Frequency of Different Perinatal Outcomes Across Grade II and Grade III Placental Maturity
DOI:
https://doi.org/10.36283/ziun-pjmd14-4/045Keywords:
Placental Maturity, Perinatal Outcomes, Grade III Placenta, Low APGAR Score, NICU AdmissionAbstract
Background:Placental maturity is an important indicator of fetal well-being and intrauterine status. Abnormal placental maturation has been linked to adverse perinatal outcomes, including fetal growth restriction, preterm birth, and perinatal mortality. Understanding its impact is critical for timely obstetric management and improved neonatal outcomes. The study aimed to evaluate the relationship between placental maturity (Grade II vs. Grade III) and perinatal outcomes in pregnancies at or beyond 34 weeks of gestation.
Methods:This cross-sectional study included 110 pregnant women with singleton pregnancies at ≥34 weeks of gestation. Placental grading was assessed by ultrasonography and classified according to Grannum’s criteria. Maternal demographic data, gestational age, mode of delivery, and perinatal outcomes (APGAR score, birth weight, NICU admission, stillbirth, and preterm delivery) were recorded. Frequencies and percentages were calculated and outcomes were compared between Grade II and Grade III placental maturity groups.
Results:The mean maternal age was 27 ± 7.2 years; 37% of women were primiparous and 63% multiparous. Grade III placental maturity was observed in 65% of participants, while 35% had Grade II maturity. Overall, 4.5% of neonates had a low APGAR score, 4.5% were stillborn, 2.7% had low birth weight, 5.45% required NICU admission, and 2.7% were preterm. Adverse outcomes were more frequent in Grade II placental maturity (low APGAR 8%, stillbirth 11%, NICU admission 8%) compared to Grade III (low APGAR 3%, stillbirth 1%, NICU admission 4%).
Conclusion: Placental maturity is significantly associated with perinatal outcomes. Delayed maturation (Grade II) beyond 34 weeks may serve as a marker of placental insufficiency and is associated with increased risk of stillbirth, low APGAR scores, and NICU admissions. Routine assessment of placental grading may aid in early identification of at-risk pregnancies and improve perinatal care.
References
1. Alemayehu TM, Bayile YS. "Determinants of Calcified Placenta and Its Association with Fetal Outcome among Mothers Who Gave Birth in Southern Ethiopia, 2018."
2. 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 31, no. 2 (2020): 94-99.
3. Agrawal V, Jain S. "Placental Grading and Its Correlation with Fetal Outcome." Hypertension 40 (2000): 32.
4. Fouedjio JH, Fouelifack FY, Fouogue JT, Tetka TT. "Associations Between the Grade of Placental Maturity at Third Trimester Ultrasound and Maternofetal Outcomes at the Maternity of the Yaoundé Central Hospital: A Prospective Cohort Study." Donald School Journal of Ultrasound in Obstetrics and Gynecology 9 (2015): 230-33.
5. Sersam LW. "Ultrasonographically Observed Grade III Placenta at 36 Weeks’ Gestation: Maternal and Fetal Outcomes." Iraqi Postgraduate Medical Journal 28, no. 1 (2011).
6. Jamal A, Moshfeghi M, Moshfeghi S, Mohammadi N, Zarean E, Jahangiri N. "Is Preterm Placental Calcification Related to Adverse Maternal and Fetal Outcome?" Journal of Obstetrics and Gynaecology 37, no. 5 (2017): 605-09.
7. Cristiana R, Gerosa C, Pampaloni P, Puddu M, Alberto R, Angioni S, Fanni D, Faa G. "Placental Calcification Score: A New Semiquantitative Method to Assess Pattern and Grading of Placental Calcifications." Journal of Clinical Ultrasound 23, no. 3 (2019): 646-51.
8. Mirza FG, Ghulmiyyah LM, Tamim H, Makki M, Jeha D, Nassar A. "To Ignore or Not to Ignore Placental Calcifications on Prenatal Ultrasound: A Systematic Review and Meta-Analysis." The Journal of Maternal-Fetal & Neonatal Medicine 31, no. 6 (2018): 797-804.
9. Bandana Das, D. Dutta, S. Chakraborthy, P. Nath. "Placental Morphology in Hypertensive Disorders of Pregnancy and Its Correlation with Fetal Outcome." Journal of Obstetrics and Gynaecology India 46, no. 1 (1996): 40-46.
10. Saddler TW. Langman’s Medical Embryology, 9th ed. Philadelphia: Lippincott Williams and Wilkins Company, 2004.
11. Cunningham FGary, et al. Williams Obstetrics, 22nd ed. New York: McGraw-Hill, 2014.
12. Dutta DC. Textbook of Obstetrics Including Perinatology and Contraception, 3rd ed. Calcutta, India: New Central Book Agency, 1992.
13. Boyd JD, Hamilton WJ. The Human Placenta, 1st ed. Cambridge, England: W. Heffer and Sons, 1970.
14. Altschuler G, Ludwig M, Deppisch. "College of American Pathologists Conference XIX on Examination of Placenta: Report of the Working Group on Indications for Placental Examination." Archives of Pathology & Laboratory Medicine 115 (1991): 701-703.
15. Naeye RL. "Functionally Important Disorders of the Placenta, Umbilical Cord and Fetal Membranes." Human Pathology 18 (1987): 680-691.
16. Driscoll SG. "Placental Examination in a Clinical Setting." Archives of Pathology & Laboratory Medicine 115 (1991): 668-671.
17. Altshuler G, Herman AA. The Medico-Legal Imperative: Placental Pathology and Epidemiology. In: Altshuller G, ed. Fetal and Neonatal Brain Injury: Mechanisms, Management and Risks of Practice, 1st ed. Philadelphia: BC Decker Inc., 1989.
18. Salafia CM, Vintzileos AM. "Why All Placentas Should Be Examined by a Pathologist in 1990." American Journal of Obstetrics and Gynecology 163 (1990): 1282-1293.
19. Claire L, Cynthia K, Trevor M, Elizabeth M, Keith P, Barasa C, Cathy M, Susan C, Guy G. "Practice Guidelines for Examination of the Placenta." Archives of Pathology & Laboratory Medicine 121 (1997): 449-496.
20. Fox H. "General Pathology of the Placenta." In Obstetrics and Gynecological Pathology, ed. H. Fox. New York: Churchill Livingstone, 1995, 1477-1508.
21. Fox H. Pathology of the Placenta. Major Problems in Pathology, Vol. 7. Philadelphia: WB Saunders Company Ltd., 1978.
22. Benrischke K, Kaufmann P. Pathology of the Human Placenta, 4th ed. New York: Springer Verlag, 2000.
23. Odegard RA, Vatten VJ, Nilsen ST, et al. "Pre-Eclampsia and Fetal Growth." Obstetrics and Gynecology 96, no. 6 (2000): 950-955.
24. "Report of National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy." American Journal of Obstetrics and Gynecology 183 (2000): S1-S22.
25. "Hypertensive Disorders of Pregnancy: Report of a WHO Study Group." World Health Organisation, Geneva, 1987.
26. Davey DA, Mac Gillivray. "The Classification and Definition of the Hypertensive Disorders of Pregnancy." American Journal of Obstetrics and Gynecology 158 (1988): 892-898.
27. Arias, Fernando. Practical Guide to High Risk Pregnancy and Delivery, 2nd ed. Philadelphia: Mosby, 1994, 183-207.
28. Mudaliar, Menon. "Hypertensive Disorders of Pregnancy." Clinical Obstetrics, Chapter 18. Chennai: Orient Longman Ltd., 1997, 133-154.
29. Louis M, Hellman, Jack A. Pritchard. Hypertensive Disorders of Pregnancy. Williams Obstetrics, 14th ed. New Delhi: Amerind Publishing Co. Pvt. Ltd., 1971, 723.
30. "Report of National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy." American Journal of Obstetrics and Gynecology 163 (1990): 1689-1712.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Pakistan Journal of Medicine and Dentistry

This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access article distributed under the terms of the CreativeCommons Attribution License (CC BY) 4.0 https://creativecommons.org/licenses/by/4.0/