Review Article Structured evaluation and reporting in imaging of placenta and umbilical cord Ishan Kumar 1 , Ashish Verma 1 , Madhu Jain 2 and Ram C Shukla 1 Abstract The human placenta plays a pivotal role in development and growth of the fetus. Disorder of this multifunctional organ is central to various fetal disorders. Doppler sonography and MRI provide excellent diagnostic evaluation of the placental morphology and umbilical cord. Decades of experience in obstetric imaging have highlighted the need of careful prenatal assessment of placenta. However, in most of the routine obstetric scans, the evaluation and reporting of the placental examination is limited to the location and grade of the placenta. The purpose of this article is to review the existing literature and facilitate step-by-step evaluation of the placenta and umbilical cord by the radiologists. Keywords Genital/reproductive, color Doppler ultrasound, magnetic resonance imaging, uterus, adults, obstetrics Date received: 7 March 2019; accepted: 29 July 2019 Introduction The placenta serves an important, sacred purpose in fostering new life. However, in clinical obstetrical imaging, the placenta is imaged almost as an after- thought to fetal assessment and mostly to determine its location in the uterus. Although uncommon, placen- tal abnormalities are important to recognize, as they harbor a significant potential of feto-maternal morbid- ity and mortality. Detailed systematic analysis of placenta is crucial for understanding the various disease processes affecting the late gestation. The superior diagnostic efficiency of modern sonographic scanners and increasing demand for obstetric magnetic resonance imaging (MRI) studies mandates a step-by-step staccato evalu- ation by the radiologist for evaluating all the structures in the placenta and the umbilical cord, so that no important pathology is missed. Unfortunately, although various recent articles recognize the need of systematic evaluation of placenta, little stress has been placed on structured reporting of the findings. A struc- tured report might aid in facilitating retrospective and prospective research in the future. The aim of this article is to review the existing body of literature and suggest a reporting template for com- prehensive evaluation of placenta by the radiologist while focusing on the common clinical scenarios encountered in our daily practice. Placental thickness Placental thickness in a normal pregnancy is in the range of 2–4 cm and should be measured near the umbilical cord insertion site (1,2). The mid-portion of the placenta should be selected and measurement should be obtained perpendicular to the uterine wall, excluding the myometrium, from subplacental vessels to the amniotic fluid (3). Note should be made of any focal thickening of placenta which may represent a focal placental hemorrhage or abruption. In cases with thickened placenta with cystic echotexture, molar pregnancy or placental mesenchymal dysplasia 1 Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India 2 Department of Obstetric and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India Corresponding author: Ashish Verma, Department of Radiodiagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India. Email: drdnv5@gmail.com Acta Radiologica 0(0) 1–20 ! The Foundation Acta Radiologica 2019 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/0284185119875644 journals.sagepub.com/home/acr