3D power doppler placental bed vascularization in the first trimester prediction of preeclampsia


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Abstract

Objective. To assess the performance of first trimester preeclampsia (PE) prediction by 3D power Doppler (3DPD) vascular indices (VI, vascularization index; FI, flow index; VFI, vascularization-flow index) of the placental bed. Subject and methods: It was case-control study including 736 singleton pregnancies taken part in the first trimester prenatal screening program. Maternal factors, mean arterial blood pressure, maternal serum biomarkers (PlGF, PAPP-A, hCGβ), uterine artery pulsatility index (UtAPI) was carried out together with 3DPD angiography to assess the placental bed vascularization and to calculate 3DPD placental bed vascular indices. Results. PE group included 102 cases, which consist 29 early PE cases, and 73 late PE cases; 570 cases was unaffected group. The placental bed indices of vascularization at first trimester are decreased in patients who later develop PE compared to unaffected pregnancies, the vascularization index (VI) was most significant marker, which had a detection rate of 48.2% for early PE and 41.2% for all PE (at false positive rate of 10%). Such predictive marker as UtAPI at a first trimester had a detection rate of 37.9% for early PE and 25,5% for all PE at false positive rate of 10%. Conclusions. Assessment of vascularization of the placental bed in the first trimester by 3D power Doppler (VI) has a good potential for PE prediction in combined models. The vascularization index of the placental bed was superior to the uterine artery pulsatility index in PE prediction, mainly the early onset forms of PE. Further researches are needed to clarify the role of first trimester placental bed 3DPD angiography in clinical practice, and it combining with other non-ultrasound markers.

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About the authors

A. M Kholin

National Medical Research Center of Obstetrics, Gynecology and Perinatology named after V.I. Kulakov

Email: a_kholin@oparina4.ru
M.D., Research Associate, Department of Maternal Fetal Medicine

Z. S Khodzaeva

National Medical Research Center of Obstetrics, Gynecology and Perinatology named after V.I. Kulakov

Email: z_khodzhaeva@oparina4.ru
M.D., Ph.D., Professor, Principal Investigator, Department of Maternal-Fetal Medicine

A. I Gus

National Medical Research Center of Obstetrics, Gynecology and Perinatology named after V.I. Kulakov

Email: a_gus@oparina4.ru
M.D., Ph.D., Head of Ultrasound Department

References

  1. Stevens W., Shih T., Incerti D., Ton T.G.N., Lee H.C., Peneva D. et al. Short-term costs of preeclampsia to the United States health care system. Am. J. Obstet. Gynecol. 2017; 217(3): 237-48. e16.
  2. Шувалова М.П., Фролова О.Г., Ратушняк С.С., Гребенник Т.К., Гусева Е.В. Преэклампсия и эклампсия как причина материнской смертности. Акушерство и гинекология. 2014; 8: 81-7.
  3. Brosens I., Pijnenborg R., Vercruysse L., Romero R. The “Great Obstetrical Syndromes” are associated with disorders of deep placentation. Am. J. Obstet. Gynecol. 2011; 204(3): 193-201.
  4. Ogge G., Chaiworapongsa T., Romero R., Hussein Y., Kusanovic J.P., Yeo L. et al. Placental lesions associated with maternal underperfusion are more frequent in early-onset than in late-onset preeclampsia. J. Perinat. Med. 2011; 39(6): 641-52.
  5. Lisonkova S., Joseph K.S. Incidence of preeclampsia: risk factors and outcomes associated with early- versus late-onset disease. Am. J. Obstet. Gynecol. 2013; 209(6): 544. e1-544. e12.
  6. Khodzhaeva Z.S., Kogan E.A., Shmakov R.G., Klimenchenko N.I., Akatyeva A.S., Vavina O.V., Kholin A.M., Muminova K.T., Sukhikh G.T. Clinical and pathogenetic features of early and late onset preeclampsia. J. Matern. Fetal Neonatal Med. 2016; 29(18): 2980-6.
  7. Rolnik D.L., Wright D., Poon L.C., O’Gorman N., Syngelaki A., de Paco Matallana C. et al. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N. Engl. J. Med. 2017; 377(7): 613-22.
  8. Kleinrouweler C.E., Cheong-See F.M., Collins G.S., Kwee A., Thangaratinam S., Khan K.S. et al. Prognostic models in obstetrics: available, but far from applicable. Am. J. Obstet. Gynecol. 2016; 214(1): 79-90.e36.
  9. Harrington K. Early screening for pre-eclampsia and intrauterine growth restriction. Ultrasound Obstet. Gynecol. 2011; 37(5): 623-4.
  10. Gebb J., Dar P. Colour Doppler ultrasound of spiral artery blood flow in the prediction of pre-eclampsia and intrauterine growth restriction. Best Pract. Res. Clin. Obstet. Gynaecol. 2011; 25(3): 355-66.
  11. Demers S., Bujold E., Arenas E., Castro A., Nicolaides K.H. Prediction of recurrent preeclampsia using first-trimester uterine artery Doppler. Am. J. Perinatol. 2014; 31(2): 99-104.
  12. Morel O., Grange G., Fresson J., Schaaps J.P., Foidart J.M., Cabrol D., Tsatsaris V. Vascularization of the placenta and the sub-placental myometrium: feasibility and reproducibility of a three-dimensional power Doppler ultrasound quantification technique. A pilot study. J. Matern. Fetal Neonatal Med. 2011; 24(2): 284-90.
  13. Raine-Fenning N.J., Nordin N.M., Ramnarine K.V., Campbell B.K., Clewes J.S., Perkins A., Johnson I.R. Determining the relationship between three-dimensional power Doppler data and true blood flow characteristics: an in-vitro flow phantom experiment. Ultrasound Obstet. Gynecol. 2008; 32(4): 540-50.
  14. Farina A. Biophysical markers for abnormal placentation: first and/or second trimester. Prenat. Diagn. 2014; 34(7): 628-34.
  15. Demers S., Girard M., Roberge S., Tetu A., Giguere Y., Forest J.C., Bujold E. First-trimester placental and myometrial blood perfusion measured by threedimensional power Doppler in preeclampsia. Am. J. Perinatol. 2015; 32(10): 920-6.
  16. Hafner E., Metzenbauer M., Stumpflen I., Waldhor T. Measurement of placental bed vascularization in the first trimester, using 3D-power-Doppler, for the detection of pregnancies at-risk for fetal and maternal complications. Placenta. 2013; 34(10): 892-8.
  17. Dar P., Gebb J., Reimers L., Bernstein P.S., Chazotte C., Merkatz I.R. Firsttrimester 3-dimensional power Doppler of the uteroplacental circulation space: a potential screening method for preeclampsia. Am. J. Obstet. Gynecol. 2010; 203(3): 238. e231-7.
  18. Rodriguez A., Tuuli M.G., Odibo A.O. First-, second-, and third-trimester screening for preeclampsia and intrauterine growth restriction. Clin. Lab. Med. 2016; 36(2): 331-51.
  19. Wright D., Syngelaki A., Akolekar R., Poon L.C., Nicolaides K.H. Competing risks model in screening for preeclampsia by maternal characteristics and medical history. Am. J. Obstet. Gynecol. 2015; 213(1):62. e1-10.
  20. Plasencia W., Maiz N., Bonino S., Kaihura C., Nicolaides K.H. Uterine artery Doppler at 11 + 0 to 13 + 6 weeks in the prediction of pre-eclampsia. Ultrasound Obstet. Gynecol. 2007; 30(5): 742-9.
  21. Poon L.C., Zymeri N.A., Zamprakou A., Syngelaki A., Nicolaides K.H. Protocol for measurement of mean arterial pressure at 11-13 weeks’ gestation. Fetal Diagn. Ther. 2012; 31(1): 42-8.
  22. Tranquilli A.L. Introduction to ISSHP new classification of preeclampsia. Pregnancy Hypertens. 2013; 3: 57-61.
  23. РОАГ, АААР. Гипертензивные расстройства во время беременности, в родах и послеродовом периоде. Преэклампсия. Эклампсия. Клинические рекомендации (протокол лечения). М.: Минздрав России; 2016. 73с.
  24. Odibo A.O., Goetzinger K.R., Huster K.M., Christiansen J.K., Odibo L., Tuuli M.G. Placental volume and vascular flow assessed by 3D power Doppler and adverse pregnancy outcomes. Placenta. 2011; 32(3): 230-4.
  25. Plasencia W., Akolekar R., Dagklis T., Veduta A., Nicolaides K.H. Placental volume at 11-13 weeks’ gestation in the prediction of birth weight percentile. Fetal Diagn. Ther. 2011; 30(1): 23-8.
  26. Raine-Fenning N.J., Campbell B.K., Clewes J.S., Kendall N.R., Johnson I.R. The reliability of virtual organ computer-aided analysis (VOCAL) for the semiquantification of ovarian, endometrial and subendometrial perfusion. Ultrasound Obstet. Gynecol. 2003; 22(6): 633-9.
  27. Merce L.T., Barco M.J., Alcazar J.L., Sabatel R., Troyano J. Intervillous and uteroplacental circulation in normal early pregnancy and early pregnancy loss assessed by 3-dimensional power Doppler angiography. Am. J. Obstet. Gynecol. 2009; 200(3): 315. e1-8.
  28. Bujold E., Roberge S., Lacasse Y., Bureau M., Audibert F., Marcoux S. et al. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstet. Gynecol. 2010; 116(2, Pt 1): 402-14.
  29. Roberge S., Giguere Y., Villa P., Nicolaides K., Vainio M., Forest J.C. et al. Early administration of low-dose aspirin for the prevention of severe and mild preeclampsi a: a systematic review and meta-analysis. Am. J. Perinatol. 2012; 29(7): 551-6.
  30. Merce L.T., Barco M.J., Bau S. Reproducibility of the study of placental vascularization by three-dimensional power Doppler. J. Perinat. Med. 2004; 32(3): 228-33.

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