Correlation of ultrasound and pathologic findings of placental anomalies in pregnancies with elevated maternal serum alpha-fetoprotein.
Twenty pregnancies with elevated maternal serum alpha-fetoprotein (MSAFP), a normal fetus and unusual or abnormal placental/cord sonographic features are reported. These include: (A) gigantic enlargement with multiple sonolucent spaces of different size and shape (n = 2; Swiss cheese); (B) placental masses of variable echogenicity (n = 5); (C) cord masses with central echo-dense zone and peripheral hypoechoic areas (n = 2); (D) enlarged placentas with patchy decrease of echogenicity (n = 6; jelly-like); and (E) large sonolucent spaces with turbulent blood flow surrounded by normal placental tissue (n = 5; placental lakes). After delivery, these ultrasound features were compared with pathologic findings. Diffuse mesenchymal hyperplasia of the stem villi were found in the gigantic placentas (n = 2). The placental masses corresponded to chorioangiomas (n = 3), infarct (n = 1) or subamniotic hematoma (n = 1) and the cord masses to angiomyxomas (n = 2). The 'jelly-like' placentas were related to subchorial thrombosis (n = 2), massive fibrin deposition (n = 1) or hypertrophy with no obvious abnormalities (n = 3). Large subchorial thrombosis (n = 2), or no obvious abnormalities (n = 3) were observed in placentas with large lakes. These findings suggest that a large range of placental and cord anomalies are associated with elevated MSAFP and are potentially diagnosable by routine sonographic examination at the time of AFP screening.
Department of Morbid Anatomy, King's College Hospital, King's College School of Medicine and Dentistry, Denmark Hill, London, U.K.
E
E
Jauniaux
G
G
Moscoso
S
S
Campbell
D
D
Gibb
M
M
Driver
K H
KH
Nicolaides
D005260:Female; D006801:Humans; D010920:Placenta / Q000000981:diagnostic imaging* / Q000473:pathology; D010922:Placenta Diseases / Q000097:blood / Q000000981:diagnostic imaging* / Q000473:pathology; D011247:Pregnancy; D011256:Pregnancy Outcome; D014463:Ultrasonography; D000509:alpha-Fetoproteins / Q000032:analysis*
D000509:alpha-Fetoproteins