Grading Scheme of Grannum et al for Placental Maturation Based on Ultrasonographic Findings

Grannum et al described ultrasonographic changes in the placenta seen during fetal maturation. The authors are from Yale University.

Parameters:

(1) chorionic plate

(2) placental substance

(3) basal layer

Grades	Chorionic Plate	Placental Substance	Basal Layer
Grade 0	straight and well defined	homogeneous	no densities
Grade I	subtle undulations	few scattered echogenic areas	no densities
Grade II	indentations extending into placenta but not to basal layer	linear echogenic densities ("comma like")	linear arrangement of small echogenic areas ("basal stippling")
Grade III	indentations communicating with basal layer	circular densities with echo-spared areas in center; large, irregular densities may cast acoustic shadows	large and somewhat confluent basal echogenic areas; may cause acoustic shadows

after Table I, page 918

More than 1 grade may seen when different sections are examined. The grade assigned is based on the most mature region.

Grades	Correlations
Grade 0	seen during first and second trimester, usually appears after 12 weeks gestation
Grade I	appears as early as 30-32 weeks and may persist to term
Grade II
Grade III	mature placenta seen during third trimester

Correlations with abnormal development:

(1) Premature aging (higher than expected grade) may be associated with intra-uterine growth retardation or preeclampsia.

(2) Persistence of Grade 0 into the third trimester may be associated with cardiovascular or renal abnormalities.

To read more or access our algorithms and calculators, please log in or register.