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Abstract
Background: Placental grading and thickness measures still underutilized in routine clinical practice in spite of their effects on fetal growth and their potential prognostic values .
This study aimed to establish the effects of placental maturity grading and thickness on the estimated fetal weight at term pregnancy.
Patients and method: A prospective , cross-sectional study on (150 ) pregnant , who attended the radiology outpatient clinic for routine obstetric ultrasound in, Thi-Qar Province, Iraq. The average gestational age and the fetal weight are calculated using Hadlock formula .The placental maturity graded in to four grades according to homogeneity, calcification and chorionic plate undulation and the thickness is measured at the site of the umbilical cord insertion in millimeters .
Results: The mean placental thickness was 35.31 mm. Most placentas were grade 2 maturity (66%). there was a statistically significant association between placental maturity grade and fetal weight (p -value < 0.04), with Grade 2 showing higher fetal weights. while at 40 weeks, the association was not significant (p-value = 0.624) .There was a significant positive correlation between placental thickness and fetal weight at 37, 38, and 39 weeks (p-value = 0.001). The strongest correlation was observed at 39 weeks.
Conclusion: This study concludes that measurement of placental thickness and grading of placental maturity during routine antenatal obstetric ultrasound assessment can help to predict the estimated fetal weight and can be used as complementary measures besides other parameters to determine fetal well-being and outcome.
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Copyright (c) 2026 Raya Abdulameer Shareef
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
- Yinka Oyelese,MD,Mishella Porez,RDMS,Waldo Sepulveda,MD, The continuous Text book of Women’s medicine , Ultrasound evaluation of the placenta, umbilical cord and membrane, vol .18 ,August 2025. https://doi.org/DOI :10.3843/GLOWM.419203 .
- Gbande P, Tchaou M, Kafupi PK, Sonhaye L, Agoda Koussema LK, Adjenou K. Placental thickness and its relationship to gestational age and fetal growth parameters in normal singleton pregnancies in the central region of Togo. West Afr J Radiol 2023;30:8-13. https://doi.org/ DOI : 10.4103/wajr.wajr_1_23
- Hernandez-Andrade E,Gerulewicz D,Soto-Torres E,et al.We Should perform asystematic evaluation of placenta ,J Ultrasound Med .Jan 9, DOI:10.1002/jum.16645.
- Grannum PA,Berkowitz RL,Hobbins JC, The ultrasonic changes in the maturing placenta and their relations to fetal pulmonic maturity .Am J Obstet Gynecol.Apr15 1979;133(8):915-22.DOI:10.1016/0002-9378(79)90312-0.
- Mushtaq S, Aziz R, Sharif A, Masood H. Assessment of Placental Grading in Normal and Pregnancy Induced Hypertensive Mothers on Ultrasonography and Fetal Outcomes. Med Forum 2023;34(6):24-27.
- Abduljabbar A. Abbood, Raad A. Hameed, Ahmed M. Mohammed-Najeeb, The correlation of placental thickness with gestational age and fetal weight by ultrasonographic examination in second and third trimesters of pregnancy ,O&G Forum 2024; 34 – 3s: 1888-1894
- Ali Abou Zeid H, Fawzy Mohamed M, Soliman Taha W. Correlation of placental thickness estimated by ultrasonography with gestational age in the second and third trimester of pregnancy. Al-Azhar Medical Journal. 2020;49(4):1723–30. doi:10.21608/amj.2020.120630.
- K. Nithya Priya Darshini, Sakthi V, Ramya TV,Ultrasonographic measurement of placental thickness and its correlation with gestational age in a tertiary care centre, coimbatore, tamilnadu. Int J Acad Med Pharm 2024; 6 (1); 1081-1084. DOI: 10.47009/jamp.2024.6.1.214.
- Kunlmann RS,Warsof S.Ultrasound of the placenta.Clin Afr.Jou Obstet.Gynecol.1996;39;519-34 DOI: 10.1097/00003081-199609000-00004
- Begum, F., Jesmin, S., Khatun, R., Parvin, S., & Rahman, A. Third Trimester Placental Grading by ultrasonography and its Relationship with Fetal Outcome. TAJ: Journal of Teachers Association,2020 33(2), 94-99.
- Jannat Aslam, Narjis Batool, Abid Ali, Akash John, Huma Manzoor, Evaluation of Placental Grading in 2nd and 3rd Trimester Using Gray Scale Ultrasound, EAS J Radiol Imaging Technol; Vol-4, Iss-4 (July-Aug, 2022): 68-73. DOI: 10.36349/easjrit.2022.v04i04.001
- Banik S, Rajkumari A, Devi AJ, Sarkar R, Ayekpam M. Placental thickness measurement by ultrasonography and its correlation with gestational age of fetus in the Manipuri population. Int J App Basic Med Res 2022;12:117-22.DOI:10.4103/ijabmr-658-21
- Zena M. Al Hindawi1, Sara A. Al-Rawaf, Inaam Faisal Mohammed, Assessment of Placental Thickness by Ultrasound and Its Correlation with Fetal Outcomes in Second and Third Trimesters of Pregnancy, JOGCR. 2025; 10(1): 59-65. DOI :10.30699/jogcr.10.1.59
- Vinchurkar K N, Aiyappan S K, P rem Kumar C , Shanmugam V, Singh A. Correlation of placental thickness with gestational age in second and third trimester using ultrasonography. Egypt J Radiol Nucl Med. 2023;54(1):164. DOI:10.1186/s43055-023-01112-y
- Farahbod F, Zarean E, Khanjani S, Moezzi M, Mohammadizade F, Shabanian S. Relationship between placental thickness, grading, and heterogeneity in fetal growth restriction in the third trimester of pregnancy by ultrasonography and pathology tests and their relationship with estimated fetal weight and neonatal outcome. Immunopathol Persa. 2024;10(2):e39471. DOI:10.34172/ ipp.2023.39471.
- Nagesh R,Shukla AK ,PramilaVVS,ultrasonographic correlation of placental thickness with fetal gestational age and grading of placental maturity.J.Evid. Based Med.Healthc.2016;3(20),825-829.DOI:10.18410/jebmh/2016/188.
- Hamidi OP, Hameroff A, Kunselman A, Curtin WM, Sinha R, Ural SH. Placental thickness on ultrasound and neonatal birthweight. J Perinat Med 2019;47:331 4.
- Kane MA. Normative Placental Growth Curves For Estimated Placental Volume (epv) And Gestational Age Using Portable 2-D Ultrasound In Two Maternity Centers In Dakar, Senegal. 2020.
- Gouda A, Aboelwan YY, Saleh H, El Anwar A. Ultrasound Assessment of Placental Thickness in The Last Two Trimesters of Normal Pregnancy and Its Relation with Fetal Outcome. Zagazig Univ Med J. 2021;27(4):638-44.
- Dr Indira Lamba, Dr Ekta Meena, Dr Manish Kumar Bhardwaj, Dr Chaiti Phulwaria ,Placental grading on usg and it's correlation with foetal outcome, INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH : Volume-12 | Issue-2 | February-2023. DOI: 10.36106/ijsr.
References
Yinka Oyelese,MD,Mishella Porez,RDMS,Waldo Sepulveda,MD, The continuous Text book of Women’s medicine , Ultrasound evaluation of the placenta, umbilical cord and membrane, vol .18 ,August 2025. https://doi.org/DOI :10.3843/GLOWM.419203 .
Gbande P, Tchaou M, Kafupi PK, Sonhaye L, Agoda Koussema LK, Adjenou K. Placental thickness and its relationship to gestational age and fetal growth parameters in normal singleton pregnancies in the central region of Togo. West Afr J Radiol 2023;30:8-13. https://doi.org/ DOI : 10.4103/wajr.wajr_1_23
Hernandez-Andrade E,Gerulewicz D,Soto-Torres E,et al.We Should perform asystematic evaluation of placenta ,J Ultrasound Med .Jan 9, DOI:10.1002/jum.16645.
Grannum PA,Berkowitz RL,Hobbins JC, The ultrasonic changes in the maturing placenta and their relations to fetal pulmonic maturity .Am J Obstet Gynecol.Apr15 1979;133(8):915-22.DOI:10.1016/0002-9378(79)90312-0.
Mushtaq S, Aziz R, Sharif A, Masood H. Assessment of Placental Grading in Normal and Pregnancy Induced Hypertensive Mothers on Ultrasonography and Fetal Outcomes. Med Forum 2023;34(6):24-27.
Abduljabbar A. Abbood, Raad A. Hameed, Ahmed M. Mohammed-Najeeb, The correlation of placental thickness with gestational age and fetal weight by ultrasonographic examination in second and third trimesters of pregnancy ,O&G Forum 2024; 34 – 3s: 1888-1894
Ali Abou Zeid H, Fawzy Mohamed M, Soliman Taha W. Correlation of placental thickness estimated by ultrasonography with gestational age in the second and third trimester of pregnancy. Al-Azhar Medical Journal. 2020;49(4):1723–30. doi:10.21608/amj.2020.120630.
K. Nithya Priya Darshini, Sakthi V, Ramya TV,Ultrasonographic measurement of placental thickness and its correlation with gestational age in a tertiary care centre, coimbatore, tamilnadu. Int J Acad Med Pharm 2024; 6 (1); 1081-1084. DOI: 10.47009/jamp.2024.6.1.214.
Kunlmann RS,Warsof S.Ultrasound of the placenta.Clin Afr.Jou Obstet.Gynecol.1996;39;519-34 DOI: 10.1097/00003081-199609000-00004
Begum, F., Jesmin, S., Khatun, R., Parvin, S., & Rahman, A. Third Trimester Placental Grading by ultrasonography and its Relationship with Fetal Outcome. TAJ: Journal of Teachers Association,2020 33(2), 94-99.
Jannat Aslam, Narjis Batool, Abid Ali, Akash John, Huma Manzoor, Evaluation of Placental Grading in 2nd and 3rd Trimester Using Gray Scale Ultrasound, EAS J Radiol Imaging Technol; Vol-4, Iss-4 (July-Aug, 2022): 68-73. DOI: 10.36349/easjrit.2022.v04i04.001
Banik S, Rajkumari A, Devi AJ, Sarkar R, Ayekpam M. Placental thickness measurement by ultrasonography and its correlation with gestational age of fetus in the Manipuri population. Int J App Basic Med Res 2022;12:117-22.DOI:10.4103/ijabmr-658-21
Zena M. Al Hindawi1, Sara A. Al-Rawaf, Inaam Faisal Mohammed, Assessment of Placental Thickness by Ultrasound and Its Correlation with Fetal Outcomes in Second and Third Trimesters of Pregnancy, JOGCR. 2025; 10(1): 59-65. DOI :10.30699/jogcr.10.1.59
Vinchurkar K N, Aiyappan S K, P rem Kumar C , Shanmugam V, Singh A. Correlation of placental thickness with gestational age in second and third trimester using ultrasonography. Egypt J Radiol Nucl Med. 2023;54(1):164. DOI:10.1186/s43055-023-01112-y
Farahbod F, Zarean E, Khanjani S, Moezzi M, Mohammadizade F, Shabanian S. Relationship between placental thickness, grading, and heterogeneity in fetal growth restriction in the third trimester of pregnancy by ultrasonography and pathology tests and their relationship with estimated fetal weight and neonatal outcome. Immunopathol Persa. 2024;10(2):e39471. DOI:10.34172/ ipp.2023.39471.
Nagesh R,Shukla AK ,PramilaVVS,ultrasonographic correlation of placental thickness with fetal gestational age and grading of placental maturity.J.Evid. Based Med.Healthc.2016;3(20),825-829.DOI:10.18410/jebmh/2016/188.
Hamidi OP, Hameroff A, Kunselman A, Curtin WM, Sinha R, Ural SH. Placental thickness on ultrasound and neonatal birthweight. J Perinat Med 2019;47:331 4.
Kane MA. Normative Placental Growth Curves For Estimated Placental Volume (epv) And Gestational Age Using Portable 2-D Ultrasound In Two Maternity Centers In Dakar, Senegal. 2020.
Gouda A, Aboelwan YY, Saleh H, El Anwar A. Ultrasound Assessment of Placental Thickness in The Last Two Trimesters of Normal Pregnancy and Its Relation with Fetal Outcome. Zagazig Univ Med J. 2021;27(4):638-44.
Dr Indira Lamba, Dr Ekta Meena, Dr Manish Kumar Bhardwaj, Dr Chaiti Phulwaria ,Placental grading on usg and it's correlation with foetal outcome, INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH : Volume-12 | Issue-2 | February-2023. DOI: 10.36106/ijsr.