Placental Grading: What It Means For Your Pregnancy

Placenta is a life-supporting organ that secures and provides nourishment to your unborn baby during the course of your pregnancy. This highly-specialised organ resembles your liver and is full of blood vessels that transport nutrients to the foetus. It attaches itself to the uterine lining and is connected to your baby through the umbilical cord, also becoming its source of food for the next nine months. After you deliver your baby, the placenta automatically detaches from the uterus lining and comes out. 

While the placenta offers critical functions to support the growth of your baby, very little is discussed about it. But you should know that as your baby grows inside the womb, your placenta undergoes several changes and gradually calcifies. It is important to track these changes through placental grading to ensure that it doesn’t age prematurely. Below, we have listed everything you need to know about placental calcification and its various stages to avoid any complications during pregnancy.

What is Placental Calcification?

The deposition of calcium-phosphate minerals in the placental tissue is known as placental calcification. According to studies, the major factor for early placental calcification can be smoking and hypertension during pregnancy. This may also lead to Abruption of placenta (a condition where the placenta becomes dislodged from the wall of the uterus).

Grades of Placenta (Types)

Placental calcification is considered normal when it happens slowly during the course of your pregnancy. It is measured in four stages of placenta. Let’s understand the four grades one by one:

• Grade 0:

This is the beginning stage when the placenta has just attached and is still pretty immature. The chorionic plates or the foetal side of the placenta is smooth without any indentations or marks.

• Grade I:

Your placenta would advance to the next grade only towards the 31st week of  pregnancy. The ultrasound might show slight calcification randomly dispersed in the placenta.

• Grade II:

This  happens anytime between the 36th and 37th week of your pregnancy. The calcification  becomes more pronounced at this stage.

• Grade III:

This is the last phase of calcification and  happens during or after the 38th week of your pregnancy. At this stage, your placenta would be too calcified with many grooves or ring-like formations inside it.

How is the Calcification of Placental Grading Measured? 

Your doctor will be able to analyse the placental grading of your placenta with regular ultrasounds during the course of your pregnancy. It is done by observing the amount of calcification seen in your placenta. Premature calcification may hamper the growth of your foetus and might lead to pregnancy complications like early labour, stunted growth, low amniotic fluid index, etc. 

• Ultrasonographic examination and detection of echogenic foci are utilised to diagnose placental calcification, which is used as a sign of viral infection.
  
• Grannum grading is used to classify placental calcification. Grades 0, I, II, and III are part of the Grannum classification system.

How Calcified Placenta Affects Pregnancy?

The sooner your placenta calcifies, the greater the risk of premature delivery rises. To lessen the risk of premature birth, your doctor will most probably recommend you to opt for a caesarean surgery or might induce labour clinically if extensive calcification is seen.

Advanced Placental Grading Before 34 Weeks

If your ultrasound shows a placental grading of stage II or III before 32 weeks of your pregnancy, you may be at a higher risk of preterm labour and birth complications like postpartum hemorrhage, heavy bleeding, or stillbirth. Your baby might also have a low APGAR score (a measure of baby health) due to the unavailability of nutrients.

This would mean that you and your unborn baby require additional monitoring and constant observation. You might be advised to have ultrasounds at more regular intervals.

Advanced Placental Grading at 36 Weeks

Grade III placenta should be ideally observed post the 38th week of pregnancy. This condition is more of a concern in high-risk pregnancy and pregnancies with complications like high BP, diabetes, placenta previa, or anaemia (in which case, the baby might be born with a low birth weight). 

Calcification After the 37th Week

Calcification observed after the 37th week of your pregnancy will have very little impact on your pregnancy.

FAQs

Which placenta grade is good for normal delivery? 

The posterior placenta is known to be good for normal delivery as it permits the baby to grow and descend to the proper position during the delivery. It allows for a vaginal birth. As the infant grows, the posterior placenta faces the mother’s spine, and the crown falls to the delivery canal over time.

What is normal AFI?

According to the conventional evaluation approach, a normal Amniotic Fluid Index should range between  5-25 cm. Oligohydramnios is defined as less than 5 cm, whereas polyhydramnios is defined as more than 25 cm.

What causes calcification of the placenta?

According to studies, factors such as smoking and hypertension during pregnancy may contribute to the formation of a calcified placenta.

Is calcification of placenta normal?

A calcified placenta is normal during pregnancy. But if you have a family history of early calcified placenta or are noticing symptoms weeks before your due date, you need to consult your doctor immediately to cure it on time.

Takeaway

There is very little research on why some placentas age prematurely and hence,  little is known about how to prevent it. The placental calcification can only be analysed on a case-to-case basis and the observation would depend on the severity of calcification, how early in the pregnancy the calcification starts, whether the pregnancy is healthy or a high-risk one, and your gynaecologist’s opinion. Also, if you want to get more information on the anterior placenta or posterior, here’s our bird’s eye view about placenta previa which you cannot skip on reading.

Also Read: Everything You Need To Know About Placental Abruption

#pregnancymustknow