Placental hypoechoic-anechoic areas and infarction: sonographic-pathologic correlation

Area of Science:

• Obstetrics and Gynecology
• Medical Imaging
• Pathology

Background:

• Placental hypoechoic-anechoic areas are common in the third trimester.
• Placental infarction is a clinically significant condition.
• The relationship between ultrasound findings and placental infarction requires clarification.

Purpose of the Study:

• To correlate high-resolution ultrasound findings with pathologic analysis of placental infarction.
• To determine the sensitivity of ultrasound in detecting placental infarction.

Main Methods:

• Comparison of third-trimester sonograms with ex utero pathologic examination of placentas.
• Analysis of placental tissue from three patient groups: those with sonographic findings, those with vascular disease risk factors, and controls.
• Quantification of placental infarcts and comparison with ultrasound-detected abnormalities.

Main Results:

• Pathologic analysis revealed significantly more infarcts in patients with vascular risk factors compared to controls.
• 86% of all placental infarcts were isoechoic to viable placenta and undetected by ultrasound.
• Hypoechoic or anechoic foci of fibrin or hemorrhage were present in the rare ultrasound-detected infarcts.
• 88% of observed placental hypoechoic-anechoic areas were not infarcts but decidual septal cysts or intervillous thrombosis.

Conclusions:

• Nonhemorrhagic placental infarction is not identifiable with ex utero ultrasound.
• Prenatal ultrasound is likely insensitive for the detection of placental infarction.
• Further research may be needed to explore advanced imaging techniques for placental infarction detection.