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Turan OM, Babischkin JS, Aberdeen GW, Turan S, Pepe GJ, Albrecht ED. B-Flow/Spatiotemporal Image Correlation M-Mode and Contrast-Enhanced/Microbubble Ultrasonography Quantification of Spiral Artery Distensibility and Placental Intervillous Perfusion in the First Trimester in a Primate Model of Impaired Spiral Artery Remodeling. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:2557-2564. [PMID: 37749012 PMCID: PMC10591761 DOI: 10.1016/j.ultrasmedbio.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/17/2023] [Accepted: 08/28/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE During early human pregnancy, placental trophoblasts remodel spiral arteries into distensible low-resistance vessels to promote placental perfusion. We have established a model of impaired spiral artery remodeling (SAR) by elevating estradiol levels in the first trimester of baboon pregnancy. In the present study, B-flow/spatiotemporal image correlation (STIC) M-mode ultrasonography, a non-Doppler technology for sharp rendering of vessel dimensions, was used to determine whether spiral artery distensibility was altered in SAR-suppressed baboons. Contrast-enhanced ultrasound/microbubble imaging was also performed to determine whether it detected changes in placenta intervillous space perfusion in SAR-suppressed baboons. METHODS The two imaging procedures were performed in the first trimester in baboons not treated or treated with estradiol to suppress SAR. RESULTS Spiral artery distensibility, that is, luminal diameter at systole minus diameter at diastole, and volume flow as quantified by B-flow/STIC M-mode were 26% (p = 0.03) and 55% (p = 0.059) lower, respectively, in SAR-suppressed baboons. However, placental intervillous space flow rate and video intensity plateau levels reflecting blood perfusion, quantified by contrast-enhanced ultrasound/microbubble imaging, were unaltered in SAR-suppressed baboons. CONCLUSION The results indicate that B-flow/STIC M-mode ultrasonography provides a non-invasive method to detect reduced distensibility and, thus, function of spiral arteries across the cardiac cycle in the first trimester in a primate model of impaired SAR. This study represents a first step in determining whether B-flow/STIC M-mode detects a similar defect in SAR early in adverse human pregnancy. This would provide an avenue to develop therapeutic modalities to prevent the devastating consequences of impaired SAR.
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Affiliation(s)
- Ozhan M Turan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jeffery S Babischkin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Graham W Aberdeen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sifa Turan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Gerald J Pepe
- Department of Physiological Sciences, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Eugene D Albrecht
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA.
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Evaluation of placental growth potential and placental bed perfusion by 3D ultrasound for early second-trimester prediction of preeclampsia. J Assist Reprod Genet 2022; 39:1545-1554. [PMID: 35670921 DOI: 10.1007/s10815-022-02530-z] [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: 02/15/2022] [Accepted: 05/26/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE This study aimed to investigate whether placental parameters measured by three-dimensional ultrasound are associated with preeclampsia (PE) and small-for-gestational-age (SGA). METHODS In total, 1163 pregnancies at 11-14 weeks of gestation were recruited between October 8, 2020, and April 30, 2021. Placenta volume (PV), placental bed vascularization flow index (PBVFI), and uterine arteries pulse index (UtA-PI) were measured. Placental quotient (PQ = PV/weeks of gestation) was calculated. All participants were re-examined 4 weeks later. The placental volume growth rate (PVGR = placental volume difference between the two examinations/interval days) was also calculated. Patients were divided into four groups by the gestational age at the onset of PE and birth weight: early-onset PE (E-PE, n = 18), late-onset PE (L-PE, n = 36), isolated SGA5 (birth weight less than the fifth percentile for gestational age without PE, n = 9), and unaffected (n = 1100) groups. RESULTS A predictive model for E-PE was established, which consisted of unnatural conception, chronic hypertension, PBVFI (of second examination), and PVGR for E-PE; 94.4% sensitivity and 96.7% specificity by receiver operating characteristic curve analysis. CONCLUSIONS Overall, decreased placental growth potential and low placental bed perfusion in the early second trimester have potential in predicting E-PE.
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Turan OM, Babischkin JS, Aberdeen GW, Turan S, Harman CR, Pepe GJ, Albrecht ED. B-flow/spatiotemporal image correlation M-mode: novel ultrasound method that detects decrease in spiral artery luminal diameter in first trimester in primate model of impaired spiral artery remodeling. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:358-364. [PMID: 34358371 PMCID: PMC9301675 DOI: 10.1002/uog.23753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To determine if B-flow/spatiotemporal image correlation (STIC) M-mode ultrasonography detects a decrease in spiral artery luminal diameter and volume flow during the first trimester in a non-human primate model of impaired spiral artery remodeling (SAR). METHODS Pregnant baboons were treated daily with estradiol benzoate on days 25-59 of the first trimester (term, 184 days), or remained untreated. On day 60 of gestation, spiral artery luminal diameter (in seven untreated and 12 estradiol-treated baboons) and volume flow (in four untreated and eight estradiol-treated baboons) were quantified by B-flow/STIC M-mode ultrasonography. In addition, in 15 untreated and 18 estradiol-treated baboons, the percent of spiral arteries remodeled by extravillous trophoblasts was quantified ex vivo by immunohistochemical image analysis on placental basal plate tissue collected via Cesarean section on day 60. Findings were compared between treated and untreated animals. The correlation between spiral artery luminal diameter and percent of SAR was assessed in three untreated and six estradiol-treated baboons which underwent both B-flow/STIC M-mode ultrasound and quantification of SAR. RESULTS The proportion of spiral arteries greater than 50 µm in diameter remodeled by extravillous trophoblasts was 70% lower in estradiol-treated baboons than in untreated animals (P = 0.000001). Spiral artery luminal diameter in systole and diastole, as quantified by B-flow/STIC M-mode in the first trimester of pregnancy, was 31% (P = 0.014) and 50% (P = 0.005) lower, respectively, and volume flow was 85% lower (P = 0.014), in SAR-suppressed baboons compared with untreated animals. There was a significant correlation between spiral artery luminal diameter as quantified by B-flow/STIC M-mode ultrasonography and the percent of SAR (P < 0.05). CONCLUSION B-flow/STIC M-mode ultrasonography provides a novel real-time non-invasive method to detect a decrease in uterine spiral artery luminal diameter and volume flow during the cardiac cycle, reflecting decreased distensibility of the vessel wall, in the first trimester in a non-human primate model of defective SAR. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- O. M. Turan
- Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of Maryland School of MedicineBaltimoreMDUSA
| | - J. S. Babischkin
- Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of Maryland School of MedicineBaltimoreMDUSA
| | - G. W. Aberdeen
- Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of Maryland School of MedicineBaltimoreMDUSA
| | - S. Turan
- Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of Maryland School of MedicineBaltimoreMDUSA
| | - C. R. Harman
- Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of Maryland School of MedicineBaltimoreMDUSA
| | - G. J. Pepe
- Department of Physiological SciencesEastern Virginia Medical SchoolNorfolkVAUSA
| | - E. D. Albrecht
- Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of Maryland School of MedicineBaltimoreMDUSA
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Chen J, Chen M, Wu X, Sun J, Zhang Y, Li Y, Zhong L, Yu B, Luo J, Liu J. The value of placental vascularization indices for predicting preeclampsia and fetal growth restriction in different stages of gestation: A prospective and longitudinal study. Placenta 2022; 122:1-8. [DOI: 10.1016/j.placenta.2022.03.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/16/2022] [Accepted: 03/25/2022] [Indexed: 02/02/2023]
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Bertholdt C, Dap M, Beaumont M, Duan J, Morel O. New insights into human functional ultrasound imaging. Placenta 2021; 117:5-12. [PMID: 34768169 DOI: 10.1016/j.placenta.2021.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 08/23/2021] [Accepted: 10/06/2021] [Indexed: 12/17/2022]
Abstract
Ultrasound imaging is a vital tool for exploring in vivo the placental function which is essential to understand pathological phenomena such as preeclampsia or intrauterine growth restriction. As technology advances including ready availability of three-dimensional (3D) probes and novel software, new markers of placental function become possible. The objective of this review was to provide an overview of the new ultrasound markers of placental function with a focus on the potential clinical application of three-dimensional power Doppler (3DPD). A broad-free text literature search was undertaken based on human placental studies and sixty full-text studies were included in this review. Three-dimensional power Doppler is a promising technique to predict preeclampsia in the first trimester. However, the influence of external factors such as body mass index, parameter standardisation and machine settings still need to be addressed. Contrast-enhanced ultrasound is currently reserved for research, because the required injected contrast mediums are not currently approved for use in pregnancy, although the safety data is reassuring.
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Affiliation(s)
- C Bertholdt
- Université de Lorraine, CHRU-Nancy, Pôle de Gynécologie-Obstétrique, F-54000 Nancy, France; Université de Lorraine, Inserm, IADI, F-54000 Nancy, France.
| | - M Dap
- Université de Lorraine, CHRU-Nancy, Pôle de Gynécologie-Obstétrique, F-54000 Nancy, France
| | - M Beaumont
- CHRU-Nancy, Inserm, Université de Lorraine, CIC, Innovation Technologique, F-54000 Nancy, France
| | - J Duan
- Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Hubei, 430071, China; Gynecology and Obstetrical Service, Zhongnan Hospital of Wuhan University, Hubei, 430071, China
| | - O Morel
- Université de Lorraine, CHRU-Nancy, Pôle de Gynécologie-Obstétrique, F-54000 Nancy, France; Université de Lorraine, Inserm, IADI, F-54000 Nancy, France
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Srinivasan V, Melbourne A, Oyston C, James JL, Clark AR. Multiscale and multimodal imaging of utero-placental anatomy and function in pregnancy. Placenta 2021; 112:111-122. [PMID: 34329969 DOI: 10.1016/j.placenta.2021.07.290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 06/09/2021] [Accepted: 07/19/2021] [Indexed: 12/12/2022]
Abstract
Placental structures at the nano-, micro-, and macro scale each play important roles in contributing to its function. As such, quantifying the dynamic way in which placental structure evolves during pregnancy is critical to both clinical diagnosis of pregnancy disorders, and mechanistic understanding of their pathophysiology. Imaging the placenta, both exvivo and invivo, can provide a wealth of structural and/or functional information. This review outlines how imaging across modalities and spatial scales can ultimately come together to improve our understanding of normal and pathological pregnancies. We discuss how imaging technologies are evolving to provide new insights into placental physiology across disciplines, and how advanced computational algorithms can be used alongside state-of-the-art imaging to obtain a holistic view of placental structure and its associated functions to improve our understanding of placental function in health and disease.
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Affiliation(s)
| | - Andrew Melbourne
- School of Biomedical Engineering & Imaging Sciences, Kings College London, UK
| | - Charlotte Oyston
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Joanna L James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Alys R Clark
- Auckland Bioengineering Institute, University of Auckland, New Zealand
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Abdallah A, Khairy M, Tawfik M, Mohamed S, Abdel-Rasheed M, Salem S, Khalifa E. Role of first-trimester three-dimensional (3D) power Doppler of placental blood flow and 3D placental volume in early prediction of pre-eclampsia. Int J Gynaecol Obstet 2020; 154:466-473. [PMID: 33368264 DOI: 10.1002/ijgo.13572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/11/2020] [Accepted: 12/22/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the efficacy of first-trimester three-dimensional (3D) placental volume as well as 3D power Doppler of placental vascular indices for early prediction of pre-eclampsia. METHODS The prospective cohort study included over 2019 women with a singleton pregnancy in their first trimester at 11-13+ weeks of pregnancy. All women were examined by 3D abdominal ultrasound, including Doppler techniques for the placental volume and placental vascular indices. Uterine artery Doppler indices were also assessed. All participants were cared for until delivery for assessment of pregnancy outcomes. RESULTS In all, 163 women developed pre-eclampsia while 1856 women remained normotensive. The women with pre-eclampsia had significantly lower placental volume (77.09 ml vs. 99.8 ml, p < 0.001), and placental vascular indices (vascularization index, flow index, and vascularization flow index were 7.41 vs. 9.89, 39.03 vs. 46.63, and 2.77 vs. 4.4, respectively, p < 0.001). In contrast, women with pre-eclampsia had significantly high mean uterine pulsatility index and resistance index (2.02 vs. 1.11, 0.83 vs. 0.64, respectively, p < 0.001) compared with the normotensive women. The placental vascular indices were highly sensitive, whereas the placental volume and the mean uterine pulsatility index and resistance index had higher specificity for the prediction of pre-eclampsia. CONCLUSION First-trimester assessment through 3D placental volume and power Doppler of placental vascular indices, especially in combination with uterine artery Doppler assessment, revealed an increase in the accuracy of early detection of women at risk for developing pre-eclampsia.
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Affiliation(s)
- Ameer Abdallah
- Department of Obstetrics and Gynecology, Minia University, Minia, Egypt
| | - Mohammed Khairy
- Department of Obstetrics and Gynecology, Minia University, Minia, Egypt
| | - Mohamed Tawfik
- Department of Obstetrics and Gynecology, Minia University, Minia, Egypt
| | - Safaa Mohamed
- Department of Obstetrics and Gynecology, Minia University, Minia, Egypt
| | - Mazen Abdel-Rasheed
- Department of Reproductive Health Research, National Research Centre, Cairo, Egypt
| | - Sondos Salem
- Department of Reproductive Health Research, National Research Centre, Cairo, Egypt
| | - Eissa Khalifa
- Department of Obstetrics and Gynecology, Minia University, Minia, Egypt
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Mathewlynn S, Collins SL. Volume and vascularity: Using ultrasound to unlock the secrets of the first trimester placenta. Placenta 2019; 84:32-36. [PMID: 31279487 DOI: 10.1016/j.placenta.2019.06.379] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 06/19/2019] [Accepted: 06/22/2019] [Indexed: 11/19/2022]
Abstract
Fetal growth restriction (FGR) is a major cause of perinatal morbidity and mortality. Identifying which pregnancies are at risk of FGR facilitates enhanced surveillance and early delivery before fetal demise can ensue. However, existing risk stratification strategies yield an unacceptably low detection rate. A robust and reliable first trimester screening test for FGR would not only enable high-risk women to be appropriately monitored but would facilitate future trials for possible interventions to enhance fetal growth. Both the volume and vascularity of the first trimester placenta has been demonstrated to be linked to adverse pregnancy outcomes including FGR and pre-eclampsia. The investigation of novel ultrasound markers for FGR are discussed along with the development of methods for fully automatic placental volume estimation which has the potential for use as part of a multi-variable population-based screening test.
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Affiliation(s)
- S Mathewlynn
- Department of Obstetrics and Gynaecology, Milton Keynes University Hospital, Milton Keynes, UK
| | - S L Collins
- Nuffield Department of Women's and Reproductive Health, University of Oxford, UK; Fetal Medicine Unit, The Women's Centre, John Radcliffe Hospital, Oxford, UK.
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Choux C, Ginod P, Barberet J, Rousseau T, Bruno C, Sagot P, Astruc K, Fauque P. Placental volume and other first-trimester outcomes: are there differences between fresh embryo transfer, frozen-thawed embryo transfer and natural conception? Reprod Biomed Online 2018; 38:538-548. [PMID: 30850320 DOI: 10.1016/j.rbmo.2018.12.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/20/2018] [Accepted: 12/10/2018] [Indexed: 12/13/2022]
Abstract
RESEARCH QUESTION Does mode of conception influence placental volume and other first-trimester outcomes? DESIGN This retrospective single-centre case-control study led in Dijon University Hospital included 252 singleton pregnancies (84 IVF with either fresh embryo transfer or frozen-thawed embryo transfer [FET] and 168 natural conceptions). First-trimester placental volume, uterine artery pulsatility index and maternal serum PAPP-A and beta-HCG were measured. Statistical analyses were adjusted for gestational age, the newborn's gender, maternal age, parity, body mass index and smoking status. RESULTS Placental volume was significantly greater in the FET group than in the control group (P = 0.043) and fresh embryo transfer (P = 0.023) groups. At birth, fresh embryo transfer newborns were significantly smaller than controls (P = 0.01) and FET newborns (P = 0.008). Postpartum haemorrhage was far more frequent in FET than in controls and fresh embryo transfer group (38.1%, 2.6% and 1.9%, respectively; P < 0.0001). Placental volume positively correlated with PAPP-A, beta-HCG and the newborn's birth weight, and negatively correlated with uterine artery pulsatility index. CONCLUSIONS Placental volume and other first-trimester parameters are modified by IVF with fresh embryo transfer and FET compared with natural conception, but with opposite trends. Given the different protocols used for these techniques, hormonal treatment per se may have a major effect on pregnancy outcomes through the modification of placental invasiveness.
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Affiliation(s)
- Cécile Choux
- Dijon University Hospital, Fetal Health and Infertility Department, Dijon F-21000, France.
| | - Perrine Ginod
- Dijon University Hospital, Fetal Health and Infertility Department, Dijon F-21000, France
| | - Julie Barberet
- Dijon University Hospital, Reproductive Biology Department, Dijon F-21000, France
| | - Thierry Rousseau
- Dijon University Hospital, Fetal Health and Infertility Department, Dijon F-21000, France
| | - Céline Bruno
- Dijon University Hospital, Reproductive Biology Department, Dijon F-21000, France
| | - Paul Sagot
- Dijon University Hospital, Fetal Health and Infertility Department, Dijon F-21000, France
| | - Karine Astruc
- Dijon University Hospital, Epidemiology Unit, Dijon F-21000, France
| | - Patricia Fauque
- Dijon University Hospital, Reproductive Biology Department, Dijon F-21000, France
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Evaluation of the predictive value of placental vascularisation indices derived from 3-Dimensional power Doppler whole placental volume scanning for prediction of pre-eclampsia: A systematic review and meta-analysis. Placenta 2017; 51:89-97. [DOI: 10.1016/j.placenta.2017.01.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/13/2016] [Accepted: 01/04/2017] [Indexed: 12/18/2022]
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Matevosyan NR. Predictive accuracy of the first trimester Doppler scan: a meta-study. Wien Med Wochenschr 2015; 165:199-209. [PMID: 26077833 DOI: 10.1007/s10354-015-0358-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 04/29/2015] [Indexed: 12/16/2022]
Abstract
AIM To determine sensitivity and cut-off indices of the uterine artery Doppler (UAD) in prediction of preeclampsia and fetal growth restriction (FGR). METHODS Seventy-six studies published in 1995-2014, present 298,329 prenatal Doppler screenings performed in nullipara in the first and early second trimesters of singleton pregnancies. The sample is stratified into four groups based on the Doppler sensitivity and specificity indices pertaining to the major clinical endpoints of the cohort. RESULTS The FGR diagnostic specificity (r = 0.728) and bilateral notching index (r = 0.803) correlations indicate that the UAD accuracy depends on the placental bed and the screening mode. CONCLUSIONS Predictive sensitivity of the UAD increases after 16 weeks + 3 days (115 days) of gestation. The best predictive parameter of preeclampsia and FGR is the placental side uterine artery resistance index which confers to the highest means when the placenta is on the midline (OR 0.9).
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