First-trimester uterine artery Doppler analysis in the prediction of later pregnancy complications

Maternal Uterine Artery Doppler and Serum Marker in the First Trimester as Predictive Markers for Small for Gestational Age Neonates and Preeclampsia: A Pilot Study

Background/Objectives: Although preeclampsia (PE) and small for gestational age (SGA) are known to come from impaired placentation during the first trimester, prior studies have focused mostly on Doppler findings in the second trimester. Methods: In this retrospective pilot study, we enrolled 628 singleton pregnant women who underwent ultrasound in both the first and second trimesters and blood test. For SGA correlation, we further excluded 12 subjects with PE because PE may be the cause of SGA. We first presented the reference range of parameters of uterine artery Doppler in the first trimester and then grouped the subjects according to the presence of SGA (presence = 104, absence = 512) or PE (presence = 12, absence = 616) and investigated the association of uterine artery Doppler findings and serum markers in the first trimester with the occurrence of SGA or PE. Results: The uterine artery pulsatility index and the resistance index and the proportion of uterine artery notch decreased progressively in the first trimester. A lower serum beta-hCG level in the first trimester predicted the occurrence of SGA (adjusted odds ratio [AOR] = 0.53, p = 0.019), while the presence of the uterine artery notch in the first trimester predicted the development of PE (notch at least on one side: AOR = 8.65, p = 0.045 and notch on both sides: AOR = 8.91, p = 0.047). Regardless of whether a notch was present in the second trimester, a uterine artery notch in the first trimester was associated with an excellent negative predictive value (99.6%) for PE. Conclusions: This study suggests the clinical importance of assessing serum beta-hCG and the uterine artery notch in the first trimester to predict SGA and PE.

Non-linear dose-response relationship between uterine artery pulsatility index and risk of preeclampsia in early pregnancy: A secondary analysis based on a nested cohort study

BACKGROUND

Previous studies have shown that higher uterine artery pulsatility index (UtA-PI) values in early pregnancy have predictive value for the risk of preeclampsia (PE). However, the sensitivity and specificity of this marker remain controversial. This study aims to explore further the association between UtA-PI in early pregnancy and the incidence of preeclampsia.

METHODS

A total of 5000 pregnant women who underwent prenatal examination and delivery at the same hospital were included in this nested cohort study. And the PI values of left and right uterine arteries of the subjects were obtained by transabdominal ultrasound using GE color doppler diagnostic device in early pregnancy (11-13 + 6 weeks), and finally the mean value of both was calculated and recorded as UtA-PI. Among them, 60 pregnant women developed preeclampsia and were randomly divided into a screening group (n = 12) and control group (n = 48) and matched with pregnant women who did not develop preeclampsia during the same period to form a subset for subsequent statistical analysis. A weighted multivariate logistic regression model was used to analyze the association between UtA-PI and PE. Additionally, the non-linear relationship between UtA-PI and the incidence of PE was examined using smooth curve fitting and a generalized additive model.

RESULTS

After adjusting for other variables, UtA-PI values were positively correlated with the incidence of PE, and the relationship showed a non-linear U-shaped relationship (inflection point 1.83).

CONCLUSION

Our study showed a significantly increased risk of PE when UtA-PI exceeded 1.83. This provides a basis for clinicians to identify high-risk pregnant women early and implement timely intervention, which helps to reduce maternal and fetal complications and improve health outcomes.

Investigation of the relationship between diastolic notching in uterine artery Doppler and serum salusin alpha and beta concentrations in the first trimester

OBJECTIVE

Studies have shown that members of the salusin family regulate the migration and proliferation of arterial smooth muscle cells and increase the tendency to atherosclerosis through fibrosis and calcification in the vascular wall. However, the effect of salusins on the uterine artery has not yet been investigated. This study was conducted to investigate whether serum salusin alpha and beta concentrations in the first trimester are associated with diastolic notching in uterine artery Doppler.

METHODS

This non-interventional cohort study was conducted on 88 pregnant women, 44 of whom had diastolic notching on unilateral or bilateral uterine artery Doppler, and 44 of whom did not have diastolic notching on uterine artery Doppler. The uterine artery notch positive and negative groups were compared in terms of serum salusin alpha and beta concentrations.

RESULTS

The two groups were similar in terms of demographic characteristics (p < 0.05). The median salusin alpha concentration was found to be 689.4 pg/ml in the uterine artery notch positive group, while it was 734.6 pg/ml in the uterine artery notch negative group (p = 0.608). The median salusin beta concentration was found to be 674.5 pg/ml in the uterine artery notch positive group, while it was 693.8 pg/ml in the uterine artery notch negative group (p = 0.453).Participants were regrouped into normal and high uterine artery resistance and compared in terms of serum salusin alpha and beta concentrations. The median salusin alpha concentration was found to be 994.5 pg/ml in the high uterine artery PI group, while it was 685.2 pg/ml in the normal uterine artery PI group (p = 0.698). The median salusin beta concentration was found to be 1,100.8 pg/ml in the high uterine artery PI group, while it was 669.1 pg/ml in the normal uterine artery PI group (p = 0.584).

CONCLUSION

Although the sample size was too small to draw a definitive conclusion, our results indicate that uterine artery diastolic notching or increased resistance in the uterine artery does not appear to be associated with serum salusin alpha or beta concentrations.

Contributions Regarding the Study of Pulsatility and Resistivity Indices of Uterine Arteries in Term Pregnancies-A Prospective Study in Bucharest, Romania

Pregnancy is a complex stage in a woman's life, considering the physical and psychological changes that occur. The introduction of Doppler studies of the pregnant woman's vessels and those of the fetus has proven to be a useful tool in evaluating the maternal-fetal relationship. Objective: The study aims to assess the correlations of PI and RI values in term pregnancies. Methods: This analysis is based on the prospective evaluation of medical data from 60 patients who were admitted to the Obstetrics and Gynecology department of Saint Pantelimon Hospital in Bucharest, Romania, from May to August 2024. Among the examined parameters are patient age, blood pressure, amniotic fluid quantity, placenta location, and pulsatility and resistivity indices of uterine arteries. Results: A higher diastolic blood pressure is associated with higher mean PI and RI values, indicating that diastolic blood pressure has a significant correlation to these values. The mean RI shows a moderately negative and significant correlation, suggesting that a lower level of amniotic fluid is associated with a higher mean RI. Regarding the PI value of the uterine arteries, the p-value suggests that the difference between the groups with and without associated diseases is statistically significant. Placental insertion on the anterior or posterior uterine wall does not have a significant impact on the PI and RI values of the uterine arteries, but the values are higher in the contralateral part of the placental insertion. Conclusions: These results strengthen the evidence previously demonstrated. Uterine artery Doppler ultrasonography is an extremely useful tool in monitoring and managing high-risk pregnancies.

The association between fetal Doppler and uterine artery blood volume flow in term pregnancies: a pilot study

PURPOSE

To investigate the relationship between uterine artery blood volume flow and fetal Doppler indices in term pregnancies.

MATERIALS AND METHODS

A prospective observational study in a tertiary-care university hospital was performed between December 2021 and May 2022. We included only term pregnancies that received accurate ultrasound scans until a week before the birth. The uterine artery (UtA) diameter and UtA volume blood flow were estimated and recorded. The volume of each artery was summed to obtain the total uterine artery volume blood flow (QUtA). The following fetal Doppler indices were evaluated: Umbilical artery (UA), middle cerebral artery (MCA), ductus venosus (DV), and cerebroplacental ratio (CPR). Linear regression analysis was performed to investigate the relationship between the QUtA and the fetal Doppler indices.

RESULTS

49 pregnancies were included. The UA pulsatility index (PI) analysis showed a significant association with QUtA (r2=0.40, p=0.01), demonstrating a decrease of the UA PI when the QUtA increased. The same relationship was noted between the UtA mean PI and QUtA (r2=0.41, p=0.005). A weak correlation between the newborn weight and the QUtA was also noted (r2=0.31, p=0.048), with an elevated newborn weight when the QUtA was high.

CONCLUSION

This study showed that UA, UtA PI, and birth weight seem to be linked to QUtA. QUtA had an inverse correlation with UA and UtA PI. In addition, increasing the QUtA showed a linear increase in fetal birth weight. These findings could be helpful in high-risk pregnancy management, but additional research is needed to identify how QUtA in the third trimester impacts labor and fetal outcomes.

Use of Photoacoustic Imaging to Study the Effects of Anemia on Placental Oxygen Saturation in Normoxic and Hypoxic Conditions

We aimed to evaluate fetal and placental oxygen saturation (sO2) in anemic and non-anemic pregnant rats throughout gestation using photoacoustic imaging (PAI). Female Sprague-Dawley rats were fed an iron-restricted or iron-replete diet before and during pregnancy. On gestational days 13, 18, and 21, PAI was coupled with high resolution ultrasound to measure oxygenation of the fetus, whole placenta, mesometrial triangle, as well as the maternal and fetal faces of the placenta. PAI was performed in 3D, which allowed sO2 to be measured within an entire region, as well as in 2D, which enabled sO2 measurements in response to a hypoxic event in real time. Both 3D and 2D PAI were performed at varying levels of FiO2 (fraction of inspired oxygen). Iron restriction caused anemia in dams and fetuses, a reduction in fetal body weight, and an increase in placental weight, but overall had minimal effects on sO2. Reductions in FiO2 caused corresponding reductions in sO2 which correlated to the severity of the hypoxic challenge. Regional differences in sO2 were evident within the placenta and between the placenta and fetus. In conclusion, PAI enables non-invasive measurement of sO2 both rapidly and with a high degree of sensitivity. The lack of overt changes in sO2 levels between control and anemic fetuses may suggest reduced oxygen extraction and utilization in the latter group, which could be attributed to compensatory changes in growth and developmental trajectories.

Maternal dietary patterns and placental outcomes among pregnant women in Los Angeles

INTRODUCTION

Epidemiological studies have linked prenatal maternal diet to fetal growth, but whether diet affects placental outcomes is poorly understood.

METHODS

We collected past month dietary intake from 148 women in mid-pregnancy enrolled at University of California Los Angeles (UCLA) antenatal clinics from 2016 to 2019. We employed the food frequency Diet History Questionnaire II and generated the Healthy Eating Index-2015 (HEI-2015), the Alternate Healthy Eating Index for Pregnancy (AHEI-P), and the Alternate Mediterranean Diet (aMED). We conducted T2-weighted magnetic resonance imaging (MRI) in mid-pregnancy (1st during 14-17 and 2nd during 19-24 gestational weeks) to evaluate placental volume (cm3) and we measured placenta weight (g) at delivery. We estimated change and 95 % confidence interval (CI) in placental volume and associations of placenta weight with all dietary index scores and diet items using linear regression models.

RESULTS

Placental volume in mid-pregnancy was associated with an 18.9 cm3 (95 % CI 5.1, 32.8) increase per 100 gestational days in women with a higher HEI-2015 (≥median), with stronger results for placentas of male fetuses. We estimated positive associations between placental volume at the 1st and 2nd MRI and higher intake of vegetables, high-fat fish, dairy, and dietary intake of B vitamins. A higher aMED (≥median) score was associated with a 40.5 g (95 % CI 8.5, 72.5) increase in placenta weight at delivery, which was mainly related to protein intake.

DISCUSSION

Placental growth represented by volume in mid-pregnancy and weight at birth is influenced by the quality and content of the maternal diet.

Early Prediction of Hypertensive Diseases of Pregnancy by Using Combined Screening Methods in a Rural Population

INTRODUCTION

The most frequent medical issue during pregnancy is hypertension, which can complicate up to 10% to 15% of pregnancies worldwide. An estimated 14% of all maternal fatalities worldwide are thought to be caused by hypertensive disease of pregnancy, one of the main causes of maternal and fetal morbidity and mortality. Despite the fact that maternal mortality is substantially lower in high-income countries than in low- and middle-income countries, hypertension is still one of the leading causes of maternal death globally. Maternal mortality associated with hypertension fluctuated between 0.08 and 0.42 per 100,000 births between 2009 and 2015. In India, the estimated overall pooled prevalence of HDP was determined to be one out of 11 women, or 11% (95% CI, 5%-17%). Despite various government programs, there is still a high prevalence of hypertension, which calls for stakeholders and healthcare professionals to focus on providing both therapeutic and preventive care. The best solution is to concentrate more on the early detection of pregnancy-related hypertension and to guarantee its universal application so that proper care can be carried out to prevent maternal and fetal morbidity.

AIM

To estimate the predictive value of the combination of maternal characteristics, i.e., mean arterial pressure (MAP), biophysical evaluation (uterine artery Doppler), and biochemical markers (pregnancy-associated plasma protein A (PAPP-A)), in the first trimester of pregnancy for hypertensive diseases of pregnancy.

METHODOLOGY

It was a prospective observational study of longitudinal variety that took over 18 months in a tertiary care rural hospital. The number of women admitted to the hospital for labor care during 2019 was 5261. A total of 513 were diagnosed with hypertensive illnesses during pregnancy. At a prevalence rate of 10%, we calculated a sample size of 350 to achieve a sensitivity of 85% with an absolute error of 12.5% at a 95% CI. Maternal histories, such as age, education, socio-economic status, gravidity, and BMI, were taken along with three parameters, i.e., MAP, which was significant above 90 mmHg, uterine artery Doppler, which was taken significant above 1.69, and serum PAPP-A, which was significant at less than 0.69 ml/IU.

OBSERVATION AND RESULTS

We have found that the following are associated with the prediction of hypertension: among the maternal characteristics are advanced age >35 years, presence of body edema, and urine proteins along with MAP, uterine artery pulsatility index (UtA-PI), and PAPP-A are significant. The predictive accuracy of the combination of MAP, UtA-PI, and PAPP-A is also significant. We also found that there is a significant increase in cesarean sections and NICU admissions in hypertensive patients.

CONCLUSION

A combination of screening parameters, including MAP, UtA-PI, and PAPP-A, to predict early hypertensive disease of pregnancy is developed and tested.

Platelet and mitochondrial RNA is decreased in plasma-derived extracellular vesicles in women with preeclampsia-an exploratory study

BACKGROUND

Circulating extracellular vesicles (EVs) are increased in preeclampsia (PE) and are associated with severity and progression. We examined in this exploratory cohort study if the mRNAs and long noncoding RNAs (lncRNAs) in plasma-derived EVs were dysregulated in PE compared to normal pregnancy and display different temporal patterns during gestation.

METHODS

We isolated EVs from plasma at weeks 22-24 and 36-38 in women with and without PE (n=7 in each group) and performed RNA-seq, focusing on mRNAs and lncRNAs. We validated highly expressed mitochondrial and platelet-derived RNAs discovered from central pathways in 60 women with/without PE. We examined further one of the regulated RNAs, noncoding mitochondrially encoded tRNA alanine (MT-TA), in leukocytes and plasma to investigate its biomarker potential and association with clinical markers of PE.

RESULTS

We found abundant levels of platelet-derived and mitochondrial RNAs in EVs. Expression of these RNAs were decreased and lncRNAs increased in EVs from PE compared to without PE. These findings were further validated by qPCR for mitochondrial RNAs MT-TA, MT-ND2, MT-CYB and platelet-derived RNAs PPBP, PF4, CLU in EVs. Decreased expression of mitochondrial tRNA MT-TA in leukocytes at 22-24 weeks was strongly associated with the subsequent development of PE.

CONCLUSIONS

Platelet-derived and mitochondrial RNA were highly expressed in plasma EVs and were decreased in EVs isolated from women with PE compared to without PE. LncRNAs were mostly increased in PE. The MT-TA in leukocytes may be a useful biomarker for prediction and/or early detection of PE.

Uterine Arteries Resistance in Pregnant Women with Gestational Diabetes Mellitus, Diabetes Mellitus Type 1, Diabetes Mellitus Type 2, and Uncomplicated Pregnancies

BACKGROUND

The examination of the uterine arteries using Doppler in the first trimester of pregnancy serves as a valuable tool for evaluating the uteroplacental circulation. Diabetes mellitus is associated with altered placental implantation and pregnancy-related pathologies, such as preeclampsia. The aim of this study was to compare the uterine arteries' pulsatility indices (UtA PI) in women with diabetes mellitus type 1 (DM1), diabetes mellitus type 2 (DM2), gestational diabetes mellitus (GDM), and uncomplicated pregnancies.

METHODS

This was a retrospective case-control trial including pregnant women with DM1, DM2, GDM, and uncomplicated pregnancies, presenting for first-trimester ultrasound screening in two tertiary university hospitals between 2013 and 2023. The first-trimester UtA pulsatility index (PI), expressed in multiples of medians (MoMs), was compared between the four groups.

RESULTS

Out of 15,638 pregnant women, 58 women with DM1, 67 women with DM2, 65 women with GDM, and 65 women with uncomplicated pregnancies were included. The mean UtA PI were 1.00 ± 0.26 MoMs, 1.04 ± 0.32 MoMs, 1.02 ± 0.31 MoMs, and 1.08 ± 0.33 MoMs in pregnant women with DM1, DM2, GDM, and uncomplicated pregnancies, respectively (p > 0.05).

CONCLUSIONS

Potential alterations in the implantation of the placenta in pregnant women with diabetes were not displayed in the first-trimester pulsatility indices of the uterine arteries, as there were no changes between the groups.

Early pregnancy imaging predicts ischemic placental disease

INTRODUCTION

To characterize early-gestation changes in placental structure, perfusion, and oxygenation in the context of ischemic placental disease (IPD) as a composite outcome and in individual sub-groups.

METHODS

In a single-center prospective cohort study, 199 women were recruited from antenatal clinics between February 2017 and February 2019. Maternal magnetic resonance imaging (MRI) studies of the placenta were temporally conducted at two timepoints: 14-16 weeks gestational age (GA) and 19-24 weeks GA. The pregnancy was monitored via four additional study visits, including at delivery. Placental volume, perfusion, and oxygenation were assessed at both MRI timepoints. The primary outcome was defined as pregnancy complicated by IPD, with group assignment confirmed after delivery.

RESULTS

In early gestation, mothers with IPD who subsequently developed fetal growth restriction (FGR) and/or delivered small-for gestational age (SGA) infants showed significantly decreased MRI indices of placental volume, perfusion, and oxygenation compared to controls. The prediction of FGR or SGA by multiple logistic regression using placental volume, perfusion, and oxygenation revealed receiver operator characteristic curves with areas under the curve of 0.81 (Positive predictive value (PPV) = 0.84, negative predictive value (NPV) = 0.75) at 14-16 weeks GA and 0.66 (PPV = 0.78, NPV = 0.60) at 19-24 weeks GA.

DISCUSSION

MRI indices showing decreased placental volume, perfusion and oxygenation in early pregnancy were associated with subsequent onset of IPD, with the greatest deviation evident in subjects with FGR and/or SGA. These early-gestation MRI changes may be predictive of the subsequent development of FGR and/or SGA.

Association between the first and second trimester cell free DNA fetal fraction and spontaneous preterm birth

OBJECTIVE

To evaluate whether the fetal fraction of cell-free DNA at the first and second trimesters is associated with spontaneous preterm birth.

METHODS

This was a retrospective cohort study with singleton pregnancies who underwent noninvasive prenatal testing. According to pregnancy outcome, eligible patients were divided into a delivery group ≥37 weeks of pregnancy (term group) and <37 weeks of pregnancy (spontaneous preterm group). Stepwise linear regression was used to identify maternal characteristics associated with the fetal fraction of cell-free DNA. Logistic regression analysis was performed to evaluate the association between the fetal fraction of cell-free DNA and spontaneous preterm birth, adjusted for confounding factors.

RESULTS

14,020 cases were included in the study, 13292 cases (94.81%) in the term group and 728 cases (5.19%) in the spontaneous preterm group. The cell-free fraction of fetal DNA was inversely correlated with maternal age and body mass index. Positively correlated with gestational age, fertility, and assisted reproductive technology. After adjusting for the covariates, logistic regression analysis revealed no statistically significant association between the fetal fraction of cell-free DNA and spontaneous preterm birth.

CONCLUSION

In our original study, we found no association between the fetal fraction on NIPT and subsequent spontaneous preterm birth.

Assessing the Impact of Uterine Artery Doppler and Low-Dose Aspirin on Fetomaternal Outcome: A Prospective Study in Low-Risk Pregnant Women in Western Part of India

Introduction Fetal growth restriction (FGR) and pregnancy-induced hypertension (PIH) are significant and clinically relevant complications observed in many pregnancies. Early prediction of these complications may be possible through the assessment of the umbilical artery pulsatility index (UAPI). However, its utility in routine practice for otherwise normal pregnancy needs further exploration in India. Objectives This study aimed to evaluate the potential benefits of incorporating UAPI for the timely use of low-dose aspirin in preventing FGR and PIH in a tertiary care hospital in the western part of India. Methodology A prospective study was conducted involving 64 low-risk (i.e., not having any feature of high-risk pregnancy) pregnant women selected from routine antenatal care outpatient departments over a period of two years. All women underwent uterine artery Doppler examination during the 11-13+6 weeks of pregnancy and those who had high UAPI received low-dose (150 mg) aspirin till the 35th week. The incidence of FGR and PIH was analyzed and compared between high UAPI and normal UAPI pregnancy. Results A total of 64 pregnant women with a mean age of 27.11±4 years participated in the study. Among the women, eight (12.5%) were found to have high UAPI and were put on aspirin. Among those eight women, two developed PIH. In the normal UAPI group, nine (16.07%) developed PIH (p-value = 0.62). FGR was found in one case among the eight who received aspirin and in eight cases among the 56 who had normal UAPI (p-value > 0.99). Conclusion The study concluded that despite having normal UAPI, women categorized as low-risk may develop PIH and FGR. Hence, the routine use of UAPI should be investigated in further cohort studies using a large sample to draw a generalizable conclusion for the Indian population.

Clinical analysis of diabetes in pregnancy with stillbirth

We analyzed the clinical characteristics of patients with diabetes in pregnancy (DIP) associated with stillbirth and explored strategies to reduce its incidence. We retrospectively analyzed 71 stillbirths associated with DIP (group A) and 150 normal pregnancies (group B) during 2009 to 2018. The incidence of the following was higher in group A (P < .05): hypertensive disorders (38.03% vs 6.00%), placenta previa (14.08% vs 2.67%), placental abruption (5.63% vs 0.67%), fetal malformation (8.45% vs 0.67%), fasting plasma glucose (FPG) ≥ 7.0 mmol/L (46.48% vs 0.67%), 2-h postprandial plasma glucose ≥ 11.1 mmol/L (57.75% vs 6.00%), HbA1c ≥ 6.5% (63.38% vs 6.00%), and polyhydramnios (11.27% vs 4.67). The incidence of oligohydramnios (4.23% vs 6.67%) was lower in group A than in group B (P < .05). According to the gestational age at the time of stillbirth, Group-A cases were subgrouped into miscarriages (20-27+6 weeks), premature deliveries (28-36+6 weeks), and full-term deliveries (≥37 weeks). Age, parity, and DIP type did not differ among the subgroups (P > .05). Among patients with DIP, antenatal FPG, 2-h postprandial plasma glucose, and HbA1c were significantly associated with stillbirth (P < .05). Stillbirth was first detected at 22 weeks and typically occurred at 28-36+6 weeks. DIP was associated with a higher incidence of stillbirth, and FPG, 2-h postprandial plasma glucose, and HbA1c were potential indicators of stillbirth in DIP. Age (odds ratio [OR]: 2.21, 95% confidence interval [CI]: 1.67-2.74), gestational hypertension (OR: 3.44, 95% CI: 2.21-4.67), body mass index (OR: 2.86, 95% CI: 1.95-3.76), preeclampsia (OR: 2.29, 95% CI: 1.45-3.12), and diabetic ketoacidosis (OR: 3.99, 95% CI: 1.22-6.76) were positively correlated with the occurrence of stillbirth in DIP. Controlling perinatal plasma glucose, accurately detecting and managing comorbidities/complications, and timely termination of pregnancy can reduce the incidence of stillbirths associated with DIP.

Fetal Growth Restriction Is Associated with Pregnancy Associated Plasma Protein A and Uterine Artery Doppler in First Trimester

Fetal growth restriction (FGR) is a major cause of stillbirth and poor neurodevelopmental outcomes. The early prediction may be important to establish treatment options and improve neonatal outcomes. The aim of this study was to assess the association of parameters used in first-trimester screening, uterine artery Doppler pulsatility index and the development of FGR. In this retrospective cohort study, 1930 singleton pregnancies prenatally diagnosed with an estimated fetal weight under the third percentile were included. All women underwent first-trimester screening assessing maternal serum pregnancy-associated plasma protein A (PAPP-A), free beta-human chorionic gonadotrophin levels, fetal nuchal translucency and uterine artery Doppler pulsatility index (PI). We constructed a Receiver Operating Characteristics curve to calculate the sensitivity and specificity of early diagnosis of FGR. In pregnancies with FGR, PAPP-A was significantly lower, and uterine artery Doppler pulsatility index was significantly higher compared with the normal birth weight group (0.79 ± 0.38 vs. 1.15 ± 0.59, p < 0.001 and 1.82 ± 0.7 vs. 1.55 ± 0.47, p = 0.01). Multivariate logistic regression analyses demonstrated that PAPP-A levels and uterine artery Doppler pulsatility index were significantly associated with FGR (p = 0.009 and p = 0.01, respectively). To conclude, these two parameters can predict FGR < 3rd percentile.

Progress Toward Reversed Uterine Diastolic Flow in the Third Trimester - An Inauspicious Sign

BACKGROUND

Increased uteroplacental resistance is associated with high uterine artery pulsatility and resistance indices and early diastolic notching. Evolution toward reversed diastolic uterine flow in the third trimester was scarcely reported previously. The feature was related to severe complications for both mother and fetus.

MATERIAL AND METHODS

Data were collected from 3638 pregnancies undergoing prenatal care in our hospital. In this study, we aimed to identify those pregnancies with development of a reversed diastolic flow at the spectral Doppler interrogation of uterine arteries later than 24 weeks of gestation. A secondary aim was to follow up and actively manage these pregnancies.

RESULTS

Previously, reversed uterine diastolic flow was reported during the third trimester in four cases only. In our study three pregnancies only developed reversed uterine arteries diastolic flow, none being associated with preeclampsia. All cases evolved with complications at birth.

CONCLUSIONS

Progressive deterioration of uterine arteries flow is possible during pregnancy. Reversed diastolic flow is a rare occurrence in the third trimester of pregnancy. Based on current knowledge, it may be considered an ominous sign and should trigger a close follow-up. Future studies using routine investigation of uterine arteries flow late in pregnancy may prove informative.

Prevalence of preeclampsia and uterine arteries resistance in the different phenotypes of gestational diabetes mellitus

AIMS

This study aims to investigate the different phenotypes of Gestational Diabetes Mellitus (GDM), in correlation to preeclampsia and uterine arteries resistance.

MATERIALS

This is a prospective cohort study including women with and without GDM per the IADPSG criteria. Three phenotypes of GDM emerged, women with only abnormal fasting (AF) glucose levels, women with only abnormal post-load (AP) glucose levels at 60' and/or 120' and women with abnormal combined (AC) fasting and post-load glucose values. All women underwent uterine arteries doppler examination in the three trimesters and assessed for preeclampsia development. Linear regression was used to express the trajectories of uterine arteries resistance throughout the pregnancy.

RESULTS

6928 pregnant women were included, 5274 without GDM and 1654 with GDM. 546, 781 and 327 of GDM pregnancies presented with AF, AP and AC phenotypes respectively. Prevalence of preeclampsia was 17.9%, 26.8% and 30% in the AF, AP and AC phenotypes respectively (p < 0.001). In women who developed preeclampsia, AC phenotype presented with statistically different trajectory of Uterine Arteries Pulsatility Index Percentiles b = 0.129 than women without GDM and women with AP GDM phenotype b = -0.015 and b = -0.016 respectively.

CONCLUSIONS

The combined abnormal phenotype presents with the highest rate of preeclampsia and the most distinct pattern of uterine arteries resistance.

Effect of Lipid-Based Multiple Micronutrients Supplementation in Underweight Primigravida Pre-Eclamptic Women on Maternal and Pregnancy Outcomes: Randomized Clinical Trial

Background and Objectives: In pre-eclampsia, restricted blood supply due to the lack of trophoblastic cell invasion and spiral artery remodeling is responsible for adverse pregnancies and maternal outcomes, which is added to by maternal undernutrition. This study was designed to observe the effect of multiple nutritional micronutrient supplements on the pregnancy outcomes of underweight pre-eclamptic women. To investigate the effects of lipid-based multiple micr supplementations (LNS-PLW) on pregnancy and maternal outcomes in underweight primigravida pre-eclamptic women. Materials and Methods: A total of 60 pre-eclamptic, underweight primigravida women from the antenatal units of tertiary care hospitals in the Khyber Pakhtunkhwa Province, Pakistan, were randomly divided into two groups (Group 1 and Group 2). The participants of both groups were receiving routine treatment for pre-eclampsia: iron (60 mgs) and folic acid (400 ug) IFA daily. Group 2 was given an additional sachet of 75 gm LNS-PLW daily till delivery. The pregnancy outcomes of both groups were recorded. The clinical parameters, hemoglobin, platelet count, and proteinuria were measured at recruitment. Results: The percentage of live births in Group 2 was 93% compared to 92% in Group 1. There were more normal vaginal deliveries (NVDs) in Group 2 compared to Group 1 (Group 2, 78% NVD; group 1, 69% NVD). In Group 1, 4% of the participants developed eclampsia. The frequency of cesarean sections was 8/26 (31%) in Group 1 and 6/28 (22%) in Group 2. The number of intrauterine deaths (IUDs) was only 1/28 (4%) in Group 2, while it was 2/26 (8%) in Group 1. The gestational age at delivery significantly improved with LNS-PLW supplementation (Group 2, 38.64 ± 0.78 weeks; Group 1, 36.88 ± 1.55 weeks, p-value 0.006). The Apgar score (Group 2, 9.3; Group 1, 8.4) and the birth weight of the babies improved with maternal supplementation with LNS-PLW (Group 2, 38.64 ± 0.78 weeks: Group 1, 36.88 ± 1.55; p-value 0.003). There was no significant difference in systolic blood pressure, while diastolic blood pressure (Group 2, 89.57 ± 2.08 mmHg; Group 1, 92.17 ± 5.18 mmHg, p-value 0.025) showed significant improvement with LNS-PLW supplementation. The hemoglobin concentration increased with the LNS-PLW supplement consumed in Group 2 (Group 2, 12.15 ± 0.78 g/dL; Group 1, 11.39 ± 0.48 g/dL, p-value < 0.001). However, no significant difference among the platelet counts of the two groups was observed. Conclusions: The pregnancy and maternal outcomes of underweight pre-eclamptic women can be improved by the prenatal daily supplementation of LNS-PLW during pregnancy, along with IFA and regular antenatal care and follow-up.

Third trimester uterine artery Doppler for prediction of adverse perinatal outcomes

PURPOSE OF REVIEW

Abnormal uterine artery Doppler (UtAD) studies early in gestation have been associated with adverse pregnancy outcomes. However, their association with complications in the third trimester is weak. We aim to review the prediction ability for perinatal complications of these indices in the third trimester.

RECENT FINDINGS

Abnormal UtAD waveforms in the third trimester are associated with preeclampsia, small-for-gestational age infants (SGA), preterm birth, perinatal death, and other perinatal complications, such as cesarean section for fetal distress, 5 min low Apgar score, low umbilical artery pH, and neonatal admission to the ICU, particularly in SGA infants. UtAD prediction performance is improved by the addition of maternal characteristics as well as biochemical markers to prediction models and is more precise if the evaluation is made closer to delivery or diagnosis.

SUMMARY

This review shows that the prediction accuracy of UtAD for adverse pregnancy outcomes during the third trimester is moderate at best. UtAD have limited additive value to prediction models that include PlGF and sFlt-1. Serial assessments rather than a single third trimester evaluation may enhance the prediction performance of the UtAD combined models.

Diagnostic biomolecules and combination therapy for pre-eclampsia

Pre-eclampsia (PE), associated with placental malperfusion, is the primary reason for maternal and perinatal mortality and morbidity that can cause vascular endothelial injury and multi-organ injury. Despite considerable research efforts, no pharmaceutical has been shown to stop disease progression. If women precisely diagnosed with PE can achieve treatment at early gestation, the maternal and fetal outcomes can be maximally optimized by expectant management. Current diagnostic approaches applying maternal characteristics or biophysical markers, including blood test, urine analysis and biophysical profile, possess limitations in the precise diagnosis of PE. Biochemical factor research associated with PE development has generated ambitious diagnostic targets based on PE pathogenesis and dissecting molecular phenotypes. This review focuses on current developments in biochemical prediction of PE and the corresponding interventions to ameliorate disease progression, aiming to provide references for clinical diagnoses and treatments.

Leveraging Optimized Transcriptomic and Personalized Stem Cell Technologies to Better Understand Syncytialization Defects in Preeclampsia

Understanding the process of human placentation is important to the development of strategies for treatment of pregnancy complications. Several animal and in vitro human model systems for the general study human placentation have been used. The field has expanded rapidly over the past decades to include stem cell-derived approaches that mimic preclinical placental development, and these stem cell-based models have allowed us to better address the physiology and pathophysiology of normal and compromised trophoblast (TB) sublineage development. The application of transcriptomic approaches to these models has uncovered limitations that arise when studying the distinctive characteristics of the large and fragile multinucleated syncytiotrophoblast (STB), which plays a key role in fetal-maternal communication during pregnancy. The extension of these technologies to induced pluripotent stem cells (iPSCs) is just now being reported and will allow, for the first time, a reproducible and robust approach to the study of the developmental underpinnings of late-manifesting diseases such as preeclampsia (PE) and intrauterine growth retardation in a manner that is patient- and disease-specific. Here, we will first focus on the application of various RNA-seq technologies to TB, prior limitations in fully accessing the STB transcriptome, and recent leveraging of single nuclei RNA sequencing (snRNA-seq) technology to improve our understanding of the STB transcriptome. Next, we will discuss new stem-cell derived models that allow for disease- and patient-specific study of pregnancy disorders, with a focus on the study of STB developmental abnormalities in PE that combine snRNA-seq approaches and these new in vitro models.

A Review of Roles of Uterine Artery Doppler in Pregnancy Complications

The invasion of trophoblasts into the uterine decidua and decidual vessels is critical for the formation of placenta. The defects of placentation are related to the etiologies of preeclampsia (PE), fetal growth restriction (FGR), and small-for-gestational age (SGA) neonates. It is possible to predict significant vascular events during pregnancy through uterine artery Doppler (UAD). From the implantation stage to the end of pregnancy, detecting changes in uterine and placental blood vessels can provide a favorable diagnostic instrument for pregnancy complications. This review aims to collect literature about the roles of UAD in pregnancy complications. We consider all relevant articles in English from January 1, 1983 to October 30, 2021. Predicting pregnancy complications in advance allows practitioners to carry out timely interventions to avoid or lessen the harm to mothers and neonates. Administering low-dose aspirin daily before 16 weeks of pregnancy can significantly reduce the incidence of pregnancy complications. From early pregnancy to late pregnancy, UAD can combine with other maternal factors, biochemical indicators, and fetal measurement data to identify high-risk population. The identification of high-risk groups can also lessen maternal mortality. Besides, through moderate risk stratification, stringent monitoring for high-risk pregnant women can be implemented, decreasing the incidence of adversities.

Pulsatile vessel at the posterior bladder wall: A new sonographic marker for placenta percreta

OBJECTIVE

We investigated using "pulsatile vessels at the posterior bladder wall" as a novel sonographic marker to demonstrate the severity of placenta accreta spectrum (PAS).

METHODS

This observational case-control study of 30 pregnant women was performed at Hackensack Meridian Health's Center for Abnormal Placentation in 2020. The case group was made up of women with historically described sonographic signs of PAS and was compared against two control groups: (1) women with uncomplicated placenta previa and (2) women with no evidence of placenta previa sonographically. All patients were evaluated with Color Flow Doppler ultrasound to assess the presence of arterial vessels at the posterior bladder wall. The flow characteristics and resistance indices (RI) were noted in the presence of pulsatile vessels. All patients' placentation was clinically confirmed at delivery. Patients with clinical invasive placentation underwent histopathological diagnosis to confirm disease presence.

RESULTS

Hundred percent of subjects in our series with suspected PAS exhibited pulsatile arterial vessels at the posterior bladder wall sonographically with a low RI of 0.38 ± 0.1 at an average of 24.6 ± 5.2 gestational weeks. Cases were histopathologically confirmed to have placenta percreta after delivery. Patients in either of the control groups did not display pulsatile vessels at the posterior bladder wall during antenatal sonographic evaluations and had no clinical evidence of PAS.

CONCLUSION

The presence of posterior urinary bladder wall pulsatile arterial vessels with low RI, in addition to traditional sonographic markers increases the suspicion of severe PAS. Thus, these findings allow for the greater opportunity for coordination of patient care prior to delivery.

Maternal anxiety, depression and vascular function during pregnancy

OBJECTIVE

We aim to clarify whether type and timing of mental health symptoms in early pregnancy distinctly contribute to maternal-fetal vascular function, independent from the psychotropic medications given to treat these conditions.

METHODS

Data from a prospective cohort study (n = 1678) were used to test whether self-reported fears about giving birth and depressive symptoms prior to 16 weeks of gestation were associated with vascular outcomes predictive of hypertensive disorders of pregnancy (HDP) i.e., systolic and diastolic blood pressure (BP); uterine artery pulsatility index (UAPI); umbilical artery resistance index (UmbARI); and urine protein creatinine ratio. Multiple linear regressions models and mediation models were used to test for associations between predictors and outcomes, controlling for previously identified risk factors for vascular dysfunction such as maternal age and history of infertility.

RESULTS

Fears about giving birth in early pregnancy were inversely associated with UmbARI (β = -0.33, p = 0.03, df = 51) mid- to late-pregnancy (≥20 weeks). Depressive symptoms in early pregnancy were also inversely associated with maternal systolic BP (β = -0.13, p = 0.01, df = 387) and diastolic BP (β = -0.10, p = 0.04, df = 387) during the first trimester.

CONCLUSIONS

While fears about giving birth in early pregnancy were associated with lower vascular resistance in the fetal-placental unit, early depressive symptoms were associated with lower maternal vascular tone. At the very least, our results support the notion that early maternal psychological distress is unlikely to account for the development of HDP later during pregnancy and provide preliminary evidence to support distinct roles of pregnancy-related anxiety and depressive symptoms in maternal-fetal vascular function.

Reassurance from second trimester sonographic placental scan for pregnancies complicated by abnormal first trimester biomarkers

OBJECTIVE

Enhanced first trimester aneuploidy screening (eFTS) combines serum biomarkers and ultrasound. Abnormal biomarkers are associated with placental complications, such as fetal growth restriction (FGR). We aimed to evaluate whether a Midtrimester placental scan can provide reassurance regarding FGR in women with abnormal eFTS biomarkers.

METHODS

We conducted a retrospective cohort study of women who had eFTS and delivered at a single referral center. Women with abnormal biomarkers had a mid-trimester scan of the placenta (morphologic assessment, fetal biometry and uterine artery pulsatility index). We compared pregnancies with abnormal eFTS biomarkers and normal placental scans (study group) with those who had normal eFTS biomarkers (control group).

RESULTS

A total of 6,514 women were included, of whom 343 (5.3%) comprised the study group. Women in the study group had an increased risk of hypertensive disorders of pregnancy [(aOR)1.96(95%CI 1.21-3.16)], and preterm birth <37 weeks [aOR1.98(95%CI 1.33-2.95)] compared to the control group. Yet, their neonates were not at higher risk for FGR <3^rd, 5^th, or 10^th percentile [aOR1.16(95%CI 0.83-1.63), 1.14(95%CI 0.70-1.87), and 0.47(95%CI 0.17-1.27), respectively].

CONCLUSION

A normal second trimester placental scan provided reassurance regarding the risk of FGR in women at high risk based on abnormal eFTS biomarkers.

Vibrational Spectroscopy: A Valuable Screening and Diagnostic Tool for Obstetric Disorders?

Preeclampsia (PE) is a common obstetric disorder typically affecting 2–8% of all pregnancies and can lead to several adverse obstetric outcomes for both mother and fetus with the greatest burden of severe outcomes in low middle-income countries (LMICs), therefore, screening for PE is vital. Globally, screening is based on maternal characteristics and medical history which are nonspecific for the disorder. In 2004, the World Health Organization acknowledged that no clinically useful test was able to predict the onset of PE, which prompted a universal search for alternative means of screening. Over the past decade or so, emphasis has been placed on the use of maternal characteristics in conjunction with biomarkers of disease combined into predictive algorithms, however these are yet to transition into the clinic and are cost prohibitive in LMICs. As a result, the screening paradigm for PE remains unchanged. It is evident that novel approaches are needed. Vibrational spectroscopy, specifically Raman spectroscopy and Fourier-transform infrared spectroscopy (FTIR), could provide better alternatives suited for implementation in low resource settings as no specialized reagents are required for conventional approaches and there is a drive to portable platforms usable in both urban and rual community settings. These techniques are based on light scattering and absorption, respectively, allowing detailed molecular analysis of samples to produce a unique molecular fingerprint of diseased states. The specificity of vibrational spectroscopy might well make it suited for application in other obstetric disorders such as gestational diabetes mellitus and obstetric cholestasis. In this review, we summarize current approaches sought as alternatives to current screening methodologies and introduce how vibrational spectroscopy could offer superior screening and diagnostic paradigms in obstetric care. Additionally, we propose a real benefit of such tools in LMICs where limited resources battle the higher prevalence of obstetric disorders.

Role of Maternal Uterine Artery Doppler Versus Serum β-hCG During the First Trimester in the Prediction of Preeclampsia and IUGR

Objective:

Preeclampsia accounts for 15% of maternal deaths and may cause fetal morbidity and mortality. The aim of this research was to evaluate the efficacy of maternal uterine artery Doppler versus serum beta-human chorionic gonadotropin (β-hCG), during the first trimester, in predicting preeclampsia and intrauterine growth restriction (IUGR).

Materials and Methods:

In a convenient sample of 388 pregnant women, uterine artery resistive index (RI) and pulsatility index (PI) were assessed, and serum β-hCG level was measured at 11 to 13 weeks of gestation. The patients’ maternal blood pressure and fetal growth were monitored.

Results:

The patients with preeclampsia (n = 58) showed a significant uterine RI and PI increase with a significant β-hCG decrease compared with the normotensive patients (n = 330). The specificity of uterine PI and RI to predict preeclampsia and IUGR is higher than that of β-hCG. However, the sensitivity of combined diagnostic tools is higher than the singular use of these diagnostic tests.

Conclusion:

Uterine artery Doppler may be better than serum β-hCG in predicting preeclampsia and IUGR. However, combined diagnostic techniques may be better to screen at-risk patients.

Whole transcriptome analysis of trophoblasts under hypoxia

INTRODUCTION

A physiological hypoxia environment exists at maternal-fetal interface during early pregnancy. In addition, there is a pathological hypoxic microenvironment in patients with preeclampsia. Therefore, investigating the hypoxic adaptation and the effects of hypoxia on trophoblasts transcriptome is helpful to better understand the function and regulatory mechanism of trophoblasts at the maternal-fetal interface.

METHODS

Trophoblast cell line HTR-8/SVneo was cultured under normoxia and hypoxia for 24 h, the full transcriptome was analyzed via RNA-Seq. GO and KEGG enrichment were performed on differentially expressed mRNA, adjacent genes of differentially expressed lncRNA, host genes of differentially expressed circRNA and target genes of differential expressed miRNA.

RESULTS

The results showed that hypoxia differentially regulated 373 mRNAs, 334 lncRNAs, 71 circRNAs and 33 miRNAs. GO and KEGG enrichment showed that hypoxia negatively regulated TLR3 and PI3K-Akt signaling pathways. Consistently, we found hypoxia significantly inhibited TLR3 agonist-induced cytokines expression and the phosphorylation of Akt and mTOR.

DISCUSSION

Our study obtained the full transcriptome data and potential regulatory network of trophoblasts under hypoxia, providing supportive data for revealing the function of trophoblasts.

Ultrasound Diagnosis of the Small and Large Fetus

Antenatal imaging is crucial in the management of high-risk pregnancies. Accurate dating relies on acquisition of reliable and reproducible ultrasound images and measurements. Quality image acquisition is necessary for assessing fetal growth and performing Doppler measurements to help diagnose pregnancy complications, stratify risk, and guide management. Further research is needed to ascertain whether current methods for estimating fetal weight can be improved with 3-dimensional ultrasound or magnetic resonance imaging; optimize dating with late initiation of prenatal care; minimize under-diagnosis of fetal growth restriction; and identify the best strategies to make ultrasound more available in low-income and middle-income countries.

Poor sleep is associated with higher blood pressure and uterine artery pulsatility index in pregnancy: a prospective cohort study

OBJECTIVE

To elucidate the association between sleep disturbances and blood pressure as well as uterine artery Doppler during pregnancy in women with no pre-existing hypertension.

DESIGN

Prospective cohort study.

SETTING

Outpatient specialist clinics at KK Women's and Children's Hospital, Singapore.

POPULATION

Women with viable singleton pregnancies confirmed by ultrasonography at less than 14 weeks of amenorrhoea at first visit.

METHODS

In all, 926 subjects were recruited for this study in the outpatient specialist clinics at KK Women's and Children's Hospital, Singapore, between 1 September 2010 and 31 August 2014. They were followed up throughout pregnancy with sleep quality, blood pressure and uterine artery Doppler assessed at each visit.

MAIN OUTCOME MEASURES

Sleep quality, blood pressure and uterine artery Doppler.

RESULTS

Sleep progressively worsened as pregnancy advanced. Shorter sleep duration and poorer sleep efficiency were associated with higher blood pressure, especially in the first trimester. Mixed model analysis demonstrated an overall positive association between sleep quality represented by Pittsburgh Sleep Quality Index (PSQI) score and diastolic blood pressure (DBP) (P < 0.001) and mean arterial pressure (MAP) (P = 0.005) during pregnancy after considering all trimesters. Sleep duration was found to be negatively associated with both systolic blood pressure (SBP) (P = 0.029) and DBP (P = 0.002), whereas sleep efficiency was negatively correlated with DBP (P = 0.002) only. Overall poor sleep during pregnancy was also found to be associated with a higher uterine artery pulsatility index.

CONCLUSION

Our prospective study demonstrated that poor sleep quality is significantly associated with higher blood pressure and uterine artery pulsatility index during pregnancy.

TWEETABLE ABSTRACT

Poor sleep quality is significantly associated with higher blood pressure and higher uterine artery pulsatility index during pregnancy.

Association between serum adiponectin levels with gestational diabetes mellitus and postpartum metabolic syndrome:A case control study

OBJECTIVE

Pregnancy can cause diabetic conditions and gestational diabetes is the most common metabolic disorder of the era. Scientific evidence suggests that obesity increases the incidence and severity of gestational diabetes. Adipokines are proteins secreted from adipose tissue in response to extracellular stimuli and altered metabolism. These hormones are involved in regulating the energy balance, lipid metabolism, and insulin sensitivity. One of the types of adipokines is called adiponectin, which has anti-diabetic, anti-inflammatory, and anti-atherogenic effects. Accordingly, this study is aimed to investigate the correlation between the serum adiponectin level with the gestational diabetes and the postpartum metabolic syndrome.

METHODS

This case-control study was carried out on 37 pregnant women (in Sari, Iran) with gestational diabetes and 37 non-diabetic pregnant women who were matched regarding age and body mass index (BMI). Serum adiponectin and glucose levels were measured. Finally, six weeks after termination of pregnancy, women in both groups were evaluated for metabolic syndrome. All statistical analyses of this study were performed using IBM SPSS software version 21 and, in all cases, the two-way p value less than 0.05 was considered statistically significant.

RESULTS

The mean age of pregnant women was 28.46±4.11 years in the non-diabetic group and 30.03±4.71 in the diabetic group. There was no statistically significant difference found between the mean age (p=0.123) and BMI (p=0.727) in two groups. Serum adiponectin levels in the diabetic group (5.51±3.15 µg/ml) were significantly lower than in the non-diabetic group (8.35±4.54 µg/ml) (p=0.003). In the diabetic group, serum adiponectin level did not correlate with the maternal age, maternal BMI, and postpartum metabolic syndrome (p>0.005).

CONCLUSIONS

The results of the present study indicate a correlation of low adiponectin concentrations with gestational diabetes, but this association with postpartum metabolic syndrome is uncertain. However, to elucidate the mechanism of adiponectin in predicting gestational diabetes and postpartum metabolic syndrome further studies are required.

To operate or to wait? Doppler indices as predictors for medical termination for first trimester missed abortion

Purpose: Missed abortion is a common obstetrical problem with a high incidence. Evidence supports a change in approach from the traditional dilatation and curettage to medical; however, few studies have investigated the prediction success of the medical approach. This study investigates whether first trimester missed abortion can be successfully terminated using Doppler indices, such as resistance index (RI) and pulsatility index (PI), as predictors. Material and Method: In this prospective study, the sample is made up of 78 patients, with a first trimester missed abortion range of 6-13 weeks of pregnancy who meets the maternal parameters as well as transvaginal Doppler indices, RI and PI. The participants were subdivided into 3 groups based on their response to sublingual misoprostol and weeks needed to terminate as Groups I (43/78), II (26/78), and III (9/78) aborted in the first, second, and third weeks, respectively. Results: Age, BMI, and gestational age of dead fetus were not significant for Groups I, II, and III with P = 0.13, P = 0.13, and P = 0.35, respectively. Parity and delivery mode showed significant differences (P < 0.0001) between group means of PI and RI. PI for Group I plus II and Group III are 1.53 (0.75-2.70) and 1.58 (1.10-2.10), respectively. RI for Group I plus II and Group III are 0.71 (0.50-1.00) and 0.80 (0.69-0.92), respectively. The coefficient of correlation proves that RI is the primary predictor of successful termination of a first trimester missed abortion with a cut-off value of 0.74 with associated sensitivity and specificity of 68.7% and 56.7%, respectively. Conclusions: Increased parity and a history of vaginal delivery, in addition to measured RI, were predictors of successful termination of a first trimester missed abortion. These results may be used in counseling patients to decide safest and most suitable option to terminate a first trimester missed abortion, depending on their demographic criteria and ultrasound scores.

Ultrasonographic features of uterine cervical lesions

Currently, ultrasound (US) is a valuable imaging tool for the initial assessment and evaluation of the female genital organs, uterus, and adnexa. However, it is easy to overlook the uterine cervix while conducting a pelvic US. Uterine cervical lesions may range from benign to malignant in nature. Therefore, meticulous examination with US may play a key role in assessing uterine cervical lesions. Although there is substantial overlap in the US findings across various uterine cervical lesions, some US features, in tandem with clinical characteristics, may suggest a specific diagnosis. Familiarity with the clinical settings and US characteristics of different uterine cervical lesions can support prompt and accurate diagnosis of suspicious lesions. This review article aims to describe the features of US and possible values for distinction of these lesions in the uterine cervix.

Uterine artery Doppler to predict growth restriction in cases of abnormal first trimester analytes

We retrospectively included women with abnormal FTS analytes and compared outcomes between those with elevated and normal UtA-PI. Out of 582 women with abnormal FTS analytes, 65 (11.2%) had elevated UtA-PI. Neonates of women in this group had higher rates of birth weight <3rd, 5th, and 10th percentile. The area under the ROC curve for predicting FGR <10th percentile by UtA-PI was 0.584, for FGR<5th percentile 0.593, and for FGR<3rd percentile 0.720. In women with abnormal FTS, elevated UtA-PI is associated with higher rates of FGR, but its predictability is moderate-to-poor.

New era of trophoblast research: integrating morphological and molecular approaches

Many pregnancy complications are the result of dysfunction in the placenta. The pathogenic mechanisms of placenta-mediated pregnancy complications, however, are unclear. Abnormal placental development in these conditions begins in the first trimester, but no symptoms are observed during this period. To elucidate effective preventative treatments, understanding the differentiation and development of human placenta is crucial. This review elucidates the uniqueness of the human placenta in early development from the aspect of structural characteristics and molecular markers. We summarise the morphogenesis of human placenta based on human specimens and then compile molecular markers that have been clarified by immunostaining and RNA-sequencing data across species. Relevant studies were identified using the PubMed database and Google Scholar search engines up to March 2020. All articles were independently screened for eligibility by the authors based on titles and abstracts. In particular, the authors carefully examined literature on human placentation. This review integrates the development of human placentation from morphological approaches in comparison with other species and provides new insights into trophoblast molecular markers. The morphological features of human early placentation are described in Carnegie stages (CS), from CS3 (floating blastocyst) to CS9 (emerging point of tertiary villi). Molecular markers are described for each type of trophoblast involved in human placental development. We summarise the character of human trophoblast cell lines and explain how long-term culture system of human cytotrophoblast, both monolayer and spheroid, established in recent studies allows for the generation of human trophoblast cell lines. Due to differences in developmental features among species, it is desirable to understand early placentation in humans. In addition, reliable molecular markers that reflect normal human trophoblast are needed to advance trophoblast research. In the clinical setting, these markers can be valuable means for morphologically and functionally assessing placenta-mediated pregnancy complications and provide early prediction and management of these diseases.

Comparative risks and predictors of preeclamptic pregnancy in the Eastern, Western and developing world

Preeclampsia (PE) is a complication of pregnancy characterized by hypertension (HTN-Preg), and often proteinuria. If not managed promptly, PE could lead to eclampsia and seizures. PE could also lead to intrauterine growth restriction (IUGR) and prematurity at birth. Although PE is a major cause of maternal and fetal morbidity and mortality, the underlying mechanisms are unclear. Also, there is a wide variability in the incidence of PE, ranging between 2 and 8% of pregnancies in the Eastern, Western and Developing world, suggesting regional differences in the risk factors and predictors of the pregnancy-related disorder. Several demographic, genetic, dietary and environmental factors, as well as maternal circulating biomarkers have been associated with PE. Demographic factors such as maternal race and ethnicity could play a role in PE. Specific genetic polymorphisms have been identified in PE. Maternal age, parity, education and socioeconomic status could be involved in PE. Dietary fat, protein, calcium and vitamins, body weight, and environmental factors including climate changes and air pollutants could also play a role in PE. Several circulating cytoactive factors including anti-angiogenic factors and cytokines have also been associated with PE. Traditional midwifery care is a common practice in local maternity care units, while advanced perinatal care and new diagnostic tools such as uterine artery Doppler velocimetry have been useful in predicting early PE in major medical centers. These PE risk factors, early predictors and diagnostic tools vary vastly in different regions of the Eastern, Western and Developing world. Further understanding of the differences in the demographic, genetic, dietary and environmental factors among pregnant women in different world regions should help in designing a region-specific cluster of risk factors and predictors of PE, and in turn provide better guidance for region-specific tools for early detection and management of PE.

Multiple Gestations and Hypertensive Disorders of Pregnancy: What Do We Know?

PURPOSE OF REVIEW

The occurrence of hypertensive disorders of pregnancy (HDP) including gestational hypertension, chronic hypertension, preeclampsia, and eclampsia is proportional to the number of fetuses: singletons 6.5%, twins 12.7%, and triplets 20.0%. Literature on HDP in multifetal gestation is sparse compared with singletons. We aim to summarize the current evidence on HDP, specifically in twins.

RECENT FINDINGS

HDP occurs more frequently, at an earlier gestational age, and can present more severely and atypically in twin pregnancies. HDP in twins carries a higher risk of maternal/fetal morbidity and mortality including renal failure, stroke, cardiac arrest, pulmonary edema, placental abruption, cesarean delivery, fetal growth restriction, and iatrogenic preterm delivery. Low-dose aspirin (60-150 mg) should be initiated in all multifetal pregnancies to reduce the risk of preeclampsia. To improve outcomes and reduce inherent risks associated with multiple gestations, twins should be managed as high-risk pregnancies, and different from singletons.

Evaluating the Effect of Utrogestan on Idiopathic Intrauterine Growth Retardation

Background:

Intrauterine growth factor (IUGR) is one of the most important causes of neonatal mortality. The aim of this study was to evaluate the therapeutic effect of utrogestan on the treatment of IUGR and its complications.

Materials and Methods:

In this clinical trial, 66 pregnant women with idiopathic IUGR embryos were enrolled. Patients in the intervention group, in addition to receiving routine treatment of control group (high-protein diet, resting), took utrogestan capsules (100 mg) twice daily. The primary and secondary outcomes of the disease were recorded in a checklist. Data were analyzed using SPSS 18 using an independent t-test, Chi-square test, and Fisher's exact test.

Results:

In the intervention group, mean neonatal weight (P = 0.003), mean neonatal Apgar score (P = 0.001), and mean gestational age at birth (P = 0.001) were significantly higher than those in the control group. There was no neonatal death in the intervention group, whereas in the control group, four cases of neonatal death were observed (P = 0.03). In the majority of subjects in the intervention group, resistance index, and pulsatility index of the umbilical artery decreased (P = 0.002). The difference in abdominal circumference and gestational age in the intervention group decreased (P = 0.01). In the intervention group, the diastolic flow of the umbilical artery increased (P = 0.002).

Conclusion:

Utrogestan was effective as an inexpensive and effective way to treat IUGR and improve pregnancy outcomes.

The Utility of Myometrial and Cervical Ultrasound Shear Wave Elastography in the Diagnosis of Ectopic Pregnancy

We aimed to assess the potential utility of myometrial and cervical elasticity measurement in the diagnosis of ectopic pregnancy (EP), which could facilitate the diagnosis process. Myometrial and cervical elasticity values were measured in women with EP, women with early intrauterine pregnancy (IP) and non-pregnant women. Transabdominal point shear wave elastography (pSWE) was used for elasticity measurements. A reliability study was performed in 20 patients of the non-pregnant group. Cervical pSWE showed poor reliability and high measurement failure rate; thus, we excluded cervical elasticity assessment from the study. In this study, 32 women with EP, 28 women with early IP and 38 non-pregnant women were enrolled for myometrial elasticity assessment by pSWE. Myometrial elasticity values were statistically significantly lower in EP (8.31 kPa [5.1-27]) and early IP (8.83 kPa [4.5-46.2]) groups than in non-pregnant women (14.85 kPa [5.1-28]) (p = 0.003). However, myometrial pSWE results were not significantly different between EP and early IP groups. In light of this data, quantitative assessment of the uterus elasticity using pSWE does not seem to be an adequate diagnostic method for EP.

The effect of aspirin on preeclampsia, intrauterine growth restriction and preterm delivery among healthy pregnancies with a history of preeclampsia

BACKGROUND

Due to the significance of preeclampsia (PE) and its adverse outcomes in the health of both mother and newborn, the present study was carried out to investigate the effect of aspirin on preventing the occurrence of PE, intrauterine growth restriction (IUGR), and preterm delivery in women with a previous history of PE.

METHODS

The present clinical trial was conducted on 90 pregnant women with a previous history of PE referred to the Khalij Fars Hospital in Bandar Abbas, Hormozgan Province Iran from April 2017 to August 2018. The subjects of the study were randomly assigned into two groups of intervention and control to receive either 80 mg of aspirin or placebo daily during the pregnancy. Patients' information was obtained and recorded upon entering the study, follow-up visits, and childbirth.

RESULTS

Among participants who entered the clinical trial, 86 patients (95.6%) completed the study. During the pregnancy, systolic blood pressure increased by 8.25 ± 14.83 and 19.06 ± 18.33 mmHg in aspirin and placebo groups, respectively (p = 0.001). Also, the same happened with diastolic blood pressure (6.12 ± 11.46 vs 13.48 ± 13.95 mmHg, p = 0.010). The rate of PE was equal to 27 (62.8%) and 38 (88.4%) in the aspirin and placebo groups, respectively (aOR = 0.23, p = 0.013). In the aspirin group, the rate of IUGR was equal to 27.9% compared with 25.6% of newborns in the control group (aOR = 1.18, p = 0.750). Similarly, there was no significant difference in the rate of preterm delivery between the two groups (p = 0.061).

CONCLUSION

The findings of the present study conducted exclusively on women with previous documented PE revealed that taking aspirin may have a preventive effect on PE in the current pregnancy.

Predictive values of clinical parameters and biophysical and biochemical markers in the first trimester for the detection of small-for-gestational age fetuses

OBJECTIVES

To evaluate the predictive values of maternal characteristics, biophysical parameters (mean arterial pressure [MAP] and Doppler uterine artery measurements), and biochemical parameters (pregnancy-associated plasma protein A [PAPP-A] and placental growth factor [PlGF]) alone and in association for small-for-gestational age (SGA) fetuses.

METHODS

We performed a retrospective analysis of a prospective observational study that evaluated 615 pregnant women in the first trimester using ultrasonography. For all the women, information regarding clinical and obstetric histories, MAP, and uterine artery mean pulsatility index (UtA-PI), and blood samples for analysis of biochemical markers (PAPP-A and PlGF) were obtained. The patients were grouped according to birth weight as follows: group I (n=571), >10th percentile (control); group II (n=44), <10th percentile; and group III (n=34), <5th percentile. The predictive values of the variables for the detection of SGA fetuses were calculated using a logistic regression model and an analysis of the area under the receiver-operating characteristic curve (AUC).

RESULTS

The sensitivity rates of the maternal characteristics, biophysical markers (MAP and UtA-PI), biochemical markers (PAPP-A and PlGF), and the association between them were: 23.3, 32.5, 25, and 30% respectively, at a false-positive (FP) rate of 10%, in group II and 26.5, 26.5, 23.5, and 23.5%, respectively, at a FP rate of 10% in group III.

CONCLUSIONS

The predictive performances of the combination of maternal characteristics and biophysical and biochemical parameters were unsatisfactory, with a slight improvement in the predictive capacity for SGA fetuses <10th percentile.

Role of second-trimester uterine artery Doppler indices in the prediction of adverse pregnancy outcomes in a low-risk population

OBJECTIVE

To evaluate use of second-trimester uterine artery Doppler velocimetry to predict adverse pregnancy outcomes.

METHODS

A prospective longitudinal study among low-risk nulliparous women with singleton pregnancies attending Ekiti State University Teaching Hospital, Nigeria, between July and December 2017. Uterine artery Doppler indices were measured at 22-26 gestational weeks. Resistance index (RI) of 0.58 or less and pulsatility index (PI) of 1.6 or less were considered normal. The ability of Doppler indices to predict adverse pregnancy outcomes was determined.

RESULTS

Among 120 women, 73 (60.8%) women had at least one abnormal Doppler index and 50 (41.7%) at least one adverse pregnancy outcome. For pre-eclampsia, sensitivity and specificity of RI were 40.0% and 37.3% (area under curve [AUC], 0.28), and those of PI were 20.0% and 89.1% (AUC, 0.33) respectively. For intrauterine growth restriction, sensitivity and specificity of RI were 23.1% and 34.6% (AUC, 0.22), and those of PI were 0% and 86.95% (AUC, 0.48), respectively. For low birthweight, sensitivity and specificity of RI were 60.0% and 38.9% (AUC, 0.54), and those of PI were 20.0% and 90.5% (AUC, 0.55), respectively.

CONCLUSION

Late second-trimester uterine artery Doppler velocimetry had limited ability to predict adverse pregnancy outcomes in a low-risk population.

Pre-eclampsia screening in the first trimester - preemptive action to prevent the peril

Pre-eclampsia complicating 2-5% of pregnancies is an obstetrical syndrome associated with deleterious short-and long-term consequences to the gravid women, the fetus and the neonate. Majority of the obstetrical complications occur in early pre-eclampsia (requiring delivery <34 weeks). The risk factor based approach recommended by the professional organizations for pre-eclampsia screening has shown suboptimal clinical performance. The combined multimarker screening for pre-eclampsia encompassing documentation of maternal medical history, measurement of mean arterial pressure, estimation of the maternal serum levels of placental growth factor, pregnancy associated plasma protein-A, and recording the Uterine artery mean pulsatility index, performed in the first trimester between 11 and 13 + 6 weeks has proven to be an effective screening strategy. The a-priori risk is determined by multivariate analysis of the factors from history, while the other parameters are converted to log 10 transformed multiple of median values. Bayes' theorem is used to calculate the final risk. The above model has shown to detect 77% of preterm pre-eclampsia (<37 weeks), 96% of early preterm pre-eclampsia (<34 weeks), 38% of term pre-eclampsia and 54% of all pre-eclampsia, at a false positive rate of 10%. Uterine artery Doppler is key to pre-eclampsia screening. Currently a risk of >1:100 for pre-eclampsia developing before 37 weeks (preterm pre-eclampsia) is regarded as screen positive. Aspirin at a dose of 150 mg at bedtime given to screen positive subjects is associated with a significant reduction of preterm pre-eclampsia and early pre-eclampsia. The intervention is now supported by a well conducted randomized trial and metanalysis data. Aspirin acts by diminishing stores of constitutive cyclooxygenase enzyme in the non-nucleated platelets without disturbing systemic prostaglandin production. Selective use of aspirin in screen positive women is associated with a very low incidence of adverse maternal, fetal and neonatal side effects. The screening protocol can be applied to twin pregnancies albeit minor differences. Hence, screening for pre-eclampsia in first trimester, which is now endorsed by the federation of international obstetrical and gynecological societies, should be offered universally to all women at 11 to 13 + 6 weeks of gestation, followed by the administration of aspirin and serial maternal-fetal surveillance in the screen positive woman.

Preeclampsia – Prediction and Monitoring Factors

Preeclampsia is one of the leading causes of maternal and perinatal morbidity and mortality, usually characterized by hypertension and proteinuria. Despite high incidence of preeclampsia the pathophysiological basis of preeclampsia is still not clear and there are a number of mechanisms and signaling pathways that intertwine. It is very important to develop specific and reliable predictive algorithms in order to enable early initiation of therapy due to facts that incidence of preeclampsia has upward trend and that cause adverse maternal and fetal outcome. Some of the most commonly used methods for prediction of preeclampsia include uterine artery Doppler velocimetry, determination of some microRNA, such as miR-210, and assessment of various pro-angiogenic and anti-angiogenic factors from blood. Angiogenic factors that possibly have most important role in pathogenesis of preeclampsia are vascular endothelial growth factor (VEGF) and placental growth factor (PlGF), which promote angiogenesis, and soluble fms-like tyrosine kinase-1 (sFlt1) and soluble form of endoglin (s-Eng), which exhibit anti-angiogenic properties. Aggravating circumstance is that preeclampsia has heterogeneous origin, and due to this fact, the value of individual markers can vary significantly. There is a constant tendency for creating comprehensive algorithm for prediction of preeclampsia which would be sufficiently specific and sensitive, and in the same time cheap and available. In that sense, new clinical studies are needed to show the most effective combination of parameters in the predeclampsia prediction.

The Transverse versus the Sagittal Approach in First-Trimester Uterine Artery Doppler Measurement

Objective

The uterine artery pulsatility index (UtA-PI) is an important marker for predicting and assessing the risk of various complications such as pre-eclampsia and fetal growth restriction. The measurement of UtA-PI in the first trimester is usually conducted via the sagittal approach. The aim of this study was to evaluate UtA Doppler measurement using the transverse approach in the first trimester.

Methods

This was a prospective observational study of 50 women with singleton pregnancy at between 11-13+6 weeks of gestation. Uterine artery (UtA) Doppler variables were measured using both the transverse and sagittal approach. The two approaches were compared in terms of time required to complete the measurements and early diastolic notch. The sample t-test and Wilcoxon rank sign test were used to analyze the outcomes when appropriate. Bland-Altman plots were used to determine the agreement between the two approaches. A P-value <0.05 was considered statistically significant. Intra-class correlation (ICC) was used to evaluate the reliability of measurements.

Results

There were a total of 50 pregnant women who participated in the study and completed the study protocol. The mean age of all subjects was 29.6 years, and 24 (48%) were nulliparous. We observed no difference in terms of mean UtA-PI between the two approaches (sagittal: 2.04, transverse: 2.03; mean difference 0.01, CI -0.01, 0.04; p>0.309), nor in the means of any other UtA variables. However, there were differences between the two approaches in terms of early diastolic notch (sagittal: 11, transverse: 13; p>0.999) and the mean time required to complete the measurements (transverse: 21.7 s, sagittal: 24.3 s; p=0.001). The intra-class correlation coefficients (ICCs) were 0.985, 0.963, and 0.988 for the right, left, and mean UtA-PIs respectively.

Conclusion

The transverse approach at a bladder depth of less than 5 cm performed better than the sagittal approach in the measurement of first-trimester uterine arteries. It may, thus, may be useful as a complementary approach in cases in which there is difficulty obtaining measurements using the sagittal approach.

Assessment of β-human-derived chorionic gonadotrophic hormone (βhCG) and pregnancy-associated plasma protein A (PAPP-A) levels as predictive factors of preeclampsia in the first trimester among Iranian women: a cohort study

Background

Preeclampsia (PE) is a leading cause of maternal and perinatal mortality. There are controversial findings regarding the prediction of PE through the assessment of the Pregnancy-Associated Plasma Protein A (PAPP-A) and β-Human-Derived Chorionic Gonadotrophic hormone (βhCG) levels in the first trimester of pregnancy. Therefore, this cohort study was conducted to evaluate of PAPP-A and βhCG levels as predictive factors for PE development in the first trimester among Iranian women.

Methods

In this cohort study, a total of 4605 volunteer Primigravida and Multigravida women were selected by the census from 16 randomly selected Health Centers in Isfahan, Iran, from July 2016 to June 2018. Eligible pregnant women participated in the study had already undergone fetal anomalies screening tests between 11 + 0 and 13 + 6 weeks of pregnancy and their PAPP-A and βhCG biomarkers were adjusted to the Multiples of the Median (MOM). MOM PAPP-A <  0.4 and MOM βhCG > 3 were considered abnormal. The samples were followed up until delivery. The biomarkers’ levels were compared in the two groups of women with and without PE and Relative risk (RR) and odds ratio (OR) of PE calculated.

Results

In the PE group, the mean MOM PAPP-A was significantly lower (1 vs. 1.09 with P = 0.006) and MOM βhCG was significantly higher (1.51 vs. 1.14 with P = 0.001) than the group without PE. RR and OR for PE in subjects with MOM PAPP-A <  0.4 were reported as follows: RR = 2.49, (p = 0.001) and OR = 2.09, (p = 0.001). RR and OR for PE in subjects with MOM βhCG > 3 were also reported as follows: RR = 4.02, (p = 0.001) and OR = 5.65, (p = 0.001). Adjusted OR for MOM PAPP-A <  0.4 and MOM βhCG > 3 was obtained as follows: OR = 2.09 (P = 0.001) and OR = 5.65 (P = 0.001), respectively.

Conclusion

The results of the study showed that the high levels of βhCG would cause 5.65 times increase and the low levels of PAPP-A would cause 2.09 times increase in the chance of developing PE.

Association between fetal fraction at the second trimester and subsequent spontaneous preterm birth

OBJECTIVE

To evaluate the association between the fetal fraction of cell-free DNA at the second trimester and subsequent spontaneous preterm birth.

METHODS

In this retrospective cohort study, data were collected from women with singleton pregnancies who underwent noninvasive prenatal testing at 14 to 25 weeks of gestation. The eligible patients were classified into three groups according to pregnancy outcome: birth at ≥37 weeks of gestation (term group), delivery at <34 weeks of gestation (early spontaneous preterm), and delivery at 34⁺⁰ to 36⁺⁶  weeks of gestation (late spontaneous preterm). Stepwise linear regression was performed to determine the maternal characteristics associated with the fetal fraction of cell-free DNA. Logistic regression was used to determine the relationship between the fetal fraction of cell-free DNA and pregnancy outcomes by adjusting for history of preterm birth.

RESULTS

A total of 8129 singleton pregnancies met the recruitment criteria. Among them, 7790 (95.83%) were in the term group, 284 (3.49%) were in the late spontaneous preterm group, and 55 (0.68%) were in the early spontaneous preterm group. The fetal fraction of cell-free DNA was negatively correlated with body mass index, maternal age, nulliparity, and history of spontaneous preterm birth; positively correlated with gestational age; and not correlated with assisted reproduction or surface antigen of hepatitis B virus (HBsAg) positivity. After adjusting for history of preterm birth, a logistic regression analysis demonstrated no statistically significant associations between the fetal fraction of cell-free DNA and spontaneous preterm birth in any of the preterm groups (<34 weeks, 34⁺⁰ to 36⁺⁶  weeks, and <37 weeks).

CONCLUSION

Our preliminary study found no relationship between the fetal fraction on NIPT at the second trimester and subsequent spontaneous preterm birth.

The first trimester uterine artery Doppler: comparison between sagittal and transverse techniques

CONTEXT

Preeclampsia is a major cause of maternal and perinatal morbidity and mortality worldwide, affecting about 2-3% of all pregnancies. There is consistent evidence today that starting to take aspirin before the 16th week of gestation manages to halve the prevalence of PE and also reduces the incidence of fetal growth restriction, hence the importance of being able to identify early high-risk pregnant women regarding those outcomes and thus finding candidates for the use of that medication. Therefore, interest in methods of PE screening and prediction has increased in recent years.

MATERIALS AND METHODS

A retrospective study was carried out by means of a review of the medical records of pregnant women submitted to the first trimester morphological examination at Mater Dei Healthcare Network from August 2017 to January 2018, which included the Doppler study of the uterine arteries performed using longitudinal and transverse insonation techniques, for calculating PE risk in the way recommended by the Fetal Medicine Foundation. Then, a comparative analysis of uterine artery mean pulsatility index (PI) measured transversally and longitudinally was performed.

RESULTS

The value for the PI in the sagittal plane (1.634 ± 0.52) was highly correlated (ICC = 0.85) and similar to the value found for the cross-section (1.633 ± 0.54), with no statistically significant differences between them (p = .93). Bland Altman's analysis highlighted the existence of a very tight agreement between both methods of measuring PI.

CONCLUSION

The pulsatility index of uterine arteries can be measured in a reliable and easily reproducible way using both the sagittal and transverse techniques, with no change in the final outcome of preeclampsia screening through the Fetal Medicine Foundation (FMF) algorithm.

Placental MRI: Developing Accurate Quantitative Measures of Oxygenation

The Human Placenta Project has focused attention on the need for noninvasive magnetic resonance imaging (MRI)-based techniques to diagnose and monitor placental function throughout pregnancy. The hope is that the management of placenta-related pathologies would be improved if physicians had more direct, real-time measures of placental health to guide clinical decision making. As oxygen alters signal intensity on MRI and oxygen transport is a key function of the placenta, many of the MRI methods under development are focused on quantifying oxygen transport or oxygen content of the placenta. For example, measurements from blood oxygen level-dependent imaging of the placenta during maternal hyperoxia correspond to outcomes in twin pregnancies, suggesting that some aspects of placental oxygen transport can be monitored by MRI. Additional methods are being developed to accurately quantify baseline placental oxygenation by MRI relaxometry. However, direct validation of placental MRI methods is challenging and therefore animal studies and ex vivo studies of human placentas are needed. Here we provide an overview of the current state of the art of oxygen transport and quantification with MRI. We suggest that as these techniques are being developed, increased focus be placed on ensuring they are robust and reliable across individuals and standardized to enable predictive diagnostic models to be generated from the data. The field is still several years away from establishing the clinical benefit of monitoring placental function in real time with MRI, but the promise of individual personalized diagnosis and monitoring of placental disease in real time continues to motivate this effort.