structure of the child's place with calcifications. These accumulations of calcium salts prevent the embryonic organ from performing its functions quite effectively. As a rule, calcifications are detected in the placenta after (in 50% of cases). At a later date (after 37 weeks), the presence of calcifications does not pose any threat to pregnancy, because this is due to the natural aging of the placenta.

Treatment

The heterogeneous structure of the child's seat can be associated with or as well as her. In this case, additional studies may be prescribed, such as Doppler, cardiotocography.

Complete restoration of the heterogeneous structure of the placenta is impossible. However, there are medications, which normalize the tone of the uterus, oxygen delivery, improve blood circulation. Also, the absence of stressful situations, all kinds of anxiety has a positive effect. And the key to the normal course of pregnancy is the timely conduct of the necessary diagnostics, proper nutrition and healthy image life.

The thickness of the placenta during pregnancy is a very important diagnostic criterion, because compliance with the norm is very important here: both too thin and too thick placenta are indicators of various pathologies.

The only way to determine the thickness of the placenta is by ultrasound. Another indicator that he defines is this. All these indicators are so important because the placenta provides the child with nutrients and oxygen, which means that any deviations in its development are fraught with complications in the development of the fetus.

To determine the thickness Placenta ultrasound is done after 20 weeks of pregnancy. For this, its section with largest size and its thickness is measured. In the normal course of pregnancy, the thickness of the placenta at 34 weeks almost reaches its maximum, and at 36 weeks, the growth of the placenta stops, the thickness remains the same or even decreases slightly. But it happens that everything does not go so smoothly, and the indicators of the main characteristics of the placenta differ from normal.

So, how thick should the placenta be during pregnancy at various times?

Week of pregnancy	Placenta thickness, mm	Limits of the norm
20	21,96	16,7-28,6
21	22,81	17,4-29,7
22	23,66	18,1-30,7
23	24,52	18,8-31,8
24	25,37	19,6-32,9
25	26,22	20,3-34,0
26	27,07	21,0-35,1
27	27,92	21,7-36,2
28	28,78	22,4-37,3
29	29,63	23,2-38,4
30	30,48	23,9-39,5
31	31,33	24,6-40,6
32	32,18	25,3-41,6
33	33,04	26,0-42,7
34	33,89	26,8-43,8
35	34,74	27,5-44,9
36	35,59	28,0-46,0
37	34,35	27,8-45,8
38	34,07	27,5-45,5
39	33,78	27,1-45,3
40	33,5	26,7-45,0

Too thin placenta during pregnancy

Even if you are diagnosed with placental hypoplasia, meaning that you have a thin placenta, do not be upset - it is not uncommon. The fetus is only affected by a severe decrease in the size of the placenta.

Most often this happens due to a genetic predisposition, under the influence of various unfavorable factors and due to certain diseases of the mother. In the latter case, a decrease in the thickness of the placenta is treated, in the rest, supportive therapy is prescribed.

One of the factors affecting the size of the placenta is the weight and physique of a woman: in fragile petite women, the size of the placenta is often much smaller than that of tall ladies with curvaceous forms.

Thickening of the placenta during pregnancy

In the case of thickening of the placenta during pregnancy, we are talking about a pathology that can lead to abortion and fetal death, however, with modern methods treatment, the child is often saved.

The thickness of the placenta may increase due to Rh-conflict, iron deficiency anemia, preeclampsia, diabetes mellitus, transferred infectious disease, therefore, pregnant women of the "risk group" are always put on a special record and more closely monitored by a doctor.

However, in the 1st and 2nd trimesters, the cause of the thickening of the placenta is mainly viral or infectious diseases, and a woman can only be a carrier of the virus, and therefore not even guess about it. This is because the body "turns on" its defense mechanisms, and the placenta grows to prevent infection of the fetus.

Why is the thickening of the placenta dangerous during pregnancy?

The rapid growth of the placenta leads to its rapid maturation, and, accordingly, aging: the structure of the placenta becomes lobular, calcifications form on its surface, the placenta gradually ceases to provide the fetus with the amount of oxygen and nutrients it needs.

Due to edema of the placenta, its hormonal function is disrupted, and this threatens premature birth or termination of pregnancy.

If there are deviations in the thickness of the placenta (in one direction or another), you will most likely be prescribed a second ultrasound scan, Doppler ultrasound and cardiotocography. If the child is developing normally, no treatment is required, only increased supervision.

If the doctor notices any disruptions in the development of the fetus, he will certainly select the appropriate therapy for you. Again, neither "rejuvenating" nor "curing" the placenta can be done, but with the right treatment, you can improve the metabolism between the baby and the placenta, thereby preserving the pregnancy and providing the fetus normal development.

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Ultrasound examination of the placenta (echoplacentography) during pregnancy is an informative diagnostic method for assessing the degree of maturity of an organ, its structure and location. Ultrasound diagnostics allows you to determine the presence of formations, presentation, and also identify complete or partial placental abruption.

Depending on the quality of the "child's place", the degree of development and the state of the fetus is determined, among other things. If there are any pathologies of the placenta and its incorrect presentation or detachment, we can talk about insufficient functioning of the "mother-placenta-fetus" system, which means - about a possible delay in the development of the child and the formation of certain pathological phenomena.

What is the placenta?

The placenta is a complex organ that forms only during pregnancy, which is the link between the mother and the baby and provides the fetus with vital functions:

1. respiratory - oxygen supply and carbon dioxide excretion;
2. nutritional - the transportation of nutrients from a pregnant woman to a baby;
3. protective - a barrier between the fetus and substances dangerous to it in the blood of a pregnant woman;
4. endocrine - providing the necessary hormones;
5. excretory - the elimination of waste products of the child.

A mature organ has the shape of a "cake" 15-20 cm in size, 2.5 to 3.5 cm thick and weighing up to 600 grams. In the case of a favorable course of pregnancy, there is a direct relationship between the height and weight indicators of the fetus and the weight and thickness of the "child's place". So, until the 16th week, the development of this important organ is noticeably faster than the development and growth of the fetus. By the 38th week of pregnancy, the "baby's place" reaches its maturity, it "grows old", i.e. at this time, the formation of new chorionic villi and feeding vessels stops.

The growth and development of the baby in the womb occurs due to the placenta, to which the fetus is connected with the help of the umbilical cord. After fertilization, the placenta actively develops with the fetus and can be seen on ultrasound. According to the characteristics of this organ, one can judge, among other things, about the rate of development of the future baby itself.

Functionally and anatomically, the "baby seat" is associated with the amniotic (water) membrane that surrounds the baby in the womb. The amnion is the thinnest membrane that lines the surface of the placenta from the side of the baby. This shell at the place of attachment of the umbilical cord, as it were, merges with skin the fetus at the level of the umbilical ring. The amniotic membrane is directly involved in many metabolic processes and performs a barrier function.

The fetus is connected to the “baby's place” by means of the umbilical cord, in which 3 vessels are localized: 1 vein and 2 arteries. Oxygenated blood goes through the vein from the placenta to the fetus, blood flows back through the arteries. The placenta, together with the umbilical cord and the amniotic membrane, is the placenta, which is excreted after the birth of the baby.

Assessment of maturity of the placenta during diagnosis

The degree of maturity of the placenta is monitored by ultrasound, with the help of which certain indicators are assigned to the organ. Normally, maturation is assessed in 4 grades:

• 0 degree of maturity is characteristic up to 27-30 weeks of gestation. The structure is homogeneous, smooth, no calcifications.
• 1 degree of maturity - from 27 to 35 weeks. An inhomogeneous structure may be noted, due to a small number of seals, the chorionic part, at the same time, is wavy. Tiny calcium deposits may be noted.
• 2 degree of maturity - from 34 to 37 weeks. The part of the placenta adjacent to the fetus has depressions. The very state of the organ is compacted, there are visible calcifications.
• 3 degree of maturity - from 37 weeks to delivery. Placental cysts, a large amount of calcium deposits are formed in the structure of the "child's place". The onset of the third degree of maturity up to 35-37 weeks is regarded as premature aging (maturation) of the organ. Such placental insufficiency requires monitoring the baby's condition.

On ultrasound, the doctor necessarily evaluates the degree of maturity of the placenta, using a special scale of 4 steps for this and correlating the indicators with the gestational age. This makes it possible to predict complications during childbirth and think over the tactics of delivery.

What to do in case of premature maturation of the placenta?

It is imperative to take into account the fact that the “aging of the child's place” during pregnancy does not threaten either the mother or the unborn child. Only with a complex combination of several pathological signs can we talk about a threat to health, among them:

• violation of uteroplacental-fetal blood flow;
• signs of intrauterine growth retardation;
• hypertension (persistent increase in blood pressure) in the mother;
• diabetes mellitus in the mother;
• the presence of Rh-conflict.

All these conditions are dangerous in themselves and require careful monitoring. Nevertheless, the "early aging child's place" is a reason for additional diagnostics - dopplerometry of the vessels of the placenta and cardiotocography (CTG). If these studies show normal values ​​of blood flow and heartbeat, you do not need to worry about the fact that the placenta is "overripe". If studies reveal severe fetal hypoxia, strict control or, in some cases, emergency delivery is required.

The thickness and location of the placenta on ultrasound

With the help of ultrasound diagnostics during pregnancy, the thickness of the placenta, its presentation are determined, cysts and calcifications (calcium deposits in the tissues of the organ) are excluded. The thickness of the "baby seat" is constantly increasing up to 32 weeks of pregnancy, and is normally about 30 mm.

Thickening or, conversely, a decrease in the thickness of the "child's seat" is a direct consequence and indicator of its premature aging... An increase in thickness (more than 4 cm) may occur due to Rh-conflict, an infectious disease, or be a consequence of the mother's diabetes mellitus.

With the help of ultrasound, the exact place of attachment of the organ to the uterus is assessed to exclude its presentation. The localization of the "child's place" is determined during each screening ultrasound examination, starting from 10 weeks, but only on the third planned ultrasound procedure it will be possible to finally see the features of the location, and in the case of a pathological condition, to determine the low attachment of the placenta - its presentation:

1. if there is complete overlap internal pharynx uterus, then talk about the central presentation of the "child's place";
2. if the internal pharynx is covered only by the edge of the organ - about the marginal presentation;
3. if close to the internal uterine pharynx - about low presentation.

It is not uncommon for a second ultrasound to diagnose placenta previa, but by the end of pregnancy, if there is no detachment, the localization of the "child's place" again becomes normal - above the internal uterine pharynx. That is why the final conclusions about the level of localization of the organ should be made only by the end of the 3rd trimester.

The overlap of the entrance to the uterus by the placenta is called presentation and is a pathology. If found, the doctor must diagnose the form of presentation - marginal, low or central. Final results can be obtained only after the 3rd trimester, when the placenta has already acquired a stable position and has matured

Placental abruption and other pathological conditions

An important stage of the ultrasound examination is the diagnosis of pathologies: calcifications, heart attacks, cysts, tumors and signs of placental abruption. So, ultrasound signs of cysts are echo-negative fluid formations with clear edges, and tumors, at the same time, have fuzzy boundaries. Heart attacks can be diagnosed by ultrasound in the form of foci of irregular shape, with hyperechoic contours. Also, the pathologies of the "child's place" are such deviations in its structure as an additional lobe, ring-shaped or fenestrated form.

A space of low echogenicity between the uterus and the placenta is a sign of premature detachment. Additional signs of detachment are:

• hyperechogenicity of one of the lobes of the organ, which has arisen as a result of bleeding;
• the formation of a blood clot adjacent to the "child's seat".

Ultrasound of the placenta is the most important stage in the diagnosis of a pregnant woman throughout the gestation. Ultrasound diagnostics allows you to track pathological conditions in time and prescribe the necessary control and correction measures.

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- one of the most important ultrasound examinations for a pregnant woman. The state of the baby, its development and growth directly depends on the state of the organ. Placenta ultrasound in Moscow appoint in order to determine where it is located, its size and structure, in addition, the examination allows you to diagnose pathologies in time.

The data obtained during the ultrasound examination allows the doctor to monitor the course of detonation and choose the tactics of childbirth, in addition, ultrasonography reduces the risk of complications during childbirth.

Preparing for diagnosis

The placenta is a unique organ, it appears only during pregnancy, the organ is a connecting tool between the child and the baby.

This body is responsible for the following functions:

• Respiratory - thanks to the organ, oxygen gets to the fetus and carbon dioxide is removed;
• Nutritional - the transfer of necessary substances to the baby, from the mother;
• Protective is a kind of buffer between the child and various dangerous substances in the blood;
• Endocrine - the organ transmits hormones to the baby;
• Excretory - removes excess fetal activity.

Before undergoing diagnostics, you should definitely undergo training. Please note that the bladder should be full, but not distended, prior to examination. Drink a couple of glasses of regular drinking water, never soda, to ensure adequate visualization of the uterine segment.

On the last weeks pregnancy in women with uterine bleeding and signs of fetal pathology, a too full bladder usually gives incorrect indications at the location of the placenta. Then before Ultrasound will have to empty the bladder a little.

How is the study going

Make an ultrasound of the placenta will have to all pregnant women. During the ultrasound examination, the woman lies on her back. Sometimes there are cases when, during the examination, the doctor needs to turn the patient on the side. Before the examination, the doctor applies a gel to the lower abdomen, which helps the passage of ultrasonic waves. Then a special device is placed in place of the bladder and, in fact, the diagnosis begins.

Price procedures are more than available to every young family, and the examination itself is absolutely safe for both the mother and the growing baby.

Study

Placenta ultrasound, prices which are the same at any stage of pregnancy, is carried out only on modern ultrasound equipment by professional specialists. When passing the examination, the doctor takes into account the following factors:

• Organ shape and stage of maturation. For a specific week of pregnancy, there is a predetermined thickness of the placenta. Zero thickness lasts up to 30 weeks, a thickness of 1 centimeter is acceptable. It begins to increase only after 34 weeks, the maximum thickness does not exceed 4 centimeters;
• The attachment site is examined. Usually the organ is attached to the endometrium (this is the inner layer of the uterus). The localization area is important for the development of the child and the course of a normal pregnancy;
• Detection of various pathologies. It happens that damage is formed on the organ, there have been cases when the placenta departed from the uterus, because it cannot increase with the growth of the baby. That is why ultrasound examination is the optimal method of step-by-step observation.

By visiting an ultrasound examination on time, you can protect yourself from potential pathologies, in addition, make sure about the condition of the placenta, because it is this organ that is responsible for the health of your baby.

Ultrasound is performed at the very modern equipment, which makes it possible to measure its thickness as accurately as possible and notice deviations in development, if any. Health to you and your baby.

The placental membrane is an important organ that connects the mother's body with the fetus. It has a protective, trophic, respiratory and hormonal function during pregnancy. Ultrasound of the placenta is an integral part of every ultrasonographic screening, since the course and outcome of pregnancy depends on the state of this organ.

How to prepare

Features of preparation for placentography depend on the method of conducting ultrasound diagnostics and, as a rule, do not differ from generally accepted rules.

With the transabdominal examination method:

• A woman, a few days before the procedure, must exclude all foods that contribute to gas formation (peas, beans, bread, raw vegetables and fruits, etc.).
• With frequent flatulence, it is recommended to drink a Smecta packet or 3 Espumisan capsules a couple of hours before the examination.
• On the early dates pregnancy, so that the doctor can clearly see the placenta, the fetus and the surrounding organs, the examined person must fill the bladder well with liquid (5-6 glasses of pure and still water).

If the study of the placenta is carried out by the transvaginal method, then the preparation consists only in following a simple diet aimed at preventing excessive gas formation in the intestinal tube. Vaginal ultrasound screening is done when the bladder is empty.

How and when is it done

Ultrasound scanning of the placental membrane is performed already from 10-12 weeks of pregnancy during each scheduled ultrasound examination. However, it is possible to finally judge its functional state, localization, thickness and the presence or absence of pathology only after the third screening ultrasound. It is at these stages of pregnancy that the placenta reaches its maximum development and the best way rendered.

As mentioned above, ultrasound of the placental membrane can be carried out in two ways:

1. Transvaginal, when a transducer-transducer of high-frequency ultrasonic waves is inserted directly into the vaginal cavity, but before that, a disposable diagnostic condom is put on it and a transparent gel is applied. Maximum proximity to the uterus allows you to get the clearest and most accurate echo picture of the state of the placenta. The procedure is painless and harmless, despite some discomfort.
2. The transabdominal method is more suitable for examining the placenta by ultrasound at 21 weeks of pregnancy and more late dates... The technique is that the procedure is performed through the external abdominal wall, which is absolutely atraumatic and painless. The woman lies down on the couch in a position convenient for her and the doctor, after which the latter places the sensor in the suprapubic region and begins the diagnosis.

Thus, ultrasonographic scanning of the placenta is not a separate procedure, but is considered a mandatory step in every routine screening with special emphasis in late pregnancy.

What is evaluated

Each examination is aimed not only at assessing the general condition, location and maturity of the membrane, but also at excluding pathology of the placenta.

Indicators that are assessed during ultrasound examination of the placental membrane:

1. Localization. This parameter plays important role during scanning, since abnormalities in the location of the placenta are quite common.
2. Echostructure, that is, the severity and thickness of the contours of the organ, homogeneity, the presence or absence of any inclusions.
3. Shell thickness.
4. The degree of maturity. This parameter indicates a woman's readiness for childbirth, indicates the development of pathology.
5. The state and speed of blood flow in the vessels of the placenta. Assessed using color Doppler mapping.

The mature placental membrane has the form of a cake, a thickness of 25 to 35 mm and a mass of no more than 550-600 grams. Its structure normally can be either homogeneous or have hyper- or isoechoic inclusions located along the basal layer. By the end of pregnancy, anechoic thin septa throughout the entire thickness, calcifications and sometimes cysts are determined in it.

Placenta maturity by week:

	Echo structure	Chorionic zone	The presence of calcifications
Until the 30th week (0 degree)	Homogeneous	Completely smooth	No or very little
27-36th week (1 degree)	There is a small amount of seals	Has a wavy surface	Only visible under a microscope
35-39th week (2 degree)	Seals available	Has some indentations	Visible on ultrasound
More than 36th week (3rd degree)	Cysts are visualized	The grooves reach the basement membrane	A large number of

The thickness of the shell also varies depending on the gestational age:

Possible deviations

To accurately determine the localization, or presentation, of the placenta, an ultrasound scan is performed in several planes and sections. She may be:

1. Central, when the membrane overlaps the internal pharynx of the uterus completely.
2. Marginal, when one of the sides of the internal pharynx overlaps.
3. In the case when the lower edge of the organ is located near the internal pharynx, in conclusion, "low attachment of the placental membrane" is displayed.

In any case, its location changes during the entire period of pregnancy and if there are no signs of placental abruption, this is considered the norm.

Occurring pathology:

1. The annular placenta is a rather rare anomaly in the structure and development of the membrane that occurs due to poor differentiation of the chorion in the early stages of embryogenesis. The annular placenta is primarily characterized by a wide attachment area and small thickness (no more than 10 mm). May lead to bleeding, fetal death, or fetal growth retardation.
2. Additional share. As a rule, it has a vascular pedicle and does not pose a particular threat to pregnancy. In rare cases, it leads to postpartum hemorrhage.
3. Thickening of the shell. During pregnancy, the thickness of the placenta is usually not accurately measured, but an increase in this indicator may indicate Rh-conflict, fetal diabetes mellitus, intrauterine infection and the beginning of placental abruption.
4. Thinning. Such a pathology often speaks of a severe course of diabetes mellitus in the mother or an intrauterine infection of the fetus.
5. An ultrasound examination of placental abruption may be indicated by a formed retroplacental hematoma (anechoic formation), as well as the subjective sensations of a woman (abdominal pain, bloody discharge from the genital tract).
6. Tumors of the membrane: hamartoma (from embryonic tissues), hemangioma (vascular origin), chorionangioma. As a rule, they differ in echogenicity and have uneven contours.

Thus, the study of the placenta - important stage ultrasound screening during pregnancy, which allows timely detection of the pathology of the membrane, which is the most significant organ for the fetus.