ABSTRACT
Background: Fetus is dependent on placenta for supply of nutrients from mother. Objective of this study was to assess the relationship between laterality of placenta by mid-trimester ultrasonography and perinatal outcome.Methods: It was a prospective observational study conducted between June 2016 to June 2017 at Burdwan Medical College, West Bengal. Participants were uncomplicated pregnant women having 18-24 weeks gestation attending antenatal clinics and admitted in ward who underwent obstetric sonography including placental localization. Women were observed till delivery. Analysis was done for site of implantation of placenta and its correlation with perinatal outcome.Results: Total of 300 women considered for the study, 195/300 (65%) had central implantation of placenta and 105/300 (35%) had lateral type of placentation. There were 4 IUFDs (1.33%); 2 (1.03) with central placenta and 2 (1.9) with lateral placenta. Among 31 (10.33%) IUGR babies 13 (6.67%) were associated with central and 18 (17.14%) with lateral placenta. Among 27 LBW babies 16 (8.21%) were related to central placenta and 11 (10.48%) were related to lateral placenta. Among 57 SNCU admissions 26 (13.33%) were related to central placenta and 31 (29.52%) were related to lateral placenta. Average birth-weight is 2.6±0.31 kg and 2.51±0.26 kg, respectively for central and lateral placenta.Conclusions: Laterally located placenta is associated with relatively poor perinatal outcome compared to central placenta with increased rates of IUGR, IUFD and LBW babies.
ABSTRACT
Background: Placental location can be estimated easily using ultrasonogram by 16 weeks. It can be classified based on its location into central and lateral. Central can be anterior or posterior. Lateral can be left lateral or right lateral. Placental location has been attributed to both normal and abnormal pregnancy and neonatal outcomes.Methods: This is a prospective cohort study conducted in the department of Obstetrics and Gynecology which comprised of 450 singleton gestations between 18 and 24 weeks. The primary objective is to determine the association between placental location and pregnancy outcome and secondary objective is to find out the association between placental location and neonatal outcome. The study population was divided into two groups – central and lateral. Results were analyzed using SPSS version 20, Chi square test and independent two sample t-test.Results: The frequency of central placenta was 377 (83.8%) and lateral placenta in 73 (16.2%). Central placentation had an abnormal outcome in 182(48.3%), lateral placentas with abnormal outcome were 44(60.3%). Abnormal maternal outcomes like hypertensive disorders (33.3%), Intra Uterine Growth Restriction (10.2%), Antepartum haemorrhage (25%), Preterm birth (16.3%) were more in lateral placentation. The number of central placentas having NICU admissions were 62(16.4%) and lateral placenta with NICU admissions were 19(26%).Conclusions: There is a significant association between lateral placentation and abnormal pregnancy and neonatal outcomes. Second trimester ultrasound can be used as non-invasive predictor of adverse pregnancy and neonatal outcomes.
ABSTRACT
OBJECTIVE: Our purpose was to investigate the relation between types of early diastolic notch and placental location and to evaluate the differences in perinatal outcomes. METHODS: We evaluated the Doppler waveform of the uterine artery in 149 pregnant women having an early diastolic notch after 26 weeks gestation, however we were unable to follow the obstetric outcomes in 20 women. Placental location was determined by transverse view of ultrasonography and classified as central and lateral placenta. The unilateral diastolic notches were divided into 3 groups depending on the placental location (ipsilateral: same side of the placenta, contralateral: opposite side of the placenta, and median: central placenta) RESULTS: In the bilateral notch group, the S/D ratio of the contralateral uterine artery was higher than the ipsilateral one(n=60, mean=3.22 Vs 2.80, p=0.0067). Of the 89 unilateral notches observed, the S/D ratio of the uterine artery in patients having early diastolic notch was higher compared to those without early diastolic notch.(t-test, mean=2.74,1.92, p=0.0001) Patients with bilateral notches were associated with poor perinatal outcomes significantly more than the patients with unilateral notches(p=0.003). Among the unilateral groups (ipsilateral: n=10, median: n=21, contralateral: n=58), there was no significant difference in perinatal outcomes. CONCLUSION: The early diastolic notch can be observed on both or either sides of the uterine artery independent on placental location. More bilateral notches were associated with poor pregnancy outcomes than unilateral notches. The pregnancy outcomes tended to be similar in unilateral notch irrespective of placental location, but showed worse outcomes than the control group. Careful analysis of the uterine artery in nonplacental side is necessary because of the frequent appearance of early diastolic notch and higher vascular resistance.