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Zheng C, Ji C, Wang B, Zhang J, He Q, Ma J, Yang Z, Pan Q, Sun L, Sun N, Ling C, Lin G, Deng X, Yin L. Construction of prediction model for fetal growth restriction during first trimester in an Asian population. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:321-330. [PMID: 37902789 DOI: 10.1002/uog.27522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/15/2023] [Accepted: 10/19/2023] [Indexed: 10/31/2023]
Abstract
OBJECTIVE To construct a prediction model for fetal growth restriction (FGR) during the first trimester of pregnancy and evaluate its screening performance. METHODS This was a prospective cohort study of singleton pregnancies that underwent routine ultrasound screening at 11 to 13 + 6 weeks at the Affiliated Suzhou Hospital of Nanjing Medical University between January 2019 and April 2022. Basic clinical information, ultrasound indicators and serum biomarkers of pregnant women were collected. Fetal weight assessment was based on the fetal growth curve for the Southern Chinese population. FGR was diagnosed according to Delphi consensus criteria. Least absolute shrinkage and selection operator (lasso) regression was used to select variables for inclusion in the model. Discrimination, calibration and clinical effectiveness of the model were evaluated in training and validation cohorts. RESULTS A total of 1188 pregnant women were included, of whom 108 had FGR. Lasso regression identified seven predictive features, including history of maternal hypertension, maternal smoking or passive smoking, gravidity, uterine artery pulsatility index, ductus venosus pulsatility index and multiples of the median values of placental growth factor and soluble fms-like tyrosine kinase-1. The nomogram prediction model constructed from these seven variables accurately predicted FGR, and the area under the receiver-operating-characteristics curve in the validation cohort was 0.82 (95% CI, 0.74-0.90). The calibration curve and Hosmer-Lemeshow test demonstrated good calibration, and the clinical decision curve and clinical impact curve supported its practical value in a clinical setting. CONCLUSION The multi-index prediction model for FGR has good predictive value during the first trimester. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C Zheng
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
- Department of Ultrasound, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - C Ji
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - B Wang
- Center for Reproduction and Genetics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - J Zhang
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Q He
- Center for Reproduction and Genetics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - J Ma
- Center for Reproduction and Genetics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Z Yang
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Q Pan
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - L Sun
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - N Sun
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - C Ling
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - G Lin
- Department of Obstetrics, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - X Deng
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - L Yin
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
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Does a Caesarean Section Scar Affect Placental Volume, Vascularity and Localization? Diagnostics (Basel) 2022; 12:diagnostics12112674. [DOI: 10.3390/diagnostics12112674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/21/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Caesarean section is associated with an increased risk of abnormal placental implantation and adverse pregnancy outcomes in subsequent pregnancies. Besides the placenta accrete spectrum, only a few of the previous studies focused on other placental development alterations in the scarred uterus. We assessed placental development deviations in the uterus with a Caesarean section scar by evaluating placental volume (PV) and vascular flow indexes. From 1 January 2021 until 31 March 2022, placental volumes and vascularization indexes (VI, FI, VFI) were prospectively measured by 3D power Doppler and VOCAL techniques in 221 patients attending the first trimester screening program. We also calculated the placental quotient to standardize PV to the gestational age. No statistically significant differences in the values of placental volume, placental quotient and placental vascularization indexes were detected between women with previous Caesarean section delivery or women with vaginal delivery. FI was significantly lower in nulliparous in the first trimester. The results of our study suggest that 3D placental evaluation was not able to detect placental development alteration in the uterus with a Caesarean section scar. Future research needs to verify whether 3D power Doppler and Vocal techniques can provide more information if used in an earlier gestational age.
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Gojnic M, Todorovic J, Stanisavljevic D, Jotic A, Lukic L, Milicic T, Lalic N, Lalic K, Stoiljkovic M, Stanisavljevic T, Stefanovic A, Stefanovic K, Vrzic-Petronijevic S, Petronijevic M, Terzic-Supic Z, Macura M, Perovic M, Babic S, Piperac P, Jovanovic M, Parapid B, Doklestic K, Cerovic R, Djurasevic S, Dugalic S. Maternal and Fetal Outcomes among Pregnant Women with Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063684. [PMID: 35329371 PMCID: PMC8953700 DOI: 10.3390/ijerph19063684] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 02/08/2023]
Abstract
The aim of this study was to examine the differences in pregnancy complications, delivery characteristics, and neonatal outcomes between women with type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and gestational diabetes mellitus (GDM). This study included all pregnant women with diabetes in pregnancy in Belgrade, Serbia, between 2010 and 2020. The total sample consisted of 6737 patients. In total, 1318 (19.6%) patients had T1DM, 138 (2.0%) had T2DM, and 5281 patients (78.4%) had GDM. Multivariate logistic regression with the type of diabetes as an outcome variable showed that patients with T1DM had a lower likelihood of vaginal delivery (OR: 0.73, 95% CI: 0.64–0.83), gestational hypertension (OR: 0.47, 95% CI: 0.36–0.62), higher likelihood of chronic hypertension (OR: 1.88, 95% CI: 1.55–2.29),and a higher likelihood ofgestational age at delivery before 37 weeks (OR: 1.38, 95% CI: 1.18–1.63) compared to women with GDM. Multivariate logistic regression showed that patients with T2DM had a lower likelihood ofgestational hypertension compared to women with GDM (OR: 0.37, 95% CI: 0.15–0.92).Our results indicate that the highest percentage of diabetes in pregnancy is GDM, and the existence of differences in pregnancy complications, childbirth characteristics, and neonatal outcomes are predominantly between women with GDM and women with T1DM.
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Affiliation(s)
- Miroslava Gojnic
- Clinic for Obstetrics and Gynecology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.G.); (A.S.); (K.S.); (S.V.-P.); (M.P.); (M.M.); (S.B.); (R.C.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.J.); (L.L.); (T.M.); (N.L.); (K.L.); (M.S.); (T.S.)
| | - Jovana Todorovic
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (J.T.); (Z.T.-S.)
| | - Dejana Stanisavljevic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Aleksandra Jotic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.J.); (L.L.); (T.M.); (N.L.); (K.L.); (M.S.); (T.S.)
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Ljiljana Lukic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.J.); (L.L.); (T.M.); (N.L.); (K.L.); (M.S.); (T.S.)
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Tanja Milicic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.J.); (L.L.); (T.M.); (N.L.); (K.L.); (M.S.); (T.S.)
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Nebojsa Lalic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.J.); (L.L.); (T.M.); (N.L.); (K.L.); (M.S.); (T.S.)
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Katarina Lalic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.J.); (L.L.); (T.M.); (N.L.); (K.L.); (M.S.); (T.S.)
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Milica Stoiljkovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.J.); (L.L.); (T.M.); (N.L.); (K.L.); (M.S.); (T.S.)
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Tamara Stanisavljevic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.J.); (L.L.); (T.M.); (N.L.); (K.L.); (M.S.); (T.S.)
| | - Aleksandar Stefanovic
- Clinic for Obstetrics and Gynecology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.G.); (A.S.); (K.S.); (S.V.-P.); (M.P.); (M.M.); (S.B.); (R.C.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.J.); (L.L.); (T.M.); (N.L.); (K.L.); (M.S.); (T.S.)
| | - Katarina Stefanovic
- Clinic for Obstetrics and Gynecology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.G.); (A.S.); (K.S.); (S.V.-P.); (M.P.); (M.M.); (S.B.); (R.C.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.J.); (L.L.); (T.M.); (N.L.); (K.L.); (M.S.); (T.S.)
| | - Svetlana Vrzic-Petronijevic
- Clinic for Obstetrics and Gynecology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.G.); (A.S.); (K.S.); (S.V.-P.); (M.P.); (M.M.); (S.B.); (R.C.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.J.); (L.L.); (T.M.); (N.L.); (K.L.); (M.S.); (T.S.)
| | - Milos Petronijevic
- Clinic for Obstetrics and Gynecology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.G.); (A.S.); (K.S.); (S.V.-P.); (M.P.); (M.M.); (S.B.); (R.C.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.J.); (L.L.); (T.M.); (N.L.); (K.L.); (M.S.); (T.S.)
| | - Zorica Terzic-Supic
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (J.T.); (Z.T.-S.)
| | - Maja Macura
- Clinic for Obstetrics and Gynecology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.G.); (A.S.); (K.S.); (S.V.-P.); (M.P.); (M.M.); (S.B.); (R.C.)
| | - Milan Perovic
- Clinic for Gynecology and Obstetrics “NarodniFront”, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Sandra Babic
- Clinic for Obstetrics and Gynecology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.G.); (A.S.); (K.S.); (S.V.-P.); (M.P.); (M.M.); (S.B.); (R.C.)
| | - Pavle Piperac
- Department for Humanities, Faculty of Medicine, University of Belgrade, 11000 belgrade, Serbia;
| | | | - Bijana Parapid
- Clinic for Cardiology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Krisitna Doklestic
- Emergency Department, University Clinical Centre of Serbia, 11000 Belgrade, Serbia;
| | - Radmila Cerovic
- Clinic for Obstetrics and Gynecology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.G.); (A.S.); (K.S.); (S.V.-P.); (M.P.); (M.M.); (S.B.); (R.C.)
| | | | - Stefan Dugalic
- Clinic for Obstetrics and Gynecology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.G.); (A.S.); (K.S.); (S.V.-P.); (M.P.); (M.M.); (S.B.); (R.C.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.J.); (L.L.); (T.M.); (N.L.); (K.L.); (M.S.); (T.S.)
- Correspondence:
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van Duijn L, Rousian M, Reijnders IF, Willemsen SP, Baart EB, Laven JSE, Steegers-Theunissen RPM. The influence of frozen-thawed and fresh embryo transfer on utero-placental (vascular) development: the Rotterdam Periconception cohort. Hum Reprod 2021; 36:2091-2100. [PMID: 33974704 PMCID: PMC8289318 DOI: 10.1093/humrep/deab070] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/28/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Does frozen-thawed or fresh embryo transfer (ET) influence utero-placental (vascular) development, when studied using three-dimensional (3D) ultrasound and virtual reality imaging techniques? SUMMARY ANSWER In the first trimester, placental developmental parameters, that is, placental volume (PV) and utero-placental vascular volume (uPVV), were comparable between pregnancies resulting from frozen-thawed ET, fresh ET and natural conception; and in the second and the third trimester, uterine artery Doppler indices were lower in pregnancies after frozen-thawed ET compared to pregnancies after fresh ET and natural conception. WHAT IS KNOWN ALREADY Pregnancies after frozen-thawed ET are at risk of developing placenta-related pregnancy complications. There is strong evidence that impaired first-trimester spiral artery remodelling is involved in the pathophysiology of these complications. Studies on longitudinal placental development in pregnancies with different modes of conception, that is, after frozen-thawed ET, fresh ET or natural conception, are lacking. STUDY, DESIGN, SIZE, DURATION Women with singleton pregnancies were included before 10 weeks of gestation, between January 2017 and July 2018, as a subcohort of the ongoing Rotterdam Periconception cohort. Results were partially validated in 722 women from the total cohort, which was conducted from November 2010 onwards. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 214 women, of whom 32 conceived after frozen-thawed ET, 56 conceived after fresh ET and 126 conceived naturally, were selected. PV and uPVV measurements were obtained at 7, 9 and 11 weeks of gestation by transvaginal 3D (power Doppler) ultrasound. The uterine artery pulsatility index (UtA-PI) and resistance index (UtA-RI) were measured transvaginally at 7, 9, 11 and 13 weeks and abdominally at 22 and 32 weeks of gestation by pulsed wave Doppler ultrasound. In the validation cohort, the PV was measured in 722 women. Associations between mode of conception and placental development were studied using linear mixed models. MAIN RESULTS AND THE ROLE OF CHANCE First-trimester parameters of placental development, that is, PV, uPVV, UtA-PI and UtA-RI, were comparable between pregnancies after frozen-thawed and fresh ET and naturally conceived pregnancies. In our validation cohort, comparable results were found for PV. However, the second- and third-trimester UtA-PI and UtA-RI in pregnancies after frozen-thawed ET were significantly lower than in pregnancies after fresh ET (βUtA-PI −0.158 (95% CI: −0.268, −0.048), P = 0.005; βUtA-RI −0.052 (95% CI: −0.089, −0.015), P = 0.006). The second- and third-trimester uterine artery indices in pregnancies after fresh ET were comparable to those in pregnancies after natural conception. LIMITATIONS, REASONS FOR CAUTION The main limitation of this study is the lack of power to optimally detect differences in placental development and placenta-related pregnancy outcomes between pregnancies after different modes of conception. Moreover, our population was selected from a tertiary hospital and included a relatively limited number of pregnancies. Therefore, external validity of the results should be confirmed in a larger sample size. WIDER IMPLICATIONS OF THE FINDINGS These findings indicate no significant impact of conception mode on early placental development and a beneficial impact for frozen-thawed ET on the second- and third-trimester Doppler indices. This suggests that frozen-thawed ET may not be as detrimental for placental perfusion as previous research has demonstrated. As the number of clinics applying the ‘freeze-all strategy’ increases, future research should focus on establishing the optimal uterine environment, with regards to hormonal preparation, prior to ET to reduce placental-related pregnancy complications after frozen-thawed ET. STUDY FUNDING/COMPETING INTEREST(S) This research was funded by the Erasmus MC Medical Research Advisor Committee’s ‘Health Care Efficiency Research’ program and the department of Obstetrics and Gynaecology of the Erasmus MC, University Medical Center, Rotterdam, The Netherlands. JSEL reports grants and personal fees from Ferring, personal fees from Titus Healthcare, grants and personal fees from Ansh Labs, grants from NIH, grants from Dutch Heart Association and grants from ZonMW outside the submitted work. None of the other authors have a conflict of interest. TRIAL REGISTRATION NUMBER Registered at the Dutch Trial Register (NTR6684).
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Affiliation(s)
- Linette van Duijn
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Melek Rousian
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Igna F Reijnders
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Sten P Willemsen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Biostatistics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Esther B Baart
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Developmental Biology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Joop S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Srinivasan V, Melbourne A, Oyston C, James JL, Clark AR. Multiscale and multimodal imaging of utero-placental anatomy and function in pregnancy. Placenta 2021; 112:111-122. [PMID: 34329969 DOI: 10.1016/j.placenta.2021.07.290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 06/09/2021] [Accepted: 07/19/2021] [Indexed: 12/12/2022]
Abstract
Placental structures at the nano-, micro-, and macro scale each play important roles in contributing to its function. As such, quantifying the dynamic way in which placental structure evolves during pregnancy is critical to both clinical diagnosis of pregnancy disorders, and mechanistic understanding of their pathophysiology. Imaging the placenta, both exvivo and invivo, can provide a wealth of structural and/or functional information. This review outlines how imaging across modalities and spatial scales can ultimately come together to improve our understanding of normal and pathological pregnancies. We discuss how imaging technologies are evolving to provide new insights into placental physiology across disciplines, and how advanced computational algorithms can be used alongside state-of-the-art imaging to obtain a holistic view of placental structure and its associated functions to improve our understanding of placental function in health and disease.
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Affiliation(s)
| | - Andrew Melbourne
- School of Biomedical Engineering & Imaging Sciences, Kings College London, UK
| | - Charlotte Oyston
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Joanna L James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Alys R Clark
- Auckland Bioengineering Institute, University of Auckland, New Zealand
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Park IY, Wie JH, Park JH, Kwon JY. Combination of three-dimensional placental vascular indices and volume and uterine artery pulsatility index at 10-13 weeks of gestation could improve the prediction of adverse pregnancy outcomes. J Obstet Gynaecol Res 2021; 47:2051-2058. [PMID: 33821516 DOI: 10.1111/jog.14781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/19/2021] [Accepted: 03/20/2021] [Indexed: 11/28/2022]
Abstract
AIM To evaluate whether three-dimensional (3D) placental vascular indices and volumes during the first trimester of pregnancy can be used as predictors of subsequent adverse outcomes. METHODS This was a prospective cohort study including women with singleton pregnancies between 10 and 13 weeks. 3D placental volume and vascular indices and uterine artery pulsatility index (UtA-PI) were measured. Adverse outcomes were defined whether there was any of the following complications: small for gestational age pregnancy, preterm delivery, and preeclampsia. The serum pregnancy-associated plasma protein-A (PAPP-A) and free beta-human chorionic gonadotropin (β-hCG) levels were also compared. We analyzed the screening performances of these parameters for prediction of any of adverse outcomes. RESULTS Of 348 women screened, 300 women were completed follow-up. Overall, 57 (19.0%) of 300 women developed any of adverse pregnancy outcomes. Multiple logistic regression analysis demonstrated that gestational age-adjusted z-scores of log10 placental volume (odds ratio [OR], 0.572; 95% confidence interval [CI], 0.416-0.788), log10 placental vascularization flow index (VFI; OR, 0.676; 95% CI, 0.496-0.921), and log10 UtA-PI (OR, 1.910; 95% CI, 1.335-2.731) were significantly associated adverse pregnancy outcomes. The multivariate model combining placental VFI, placental volume, UtA-PI, and underweight or obese body mass index exhibited the highest screening performances (AUC = 0.77) and PAPP-A and β-hCG did not add any significance to multivariate model. CONCLUSIONS Placental volume and vascular indices at 10-13 weeks of gestation are significantly associated with adverse pregnancy outcomes. Combination of these placental indices and UtA-PI could improve the screening performance for adverse outcomes.
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Affiliation(s)
- In Yang Park
- Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, South Korea
| | - Jeong Ha Wie
- Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, South Korea
| | - Ji Hyun Park
- Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, South Korea
| | - Ji Young Kwon
- Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, South Korea
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Stampalija T, Quadrifoglio M, Casati D, Zullino S, Maggi V, Di Martino D, Rosti E, Mastroianni C, Signorelli V, Ferrazzi E. First trimester placental volume is reduced in hypertensive disorders of pregnancy associated with small for gestational age fetus. J Matern Fetal Neonatal Med 2021; 34:1304-1311. [PMID: 31232131 DOI: 10.1080/14767058.2019.1636026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Trophoblastic invasion and placental growth are critical for pregnancy outcome. The placental volume can be assessed by 3 D ultrasound using Virtual Organ Computer-aided Analysis (VOCAL). Epidemiological and clinical data suggest that there are two different clinical phenotypes of hypertensive disorders of pregnancy (HDP) that coexist at any gestational age: HDP associated to fetal growth impairment and HDP associated to appropriate for gestational age fetal growth. The aim of this study was to determine whether placental volume in the first trimester of pregnancy differs between women with HDP associated or not to fetal growth impairment and uncomplicated pregnancies. METHODS This is a retrospective cross-sectional study of prospectively recruited data in which maternal characteristics, Doppler velocimetry of uterine arteries, and three-dimensional (3 D) volume of the placenta were collected at 11 + 1 - 13 + 6 gestational weeks. The placental quotient (PQ) was calculated as placental volume/crown rump length. RESULTS In a 2-year period, we prospectively collected first trimester data of 1322 women. For the purposes of this cross-sectional study, 57 women that delivered a SGA fetus, 34 that developed HDP-AGA, and six that developed HDP-SGA, respectively, were included in the study as cases. The control group was made of 117 uncomplicated pregnancies. The PQ was higher in women with uncomplicated pregnancies (PQ median 16.36 cm3/cm) than in all other study groups (PQ in SGA: 13.02 cm3/cm, p < .001; PQ in HDP-AGA: 12.65 cm3/cm, p = .002; and PQ in women with HDP-SGA: 8.33 cm3/cm [IQR 6.50-10.13], p < .001). The lowest PQ was observed in women with HDP-SGA and was significantly lower than PQ in either women with SGA or those with HDP-AGA (p = .02 and p = .04, respectively). The mean uterine artery pulsatility index was the highest in women with HDP-SGA (median 2.30) compared to all other groups (uncomplicated pregnancies 1.48, p < .0001; women with SGA 1.59, p = .001; and women with HDP-AGA 1.75, p = .009). DISCUSSION Our findings suggest that HDP associated with SGA is characterized by impaired placental growth and perfusion as soon as in the first trimester of pregnancy. The role of PQ, isolated or in association with other biophysical parameters, to predict HDP with fetal growth impairment remains to be evaluated.
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Affiliation(s)
- Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, IRCCS Materno Infantile Burlo Garofolo, Trieste, Italy
| | - Mariachiara Quadrifoglio
- Unit of Fetal Medicine and Prenatal Diagnosis, IRCCS Materno Infantile Burlo Garofolo, Trieste, Italy
| | - Daniela Casati
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, Milano, Italy
| | - Sara Zullino
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, Milano, Italy
| | - Valeria Maggi
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, Milano, Italy
| | - Daniela Di Martino
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Eleonora Rosti
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, Milano, Italy
| | - Cristina Mastroianni
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, Milano, Italy
| | - Valentina Signorelli
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, Milano, Italy
| | - Enrico Ferrazzi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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Zhang X, Huangfu Z, Shi F, Xiao Z. Predictive Performance of Serum β-hCG MoM Levels for Preeclampsia Screening: A Meta-Analysis. Front Endocrinol (Lausanne) 2021; 12:619530. [PMID: 34177797 PMCID: PMC8223748 DOI: 10.3389/fendo.2021.619530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 05/12/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE The aim of the present study was to investigate the predictive value of using the multiple of the median (MoM) of β-human chorionic gonadotropin (β-hCG) levels in patients with preeclampsia (PE) and healthy pregnant women. METHODS Electronic databases including PubMed, EBSCO, Ovid, Web of Science, China National Knowledge Infrastructure (CNKI), SinoMed, Wangfang and the Weipu Journal were searched up to May 31, 2020. Two reviewers independently selected the articles and extracted data on study characteristics, quality and results. A random-effects model was employed, and standardized mean difference and 95% confidence intervals were calculated. Twenty-one case-control studies were analyzed in the present meta-analysis, including a total of 2,266 cases and 25,872 healthy controls. RESULTS Women who were diagnosed with PE were found to have higher early second-trimester levels of serum β-hCG MoM compared with healthy controls, although the levels in the first trimester were not significantly different. Ethnicity subgroup analysis demonstrated that the MoM of β-hCG serum levels was significantly higher in PE patients in both Asian and Caucasian populations during the early second trimester. CONCLUSION The MoM of β-hCG serum levels was found to be a valuable clinical indicator for predicting PE in the early second trimester, but had little predictive value in the first trimester. However, further assessment of the predictive capacity of β-hCG within larger, diverse populations is required.
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Affiliation(s)
- Xiao Zhang
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhao Huangfu
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Fangxin Shi
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
- *Correspondence: Fangxin Shi, ; Zhen Xiao,
| | - Zhen Xiao
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Institute of High Altitude Medicine, People’s Hospital of Naqu Affiliated to Dalian Medical University, Naqu, China
- *Correspondence: Fangxin Shi, ; Zhen Xiao,
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Abdallah A, Khairy M, Tawfik M, Mohamed S, Abdel-Rasheed M, Salem S, Khalifa E. Role of first-trimester three-dimensional (3D) power Doppler of placental blood flow and 3D placental volume in early prediction of pre-eclampsia. Int J Gynaecol Obstet 2020; 154:466-473. [PMID: 33368264 DOI: 10.1002/ijgo.13572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/11/2020] [Accepted: 12/22/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the efficacy of first-trimester three-dimensional (3D) placental volume as well as 3D power Doppler of placental vascular indices for early prediction of pre-eclampsia. METHODS The prospective cohort study included over 2019 women with a singleton pregnancy in their first trimester at 11-13+ weeks of pregnancy. All women were examined by 3D abdominal ultrasound, including Doppler techniques for the placental volume and placental vascular indices. Uterine artery Doppler indices were also assessed. All participants were cared for until delivery for assessment of pregnancy outcomes. RESULTS In all, 163 women developed pre-eclampsia while 1856 women remained normotensive. The women with pre-eclampsia had significantly lower placental volume (77.09 ml vs. 99.8 ml, p < 0.001), and placental vascular indices (vascularization index, flow index, and vascularization flow index were 7.41 vs. 9.89, 39.03 vs. 46.63, and 2.77 vs. 4.4, respectively, p < 0.001). In contrast, women with pre-eclampsia had significantly high mean uterine pulsatility index and resistance index (2.02 vs. 1.11, 0.83 vs. 0.64, respectively, p < 0.001) compared with the normotensive women. The placental vascular indices were highly sensitive, whereas the placental volume and the mean uterine pulsatility index and resistance index had higher specificity for the prediction of pre-eclampsia. CONCLUSION First-trimester assessment through 3D placental volume and power Doppler of placental vascular indices, especially in combination with uterine artery Doppler assessment, revealed an increase in the accuracy of early detection of women at risk for developing pre-eclampsia.
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Affiliation(s)
- Ameer Abdallah
- Department of Obstetrics and Gynecology, Minia University, Minia, Egypt
| | - Mohammed Khairy
- Department of Obstetrics and Gynecology, Minia University, Minia, Egypt
| | - Mohamed Tawfik
- Department of Obstetrics and Gynecology, Minia University, Minia, Egypt
| | - Safaa Mohamed
- Department of Obstetrics and Gynecology, Minia University, Minia, Egypt
| | - Mazen Abdel-Rasheed
- Department of Reproductive Health Research, National Research Centre, Cairo, Egypt
| | - Sondos Salem
- Department of Reproductive Health Research, National Research Centre, Cairo, Egypt
| | - Eissa Khalifa
- Department of Obstetrics and Gynecology, Minia University, Minia, Egypt
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Morikawa M, Kato-Hirayama E, Mayama M, Saito Y, Nakagawa K, Umazume T, Chiba K, Kawaguchi S, Okuyama K, Watari H. Glycemic control and fetal growth of women with diabetes mellitus and subsequent hypertensive disorders of pregnancy. PLoS One 2020; 15:e0230488. [PMID: 32176740 PMCID: PMC7075561 DOI: 10.1371/journal.pone.0230488] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 03/02/2020] [Indexed: 11/25/2022] Open
Abstract
Pregnant women with diabetes mellitus (DM) are at high risk for hypertensive disorder of pregnancy (HDP). Women with poor control DM sometimes have heavy-for-dates infants. However, women with HDP sometimes have light-for-dates infants. We aim to clarify the relationship between glycemic control and fetal growth in women with DM and/or subsequent HDP. Of 7893 women gave singleton birth at or after 22 gestational weeks, we enrolled 154 women with type 1 DM (T1DM) or type 2 DM (T2DM) whose infants did not have fetal abnormalities. Among women with T1DM or T2DM, characteristics of the three groups (with HDP, without HDP, and with chronic hypertension [CH]) were compared. No women with T1DM had CH, but 19 (17.4%) of 109 with T2DM did. HDP incidence was similar between women with T1DM (22.2%) and T2DM without CH (16.7%). Among women with T1DM, the incidences of fetal growth restriction (FGR) with and without HDP were similar. However, among women with T2DM without CH, this incidence was significantly higher among those with HDP (33.3%) than among those without HDP (5.3%), was significantly more common with HbA1c levels at first trimester ≥ 7.2% (33.3%) than with those < 7.2% (5.6%), and significantly more numerous without pre-pregnancy therapies for DM (23.3%) than with them (3.3%). Among women with T2DM and HDP, those with FGR had smaller placenta SDs and higher insulin dosages at delivery than those without light-for-dates. In multivariate analysis, the presence of diabetic nephropathy was a predictor of T1DM and HDP (P = 0.0105), whereas HbA1c levels ≥ 7.2% before pregnancy was a predictor of T2DM and HDP (P = 0.0009). Insulin dosage ≥ 50U/day at delivery (P = 0.0297) and the presence of HDP (P = 0.0116) independently predicted T2DM, HDP, and FGR development. Insufficient pre-pregnancy treatment of DM increased the risk of HDP.
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Affiliation(s)
- Mamoru Morikawa
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
- * E-mail:
| | - Emi Kato-Hirayama
- Department of Obstetrics and Gynecology, Sapporo City Hospital, Sapporo, Japan
| | - Michinori Mayama
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yoshihiro Saito
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kinuko Nakagawa
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takeshi Umazume
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kentaro Chiba
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoshi Kawaguchi
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazuhiko Okuyama
- Department of Obstetrics and Gynecology, Sapporo City Hospital, Sapporo, Japan
| | - Hidemichi Watari
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Guo J, Fang M, Zhuang S, Qiao Y, Huang W, Gong Q, Xu D, Zhang Y, Wang H. Prenatal dexamethasone exposure exerts sex-specific effect on placental oxygen and nutrient transport ascribed to the differential expression of IGF2. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:233. [PMID: 32309380 PMCID: PMC7154419 DOI: 10.21037/atm.2019.12.156] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Clinical studies have showed that dexamethasone exposure during pregnancy could cause fetal growth retardation, but the mechanism by which prenatal dexamethasone exposure influences placental nutrient transport is still unclear. This study investigated the impacts of prenatal dexamethasone on the placental oxygen and nutrient transport. Methods Pregnant Wistar rats were subcutaneously administered with dexamethasone from day 9 to day 20 of gestation at 0.2 or 0.8 mg/kg·d. Pregnant rats were sacrificed on gestational day 20. The placental tissue was collected for analysis. Results Prenatal dexamethasone exposure (PDE) declined the fetal weight and increased the intrauterine growth retardation (IUGR) rate in a dose-dependent manner. The total placental volume and the length, density and surface area of fetal capillaries in the labyrinth zone reduced in a dose-dependent manner. In addition, the thickness of syncytial membrane dose-dependently increased, resulting in a dose-dependent decrease in oxygen diffusion capacity. Furthermore, after PDE, the nutrient transport area and oxygen diffusion capacity of male placenta were lower than that of female placenta. The mRNA and protein expression of placental nutrient transporters including glucose transporter 1 (GLUT1), glucose transporter 3 (GLUT3), L-type amino acid transporter 1 (LAT1), lipoprotein lipase (LPL) and scavenger receptor class B type 1 (SRB1) increased in female placenta. However, in male placenta, the expression of LAT1, LPL and SRB1 was significantly decreased and GLUT1 and GLUT3 have a decrease trend. We further investigated the expression of insulin-like growth factor 1 (IGF1) and insulin-like growth factor 2 (IGF2) related to placental and fetal growth and development. Our study showed that the expression of IGF1 was significantly decreased both in male and female placentas after PDE. But the expression of IGF2 was significantly increased in female placentas while significantly decreased in male placentas. Conclusions Our study shows prenatal dexamethasone exposure exerts sex-specific influence on the placental oxygen and nutrient transport. This might be ascribed to the differential expression of IGF2 after PDE. These findings provide evidence on the dexamethasone-induced toxicity to the placenta and fetal development.
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Affiliation(s)
- Juanjuan Guo
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China.,Hubei Provincial Key Laboratory of Developmentally Originated Diseases, Wuhan 430071, China
| | - Man Fang
- Department of Pharmacology, Basic Medical School of Wuhan University, Wuhan 430071, China
| | - Siying Zhuang
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Yuan Qiao
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China.,Hubei Provincial Key Laboratory of Developmentally Originated Diseases, Wuhan 430071, China
| | - Wen Huang
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Qing Gong
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Dan Xu
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China.,Hubei Provincial Key Laboratory of Developmentally Originated Diseases, Wuhan 430071, China
| | - Yuanzhen Zhang
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China.,Hubei Provincial Key Laboratory of Developmentally Originated Diseases, Wuhan 430071, China
| | - Hui Wang
- Department of Obstetrics and Gynecology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China.,Hubei Provincial Key Laboratory of Developmentally Originated Diseases, Wuhan 430071, China.,Department of Pharmacology, Basic Medical School of Wuhan University, Wuhan 430071, China
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Abstract
Placental dysfunction is a major contributing factor to fetal growth restriction. Placenta-mediated fetal growth restriction occurs through chronic fetal hypoxia owing to poor placental perfusion through a variety of mechanisms. Maternal vascular malperfusion is the most common placental disease contributing to fetal growth restriction; however, the role of rare placental diseases should not be overlooked. Although the features of maternal vascular malperfusion are identifiable on placental pathology, antepartum diagnostic methods are evolving. Placental imaging and uterine artery Doppler, used in conjunction with angiogenic growth factors (specifically placenta growth factor and soluble fms-like tyrosine kinase-1), play an increasingly important role.
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Chen SJ, Chen CP, Sun FJ, Chen CY. Comparison of Placental Three-Dimensional Power Doppler Vascular Indices and Placental Volume in Pregnancies with Small for Gestational Age Neonates. J Clin Med 2019; 8:jcm8101651. [PMID: 31614452 PMCID: PMC6832172 DOI: 10.3390/jcm8101651] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 10/04/2019] [Accepted: 10/09/2019] [Indexed: 01/08/2023] Open
Abstract
This prospective observational study aimed to compare the changes in placental vascular indices and placental volume using three-dimensional power Doppler (3DPD) ultrasound in pregnancies with small for gestational age (SGA) neonates. We enrolled 396 women with singleton pregnancies from September 2013 to June 2016. Placental vascular indices, including the vascularization index (VI), flow index (FI), and vascularization flow index (VFI), and placental volume were obtained using 3DPD ultrasound in the first and second trimesters. Of the enrolled women, 21 delivered SGA neonates and 375 did not. In the first trimester, the SGA group had a significantly lower mean FI (25.10 ± 7.51 versus 33.10 ± 10.97, p < 0.001) and VFI (4.59 ± 1.95 versus 6.28 ± 2.35, p = 0.001) than the non-SGA group. However, there was no significant difference in the placental volume between the two groups during the first trimester. In the second trimester, the SGA group also had a significantly lower mean FI (27.08 ± 7.97 versus 31.54 ± 11.01, p = 0.022) and VFI (6.68 ± 1.71 versus 8.68 ± 3.09, p < 0.001) than the non-SGA group. In addition, a significantly smaller placental volume was noted in the SGA group (104.80 ± 24.23 cm3 versus 122.67 ± 26.35 cm3, p = 0.003) than in the non-SGA group during the second trimester. The results showed that a decreased placental VFI occurred earlier than a decreased placental volume in SGA pregnancies.
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Affiliation(s)
- Sue-Jar Chen
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan.
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei 104, Taiwan.
| | - Chie-Pein Chen
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan.
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei 104, Taiwan.
| | - Fang-Ju Sun
- Department of Medical Research, Mackay Memorial Hospital, Taipei 104, Taiwan.
| | - Chen-Yu Chen
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan.
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei 104, Taiwan.
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Choux C, Ginod P, Barberet J, Rousseau T, Bruno C, Sagot P, Astruc K, Fauque P. Placental volume and other first-trimester outcomes: are there differences between fresh embryo transfer, frozen-thawed embryo transfer and natural conception? Reprod Biomed Online 2018; 38:538-548. [PMID: 30850320 DOI: 10.1016/j.rbmo.2018.12.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/20/2018] [Accepted: 12/10/2018] [Indexed: 12/13/2022]
Abstract
RESEARCH QUESTION Does mode of conception influence placental volume and other first-trimester outcomes? DESIGN This retrospective single-centre case-control study led in Dijon University Hospital included 252 singleton pregnancies (84 IVF with either fresh embryo transfer or frozen-thawed embryo transfer [FET] and 168 natural conceptions). First-trimester placental volume, uterine artery pulsatility index and maternal serum PAPP-A and beta-HCG were measured. Statistical analyses were adjusted for gestational age, the newborn's gender, maternal age, parity, body mass index and smoking status. RESULTS Placental volume was significantly greater in the FET group than in the control group (P = 0.043) and fresh embryo transfer (P = 0.023) groups. At birth, fresh embryo transfer newborns were significantly smaller than controls (P = 0.01) and FET newborns (P = 0.008). Postpartum haemorrhage was far more frequent in FET than in controls and fresh embryo transfer group (38.1%, 2.6% and 1.9%, respectively; P < 0.0001). Placental volume positively correlated with PAPP-A, beta-HCG and the newborn's birth weight, and negatively correlated with uterine artery pulsatility index. CONCLUSIONS Placental volume and other first-trimester parameters are modified by IVF with fresh embryo transfer and FET compared with natural conception, but with opposite trends. Given the different protocols used for these techniques, hormonal treatment per se may have a major effect on pregnancy outcomes through the modification of placental invasiveness.
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Affiliation(s)
- Cécile Choux
- Dijon University Hospital, Fetal Health and Infertility Department, Dijon F-21000, France.
| | - Perrine Ginod
- Dijon University Hospital, Fetal Health and Infertility Department, Dijon F-21000, France
| | - Julie Barberet
- Dijon University Hospital, Reproductive Biology Department, Dijon F-21000, France
| | - Thierry Rousseau
- Dijon University Hospital, Fetal Health and Infertility Department, Dijon F-21000, France
| | - Céline Bruno
- Dijon University Hospital, Reproductive Biology Department, Dijon F-21000, France
| | - Paul Sagot
- Dijon University Hospital, Fetal Health and Infertility Department, Dijon F-21000, France
| | - Karine Astruc
- Dijon University Hospital, Epidemiology Unit, Dijon F-21000, France
| | - Patricia Fauque
- Dijon University Hospital, Reproductive Biology Department, Dijon F-21000, France
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Chandra I, Sun L. Preterm and term preeclampsia: differences in biochemical parameter and pregnancy outcomes. Postgrad Med 2018; 130:703-707. [PMID: 30246594 DOI: 10.1080/00325481.2018.1527169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To analyze the similarities and differences in the clinical parameters, laboratory biomarkers, and pregnancy outcomes between preterm and term preeclampsia (PE). METHODS Data on 185 women diagnosed with PE were collected from a Jiangsu Province Hospital from January 2017 to December 2017 and analyzed. 74 (40%) patients were diagnosed with preterm PE, of which 70 (94.6%) patients with PE with severe features (PEs) and the rest with PE. 111 (60%) patients were diagnosed with term PE, of which 54 (48.6%) patients with PEs and the rest with PE. RESULTS Preterm PE group had significantly higher blood pressure than that of term PE, with mean delivery at gestational age of 34.3[Formula: see text]2.1 weeks for preterm PE and 39[Formula: see text]1.2 weeks for term PE. Preterm PE group was associated with previous cesarean section and PE history, fetal growth restriction (FGR), non-reassuring fetal status (NRFS), and fetal umbilical artery (UA) systolic velocity/diastolic velocity ratio (S/D R) abnormality, neonatal lower birth weight, lower APGAR score, and higher NICU transfer rate. 74.3% of pregnant women from preterm PE group had proteinuria of +2 to +4, whilst only 37.8% pregnant women from term PE group developed that condition. Liver and renal function, also serum Ca and K were significantly higher in preterm PE. CONCLUSION Our study found that preterm PE significantly correlated with higher incidence of PEs, neonatal morbidities, also higher liver and kidney function compared to term PE. These results may be helpful for obstetricians to make accurate quantification of risk regarding every result of antenatal check-up, and perform close follow up if any abnormalities were found on blood pressure, ultrasound, or blood tests.
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Affiliation(s)
- Ivana Chandra
- a Department of Obstetrics and Gynecology , The First Affiliated Hospital of Nanjing Medical University , Nanjing , Jiangsu , China
| | - Lizhou Sun
- a Department of Obstetrics and Gynecology , The First Affiliated Hospital of Nanjing Medical University , Nanjing , Jiangsu , China
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