Sonography of the placenta with emphasis on pathological correlation

The placenta is a most interesting but unfortunately often ignored and misunderstood organ. Included in its many functions are fetal oxygenation and nutrition as well as a myriad of endocrinological contributions and protein synthesis. The sonologist is strongly encouraged to study this amazing structure with ultrasound because significant pathology afflicts the placenta, often before affecting the fetus. Placental abnormalities, therefore, can be an 'early warning system' for fetal problems. Recognition of clinically important lesions (abruption, accreta) as well as important anatomical variants (intervillous thrombosis, septal cyst) is crucial for the physician who performs and interprets prenatal ultrasound. This article discusses the common abnormalities of the placenta and highlights some correlative pathological processes, which will serve to enhance the reader's understanding of sonographic findings. A practical approach is presented with respect to assessment of the hypoechoic lesion, placental infarction, thick placenta, placenta previa, abruption, placenta accreta, and placental tumors.