Placental lakes vs lacunae: spot the differences.

Area of Science:

• Obstetrics and Gynecology
• Medical Imaging
• Fetal Medicine

Background:

• Sonographic sonolucencies, appearing as anechoic areas in placental parenchyma, are common in the second and third trimesters.
• These spaces, termed lakes and lacunae, result from maternal blood flow within the intervillous space.
• Their appearance and development differ between normal placentation and conditions like placenta accreta spectrum.

Purpose of the Study:

• To elucidate the etiopathology of placental sonolucent spaces (lakes and lacunae).
• To correlate sonolucent space morphology with pregnancy complications.
• To improve identification of patients at risk for adverse pregnancy and delivery outcomes.

Main Methods:

• Descriptive ultrasound analysis of placental parenchyma.
• Correlation of sonolucent space characteristics with gestational age and placental pathology.
• Evaluation of associations with fetal growth and maternal conditions.

Main Results:

• Placental lakes typically appear by the end of the first trimester in normal pregnancies.
• Lacunae, associated with placenta accreta spectrum, develop progressively in the second trimester, often within uterine scars.
• While variable lakes are usually benign, echogenic cystic lesions may indicate fetal growth issues and placental malperfusion.

Conclusions:

• Placental lakes and lacunae have distinct sonographic appearances and developmental patterns.
• Lacunae formation is linked to uterine scarring and a high probability of placenta accreta spectrum.
• Further understanding of sonolucent spaces is crucial for identifying high-risk pregnancies and optimizing management.