Measure the Placenta

Behind every healthy baby is a healthy placenta. Though a temporary resident in your body, the placenta is arguably one of the most important organs - without it, pregnancy wouldn't be possible!

Unfortunately, the placenta is also one of the least understood parts of the body. (We're going to go ahead and chalk that one up to the patriarchy! Ugh.)

But never fear - a handful of intrepid scientists are blazing the trail and discovering new insights about this miraculous hunk of mystery every day, including why every doctor should be paying it much closer attention.

Download an informational Measure the Placenta pamphlet to share with your doctor here!

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The Importance of Estimated Placental Volume

It has been well documented that there is a clear link between the size of the placenta and pregnancy outcomes. In fact, a small placenta is the most common cause of stillbirth. But most doctors don't give the placenta more than a cursory glance during pregnancy. Why?

Until recently, it was really hard to #MeasureThePlacenta - but that all changed with the advent of Estimated Placental Volume (EPV).

 

This simple set of measurements can be done in 30 seconds during any routine ultrasound, and will give your healthcare provider an accurate estimate of how the size of your baby's placenta compares to other babies' of the same gestational age (also known as a growth curve). This will allow them to flag if your baby's placenta is unusually small or large, or if there is a mismatch between the size of your baby and his/her placenta. If there is any cause for concern, your doctor can then order extra monitoring until they determine it is safe to deliver.

Share this informational flyer with your provider to help them learn about Measuring the Placenta with EPV!

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Isn't My Doctor Already Monitoring This?

Your medical provider is likely already charting your baby's growth, but before EPV was created, it wasn't possible to do this for their placenta. Instead, most doctors simply observed the location of the placenta within the uterus and noted where your baby's umbilical cord attached to the placenta. These are important data points, but are missing a key piece of the puzzle - adding EPV to the mix gives your doctor a much fuller picture of your baby's wellbeing.

It's important to recognize that babies of any size can have a small placenta; there is a common misconception that if the baby is not concerningly small, the placenta must be fine. Unfortunately, this isn't true - some babies will slow their growth to match the placenta, but (likely due to genetic factors determining their size), others won't. And in time, those babies will actually outgrow their own placenta, like trying to run an 18-wheeler on a compact car engine. The closer these babies get to full term, the more likely their placenta is to reach its limit, tragically resulting in the stillbirth of an otherwise healthy baby.

Sometimes, a baby whose placenta is struggling will show changes in their normal fetal movement (see #MovementsMatter & #KnowYourNormal). But not always. Much like a car running low on fuel will operate normally until it just gives out and the car stops operating without warning, so too will the placenta.

EPV is a new tool in prenatal care - bring a copy of this informational flyer to your next prenatal appointment to help your provider learn about Measuring the Placenta with EPV!

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The Bottom Line

There is solid data on the accuracy of EPV measurements - its effectiveness as a tool to detect small placentas during pregnancy is not in dispute. And we know that small placentas increase the risk of stillbirth. What is not yet demonstrated in published research is this million dollar question: Does using EPV actually improve pregnancy outcomes in clinical practice? It certainly seems likely, but the necessary studies have not yet been completed. Unfortunately, there are major logistical and ethical challenges associated with running a typical study on any stillbirth prevention technique, and that includes EPV, so it may be a while before we have the highest levels of evidence in hand.

That being said, prenatal care providers do MANY things in clinical practice that do not meet this high, ideal level of evidence, and providers often face important decisions with less-than-perfect information. Given that EPV is a low-cost, easy, non-invasive tool with potentially huge benefits - and since we know from experience that no parent would opt for a stillbirth over giving their child a fighting chance in the NICU - we are in favor of routinely using EPV as one more tool in the toolbox for all pregnant patients, as long as they are well-informed about any potential risks (for example, pushing up the timing of a baby's delivery, even if it may lead to a NICU stay).

As such, we recommend requesting EPV as part of all ultrasounds performed during routine prenatal care (this is usually at ~10 and 20 weeks), and also - especially - in the third trimester (when the risk of your baby "outgrowing" his/her placenta is highest). Third trimester measurements would ideally be performed on a monthly basis, and more frequently if there is cause for concern.

If you have further questions on EPV, check out this informational flyer and the thorough FAQs on the Measure the Placenta website, and don't hesitate to reach out to them at measuretheplacenta@gmail.com or @measuretheplacenta on Instagram. You can also direct your medical provider to contact Dr. Harvey Kliman - he's an MD PhD Research Scientist, Director of the Yale University Reproductive and Placental Research Unit, creator of EPV, and one of our PUSH Medical Advisors - and he's very responsive!

Psst - You can also join us at our monthly Clubhouse series, Dr. Harvey's Empowered Pregnancy Hour to ask him questions directly! Schedule here.

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