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 ultrasound. Another indicator determined by him is. All these indicators are so important because the placenta provides the baby 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 An ultrasound of the placenta is done after the 20th week of pregnancy. To do this, its area with largest size and its thickness is measured. During 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, what thickness should the placenta be during pregnancy at different stages?
| Week of pregnancy | Thickness of the placenta, mm | Normal limits |
|---|---|---|
| 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, which means you have a thin placenta, don't be upset—it's not uncommon. The fetus is only affected by a serious reduction in the size of the placenta.
Most often this occurs due to 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, maintenance therapy is prescribed.
One of the factors influencing the size of the placenta is the woman’s weight and physique: in fragile, petite women, the size of the placenta is often much smaller than in tall, curvy women.
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 termination of pregnancy and fetal death, but when modern methods treatment, the child can often be saved.
The thickness of the placenta can increase due to Rh conflict, iron deficiency anemia, preeclampsia, diabetes mellitus, or previous infectious disease, therefore pregnant women at risk are always placed on special register and are more carefully monitored by a doctor.
However, in the 1st and 2nd trimesters, placental thickening is mainly caused by viral or infectious diseases, and a woman can only be a carrier of the virus, and therefore not even know about it. This happens because the body “turns on” its defense mechanisms, and the placenta grows to prevent infection of the fetus.
What are the dangers of thickening the placenta during pregnancy?
The rapid growth of the placenta leads to its rapid maturation and, accordingly, aging: the structure of the placenta becomes lobulated, calcifications form on its surface, and the placenta gradually ceases to provide the fetus with the amount of oxygen and nutrients it needs.
Due to swelling 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 repeat ultrasound, Dopplerography and cardiotocography. If the child develops normally, no treatment will be required, only increased observation.
If the doctor notices any disruptions in the development of the fetus, he will definitely select the appropriate therapy for you. Again, it is impossible to “rejuvenate” or “cure” the placenta, but with the help of proper treatment, you can improve the metabolism between the child and the placenta, thereby maintaining the pregnancy and ensuring the fetus normal development.
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The patient should have a full but not overdistended bladder so that the lower uterine segment and vagina are clearly visualized. Ask the patient to drink 3 or 4 glasses of water before the test.
To examine the placenta, it is necessary to make multiple longitudinal and transverse sections. Oblique cuts may also be necessary.
Normal placenta
At the 16th week of pregnancy, the placenta occupies half of the inner surface of the uterus. At 36-40 weeks, the placenta occupies from 1/4 to 1/3 of the area of the inner surface of the uterus.
Uterine contractions may simulate placenta or a mass in the uterine wall. Repeat the test after 5 minutes, but keep in mind that the contraction may last longer. long time. If in doubt, wait a little longer.
Accurate determination of the location of the placenta is very important for patients with vaginal bleeding or signs of fetal distress, especially in late pregnancy.
Overdistension of the bladder can sometimes create a false echographic picture of placenta previa. Ask the patient to partially empty the bladder and repeat the test.
Location of the placenta
The placenta is easily visualized from 14 weeks of pregnancy. To examine the placenta located along the posterior wall, it is necessary to make oblique sections.
The location of the placenta is assessed in relation to the uterine wall and the axis of the cervical canal. The position of the placenta can be as follows: in the midline, on the right side wall, on the left side wall. Also, the placenta can be located on the anterior wall, on the anterior wall with extension to the bottom. in the bottom area, on the back wall, on the back wall with a transition to the bottom.
Placenta previa
It is extremely important to visualize the cervical canal if placenta previa is suspected. The cervical canal is visualized as an echogenic line surrounded by two hypo- or anechoic rims, or it may be entirely hypoechoic. The cervix and lower uterine segment will be visualized differently depending on the degree of bladder filling. When the bladder is full, the cervix appears elongated; lateral shadows from the fetal head, bladder or pelvic bones may obscure some details. With less filling of the bladder, the neck changes its orientation to a more vertical one and becomes perpendicular to the scanning plane. The cervix is more difficult to visualize when the bladder is empty, but under these conditions it is less displaced and the relationship between the placenta and the cervical canal is more clearly defined.
The diagnosis of placenta previa, established during the examination with a full bladder, should be confirmed during the examination after its partial emptying.
Location of the placenta
- If the placenta completely covers the internal uterine os, then this is central placenta previa.
- If the edge of the placenta overlaps the internal os, there is regional placenta previa (in this case, the internal uterine os is still completely blocked by placental tissue).
- If the lower edge of the placenta is located close to the internal os, there is low attachment placenta. It is difficult to accurately establish such a diagnosis, since only part of the uterine os is covered by the placenta.
The location of the placenta may change during pregnancy. If the study is carried out with a full bladder, it is necessary to repeat the study with a partially emptied bladder.
Placenta previa may be detected in the early stages of pregnancy and not detected at the end. However, central placenta previa is diagnosed at any stage of pregnancy, marginal presentation placenta - after 30 weeks, and after that no significant changes are noted. If no bleeding is observed in the second trimester of pregnancy, a second standard ultrasound examination of the placenta can be delayed until 36 weeks of gestation to confirm the diagnosis of previa. If in doubt, the test should be repeated before 38 weeks of pregnancy or immediately before birth.
Normal echostructure of the placenta
The placenta may be homogeneous or have isoechoic or hyperechoic foci throughout the basal layer. In the last stages of pregnancy, echogenic septa can be detected throughout the thickness of the placenta.
Anechoic areas immediately below the chorionic plate or within the placenta are often found as a result of thrombosis and subsequent fibrin accumulation. If they are not extensive, they can be considered normal.
Intraplacental anechoic areas may be caused by blood flow visible in dilated veins. If they affect only a small part of the placenta, they have no clinical significance.
Beneath the basal layer of the placenta, retroplacental hypoechoic channels can be seen along the uterine wall as a result of venous drainage. They should not be confused with retroplacental hematoma.
Pathology of the placenta
Hydatidiform mole can be easily diagnosed by its inherent echographic sign of a “snow storm”. It should be noted that the fetus may still be alive if the process affects only part of the placenta.
Enlargement (thickening) of the placenta
Measurement of placental thickness is too imprecise to significantly influence the diagnosis process. Any assessment is quite subjective.
- Thickening of the placenta occurs with Rhesus conflict or fetal hydrops.
- Diffuse thickening of the placenta can be observed in mild forms of diabetes mellitus in the mother.
- The placenta may thicken if the mother has an infectious disease during pregnancy.
- The placenta may become thickened with placental abruption.
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The hematoma may appear hyperechoic, and sometimes its echogenicity is comparable to normal placenta. In this case, the only sign of a hematoma may be local thickening of the placenta, but the placenta may appear completely unchanged.
Ultrasound examination is not very precise method diagnosis of placental abruption. Clinical study is still extremely important.
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– one of the most important ultrasound examinations for a pregnant woman. The condition of the baby, its development and growth directly depends on the condition of the organ. Ultrasound of the placenta in Moscow are prescribed in order to determine where it is located, its size and structure; in addition, the examination allows for timely diagnosis of pathologies.
The data obtained during the ultrasound examination allows the doctor to monitor the progress of pregnancy and choose delivery tactics; in addition, ultrasound examination 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 instrument between the child and the baby.
This body is responsible for the following functions:
- Respiratory - thanks to the organ, oxygen enters the fetus and carbon dioxide is removed;
- Nutritional – 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 vital activity of the fetus.
Before undergoing diagnostics, you should definitely undergo preparation. Please note that the bladder should be full, but not distended, before the examination. It is necessary to drink a couple of glasses of regular drinking water, never soda, to ensure sufficient quality of visualization of the uterine segment.
On last weeks During pregnancy in women with uterine bleeding and signs of fetal pathology, an overly full bladder usually gives incorrect readings at the location of the placenta. Then up to Ultrasound You will have to empty your bladder a bit.
How the research works
Perform an ultrasound of the placenta All pregnant women will have to. During the entire ultrasound examination, the woman lies on her back. Sometimes there are cases when during an examination the doctor needs to turn the patient on her side. Before the examination, the doctor must apply a gel to the lower abdomen, which helps the passage of ultrasound waves. Then a special device is placed in place of the bladder and, in fact, the diagnosis begins.
Price The procedure is more than accessible to every young family, and the examination itself is absolutely safe for both the mother and the growing baby.
Study
Ultrasound of the placenta, prices which are the same at any stage of pregnancy, is carried out only on modern ultrasound equipment by professional specialists. When undergoing an examination, the doctor takes into account the following factors:
- Organ shape and stage of maturation. For a certain week of pregnancy there is a set thickness of the placenta. Zero thickness remains until week 30; 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 occurs on the organ; there have been cases when the placenta moves away from the uterus because it cannot grow with the growth of the baby. That is why ultrasound examination - optimal method step-by-step observation.
By attending an ultrasound examination in a timely manner, you can protect yourself from potential pathologies; in addition, make sure of the condition of the placenta, because it is this organ that is responsible for the health of your baby.
Ultrasound is performed on 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 connecting the maternal body with the fetus. It provides protective, trophic, respiratory and hormonal functions during pregnancy. Ultrasound of the placenta is an integral part of every ultrasonographic screening, since the course and outcome of pregnancy depends on the condition of this organ.
How to prepare
Features of preparation for placentography depend on the method of ultrasound diagnostics and, as a rule, do not differ from generally accepted rules.
With the transabdominal examination method:
- A few days before the procedure, a woman must exclude all foods that contribute to gas formation (peas, beans, bread, raw vegetables and fruits, etc.).
- If you experience frequent flatulence, it is recommended to drink a packet of Smecta or 3 capsules of Espumisan a couple of hours before the examination.
- On early stages pregnancy, in order for the doctor to clearly see the placenta, fetus and surrounding organs, the patient must fill the bladder well with liquid (5-6 glasses of clean and still water).
If the placenta is examined using the transvaginal method, then preparation consists only of following a simple diet aimed at preventing excessive gas formation in the intestinal tube. Ultrasound screening through the vagina is performed with an empty bladder.
How and when it is carried out
Ultrasound scanning of the placental membrane is carried out already from 10-12 weeks of pregnancy during each routine 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 visualized.
As mentioned above, ultrasound of the placental membrane can be performed in two ways:
- Transvaginal, when a sensor-converter 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 obtain the clearest and most accurate echo picture of the condition of the placenta. The procedure is painless and harmless, despite some discomfort.
- The transabdominal method is more suitable for examining the placenta by ultrasound at 21 weeks of pregnancy and at a later date. The technique is that the procedure is performed through the outer abdominal wall, which is absolutely atraumatic and painless. The woman lies down on the couch in a position that is comfortable for her and the doctor, after which the latter installs the sensor in the suprapubic area 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 being assessed
Each examination is aimed not only at assessing general condition, location and maturity of the membrane, but also to exclude pathology of the placenta.
Indicators that are assessed during ultrasound of the placental membrane:
- Localization. This parameter plays important role during scanning, since abnormalities in the location of the placenta are quite common.
- Echostructure, that is, the severity and thickness of the contours of the organ, homogeneity, the presence or absence of any inclusions.
- Shell thickness.
- Degree of maturity. This parameter indicates a woman’s readiness for childbirth and indicates the development of pathology.
- The state and speed of blood flow in the vessels of the placenta. Assessed using color Doppler mapping.
The mature placental membrane has the appearance of a cake, thickness from 25 to 35 mm and weight no more than 550-600 grams. Its structure can normally be either homogeneous or have hyper- or isoechoic inclusions located in the basal layer. By the end of pregnancy, anechoic thin septa along the entire thickness, calcifications and sometimes cysts are identified.
Degree of placenta maturity by week:
| Echostructure | Chorionic zone | Presence of calcifications | |
| Until the 30th week (grade 0) | Homogeneous | Completely smooth | No or very little |
| 27-36th week (1st degree) | A small amount of compaction is noted | Has a wavy surface | Visible only under a microscope |
| 35-39th week (2nd degree) | Seals available | Has some indentations | Visible on ultrasound |
| More than 36 weeks (grade 3) | Cysts are visualized | The grooves reach the basement membrane | A large number of |
The thickness of the membrane also varies depending on the stage of pregnancy:
Possible deviations
To accurately determine the location, or presentation, of the placenta, ultrasound is performed in several planes and sections. She may be:
- Central, when the membrane completely covers the internal os of the uterus.
- Edge, when one of the sides overlaps internal pharynx.
- In the case when the lower edge of the organ is located near the internal os, the conclusion is “low attachment of the placental membrane.”
In any case, its location changes throughout the entire period of pregnancy and, if there are no signs of placental abruption, this is considered normal.
Common pathology:
- A ring-shaped placenta is a fairly rare anomaly in the structure and development of the membrane, resulting from poor differentiation of the chorion in the early stages of embryogenesis. The ring-shaped placenta is primarily characterized by a wide attachment area and small thickness (no more than 10 mm). May cause bleeding, fetal death or developmental delay.
- 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.
- Thickening of the shell. During pregnancy, the thickness of the placenta is usually measured inaccurately, but an increase in this indicator may indicate Rh conflict, fetal diabetes mellitus, intrauterine infection and the onset of placental abruption.
- Thinning. This pathology often indicates severe diabetes mellitus in the mother or an intrauterine infection of the fetus.
- Placental abruption on ultrasound may be indicated by the formation of a retroplacental hematoma (anechoic formation), as well as by the woman’s subjective sensations (abdominal pain, bleeding from the genital tract).
- Tumors of the membrane: hamartoma (from germinal tissues), hemangioma (vascular origin), chorioangioma. As a rule, they differ in echogenicity and have uneven contours.
Thus, examination of the placenta - important stage ultrasound screening during pregnancy, allowing timely detection of pathology of the membrane, which is the most significant organ for the fetus.
The placenta is a temporary organ that develops in a woman’s body during pregnancy. The baby's place has a complex structure; it connects mother and child without mixing their circulatory systems. The placenta is formed from chorionic villi from the moment the fertilized egg attaches to the wall of the uterus, provides the fetus with nutrients, supplies oxygen, removes metabolic products, and protects against infections. One of the key functions is the creation of a fetoplacental barrier.
This kind of filter protects the unborn child from everything bad. Beginning to fully function by 12 weeks, it allows some substances to pass through and delays the transport of others that are dangerous to the embryo and fetus. The baby's place produces hormones necessary during pregnancy and provides immunological protection for the fetus.
Development and maturation
These parameters can be determined by ultrasound. Three dimensions are measured: longitudinal and transverse, forming two perpendicular segments drawn through the points of the edges that are most distant from each other, and thickness (depth).
Typically, the placenta completes its formation by the 16th week of pregnancy, with a normal course without pathologies, and grows until the 37th week, reaching its maximum size by this time.
The first measurement of the child's seat parameters is carried out at 20 weeks. Further - according to indications. By the end of the gestation period, the thickness of the baby's place decreases. This size also has its indicators within the normal range, in accordance with the stage of pregnancy. It can vary within certain limits as long as there is no danger of disruption of basic functions.
In addition to the physiological thickness of the placenta, important sign The normal course of pregnancy is considered to be the degree of maturity of the child's place. Thickening in combination with premature aging (involution) usually indicates pathology during pregnancy. A decrease in the functional capacity of this organ, which is important for the full intrauterine period of a child’s life, is called fetoplacental insufficiency.
Periods of development
As the child matures, it goes through a number of stages. They are tied to the time of pregnancy and at a certain period must meet certain parameters. There are 4 degrees of maturity:
- Zero degree – an organ of a homogeneous structure is formed, with a normal course of up to 30 weeks.
- The first is the growth and development of the organ, with the appearance of echogenic inclusions from 27 to 34 weeks.
- The second is a mature placenta, changing structure, multiple inclusions, period from 34 to 39 weeks.
- The third is the time of aging of the placenta, which occurs after the 37th week, the structure becomes lobed, and calcifications appear.
Normal thickness on average in millimeters is close in value to the gestational age by week, at 20 weeks average value thickening is 20 mm. Normal for ultrasound examination at 20 weeks, placental thickening ranges from 16.7 to 28.6 mm.
If the thickening has large parameters, we can talk about pathology. A thick placenta does not cope with its tasks so well and often leads to disruptions in life support and development of the fetus, and the hormonal levels of the pregnant woman.
Placental hyperplasia
The diagnosis of placental hyperplasia will alarm a woman both at 20 weeks during the first measurement of parameters on an ultrasound, and at any other time.
Hyperplasia or thickening of the placenta is a serious pathology during pregnancy, it can lead to chronic placental insufficiency.
Excessive growth of tissues, and not necessarily functional ones, disrupts the supply of oxygen and nutrition to the child. The excretory function also suffers. This can lead to slower fetal development, oxygen starvation, weight loss and complications of childbirth.
What is the threat of pathology?
Excessive hyperplasia of the placenta indicates rapid growth and premature aging organ with loss of its basic functions. The placenta changes its structure to lobulated, calcifications appear, which disrupts the normal supply of oxygen and essential nutrients from mother to fetus.
The child begins to suffer from oxygen starvation and malnutrition, and lags behind in development. In severe pathologies, there may be intrauterine fetal death and premature placental abruption.
The endocrine function of the organ is disrupted, which can cause pregnancy failure or premature birth.
Reasons for appearance
Any deviations from the norm in the body of a pregnant woman do not occur without a good reason and require study. This thesis also applies to placental hyperplasia. Most often, this condition is provoked by the following factors:
- Anemia during pregnancy, especially severe forms. Here we are talking about a compensatory mechanism.
- ARVI diseases. Viruses easily enter the placenta, destroy cells and disrupt their function.
- Diabetes. Glycosylated hemoglobin and other proteins are not able to adequately perform the tasks assigned to them, and the metabolism changes greatly.
- Chronic venereal and TORCH infections.
- Preeclampsia on later. Exposure to toxins often leads to damage to areas of the placenta and replacement of normal tissue with scar tissue.
- Multiple pregnancy. This is more or less a variant of the norm: in order to provide several children with everything they need, they have to increase in size.
- Low or overweight mother.
- Rh conflict between the blood of the mother and the fetus. A very serious reason. Indirectly indicates that the fetoplacental barrier is damaged, there is contact between the mother’s blood and the embryonic blood and there is a risk of fetal death.
At diabetes mellitus mother, there is another factor in the thickening of the placenta: pregnant women with this pathology are characterized by the development large fruit. To provide him with everything he needs, the child’s place is also forced to increase.
Gestational trophoblastic disease
One of the flow options is sometimes called incomplete hydatidiform mole. Occurs when one egg is fertilized simultaneously by two sperm, which leads to a genetic abnormality of the embryo. Occurs infrequently, but requires special attention, as it can cause cancer.
Chromosomal abnormalities in 90% of cases lead to early interruption pregnancy, but in 10% pregnancy does not stop. The placenta thickens in places, the size of the uterus corresponds to the duration of pregnancy. The fetal heartbeat can even be heard.
The diagnosis is made only by ultrasound examination and the sooner the better. The only option for help is curettage.
Clinical manifestations and diagnosis
External symptoms of placental hyperplasia of any origin are usually absent. Symptoms do not appear in the early stages; the diagnosis is established at the next ultrasound examination, starting from the 20th week of pregnancy. The thickness of the placenta is measured at its widest points.
There are no symptomatic manifestations of abnormal thickening of the placenta in the early stages up to 20 weeks.
This organ has no pain nerve endings, therefore, you can independently suspect hyperplasia only by indirect signs:
- At later stages, when movement is already heard, at 18–20 weeks, a change in fetal movements is noted from activation to deceleration.
- The appearance or increase in the intensity of gestosis, especially in the early stages.
- Almost always there is a disturbance in the heartbeat when listening to cardiotocography.
Based on survey results. the doctor finds out the reasons, prescribes further examination for the pregnant woman (if necessary) and carries out symptomatic treatment based on the reasons that caused the thickening.
Ultrasound diagnostics
To determine the thickness of the baby's place, ultrasound is performed starting from 18–20 weeks. There is no point in delaying this study, since placental abnormalities detected early are easier to compensate for. The most important indicators:
- Correspondence of the degree of maturity of the placenta to the gestational age.
- Uniformity of structure.
- Physiological tissue density.
- The presence or absence of additional segments.
If the structure is preserved and the placenta is slightly thickened, no measures are required; dynamic monitoring is carried out.
The most important indicator is the condition of the fetus and what effect thickening of the placenta has on its growth and development, and whether it affects the normal course of pregnancy.
There is no more informative method for identifying placental pathology than ultrasound. Therefore, the timing of research cannot be neglected.
Prevention of complications
If a thickening of the placenta is detected by ultrasound before 20 weeks, there is no need to panic: the doctor will find out the reasons and give recommendations for the prevention of fetoplacental insufficiency. If necessary, treatment will be provided.
The woman herself can contribute well to the prevention of complications:
- You need to be outside more often.
- To refuse from bad habits.
- Eat good and quality food.
- Avoid contact with viral infections.
- Treat chronic infections at the planning stage of pregnancy.
- Control your weight and vitamin intake.
- Prevent anemia by getting tested on time.
- Visit regularly antenatal clinic for early identification of causes that can be eliminated.
If the placenta is too thick and the reasons are clarified, the specialist prescribes therapy in accordance with the period in order to improve metabolism and support the fetus in the current conditions. Timely measures taken significantly increase the chances of giving birth to a normal child, even with significant thickening of the placenta.