FIRST TRIMESTER PREDICTION OF PREECLAMPSIA BASED ON MATERNAL FACTORS, BIOMARKERS AND 3D POWER DOPPLER OF PLACENTAL BED VASCULARIZATION


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Abstract

Objective. To develop the best screening model for preeclampsia (PE) based on maternal characteristics, biomarkers with 3D power Doppler of placental bed vascularization. Materials and methods. A prospective nonintervention cohort study. Patients who presented for combined screening were measured/recorded at 11-13+6 weeks maternal characteristics, mean arterial blood pressure (MAP), uterine artery Doppler pulsatility indices (UtA-PI), 3D power Doppler of placental bed vascularization indices (PB-VI) and VOCAL technology, maternal serum placental growth factor (PlGF) Logistic regression analysis was used to predict PE. Results. We screened 5157 pregnant women of whom 3424 (66,4%) were available for analysis. In all, 102 (3,0%) developed PE, with 29 (0,9%) having early-onset PE and 73 (2,1%) having late-onset PE. The best model for early PE (n=29) and late PE (n=73) included maternal risk factors, MAP, PlGF and PB-VI achieving detection rates of 89,7% (AUC 0,941; CI: 0,944-0,978) and 50,7% (AUC 0,833; 95% CI: 0,800-0,863) for 10% of false-positive rates. There was no significant improvement when adding PAPP-A, uterine artery Doppler values, or both. Conclusions. Preeclampsia can be predicted with high accuracy in low risk population by combined algorithms with vascularization indices of placental bed using 3D power Doppler angiography. Among Doppler parameters as PB-VI and UtA-PI, improve the prediction for early and late PE, and PB-VI vs UtA-PI detects significantly higher rates of early PE. The data need confirmation in larger studies.

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About the authors

Alexey Mikhaylovich Kholin

National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia

Email: a_kholin@oparina4.ru
M.D., Clinical & Research Fellow, Department of Maternal Fetal Medicine Moscow 117997, Ac. Oparina str. 4, Russia

Kamilla Timurovna Muminova

National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia

D. Clinical Fellow, Department of Maternal Fetal Medicine Moscow 117997, Ac. Oparina str. 4, Russia

Nagoev Temirlan Mukhamedovich

National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia

resident trainee Moscow 117997, Ac. Oparina str. 4, Russia

Zulfiya Sagdullaevna Khodzhaeva

National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia

resident trainee Moscow 117997, Ac. Oparina str. 4, Russia

Alexander Iosifovich Gus

National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia

M.D., Ph.D., Professor, Principal Investigator, Department of Maternal-Fetal Medicine Moscow 117997, Ac. Oparina str. 4, Russia

References

  1. Lisonkova S., Sabr Y., Mayer C., Young C., Skoll A., Joseph K.S. Maternal morbidity associated with early-onset and late-onset preeclampsia. Obstet. Gynecol. 2014; 124(4): 771-81.
  2. Сидорова И.С., Никитина Н.А., Унанян А.Л. Преэклампсия и снижение материнской смертности в России. Акушерство и гинекология. 2018; 1: 107-12.
  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. Chaiworapongsa T., Chaemsaithong P., Yeo L., Romero R. Pre-eclampsia part 1: current understanding of its pathophysiology. Nat. Rev. Nephrol. 2014; 10(8): 466-80.
  5. 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.
  6. O'Gorman N., Wright D., Syngelaki A., Akolekar R., Wright A., Poon L.C., Nicolaides K.H. Competing risks model in screening for preeclampsia by maternal factors and biomarkers at 11-13 weeks gestation. Am. J. Obstet. Gynecol. 2016; 214(1): 103. e101-3. e112.
  7. Scazzocchio E., Figueras F., Crispi F., Meier E., Masoller N., Mula R., Gratacos E. Performance of a first-trimester screening of preeclampsia in a routine care low-risk setting. Am. J. Obstet. Gynecol. 2013; 208(3): 203. e1-203. e10.
  8. D'Silva A., Fyfe R., Hyett J. First trimester prediction and prevention of adverse pregnancy outcomes related to poor placentation. Curr. Opin. Obstet. Gynecol. 2017; 29(6): 367-74.
  9. Crovetto F., Figueras F., Triunfo S., Crispi F., Rodriguez-Sureda V., Dominguez C. et al. First trimester screening for early and late preeclampsia based on maternal characteristics, biophysical parameters, and angiogenic factors. Prenat. Diagn. 2015; 35(2): 183-91.
  10. Gorman N., Wright D., Poon L.C., Rolnik D.L., Syngelaki A., de Alvarado M. et al. Multicenter screening for pre-eclampsia by maternal factors and biomarkers at 11-13 weeks' gestation: comparison with NICE guidelines and ACOG recommendations. Ultrasound Obstet. Gynecol. 2017; 49(6): 756-60.
  11. 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.
  12. Hannaford K.E., Tuuli M., Goetzinger K.R., Odibo L., Cahill A.G., Macones G., Odibo A.O. First-trimester 3-dimensional power Doppler placental vascularization indices from the whole placenta versus the placental bed to predict preeclampsia: does pregnancy-associated plasma protein a or uterine artery Doppler sonography help? J. Ultrasound Med. 2015; 34(6): 965-70.
  13. Холин А.М., Ходжаева З.С., Гус А.И. Трехмерная энергетическая допплеровская оценка васкуляризации плацентарного ложа в прогнозировании преэклампсии в первом триместре. Акушерство и гинекология. 2018; 2: 36-43.
  14. Холин А.М., Муминова К.Т., Балашов И.С., Ходжаева З.С., Боровиков П.И., Иванец Т.Ю., Гус А.И. Прогнозирование преэклампсии в первом триместре беременности: валидация алгоритмов скрининга на Российской популяции. Акушерство и гинекология. 2017; 8: 74-84
  15. 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.
  16. Tranquilli A.L. Introduction to ISSHP new classification of preeclampsia. Pregnancy Hypertens. 2013; 3(2): 57-61.
  17. РОАГ, АААР. Гипертензивные расстройства во время беременности, в родах и послеродовом периоде. Преэклампсия. Эклампсия. Клинические рекомендации (протокол лечения). М.: Минздрав России; 2016.
  18. Figueras F., Gratacos E. An integrated approach to fetal growth restriction. Best Pract. Res. Clin. Obstet. Gynaecol. 2017; 38: 48-58.
  19. Odeh M., Ophir E., Maximovsky O., Grinin V., Bornstein J. Placental volume and three-dimensional power Doppler analysis in prediction of pre-eclampsia and small for gestational age between Week 11 and 13 weeks and 6 days of gestation. Prenat. Diagn. 2011; 31(4): 367-71.
  20. Plasencia W., Gonzalez-Davila E., Gonzalez Lorenzo A., Armas-Gonzalez M., Padron E., Gonzalez-Gonzalez N.L. First trimester placental volume and vascular indices in pregnancies complicated by preeclampsia. Prenat. Diagn. 2015; 35(12): 1247-54.
  21. Rizzo G., Capponi A., Cavicchioni O., Vendola M., Arduini D. First trimester uterine Doppler and three-dimensional ultrasound placental volume calculation in predicting pre-eclampsia. Eur. J. Obstet. Gynecol. Reprod. Biol. 2008; 138(2): 147-51.
  22. Hafner E., Metzenbauer M., Stumpflen I., Waldhor T., Philipp K. First trimester placental and myometrial blood perfusion measured by 3D power Doppler in normal and unfavourable outcome pregnancies. Placenta. 2010; 31(9): 756-63.
  23. 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.
  24. Gonzalez-Gonzalez N.L., Gonzalez Davila E., Padron E., Armas Gonzalez M., Plasencia W. Value of placental volume and vascular flow indices as predictors of early and late preeclampsia at first trimester. Fetal Diagn. Ther. 2018; Jan 23.
  25. Sonek J., Krantz D., Carmichael J., Downing C., Jessup K., Haidar Z. et al. First-trimester screening for early and late preeclampsia using maternal characteristics, biomarkers, and estimated placental volume. Am. J. Obstet. Gynecol. 2018; 218(1): 126. e121-6. e113.
  26. 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. e311-8.
  27. Eastwood K.A., Patterson C., Hunte rA.J., McCance D.R., Young I.S., Holmes V.A. Evaluation of the predictive value of placental vascularisation indices derived from 3-Dimensional power Doppler whole placental volume scanning for prediction of pre-eclampsia: A systematic review and meta-analysis. Placenta. 2017; 51: 89-97.
  28. Arakaki T., Hasegawa J., Nakamura M., Hamada S., Muramoto M., Takita H. et al. Prediction of early- and late-onset pregnancy-induced hypertension using placental volume on three-dimensional ultrasound and uterine artery Doppler. Ultrasound Obstet. Gynecol. 2015; 45(5): 539-43.
  29. Poon L. Re: Prediction of early- and late-onset pregnancy-induced hypertension using placental volume on three-dimensional ultrasound and uterine artery Doppler. T. Arakaki, J. Hasegawa, M. Nakamura, S. Hamada, M. Muramoto, H. Takita, K. Ichizuka and A. Sekizawa. Ultrasound Obstet. Gynecol. 2015; 45: 539-543. Ultrasound Obstet. Gynecol. 2015; 45(5): 513.
  30. 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.

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