Estimated Placental Volume (EPV)

Dr. Harvey Kliman, working with his father, mathematician Merwin Kliman, has developed a technique to measure Estimated Placental Volume (EPV) during pregnancy. This information has the potential to improve patients' prenatal care and pregnancy outcomes, as small placentas can lead to intrauterine growth restriction, and in severe cases, even intrauterine fetal demise.

EPV can be measured from 7 to 40 weeks. Use widest angle probe for large placentas. Beyond 36 weeks the placenta may be too large to visualize. In that case record the result as: Too large to measure EPV (which means by definition that the placenta is not small for gestational age).

Ideal measurements: Freeze cross section at maximal width of placenta. Take Width measurements from edge to edge (triangle). Start at apex and measure Height (O) and Thickness (X) down to baseline along same line. Height is always greater or equal to thickness.

To download the manual click here.

alt text 

alt textAnterior crescent shaped placenta with markers placed to measure width, height and thickness. 

Placenta is an obvious crescent. Baseline Width is measured from tip to tip (+). Apex is found and Height is measured from apex to baseline (O). Thickness is measured starting from same apex point as Height and then measured along the same line down to edge of placenta (X).

alt textLateral thick placenta with W, H and T marks in place. 
Placenta is a thick crescent. Baseline Width is measured from tip to tip (+). Note that the lower tip is estimated. Apex is found and Height is measured from apex to baseline (X). Thickness is measured starting from same apex point as Height and then measured down along the same line to edge of placenta (O).
alt textFlat placenta showing marks for width and height. Thickness equals height in this case. 
Placenta is flat, without any evidence of curvature. The maximal Width is measured from tip to tip (+). The Height and Thickness (X) are the same and are measured once to obtain both values.
  1. Azpurua HJ, Funai EF, Coraluzzi L, Sasson I, Doherty L, Kliman M, Kliman HJ. Determination of placental weight using two-dimensional sonography and volumetric mathematic modeling, Am J Perinatology, 27: 151-155, 2010.
  2. Kliman HJ, Arleo EK, Troiano RN. Development of In Utero Normative Placental Growth Curves Using a Validated Mathematical Model, ACOG 59th Annual Meeting, April 30 to May 4, 2011, Washington, DC
  3. Staff AC, Laine K, Lahmami G, Gustafsson J, Surbehan H, Barbero ML, Kliman HJ. Second trimester estimated placental volume (EPV) screening is predictive of SGA and LGA at birth. International Federation of Placenta Associations, September 13-17, 2008, Geilo, Norway.
  4. Arleo EK, Troiano RN, da Silva R, Greenbaum D, Hartigan JA, Ge W, Zeissler AG, Kliman HJ. Estimated Placental Volume (EPV): Set a Competitive New Standard of Prenatal Care in Less Than One Minute. Radiologic Society of North America, November 27-December 2, Chicago, IL.
  5. Arleo EK, Troiano RN, da Silva R, Greenbaum D, Kliman HJ. Utilizing 2-Dimensional Ultrasound to Develop Normative Curves for Estimated Placental Volume (EPV). Am J Perinatology. 2013 Oct 9. [Epub ahead of print]