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Schiffer VMMM, Pellaers D, Hoenen JLJM, van Kuijk SMJ, Spaanderman MEA, Al-Nasiry S. Feasibility of three dimensional power Doppler ultrasonography methods to assess placental perfusion. Eur J Obstet Gynecol Reprod Biol 2020; 254:321-328. [PMID: 33008645 DOI: 10.1016/j.ejogrb.2020.08.006] [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: 05/29/2020] [Revised: 07/28/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Given the crucial role of the placenta in establishing a healthy pregnancy, reliable non-invasive methods to measure placental perfusion are desirable. The aim of this study is to determine the reproducibility and potential bias in different three-dimensional power Doppler (3DPD) methods assessing placenta perfusion. METHODS Ten singleton pregnancies around 16 weeks of gestation, with an anteriorly located placenta and centrally inserted umbilical cord were included in this study. Eight different combinations of a specific placental sweep and sonobiopsy method were used to evaluate placental perfusion. Vascularization index (VI), flow index (FI) and vascularization-flow index (VFI) were determined offline using the 4D-view program. Reproducibility and repeatability of the methods, expressed as correlation coefficients and Bland-Altman mean differences, were calculated. Differences between sampling methods were analyzed using t-test or Mann-Whitney U test. RESULTS Intra- and inter-class correlation coefficient (CC) was highest when using a spherical centrally placed sonobiopsy of 2 cm3 in a whole placenta sweep (method 1; IntraCC VI 0.985, FI 0.769, VFI 0.993, InterCC VI 0.986, FI 0.784, VFI 0.987). Overall, intraCCs were higher compared to interCCs. Lowest mean differences in VI and FI were found comparing spherical to manual sonobiopsies, whereas the mean differences in VFI were lowest when comparing central versus peripheral located sonobiopsies. Comparing the three vascular indices, best median intra- and interCC and lowest mean differences were found for VFI. CONCLUSIONS Three dimensional placental vascularization analysis showed best reproducibility using whole placental sweep volume and centrally located, spherical sonobiopsy of 2 cm3.
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Affiliation(s)
- V M M M Schiffer
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre (MUMC+), the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands.
| | - D Pellaers
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre (MUMC+), the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, the Netherlands
| | - J L J M Hoenen
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre (MUMC+), the Netherlands
| | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre (MUMC+), the Netherlands
| | - M E A Spaanderman
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre (MUMC+), the Netherlands
| | - S Al-Nasiry
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre (MUMC+), the Netherlands
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4
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Zhang L, Liu X, Li J, Wang X, Huang S, Luo X, Zhang H, Wen L, Tong C, Saffery R, Yan J, Qi H, Kilby MD, Baker PN. Maternal Utero-Placental Perfusion Discordance in Monochorionic-Diamniotic Twin Pregnancies with Selective Growth Restriction Assessed by Three-Dimensional Power Doppler Ultrasound. Med Sci Monit 2020; 26:e919247. [PMID: 31971163 PMCID: PMC6996265 DOI: 10.12659/msm.919247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background The aim of this study was to assess the correlation between selective growth restriction (sGR) and co-twin utero-placental perfusion discordance by using three-dimensional power Doppler (3DPD). Material/Methods We prospectively recruited 60 sGR and 64 normal monochorionic-diamniotic (MCDA) twin pregnancies. Vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were assessed by 3DPD, while umbilical artery pulsatility index (UA-PI), middle cerebral artery peak systolic velocity (MCA-PSV), pulsatility index (MCA-PI), and cerebroplacental ratio (CPR) were assessed by conventional Doppler imaging. Results In sGR co-twins, the VI, FI, VFI, MCA-PI, and CPR were significantly lower, while the UA-PI and MCA-PSV were significantly greater, in the smaller fetuses compared with the larger fetuses; significant differences were also observed in the VI, FI, VFI, CPR, and UA-PI in normal co-twins. Compared with the appropriately grown twins, the discordances of the VI, FI, VFI, UA-PI, MCA-PI, and CPR were increased in the sGR cohort. The discordances of the VI, FI, VFI, UA-PI, MCA-PI, and CPR were associated with birthweight discordance, and the FI discordance and CPR discordance were independently associated with sGR. The combination of the FI and CPR discordance showed a higher predictive accuracy for sGR, with an area under the ROC curve of 0.813, and a sensitivity and specificity of 68.33% and 85.94%, respectively. Conclusions MCDA twin pregnancies with birthweight discordance presented utero-placental perfusion deterioration assessed by 3DPD prior to sGR diagnosis. Co-twin utero-placental perfusion discordance was significantly correlated with growth discordance, and this correlation was more predictive of sGR when 3DPD was combined with conventional Doppler imaging.
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Affiliation(s)
- Lan Zhang
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland).,Fetal Medicine Unit, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland).,International Collaborative Joint Laboratory of Reproduction and Development of Ministry of Education P.R.C., Chongqing Medical University, Chongqing, China (mainland).,State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Xiyao Liu
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland).,International Collaborative Joint Laboratory of Reproduction and Development of Ministry of Education P.R.C., Chongqing Medical University, Chongqing, China (mainland).,State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Junnan Li
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland).,Fetal Medicine Unit, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland).,International Collaborative Joint Laboratory of Reproduction and Development of Ministry of Education P.R.C., Chongqing Medical University, Chongqing, China (mainland).,State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Xing Wang
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland).,Fetal Medicine Unit, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland).,International Collaborative Joint Laboratory of Reproduction and Development of Ministry of Education P.R.C., Chongqing Medical University, Chongqing, China (mainland).,State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Shuai Huang
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland).,Fetal Medicine Unit, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland).,International Collaborative Joint Laboratory of Reproduction and Development of Ministry of Education P.R.C., Chongqing Medical University, Chongqing, China (mainland).,State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Xiaofang Luo
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland).,International Collaborative Joint Laboratory of Reproduction and Development of Ministry of Education P.R.C., Chongqing Medical University, Chongqing, China (mainland).,State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Hua Zhang
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland).,International Collaborative Joint Laboratory of Reproduction and Development of Ministry of Education P.R.C., Chongqing Medical University, Chongqing, China (mainland).,State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Li Wen
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland).,International Collaborative Joint Laboratory of Reproduction and Development of Ministry of Education P.R.C., Chongqing Medical University, Chongqing, China (mainland).,State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Chao Tong
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland).,International Collaborative Joint Laboratory of Reproduction and Development of Ministry of Education P.R.C., Chongqing Medical University, Chongqing, China (mainland).,State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Richard Saffery
- Cancer, Disease and Developmental Epigenetics, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Pediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Jianying Yan
- Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Hongbo Qi
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland).,International Collaborative Joint Laboratory of Reproduction and Development of Ministry of Education P.R.C., Chongqing Medical University, Chongqing, China (mainland).,State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland).,Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Mark D Kilby
- Institute of Metabolism and System Research, University of Birmingham, Edgbaston, United Kingdom.,Fetal Medicine Centre, Birmingham Women's and Children's Foundation Trust, Birmingham, United Kingdom
| | - Philip N Baker
- College of Life Sciences, University of Leicester, Leicester, United Kingdom
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5
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Dallmann A, Ince I, Meyer M, Willmann S, Eissing T, Hempel G. Gestation-Specific Changes in the Anatomy and Physiology of Healthy Pregnant Women: An Extended Repository of Model Parameters for Physiologically Based Pharmacokinetic Modeling in Pregnancy. Clin Pharmacokinet 2018; 56:1303-1330. [PMID: 28401479 DOI: 10.1007/s40262-017-0539-z] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND In the past years, several repositories for anatomical and physiological parameters required for physiologically based pharmacokinetic modeling in pregnant women have been published. While providing a good basis, some important aspects can be further detailed. For example, they did not account for the variability associated with parameters or were lacking key parameters necessary for developing more detailed mechanistic pregnancy physiologically based pharmacokinetic models, such as the composition of pregnancy-specific tissues. OBJECTIVES The aim of this meta-analysis was to provide an updated and extended database of anatomical and physiological parameters in healthy pregnant women that also accounts for changes in the variability of a parameter throughout gestation and for the composition of pregnancy-specific tissues. METHODS A systematic literature search was carried out to collect study data on pregnancy-related changes of anatomical and physiological parameters. For each parameter, a set of mathematical functions was fitted to the data and to the standard deviation observed among the data. The best performing functions were selected based on numerical and visual diagnostics as well as based on physiological plausibility. RESULTS The literature search yielded 473 studies, 302 of which met the criteria to be further analyzed and compiled in a database. In total, the database encompassed 7729 data. Although the availability of quantitative data for some parameters remained limited, mathematical functions could be generated for many important parameters. Gaps were filled based on qualitative knowledge and based on physiologically plausible assumptions. CONCLUSION The presented results facilitate the integration of pregnancy-dependent changes in anatomy and physiology into mechanistic population physiologically based pharmacokinetic models. Such models can ultimately provide a valuable tool to investigate the pharmacokinetics during pregnancy in silico and support informed decision making regarding optimal dosing regimens in this vulnerable special population.
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Affiliation(s)
- André Dallmann
- Department of Pharmaceutical and Medical Chemistry, Clinical Pharmacy, Westfälische Wilhelm-University Münster, Münster, Germany
| | - Ibrahim Ince
- ET-TD-ET Systems Pharmacology CV, Bayer AG, Leverkusen, Germany.
| | - Michaela Meyer
- DD-CS Clinical Pharmacometrics, Bayer AG, Wuppertal, Germany
| | - Stefan Willmann
- DD-CS Clinical Pharmacometrics, Bayer AG, Wuppertal, Germany
| | - Thomas Eissing
- ET-TD-ET Systems Pharmacology CV, Bayer AG, Leverkusen, Germany
| | - Georg Hempel
- Department of Pharmaceutical and Medical Chemistry, Clinical Pharmacy, Westfälische Wilhelm-University Münster, Münster, Germany
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7
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Hettfleisch K, Bernardes LS, Carvalho MA, Pastro LDM, Vieira SE, Saldiva SRDM, Saldiva P, Francisco RPV. Short-Term Exposure to Urban Air Pollution and Influences on Placental Vascularization Indexes. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:753-759. [PMID: 27384326 PMCID: PMC5381983 DOI: 10.1289/ehp300] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 05/26/2016] [Accepted: 06/14/2016] [Indexed: 05/05/2023]
Abstract
BACKGROUND It has been widely demonstrated that air pollution can affect human health and that certain pollutant gases lead to adverse obstetric outcomes, such as preeclampsia and fetal growth restriction. OBJECTIVES We evaluated the influence of individual maternal exposure to air pollution on placental volume and vascularization evaluated in the first trimester of pregnancy. METHODS This was a cross-sectional study on low-risk pregnant women living in São Paulo, Brazil. The women carried passive personal NO2 and O3 monitors in the week preceding evaluation. We employed the virtual organ computer-aided analysis (VOCAL) technique using three-dimensional power Doppler ultrasound to evaluate placental volume and placental vascular indexes [vascularization index (VI), flow index (FI), and vascularization flow index (VFI)]. We analyzed the influence of pollutant levels on log-transformed placental vascularization and volume using multiple regression models. RESULTS We evaluated 229 patients. Increased NO2 levels had a significant negative association with log of VI (p = 0.020 and beta = -0.153) and VFI (p = 0.024 and beta = -0.151). NO2 and O3 had no influence on the log of placental volume or FI. CONCLUSIONS NO2, an estimator of primary air pollutants, was significantly associated with diminished VI and VFI in the first trimester of pregnancy.
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Affiliation(s)
| | - Lisandra Stein Bernardes
- Department of Obstetrics and Gynecology, and
- Address correspondence to L.S. Bernardes, The Procriar Study Group, Department of Obstetrics and Gynecology, School of Medicine at the University of São Paulo, São Paulo, Brazil; 255, Av. Dr. Enéas de Carvalho Aguiar, São Paulo, Brazil 05403-900. Telephone: 551126616209. E-mail:
| | - Mariana Azevedo Carvalho
- Department of Obstetrics and Gynecology, and
- Address correspondence to L.S. Bernardes, The Procriar Study Group, Department of Obstetrics and Gynecology, School of Medicine at the University of São Paulo, São Paulo, Brazil; 255, Av. Dr. Enéas de Carvalho Aguiar, São Paulo, Brazil 05403-900. Telephone: 551126616209. E-mail:
| | | | | | | | - Paulo Saldiva
- Institute of Advanced Studies of the University of São Paulo, São Paulo, Brazil
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8
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Mourier E, Tarrade A, Duan J, Richard C, Bertholdt C, Beaumont M, Morel O, Chavatte-Palmer P. Non-invasive evaluation of placental blood flow: lessons from animal models. Reproduction 2016; 153:R85-R96. [PMID: 27845691 DOI: 10.1530/rep-16-0428] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/03/2016] [Accepted: 11/14/2016] [Indexed: 01/11/2023]
Abstract
In human obstetrics, placental vascularisation impairment is frequent as well as linked to severe pathological events (preeclampsia and intrauterine growth restriction), and there is a need for reliable methods allowing non-invasive evaluation of placental blood flow. Uteroplacental vascularisation is complex, and animal models are essential for the technical development and safety assessment of these imaging tools for human clinical use; however, these techniques can also be applied in the veterinary context. This paper reviews how ultrasound-based imaging methods such as 2D and 3D Doppler can provide valuable insight for the exploration of placental blood flow both in humans and animals and how new approaches such as the use of ultrasound contrast agents or ultrafast Doppler may allow to discriminate between maternal (non-pulsatile) and foetal (pulsatile) blood flow in the placenta. Finally, functional magnetic resonance imaging could also be used to evaluate placental blood flow, as indicated by studies in animal models, but its safety in human pregnancy still requires to be confirmed.
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Affiliation(s)
- E Mourier
- UMR BDRINRA, ENVA, Université Paris Saclay, Jouy en Josas, France .,PremUp FoundationParis, France
| | - A Tarrade
- UMR BDRINRA, ENVA, Université Paris Saclay, Jouy en Josas, France.,PremUp FoundationParis, France
| | - J Duan
- IADIInserm U947, University of Lorraine, CHRU of Brabois, Nancy, France.,CHRU of Nancypole de Gynécologie Obstétrique, Nancy, France
| | - C Richard
- UMR BDRINRA, ENVA, Université Paris Saclay, Jouy en Josas, France.,PremUp FoundationParis, France
| | - C Bertholdt
- IADIInserm U947, University of Lorraine, CHRU of Brabois, Nancy, France.,CHRU of Nancypole de Gynécologie Obstétrique, Nancy, France
| | - M Beaumont
- IADIInserm U947, University of Lorraine, CHRU of Brabois, Nancy, France.,CHRU of Nancypole de Gynécologie Obstétrique, Nancy, France
| | - O Morel
- IADIInserm U947, University of Lorraine, CHRU of Brabois, Nancy, France.,CHRU of Nancypole de Gynécologie Obstétrique, Nancy, France
| | - P Chavatte-Palmer
- UMR BDRINRA, ENVA, Université Paris Saclay, Jouy en Josas, France.,PremUp FoundationParis, France
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9
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Abulé RMD, Bernardes LS, Doro GF, Miyadahira S, Francisco RPV. Reduced placental volume and flow in severe growth restricted fetuses. Clinics (Sao Paulo) 2016; 71:332-7. [PMID: 27438567 PMCID: PMC4930658 DOI: 10.6061/clinics/2016(06)08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 03/21/2016] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To evaluate placental volume and vascular indices in pregnancies with severe fetal growth restriction and determine their correlations to normal reference ranges and Doppler velocimetry results of uterine and umbilical arteries. METHODS Twenty-seven fetuses with estimated weights below the 3rd percentile for gestational age were evaluated. Placental volume and vascular indices, including vascularization, flow, and vascularization flow indices, were measured by three-dimensional ultrasound using a rotational technique and compared to a previously described nomogram. The observed-to-expected placental volume ratio for gestational age and observed-to-expected placental volume ratio for fetal weight were calculated. Placental parameters correlated with the Doppler velocimetry results of uterine and umbilical arteries. RESULTS The mean uterine artery pulsatility index was negatively correlated with the observed-to-expected placental volume ratio for gestational age, vascularization index and vascularization flow index. The observed-to-expected placental volume ratio for gestational age and observed-to-expected placental volume ratio for fetal weight and vascularization index were significantly lower in the group with a bilateral protodiastolic notch. No placental parameter correlated with the umbilical artery pulsatility index. CONCLUSIONS Pregnancies complicated by severe fetal growth restriction are associated with reduced placental volume and vascularization. These findings are related to changes in uterine artery Doppler velocimetry. Future studies on managing severe fetal growth restriction should focus on combined results of placental three-dimensional ultrasound and Doppler studies of uterine arteries.
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Affiliation(s)
- Renata Montes Dourado Abulé
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Obstetrícia e Ginecologia, Disciplina de Obstetrícia, São Paulo/SP, Brazil
| | - Lisandra Stein Bernardes
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Obstetrícia e Ginecologia, Disciplina de Obstetrícia, São Paulo/SP, Brazil
- E-mail:
| | - Giovana Farina Doro
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Obstetrícia e Ginecologia, Disciplina de Obstetrícia, São Paulo/SP, Brazil
| | - Seizo Miyadahira
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Obstetrícia e Ginecologia, Disciplina de Obstetrícia, São Paulo/SP, Brazil
| | - Rossana Pulcinelli Vieira Francisco
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Obstetrícia e Ginecologia, Disciplina de Obstetrícia, São Paulo/SP, Brazil
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