Diagnosis of Placental Position by Early First-Trimester Ultrasound: A Pilot Study

Abstract

Objective: Conventional wisdom is that placental location cannot be identified before 8 weeks’ gestation when the placenta first becomes hyperechogenic on ultrasound. We sought to evaluate whether placental location could be reliably diagnosed between 5 and 6 weeks’ gestation. Materials and Methods: This was a retrospective analysis of prospectively acquired data. Early placental location was diagnosed by evaluation of the embryonal and yolk sac position inside the gestational sac on transvaginal ultrasound. Placental position was described as anterior, posterior, fundal, or lateral. Early and mid-pregnancy placental locations were compared and coded as being the same, having migrated to an adjacent surface, or being on an opposite surface. Results: A total of 111 patients met study criteria, providing 141 placental locations, comprising 85 singleton and reduced pregnancies and 28 dichorionic twin pregnancies. The most common placental location was anterior in both singleton and twin/triplet pregnancies. Placental location at the mid-pregnancy ultrasound was consistent with early pregnancy location in 100% of cases, with 79.5% (112/141) being on the same surface and 20.5% (29/141) having expanded onto an adjacent surface. Placental location was not associated with pregnancy outcome, although our study may have been underpowered to detect a significant difference. Conclusions: Placental location diagnosed at 5 to 6 weeks’ gestation is consistent with the location on mid-pregnancy ultrasound. Excluding the presence of an ectopic, cornual, or cesarean section scar and uterine subseptation pregnancy in early first trimester would allow a more effective tailoring of pregnancy follow-up.

The Yolk Sac Abnormalities, Maternal Serum Level of Cancer Antigen 125 (CA-125) and Beta Human Chorionic Gonadotropin (B-HCG) as an Early Predictors of First Trimester Pregnancy Loss in Patients with Threatened Miscarriage

“…In our study, aborted group had significantly higher prevalence of lower abdominal pain, vaginal discharge and itching than complete pregnancy group. This is in agreement with a recent study which reported that women with recurrent pregnancy loss, had higher pelvic pain and vaginal bleeding (7). While the risk of threatening abortion was highest among those who reported abdominal discomfort (55.9%), those who did not report pain (42.6%) nevertheless had an abortion.…”

“…While the risk of threatening abortion was highest among those who reported abdominal discomfort (55.9%), those who did not report pain (42.6%) nevertheless had an abortion. (7).…”

Sonographic Detection of Placenta Percreta With Associated Placenta Previa and Succenturiate Lobe

“…7 The most common location of a placenta in a pregnancy, not complicated by previa, is anterior. 8 Other normal locations of the placenta include posterior, lateral, or fundal. There are varying degrees of placenta previa including “total,” “partial,” and “marginal.” 7 A total previa describes the placenta completely covering the internal cervical os whereas partial and marginal previas describe the placenta either partially covering or lying just next to the internal cervical os, respectively.…”

“…7 The most common location of a placenta in a pregnancy, not complicated by previa, is anterior. 8 Other normal locations of the placenta include posterior, lateral, or fundal. There are varying degrees of placenta previa including "total," "partial," and "marginal."…”

The Yolk Sac Abnormalities, Maternal Serum Level of Cancer Antigen 125 (CA-125) and Beta Human Chorionic Gonadotropin (B-HCG) as an Early Predictors of First Trimester Pregnancy Loss in Patients with Threatened Miscarriage: Review Article

“…It is common knowledge that the heart rate of an embryo will increase from an average of 97.7 beats per minute at thirty-six to thirty-eight days to 174.7 beats per minute at sixty to sixty-two days, & it is also common knowledge that the embryonic heart rate (HER) will continue to increase by approximately 4 beats per minute every day until eight weeks of gestation. This shows that the measurement of EHR by ultrasound may be helpful in timing early pregnancy in the first trimester, & in addition, bradycardia during the 1st trimester can be linked with a bad prognosis (25) .…”