“Comparative Study of Ultrasonic Placental Grading in Hypertensive Disorder in Pregnancy with Normal Pregnancy”

Abstract

I. IntroductionHypertensive disorder of pregnancy affects about 5-8% of all pregnant women worldwide [1]. The incidence of pregnancy induced hypertension (PIH) in the world varies in developing countries, from around 7% in Zimbabwe to around 0.81% in Columbia. In rural India the incidence is 10% [2]. Hypertension in pregnancy contributes significantly to maternal & perinatal morbidity and mortality. The relationship between placental morphology function and foetal outcome has been the subject of study for many years. Placenta is an important foetal organ which is an intermediate link between the fetus and the mother. Owing to the delicate and important nature of the placenta, it is sometimes referred to as the "mirror of the perinatal period which has not been sufficiently polished" [3,4].Proper functioning of the placenta is important for proper growth and development of the foetus in utero. Placenta being a foetal organ shows the same stress and strain, to which the foetus is exposed. Thus any disease process affecting the mother and foetus has a great impact on placenta and vice versa. Morphology of placenta varies during its short life span. Alteration in placenta as part of "ageing" phenomena are probably a part of maturation process and goes hand in hand with continued growth of placenta. The well being of the foetus is affected by many factors but a healthy placenta is the single most important factor in producing a healthy baby [5,6]. There is a widely and tenaciously held belief that during course of normal pregnancy the placenta progressively ages and that the term placenta is in verge of a decline into morphological and functional senescence [7]. Various complications in pregnancy have been correlated with specific micro and macroscopic placental changes. Compromised placental perfusion from uterine vasospasm almost certainly a major culprit in the genesis of increased perinatal morbidity and mortality [8] associated with pregnancy induced or pregnancy aggravated hypertension [9].Evolution of Ultrasonography has been very useful in Obstetrics and has found application in placental studies [10]. Sonography remains the imaging modality of choice for evaluation of the placenta. It is an important part of obstetrical evaluation of pregnancy. With grey scale Ultrasonography it is possible to identify changes in placental anatomy which formally have been recognized only by examination of the placenta after delivery. By serial ultrasound examination these changes can be detected as they occur, since placenta is a foetal organ it seems logical that it should mature in fashion similar to that of other foetal organ system. In order to categorize the phase of maturation of placenta Grannum & associates classified ultrasonic variations in placental appearance occurring during gestation and then to correlate these findings with an index of foetal lung maturity, . The advent of antenatal detection of foetal pulmonary maturity by measurement of L/S ratio in amniotic fluid has resulted in a significant reduction in b...