Third trimester placental grading by ultrasonography as a test of fetal wellbeing

In a study of 2000 unselected pregnant women the development of a mature placental appearance (grade 3) on ultrasonography by 34-36 weeks' gestation, observed in 15% of cases, was associated with maternal smoking, low parity, low maternal age, and being white. These women had an increased risk of problems during labour and their babies had an increased risk of low birth weight, poor condition at birth, and perinatal death. The women were randomly allocated to two groups: in one group the result of the placental grading was reported to the clinician responsible for care; in the second the result was noted but not reported. There was a significant decrease in the risk of perinatal death in the group where the grading was known. This reduction was responsible for a difference in the principal outcome index, a heterogeneous group of measures of mortality and morbidity, but this difference was not significant. This study alone does not justify routine late scanning, and further, larger trials are required. Nevertheless, the results do provide a basis for the reporting of placental grading when ultrasound examination is performed during the third trimester.