PRENATAL DIAGNOSIS Prenat Diagn 2004; 24: 182–188. Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/pd.828 The thick heterogeneous (jellylike) placenta: a strong predictor of adverse pregnancy outcome Luigi Raio 1 *, Fabio Ghezzi 2 , Antonella Cromi 2 , Mathias Nelle 3 , Peter D¨ urig 1 and Henning Schneider 1 The Department of Obstetrics and Gynecology, University of Berne-Inselspital, Switzerland 2 The Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy 3 The Department of Neonatology, University of Berne-Inselspital, Switzerland Objective To present a series of cases with a sonographic thick and heterogeneous placenta, and to review the literature. Methods A series of 16 cases were analyzed. A heterogeneous placenta was defined as a thick placenta with a patchy decrease of echogenicity, which quivered like jelly to sharp abdominal pressure. A comprehensive morphologic and Doppler evaluation of the fetus and the uteroplacental circulation was performed. The pregnancy course and the neonatal outcome of the present series and of those reported in the literature were reviewed. Results Placental thickness was greater than the 95th centile in all cases. The placenta was located laterally in 13 (81.3%) cases. Twelve women delivered earlier than 34 weeks either spontaneously or because of deteriorating maternal and/or fetal conditions (n = 10). Perinatal death occurred in eight cases. The uterine artery Doppler and the umbilical artery were abnormal in eight and eight cases respectively. A discordancy between the umbilical artery size was present in six cases. Abruptio placentae occurred in three cases. A strong association between hypertensive disorders and fetal growth restriction was found in our series and in literature. Conclusions The sonographic presence of thick heterogeneous placenta is strongly associated with an adverse pregnancy outcome and often with perinatal death. Copyright  2004 John Wiley & Sons, Ltd. KEY WORDS: jellylike placenta; thick placenta; perinatal death; ultrasound; umbilical cord INTRODUCTION Two decades ago, on the basis of the assumption that the placenta matures similar to other fetal organs, a sono- graphic scoring system of the placental morphology was proposed with the aim of predicting fetal maturity in high-risk pregnancy (Grannum et al., 1979). With the advent of sophisticated ultrasound machines equipped with pulsed and color Doppler facilities allowing a func- tional evaluation of maternal and fetoplacental vessels, the assessment of the sonographic morphology of the placenta is considered less important for the evaluation of the fetal well-being. Although placental grading has been shown to have only limited value in predicting pulmonary maturity (Quinlan et al., 1982), controversies still exist on the association between some placental features and preg- nancy complications. Sonolucent placental lakes have been inconsistently associated with a poor pregnancy outcome (Haney and Trought, 1980; Jauniaux et al., 1994; Thompson et al., 2002). A number of investigators described an association between an elevated placental thickness and an increased risk of an adverse pregnancy outcome (Jauniaux, 1992; Jauniaux et al, 1994; Haris *Correspondence to: Luigi Raio, University of Berne-Inselspital, Department of Obstetrics and Gynecology, Effingerstrasse 102, 3010 Berne, Switzerland. E-mail: luigi.raio@insel.ch et al., 1996; Elchalal et al., 2000). Conversely, Thomp- son et al. (2002), apart from a mild association with severe preeclampsia, found no correlation between a thick placenta and a poor obstetrical outcome. Abnormal sonographic placental findings have been found in the presence of elevated maternal serum concentrations of α-fetoprotein and human chorionic gonadotrophin, which, in turn, have been correlated to adverse pregnancy outcome (Kelly et al., 1989; Jauniaux et al., 1990; Jauniaux et al., 1994; Jauniaux and Nico- laides, 1996). A sonographic finding poorly investigated is the thick and heterogeneous appearance of the placenta, often described in the presence of an adverse pregnancy outcome. The aim of the present study was to present a series of cases with a sonographic thick heterogeneous placenta and to review the available literature. PATIENTS AND METHODS This is a retrospective observational study consisting of women referred for ultrasonographic examination during a three-year period and diagnosed to have a thick heterogeneous placenta. Gestational age was determined by a reliable recollection of the last menstrual period confirmed by an ultrasonographic examination within 14 weeks of gestation in all cases. Copyright  2004 John Wiley & Sons, Ltd. Received: 1 August 2003 Revised: 26 November 2003 Accepted: 1 December 2003