Changes in placental ultrasonic appearance. II. Pathologic significance of Grade III placental changes.

Changes in placental texture and structure on ultrasonic examination have been suggested as correlating to advancing fetal pulmonary maturity. The association of preterm appearance of Grade III changes in the placenta in the complicated pregnancy suggests that these changes are associated with a decrease in placental function and premature senescence of the placenta. Placentas were routinely graded on all obstetric examinations performed during a 1-year period of time. Those pregnancies in which Grade III changes in the placenta prior to term were reviewed. A high incidence (78%) of perinatal problems were found in association with preterm appearance of Grade III changes. Perinatal complications included maternal hypertensive disorders, intrauterine growth retardation, abruptio placentae, and fetal distress in labor. The high incidence of these disorders in preterm pregnancies with Grade III changes in the placenta suggests that the sonographic changes found reflect placental dysfunction or senescence rather than normal maturational development. The appearance of Grade III changes in the placenta in the preterm pregnancy is suggested as a predictive indicator of potential perinatal problems in late pregnancy.