DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20171405
Published: 2017-03-30

The ultrasonic changes in maturing placenta in pregnancy complicated with hypertension and its correlation with neonatal outcome

Amit Dutta, Kripasindhu Chatterjee, Sukanta Sen, Swapan Kumar Ray, Pradyut Kumar Mandal, Sima Mukhopadhyay

Abstract


Background: Hypertension is the most common medical problem encountered during pregnancy, complicating 2-3% of pregnancies. Obstetric ultrasound provides a cornerstone to other modalities used for assessing hypertensive disorders of pregnancy. This study was designed to detect the placental changes in hypertensive disorders of pregnancy and correlation with neonatal outcome.

Methods: The study group comprised of 42 patients with pregnancy complicated with hypertension with period of gestation above 20 weeks and B.P. more than 140/90 mm of Hg measured on two occasions 6 hours or more apart. The control group consists of 42 normotensive patients matched with age and parity. One ultrasonic examination were performed between 28 weeks and 34 weeks and another after 34 weeks till term. Apart from routine parameters i.e. BPD, AC, FL, Amniotic fluid index, EBW and gestational age routine placental grading were performed according to the classification proposed by Grannum and associates. To evaluate perinatal outcome following measurement were studied – birth weight immediately after delivery, mode of delivery, perinatal morbidity and mortality , APGAR  score , presence of fetal distress.

Results: In 97.62%  cases (41 out of 42 ) of control group showed Grade–II changes as opposed to 57.14% of cases (24 out of 42) in study group before 34 weeks.

Conclusions: Accelerated maturation of placenta in pregnancy complicated with hypertension are more common in the hypertensive group.


Keywords


Hypertension, Neonatal outcome, Obstetric ultrasound, Placenta, Pregnancy

Full Text:

PDF

References


National high blood pressure education program working group on high blood pressure in pregnancy. Report of the national high blood pressure education program working group on high blood pressure in pregnancy. Am J Obstet Gynecol. 2000;183(1):S1-22.

Grannum PA, Berkowitz RL, Hobbins JC. The ultrasonic changes in the maturing placenta and their relation to fetal pulmonic maturity. Am J Obstet Gynecol. 1979;133(8):915-22.

Carroll B. Ultrasonic features of preeclampsia. J Clin Ultrasound. 1980;8(6):483-8.

Fox H. The significance of placental infarction in perinatal morbidity and mortality. Biol Neonat. 1967;11(1):87-105.

Fox H. The morphological basis of placental insufficiency. J Obstet Gynaecol India. 1975;25:441-50.

Krause FT. Gynaecologic Pathology. Mosby Co. 446;1967.

Nobis P, Das U. Placental morphology in hypertensive pregnancy. J Obstet Gynecol. 1991;41:166-9.

Mirchandani JJ, Mallik GB, Chitra S. Correlation of foetal outcome with some pathological changes of placenta. J Obstet Gynaecol India. 1979;29:1131-9.

Quinlan RW, Cruz AL, Buhi WC, Martin M. Changes in placental ultrasonic appearance. II. Pathologic significance of grade III placental changes. Am J Obstet Gynecol. 1982;144:471-3.

Quinlan RW, Cruz AL, Buhi WC, Martin M. Changes in placental ultrasonic appearance. I. Incidence of grade III changes in the placenta in correlation to fetal pulmonary maturity. Am J Obstet Gynecol. 1982;144:468-70.

Hill LM, Breckle R, Ragozzino MW, Wolfgram KR, O'Brien PC. Grade 3 placentation: incidence and neonatal outcome. Obstet Gynecol. 1983;61:728-32.

Hills D, Irwin GA, Tuck S, Baim R. Distribution of placental grade in high-risk gravidas. American Journal of Roentgenology. 1984;143:1011-3.

Damania KR, Salvi VS, Ratnaparki SK, Daftari SN.The placenta in hypertensive disorder in pregnancy. J Obst and Gynaecol India. 1989;39:28-31.

Lin CC, Lindheimer MD, River P, Moawad AH. Fetal outcome in hypertensive disorders of pregnancy. Am J Obstet Gynecol. 1982;142(3):255-60.

GM Kazzi, Gross TL, Sokol R J, Kazzi N J. Detection of Intrauterine Growth Retardation: A New Use for Sonographic Placental Grading. Am J Obstet Gynecol March 1983;145(6):733-7.

Ashton SS, Russo MP, Simon NV, Shearer DM. Relationship between grade III placentas and biparietal diameter determinations. J Ultrasound Med. 1983;2:127-9.