- Fetal Upturned Nose
- IgA Nephropathy in Pregnancy
- Umbilical vein varix
- Timing of Cranial Markers in Open NTD
- Real world experience Open Neural tube defect and Brain Signs
- Real world experience First Trimester Megacystis – Management
- Real world experience Fetal Megacystis
- Abnormal facial profile
- Azygous Vein & ARSA
- Blakes Pouch Cyst
- Absent nasal bone (ANB)
- Choroid plexus cysts
- Chronic placental abruption
- Fetal Alcohol Syndrome
- Placenta-First Risk Stratification
- AVSD
- Blakes Pouch Cyst
- Confined Placental Mosaicism
- Echogenic Bowel
- Fetal Anemia
- Fetal Club Foot
- Fetal Mild Micromelia
- Hypochondroplasia – Mild Micromelia
- Hypoplastic Nasal Bone
- IgM IgG IgG Avidity
- Increased Nuchal Translucency
- Isotretinoin in Pregnancy
- Partial agenesis of corpus callosum
- PGT A
- PGT-A Mosaicism to CPM
- Placenta First - CPM
- Radiation exposure during pregnancy
- Real world Chorionic bump experience
- Real world Fetal Isotretinoin exposure
- Real world Increased Nuchal Translucency & Genetic RISK
- Real world Renal Pyelectasis
- Real world Transient NT & Cystic Hygroma
- Real world Transient NT
- Renal Pyelectasis or Extra Renal Pelvis
- Right And Double Aortic Arch
- Short Femur Length Foot FL ratio
- Y Microdeletion
- CCAM CPAM
- Coffin–Siris syndrome
- Congenital CMV Infection
- Increased NT and Localized CHAOS
- Indomethacin and Reduction for AFI
- Atrioventricular septal defect (AVSD)
- Choledochal cyst & Cystic biliary atresia
- Duodenal Atresia
- Fetal atrial bigeminy
- Fetal Dilated stomach
- Mutation Types in DMD
- Risk of rubella in nonimmune pregnant woman
- Salt-losing nephropathy
- Syndromic Cystic biliary atresia
- TGA DORV TOF CCTGA
- Unilateral echogenic kidney with polyhydramnios
- Unilateral renal agenesis, Ectopic, Cross fused kidney
Placenta-first risk stratification mode
In pregnancies with suspected or proven CPM, placental genotype and function determine risk more than fetal karyotype.
STEP 1: Define the placental genetic risk tier
Tier P0 – No placental genetic signal
- Normal NIPT
- Normal CVS / amnio
- No discordance
Placental risk: Baseline
Management: Routine obstetric care
Tier P1 – Cytotrophoblast-limited abnormality (CPM type 1)
Typical scenario
- NIPT positive
- Amniocentesis normal
- CVS STC abnormal, LTC normal
Biology
- Usually mitotic
- Abnormal cells confined to trophoblast
- Placental architecture often preserved
Placental risk
- Low but not zero
Clinical expectation
- Mostly normal growth
- Small increase in FGR risk
Tier P2 – Mesenchymal or mixed placental abnormality (CPM type 2 or 3)
Typical scenarios
- Discordant CVS cultures
- Positive NIPT + abnormal LTC
- Known CPM after amnio
- Trisomy rescue suspected
Biology
- Often early mitotic or meiotic
- Placental villous core affected
- Vascular and exchange dysfunction likely
Placental risk
- Moderate to high
STEP 2: Overlay chromosome-specific placental behavior
Some chromosomes are disproportionately placentotoxic
| Chromosome | Placental impact | Typical outcome |
|---|---|---|
| 16 | Severe | Early FGR, IUFD risk |
| 22 | Severe | FGR, preeclampsia |
| 15 | Moderate | UPD syndromes |
| 7 | Moderate | FGR, Silver–Russell |
| 18 | Moderate | CPM common, variable |
| 21 | Mild | Often compensated |
STEP 3: Add functional placental phenotype
Ultrasound and Doppler markers
- Uterine artery PI
- Umbilical artery PI
- Placental thickness
- Placental lakes / cysts
- Cord insertion abnormalities
Growth trajectory
- Early symmetric FGR → genetic/placental
- Late asymmetric FGR → functional placental failure
STEP 4: The integrated placenta-first risk matrix
Low risk
- CPM type 1
- Non-placentotoxic chromosome
- Normal uterine artery Doppler
- Normal growth
Management
- Growth scans every 4 weeks
- Routine third-trimester surveillance
Intermediate risk
- CPM type 1 with placentotoxic chromosome
- OR
- CPM type 2 with normal Dopplers
Management
- Growth every 3 weeks
- Umbilical artery Doppler
- Low-dose aspirin if early
- Lower threshold for steroids
High risk
- CPM type 3
- Meiotic trisomy rescue
- Trisomy 16 or 22
- Abnormal uterine artery Doppler
- Early FGR
Management
- Growth every 2 weeks
- Full Doppler surveillance
- Early antenatal steroids
- Delivery planning in tertiary unit
STEP 6: Prevention of adverse outcomes
It catches early
- “Unexplained” early FGR
- Late IUFD with normal fetus
- Preeclampsia with normal genetics
- Discordant NIPT cases dismissed as false positives
Placenta-first stratification recognizes CPM as a placental disease with fetal consequences, allowing risk prediction even when fetal karyotype is normal.