BGDA Practical Placenta - Diagnostic Techniques

From Embryology
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Practical 14: Implantation and Early Placentation | Villi Development | Maternal Decidua | Cord Development | Placental Functions | Diagnostic Techniques | Abnormalities



Fetus in Utero Between fifth and sixth months


Chorionic Villus Sampling

Cvs.jpg Chorionic Villus Sampling test is done in GA week 10 to 12.

The test is done by looking at cells taken from the chorionic membrane or placenta. No anaesthetic is required, and a test result is usually available in two to three weeks.

When the test is carried out by an obstetrician experienced in the technique, the risk of miscarriage related to the test is about 2%.

Potential disadvantages include maternal cell contamination, placental mosaicism and failure to obtain an adequate specimen. This may result in the need for a repeat procedure or amniocentesis.


Links: Chorionic villus sampling | Trisomy 21 | Abnormal Genetic

Amniocentesis

Amniocentesis.jpg Amniocentesis is a prenatal diagnostic test carried out mainly between GA week 14 to 18.

Amniotic fluid is taken from the uterus, sent to a diagnostic laboratory and embryonic cells isolated from the amniotic fluid. No anaesthetic is required, and a result is usually obtained in about three to four weeks. When the test is carried out by an obstetrician experienced in the technique, the risk of a miscarriage related to the test is about 1 %.


Links: Amniocentesis


Diagnosis Links: Prenatal Diagnosis | pregnancy test | amniocentesis | chorionic villus sampling | ultrasound | Alpha-Fetoprotein | Pregnancy-associated plasma protein-A | Fetal Blood Sampling | Magnetic Resonance Imaging | Computed Tomography | Non-Invasive Prenatal Testing | Fetal Cells in Maternal Blood | Preimplantation Genetic Screening | Comparative Genomic Hybridization | Genome Sequencing | Neonatal Diagnosis | Category:Prenatal Diagnosis | Fetal Surgery | Classification of Diseases | Category:Neonatal Diagnosis

| Placenta - Amnionic Sac

What does a DNA Sequencer look like?

Ultrasound

Placenta - position, size and structure.

Placental Cord Placenta Previa
Placental cord ultrasound 04.jpg Placenta previa ultrasound 01.jpg Cord
  • length (cm)
  • cross-sectional area (mm2)
  • coiling index
  • Wharton’s jelly area (mm2)

Artery

  • cross-sectional area (mm2)
  • pulsatility index

Vein

  • cross-sectional area (mm2)
  • absolute blood flow (ml/min)
  • blood flow for fetal weight (ml/kg/min)
  • blood flow mean velocity (cm/second)
Ultrasound12wk 3D image2.jpg
 ‎‎Ultrasound 12wk
Page | Play

Placenta Term Parameters

Human term placental volumes sorted by size (from table below).

There are a variety of diagnostic and morphological measurements that can be made of the placenta during pregnancy and at term.

Simple measurements of overall placental diameter, thickness and volume:

  • placental diameter - is measured in the transverse section by calculating the maximum dimensions of the chorionic surface.
  • placental thickness - is measured at its mid-portion from the chorionic plate to the basilar plate, on a longitudinal plane (less than 4 cm at term). Excludes any abnormalities (fibroids, myometrial contractions, or venous lakes). The placental thickness approximates in millimeters to the weeks of gestation.
  • placental volume - is measured by a range of different methods and calculations, more recently with three-dimensional ultrasound.

Amniotic Fluid Volume

The amniotic fluid volume increases as the embryo and then fetus grows and rate of change varies during the pregnancy.

  • up to 8 weeks - increases at 10 ml/week
  • 8 to 13 weeks - increases at 25 ml/week
  • 13 to 21 weeks - increases at 60 ml/week
  • 21 to 33 weeks - amniotic volume increase starts decreasing and eventually levels.
  • 34 weeks (GA) - peaks at about 800 mL.
  • 40 weeks (GA) - about 600 mL at term.


Diagnostic Techniques Interactive Component

Attempt the Quiz - Diagnostic Techniques  
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Here are a few simple Quiz questions that relate to Diagnostic Techniques from the practical.

1

Which of the following options would be the earliest invasive diagnostic technique carried out clinically:

  ultrasound
  amniocentesis
  chorionic villus sampling
  none of the above

2

Which placental parameter is measured by ultrasound at the mid-portion from the chorionic plate to the basilar plate.

  placental diameter
  placental thickness
  placental volume
  placenta position

3

Doppler ultrasound of the placental cord can be used to mainly measure:

  placental cord diameter
  placental artery diameter
  placental vein diameter
  placenta position
  placental blood flow

4

The amniotic fluid volume increases as the embryo and fetus grows, with the rate of change varying during the pregnancy. When typically is the period of maximum weekly volume increase?

  up to 8 weeks
  8 to 13 weeks
  13 to 21 weeks
  21 to 33 weeks
  34 weeks
  40 weeks

5

Cord stem cells can be derived from which of the following tissues:

  placental cord blood
  placental cord connective tissue
  maternal placental tissue
  all of the above
  none of the above

6

Which of the following diagnostic techniques has in the past identified as having the higher risk for miscarriage?

  ultrasound
  amniocentesis
  chorionic villus sampling
  fetal cells from maternal blood


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Practical 14: Implantation and Early Placentation | Villi Development | Maternal Decidua | Cord Development | Placental Functions | Diagnostic Techniques | Abnormalities


Additional Information: pregnancy test | amniocentesis | chorionic villus sampling | ultrasound | hCG


Additional Information

Additional Information - Content shown under this heading is not part of the material covered in this class. It is provided for those students who would like to know about some concepts or current research in topics related to the current class page.


Diagnosis Links: Prenatal Diagnosis | pregnancy test | amniocentesis | chorionic villus sampling | ultrasound | Alpha-Fetoprotein | Pregnancy-associated plasma protein-A | Fetal Blood Sampling | Magnetic Resonance Imaging | Computed Tomography | Non-Invasive Prenatal Testing | Fetal Cells in Maternal Blood | Preimplantation Genetic Screening | Comparative Genomic Hybridization | Genome Sequencing | Neonatal Diagnosis | Category:Prenatal Diagnosis | Fetal Surgery | Classification of Diseases | Category:Neonatal Diagnosis


Term placental composition, villous capillarization and the mean cross-sectional areas of peripheral villi and capillaries, data from a study sample of 15 normal placenta (mean placental volume, 652 ml).[1]

Term Placenta Measurements
Variable Unit Placenta (mean, n = 15)
Intervillous space mL 213
Stem villi mL 71.4
Peripheral villi mL 326
Trophoblast mL 95.5
Stroma mL 184
Fetal capillaries mL 46.9
Non-parenchyma mL 41.5
Peripheral villi km 89.2
Fetal capillaries km 310
total surface area villi µm2 3700
total surface area capillary µm2 150
Capillaries mL mL-1 0.147
Length ratio km km-1 3.6
Table data[1]

Replacing Invasive Techniques

Noninvasive prenatal screening for fetal trisomies 21, 18, 13 and the common sex chromosome aneuploidies from maternal blood using massively parallel genomic sequencing of DNA[2]

"The objective of this study was to validate the clinical performance of massively parallel genomic sequencing of cell-free deoxyribonucleic acid contained in specimens from pregnant women at high risk for fetal aneuploidy to test fetuses for Trisomy 21, Trisomy 18, and Trisomy 13; fetal sex; and the common sex chromosome aneuploidies (45, X; 47, XXX; 47, XXY; 47, XYY). ...Our prospective study demonstrates that noninvasive prenatal analysis of cell-free deoxyribonucleic acid from maternal plasma is an accurate advanced screening test with extremely high sensitivity and specificity for trisomy 21 (>99%) but with less sensitivity for trisomies 18 and 13. Despite high sensitivity, there was modest positive predictive value for the small number of common sex chromosome aneuploidies because of their very low prevalence rate."

Note that some recent statistical analysis of the risk of miscarriage following amniocentesis or chorionic villus sampling[3] suggests that "The procedure-related risks of miscarriage following amniocentesis and CVS are lower than currently quoted to women. The risk appears to be negligible when these interventions are compared to control groups of the same risk profile."

References

  1. 1.0 1.1 Mayhew TM. (2009). A stereological perspective on placental morphology in normal and complicated pregnancies. J. Anat. , 215, 77-90. PMID: 19141109 DOI.
  2. Porreco RP, Garite TJ, Maurel K, Marusiak B, Ehrich M, van den Boom D, Deciu C & Bombard A. (2014). Noninvasive prenatal screening for fetal trisomies 21, 18, 13 and the common sex chromosome aneuploidies from maternal blood using massively parallel genomic sequencing of DNA. Am. J. Obstet. Gynecol. , 211, 365.e1-12. PMID: 24657131 DOI.
  3. Salomon LJ, Sotiriadis A, Wulff CB, Odibo A & Akolekar R. (2019). Risk of miscarriage following amniocentesis or chorionic villus sampling: systematic review of the literature and updated meta-analysis. Ultrasound Obstet Gynecol , , . PMID: 31124209 DOI.

Terms

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Cite this page: Hill, M.A. (2019, July 17) Embryology BGDA Practical Placenta - Diagnostic Techniques. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/BGDA_Practical_Placenta_-_Diagnostic_Techniques

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© Dr Mark Hill 2019, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G