The thick heterogeneous (jellylike) placenta: a strong predictor of adverse pregnancy outcome

Abstract

Objective: To present a series of cases with a sonographic thick and heterogeneous placenta, and to review the literature.

Methods: A series of 16 cases were analyzed. A heterogeneous placenta was defined as a thick placenta with a patchy decrease of echogenicity, which quivered like jelly to sharp abdominal pressure. A comprehensive morphologic and Doppler evaluation of the fetus and the uteroplacental circulation was performed. The pregnancy course and the neonatal outcome of the present series and of those reported in the literature were reviewed.

Results: Placental thickness was greater than the 95th centile in all cases. The placenta was located laterally in 13 (81.3%) cases. Twelve women delivered earlier than 34 weeks either spontaneously or because of deteriorating maternal and/or fetal conditions (n = 10). Perinatal death occurred in eight cases. The uterine artery Doppler and the umbilical artery were abnormal in eight and eight cases respectively. A discordancy between the umbilical artery size was present in six cases. Abruptio placentae occurred in three cases. A strong association between hypertensive disorders and fetal growth restriction was found in our series and in literature.

Conclusions: The sonographic presence of thick heterogeneous placenta is strongly associated with an adverse pregnancy outcome and often with perinatal death.