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Contribution of Second Trimester Sonographic Placental Morphology to Uterine Artery Doppler in the Prediction of Placenta-Mediated Pregnancy Complications. J Clin Med 2022; 11:jcm11226759. [PMID: 36431236 PMCID: PMC9697802 DOI: 10.3390/jcm11226759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/27/2022] [Accepted: 11/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Second-trimester uterine artery Doppler is a well-established tool for the prediction of preeclampsia and fetal growth restriction. At delivery, placentas from affected pregnancies may have gross pathologic findings. Some of these features are detectable by ultrasound, but the relative importance of placental morphologic assessment and uterine artery Doppler in mid-pregnancy is presently unclear. Objective: To characterize the association of second-trimester sonographic placental morphology markers with placenta-mediated complications and determine whether these markers are predictive of placental dysfunction independent of uterine artery Doppler. Methods: This was a retrospective cohort study of patients with a singleton pregnancy at high risk of placental complications who underwent a sonographic placental study at mid-gestation (160/7−246/7 weeks’ gestation) in a single tertiary referral center between 2016−2019. The sonographic placental study included assessment of placental dimensions (length, width, and thickness), placental texture appearance, umbilical cord anatomy, and uterine artery Doppler (mean pulsatility index and early diastolic notching). Placental area and volume were calculated based on placental length, width, and thickness. Continuous placental markers were converted to multiples on medians (MoM). The primary outcome was a composite of early-onset preeclampsia and birthweight < 3rd centile. Results: A total of 429 eligible patients were identified during the study period, of whom 45 (10.5%) experienced the primary outcome. The rate of the primary outcome increased progressively with decreasing placental length, width, and area, and increased progressively with increasing mean uterine artery pulsatility index (PI). By contrast, placental thickness followed a U-shaped relationship with the primary outcome. Placental length, width, and area, mean uterine artery PI and bilateral uterine artery notching were all associated with the primary outcome. However, in the adjusted analysis, the association persisted only for placenta area (adjusted odds ratio [aOR] 0.21, 95%-confidence interval [CI] 0.06−0.73) and mean uterine artery PI (aOR 11.71, 95%-CI 3.84−35.72). The area under the ROC curve was highest for mean uterine artery PI (0.80, 95%-CI 0.71−0.89) and was significantly higher than that of placental area (0.67, 95%-CI 0.57−0.76, p = 0.44). A model that included both mean uterine artery PI and placental area did not significantly increase the area under the curve (0.82, 95%-CI 0.74−0.90, p = 0.255), and was associated with a relatively minor increase in specificity for the primary outcome compared with mean uterine artery PI alone (63% [95%-CI 58−68%] vs. 52% [95%-CI 47−57%]). Conclusion: Placental area is independently associated with the risk of placenta-mediated complications yet, when combined with uterine artery Doppler, did not further improve the prediction of such complications compared with uterine artery Doppler alone.
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Does a Caesarean Section Scar Affect Placental Volume, Vascularity and Localization? Diagnostics (Basel) 2022; 12:diagnostics12112674. [DOI: 10.3390/diagnostics12112674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 10/21/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Caesarean section is associated with an increased risk of abnormal placental implantation and adverse pregnancy outcomes in subsequent pregnancies. Besides the placenta accrete spectrum, only a few of the previous studies focused on other placental development alterations in the scarred uterus. We assessed placental development deviations in the uterus with a Caesarean section scar by evaluating placental volume (PV) and vascular flow indexes. From 1 January 2021 until 31 March 2022, placental volumes and vascularization indexes (VI, FI, VFI) were prospectively measured by 3D power Doppler and VOCAL techniques in 221 patients attending the first trimester screening program. We also calculated the placental quotient to standardize PV to the gestational age. No statistically significant differences in the values of placental volume, placental quotient and placental vascularization indexes were detected between women with previous Caesarean section delivery or women with vaginal delivery. FI was significantly lower in nulliparous in the first trimester. The results of our study suggest that 3D placental evaluation was not able to detect placental development alteration in the uterus with a Caesarean section scar. Future research needs to verify whether 3D power Doppler and Vocal techniques can provide more information if used in an earlier gestational age.
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Bigelow CA, Robles BN, Pan S, Overbey J, Robin E, Melamed A, Bianco A, Mella MT. Placental cord insertion distance from the placental margin and its association with adverse perinatal outcomes. Eur J Obstet Gynecol Reprod Biol 2020; 255:51-55. [PMID: 33080485 DOI: 10.1016/j.ejogrb.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/28/2020] [Accepted: 10/08/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The placental cord insertion (PCI) to the placental margin has not been well studied as a continuous variable in relation to birth outcomes. We sought to evaluate the impact of PCI distance on outcomes associated with placental function and development of fetal growth restriction (FGR). STUDY DESIGN This was a retrospective study of singleton gestations that underwent a fetal anatomy ultrasound from 2011-2013. The PCI was recorded as the distance in centimeters from the placental margin. Patients had FGR if the overall estimated fetal weight was <10 % for gestational age or abdominal circumference <5 % in the third trimester. Delivery, obstetric, and neonatal outcomes were obtained via medical chart review. Logistic and linear regression models were used to assess the impact of PCI distance on maternal and neonatal delivery outcomes. RESULTS Of the 1443 women who met inclusion criteria, 93.6 % delivered at term. The mean (±SD) PCI distance was 4.4 ± 1.4 cm. There was no association between PCI and cesarean delivery, peripartum hemorrhage (PPH), pre-eclampsia, 5-min Apgar, or intrauterine fetal demise. PCI distance was statistically significantly shorter in patients requiring neonatal intensive care unit (NICU) admission (4.1 ± 1.5 cm vs. 4.4 ± 1.4 cm, p = 0.02) and was associated with lower birthweight (p = 0.01), though this association was no longer seen when corrected for gestational age. There were 3.5 % of patients who developed FGR; PCI distances from the placental edge were not significantly different for patients who developed FGR compared to those who did not (4.2 ± 1.4 cm vs. 4.5 ± 1.4 cm, p = 0.18). Furthermore, a receiver operating characteristic (ROC) curve for PCI had poor sensitivity (area under the curve [AUC] 0.57, 95 % CI 0.49-0.65). CONCLUSION PCI distance at the time of fetal anatomic survey is significantly associated with NICU admission, though does not appear to impact rates of preterm birth, pre-eclampsia, PPH or cesarean delivery. PCI distance in singleton gestations does not appear to be predictive of FGR.
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Affiliation(s)
- Catherine A Bigelow
- Icahn School of Medicine at Mount Sinai, Department of Obstetrics, Gynecology, and Reproductive Science, Division of Maternal-Fetal Medicine, One Gustave L. Levy Place, New York, NY 10029, USA.
| | - Brittany N Robles
- Icahn School of Medicine at Mount Sinai, Department of Obstetrics, Gynecology, and Reproductive Science, Division of Maternal-Fetal Medicine, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Stephanie Pan
- Icahn School of Medicine at Mount Sinai, Department of Obstetrics, Gynecology, and Reproductive Science, Division of Maternal-Fetal Medicine, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Jessica Overbey
- Icahn School of Medicine at Mount Sinai, Department of Obstetrics, Gynecology, and Reproductive Science, Division of Maternal-Fetal Medicine, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Esther Robin
- Icahn School of Medicine at Mount Sinai, Department of Obstetrics, Gynecology, and Reproductive Science, Division of Maternal-Fetal Medicine, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Alexander Melamed
- Massachusetts General Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, 55 Fruit Street, Boston, MA 02115, USA
| | - Angela Bianco
- Icahn School of Medicine at Mount Sinai, Department of Obstetrics, Gynecology, and Reproductive Science, Division of Maternal-Fetal Medicine, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Maria Teresa Mella
- Icahn School of Medicine at Mount Sinai, Department of Obstetrics, Gynecology, and Reproductive Science, Division of Maternal-Fetal Medicine, One Gustave L. Levy Place, New York, NY 10029, USA
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Ismail KI, Hannigan A, O'Donoghue K, Cotter A. Role of 2-Dimensional Ultrasound Imaging in Placental and Umbilical Cord Morphometry: Literature and Pictorial Review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3131-3140. [PMID: 31144344 DOI: 10.1002/jum.15024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 04/23/2019] [Indexed: 06/09/2023]
Abstract
Abnormalities of the placenta and umbilical cord have been associated with adverse pregnancy outcomes. Antenatal detection of placental and umbilical cord abnormalities using ultrasound (US) imaging is now gaining popularity with the advancements in obstetric US. This article reviews the use of 2-dimensional obstetric US as a tool to measure and assess placental and umbilical cord morphometry. It highlights the potential role of placental and umbilical cord morphometry as a valuable component of the screening tool for high risk pregnancies and identifies the need for further research to examine its feasibility.
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Affiliation(s)
- Khadijah I Ismail
- Departments of Obstetrics and Gynecology, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Ailish Hannigan
- Departments of Biostatistics, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Keelin O'Donoghue
- Department of Obstetrics and Gynecology, University College Cork, Cork, Ireland
| | - Amanda Cotter
- Departments of Obstetrics and Gynecology, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
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Baller D, Thomas DM, Cummiskey K, Bredlau C, Schwartz N, Orzechowski K, Miller RC, Odibo A, Shah R, Salafia CM. Gestational growth trajectories derived from a dynamic fetal-placental scaling law. J R Soc Interface 2019; 16:20190417. [PMID: 31662073 DOI: 10.1098/rsif.2019.0417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Fetal trajectories characterizing growth rates in utero have relied primarily on goodness of fit rather than mechanistic properties exhibited in utero. Here, we use a validated fetal-placental allometric scaling law and a first principles differential equations model of placental volume growth to generate biologically meaningful fetal-placental growth curves. The growth curves form the foundation for understanding healthy versus at-risk fetal growth and for identifying the timing of key events in utero.
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Affiliation(s)
- Daniel Baller
- Department of Mathematical Sciences, United States Military Academy, West Point, NY 10996, USA
| | - Diana M Thomas
- Department of Mathematical Sciences, United States Military Academy, West Point, NY 10996, USA
| | - Kevin Cummiskey
- Department of Mathematical Sciences, United States Military Academy, West Point, NY 10996, USA
| | - Carl Bredlau
- Department of Computer Science, Montclair State University, Montclair, NJ 07043, USA
| | - Nadav Schwartz
- Division of Maternal Fetal Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | | | - Richard C Miller
- Department of Obstetrics and Gynecology, St Barnabas Medical Center, Livingston, NJ 07039, USA
| | - Anthony Odibo
- Division of Maternal Fetal Medicine, University of South Florida, Tampa, FL 33620, USA
| | - Ruchit Shah
- Placental Analytics, New Rochelle, NY 10538, USA
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In vivo textural and morphometric analysis of placental development in healthy & growth-restricted pregnancies using magnetic resonance imaging. Pediatr Res 2019; 85:974-981. [PMID: 30700836 PMCID: PMC6531319 DOI: 10.1038/s41390-019-0311-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 11/02/2018] [Accepted: 01/16/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND The objective of this study was to characterize structural changes in the healthy in vivo placenta by applying morphometric and textural analysis using magnetic resonance imaging (MRI), and to explore features that may be able to distinguish placental insufficiency in fetal growth restriction (FGR). METHODS Women with healthy pregnancies or pregnancies complicated by FGR underwent MRI between 20 and 40 weeks gestation. Measures of placental morphometry (volume, elongation, depth) and digital texture (voxel-wise geometric and signal-intensity analysis) were calculated from T2W MR images. RESULTS We studied 66 pregnant women (32 healthy controls, 34 FGR); during the study period, placentas undergo significant increases in size; signal intensity remains relatively constant, however there is increasing variation in spatial arrangements, suggestive of progressive microstructural heterogeneity. In FGR, placental size is smaller, with great homogeneity of signal intensity and spatial arrangements. CONCLUSION We report quantitative textural and morphometric changes in the in vivo placenta in healthy controls over the second half of pregnancy. These MRI features demonstrate important differences in placental development in the setting of placental insufficiency that relate to onset and severity of FGR, as well as neonatal outcome.
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Ismail KI, Hannigan A, Kelehan P, Fitzgerald B, O'Donoghue K, Cotter A. Small for gestational age infants and the association with placental and umbilical cord morphometry: a digital imaging study. J Matern Fetal Neonatal Med 2019; 33:3632-3639. [PMID: 30760075 DOI: 10.1080/14767058.2019.1582628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Individual placental and umbilical cord morphometry have been previously identified to have an association with fetal growth. This study aims to identify which of the morphometric measurements in combination are associated with pregnancies with small for gestational age (SGA) infants using digital imaging of the delivered placenta.Material and methods: This study examined 1005 placentas from consecutively delivered singleton pregnancies in a tertiary center. Standardized images of each placenta were taken. Placental weight and thickness; umbilical cord length and diameter were measured on gross examination. Distance from the placental cord insertion site to placental margin, length and breadth of the placenta and placental chorionic surface area were measured digitally using ImageJ software. Logistic regression models and area under the curve (AUC) were used to identify the best subset of morphometric measurements to classify infants as SGA (<10th centile).Results: Overall, 141 (14%) infants were SGA. The morphometric measurements at delivery most strongly associated with the classification of infants as SGA were placental weight (AUC = 0.806) and placental surface area (AUC = 0.749). Of the potential antenatal morphometric measurements, umbilical cord diameters, both placental (AUC = 0.644) and fetal end (AUC = 0.629) were most strongly associated with SGA. A logistic regression model with maternal age, smoking status, current history of preeclampsia, umbilical cord length, placental weight, birthweight-to-placental weight ratio and umbilical cord diameter (placental end) had a sensitivity of 53% and a false-positive rate of 2% (AUC = 0.945) for the classification of infants as SGA.Conclusion: Placental and umbilical cord morphometry measured at delivery are different between SGA and non-SGA infants. Further studies are warranted to investigate the feasibility and accuracy of ultrasound to measure placental and umbilical cord morphometry during pregnancy.
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Affiliation(s)
- Khadijah I Ismail
- Obstetrics and Gynecology Department, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Ailish Hannigan
- Biostatistics Department, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Peter Kelehan
- Pathology Department, National Maternity Hospital, Dublin, Ireland
| | | | - Keelin O'Donoghue
- Obstetrics and Gynecology Department, University College Cork, Cork, Ireland
| | - Amanda Cotter
- Obstetrics and Gynecology Department, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
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First-trimester placental thickness and the risk of preeclampsia or SGA. Placenta 2017; 57:123-128. [DOI: 10.1016/j.placenta.2017.06.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 06/13/2017] [Accepted: 06/17/2017] [Indexed: 01/02/2023]
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Quant HS, Sammel MD, Parry S, Schwartz N. Second-Trimester 3-Dimensional Placental Sonography as a Predictor of Small-for-Gestational-Age Birth Weight. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1693-1702. [PMID: 27335442 DOI: 10.7863/ultra.15.06077] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 11/17/2015] [Indexed: 06/06/2023]
Abstract
OBJECTIVES We previously reported the association between first-trimester 3-dimensional (3D) placental measurements and small-for-gestational-age (SGA) neonates. In this study, we sought to determine whether second-trimester measurements further contribute to the antenatal detection of SGA and preeclampsia. METHODS We prospectively collected 3D sonographic volume sets and uterine artery pulsatility indices of singleton pregnancies at 18 to 24 weeks. Placental volume, placental quotient (placental volume/gestational age), mean placental diameter and chorionic diameter, placental morphologic index (mean placental diameter/placental quotient), placental chorionic index (mean chorionic diameter/placental quotient), and placental growth (volume per week) were assessed and evaluated as predictors of SGA and preeclampsia as a composite and alone. RESULTS Of 373 pregnancies, the composite outcome occurred in 67 (18.0%): 36 (9.7%) manifested SGA alone; 27 (7.2%) developed preeclampsia alone, and 4 (1.1%) developed both. The placental volume, placental quotient, mean placental diameter, mean chorionic diameter, and volume per week were significantly smaller, whereas the placental morphologic index and chorionic index were significantly larger in pregnancies with the composite outcome (P < .01). Further analyses revealed that the significant associations with placental parameters were limited to the SGA outcome. Each placental measure remained significantly associated with SGA after adjusting for confounders. The mean uterine artery pulsatility index was not associated with either outcome. Placental parameters were moderately predictive of SGA, with adjusted areas under the curve ranging from 0.72 to 0.76. Sensitivity for detection of SGA ranged from 32.5% to 45.0%, with positive predictive values ranging from 17.3% to 22.7%. CONCLUSIONS Second-trimester 3D placental measurements can identify pregnancies at risk of SGA. However, there appears to be no significant improvement compared to those obtained in the first trimester.
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Affiliation(s)
- Hayley S Quant
- Department of Obstetrics and Gynecology, Maternal and Child Health Research Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania USA
| | - Mary D Sammel
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania USA
| | - Samuel Parry
- Department of Obstetrics and Gynecology, Maternal and Child Health Research Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania USA
| | - Nadav Schwartz
- Department of Obstetrics and Gynecology, Maternal and Child Health Research Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania USA
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Affiliation(s)
- Sara Zullino
- a Department of Woman , Mother and Neonate, Buzzi Children's Hospital, Biological and Clinical Sciences, University of Milan , Milan , Italy and
| | - Daniela Di Martino
- a Department of Woman , Mother and Neonate, Buzzi Children's Hospital, Biological and Clinical Sciences, University of Milan , Milan , Italy and
| | - Tamara Stampalija
- b Unit of Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo , Trieste , Italy
| | - Enrico Ferrazzi
- a Department of Woman , Mother and Neonate, Buzzi Children's Hospital, Biological and Clinical Sciences, University of Milan , Milan , Italy and
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Kozinszky Z, Surányi A, Péics H, Molnár A, Pál A. Placental Volumetry by 2-D Sonography with a New Mathematical Formula: Prospective Study on the Shell of a Spherical Sector Model. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:2252-2258. [PMID: 25959054 DOI: 10.1016/j.ultrasmedbio.2015.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 03/12/2015] [Accepted: 04/06/2015] [Indexed: 06/04/2023]
Abstract
The aim of this study was to determine the utility of a new mathematical model in volumetric assessment of the placenta using 2-D ultrasound. Placental volumetry was performed in a prospective cross-sectional survey by virtual organ computer-aided analysis (VOCAL) with the help of a shell-off method in 346 uncomplicated pregnancies according to STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. Furthermore, placental thickness, length and height were measured with the 2-D technique to estimate placental volume based on the mathematical formula for the volume of "the shell of the spherical sector." Fetal size was also assessed by 2-D sonography. The placental volumes measured by 2-D and 3-D techniques had a correlation of 0.86. In the first trimester, the correlation was 0.82, and later during pregnancy, it was 0.86. Placental volumetry using "the circle-shaped shell of the spherical sector" mathematical model with 2-D ultrasound technique may be introduced into everyday practice to screen for placental volume deviations associated with adverse pregnancy outcome.
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Affiliation(s)
- Zoltan Kozinszky
- Reproductive Medicine, Department of Obstetrics and Gynecology, Huddinge Karolinska University Hospital, Stockholm, Sweden.
| | - Andrea Surányi
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary
| | - Hajnalka Péics
- Faculty of Civil Engineering, University of Novi Sad, Subotica, Serbia
| | - András Molnár
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary
| | - Attila Pál
- Department of Obstetrics and Gynecology, University of Szeged, Szeged, Hungary
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Milligan N, Rowden M, Wright E, Melamed N, Lee YM, Windrim RC, Kingdom JC. Two-dimensional sonographic assessment of maximum placental length and thickness in the second trimester: a reproducibility study. J Matern Fetal Neonatal Med 2014; 28:1653-9. [DOI: 10.3109/14767058.2014.963047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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First-trimester placental ultrasound and maternal serum markers as predictors of small-for-gestational-age infants. Am J Obstet Gynecol 2014; 211:253.e1-8. [PMID: 24607753 DOI: 10.1016/j.ajog.2014.02.033] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 02/26/2014] [Accepted: 02/28/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The objective of the study was to combine early, direct assessment of the placenta with indirect markers of placental development to identify pregnancies at greatest risk of delivering small-for-gestational age infants (SGA10). STUDY DESIGN We prospectively collected 3-dimensional ultrasound volume sets, uterine artery pulsatility index, and maternal serum of singleton pregnancies at 11-14 weeks. Placental volume (PV), quotient (placental quotient [PQ] = PV/gestational age), mean placental diameter (MPD) and chorionic diameters, and the placental morphology index (PMI = MPD/PQ and adjusts the lateral placental dimensions for quotient) were measured offline. Maternal serum was assayed for placental growth factor and placental protein-13. These variables were evaluated as predictors of SGA10. RESULTS Of the 578 pregnancies included in the study, 56 (9.7%) delivered SGA10. SGA10 pregnancies had a significantly smaller PV, PQ, MPD, and mean placental diameter and higher PMI compared with normal pregnancies (P < .001 for each). Each placental measure remained significantly associated with SGA10 after adjusting for confounders and significantly improved the performance of the model using clinical variables alone (P < .04 for each) with adjusted areas under the curve ranging from 0.71 to 0.74. Uterine artery pulsatility index did not remain significantly associated with SGA10 after adjusting for confounders (P = .06). Placental growth factor was significantly lower in SGA10 pregnancies (P = .02) and remained significant in adjusted models but failed to significantly improve the predictive performance of the models as measured by area under the curve (P > .3). Placental protein-13 was not associated with SGA10 (P = .99). CONCLUSION Direct assessment of placental size and shape with 3-dimensional ultrasound can serve as the foundation upon which to build a multivariable model for the early prediction of SGA.
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Schwartz N, Quant HS, Sammel MD, Parry S. Macrosomia has its roots in early placental development. Placenta 2014; 35:684-90. [PMID: 25064071 DOI: 10.1016/j.placenta.2014.06.373] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 06/11/2014] [Accepted: 06/28/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION We sought to determine if early placental size, as measured by 3-dimensional ultrasonography, is associated with an increased risk of delivering a macrosomic or large-for-gestational age (LGA) infant. METHODS We prospectively collected 3-dimensional ultrasound volume sets of singleton pregnancies at 11-14 weeks and 18-24 weeks. Birth weights were collected from the medical records. After delivery, the ultrasound volume set were used to measure the placental volume (PV) and placental quotient (PQ = PV/gestational age), as well as the mean placental and chorionic diameters (MPD and MCD, respectively). Placental measures were analyzed as predictors of macrosomia (birth weight ≥4000 g) and LGA (birth weight ≥90th percentile). RESULTS The 578 pregnancies with first trimester volumes included 44 (7.6%) macrosomic and 43 (7.4%) LGA infants. 373 subjects also had second trimester volumes available. A higher PV and PQ were both significantly associated with macrosomia and LGA in both the first and second trimesters. Second trimester MPD was significantly associated with both outcomes as well, while second trimester MCD was only associated with LGA. The above associations remained significant after adjusting for maternal demographic variables such as race, ethnicity, age and diabetes. Adjusted models yielded moderate prediction of macrosomia and LGA (AUC: 0.71-0.77). CONCLUSIONS Sonographic measurement of the early placenta can identify pregnancies at greater risk of macrosomia and LGA. Macrosomia and LGA are already determined in part by early placental growth and development.
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Affiliation(s)
- N Schwartz
- Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.
| | - H S Quant
- Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - M D Sammel
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - S Parry
- Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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Farina A. Biophysical markers for abnormal placentation: first and/or second trimester. Prenat Diagn 2014; 34:628-34. [DOI: 10.1002/pd.4377] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 03/27/2014] [Accepted: 04/02/2014] [Indexed: 11/10/2022]
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Suri S, Muttukrishna S, Jauniaux E. 2D-Ultrasound and endocrinologic evaluation of placentation in early pregnancy and its relationship to fetal birthweight in normal pregnancies and pre-eclampsia. Placenta 2013; 34:745-50. [PMID: 23756051 DOI: 10.1016/j.placenta.2013.05.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 05/01/2013] [Accepted: 05/08/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To study the relationships between 2D ultrasound measurements of placentation and maternal serum (MS) levels of PAPP-A, inhibin A and fβhCG in early pregnancy and subsequent fetal growth in pregnancies with a normal and abnormal outcome. STUDY DESIGN Prospective population-based cohort study of 301 pregnancies with a normal outcome, 18 with a pregnancy complicated by pre-term delivery (PTD) and 14 with subsequent pre-eclampsia (PE). MAIN OUTCOME MEASURES Basal placental surface area, placental thickness, ellipsivity and volume; MS PAPP-A and fβhCG at 11-13 + 6 weeks, MS inhibin A at 15-22 weeks and birthweight centile at delivery. RESULTS In the normal group, the basal surface area showed a significantly (P < 0.001) positive correlation with placental thickness and placental ellipsivity. With the exception of placental ellipsivity, all other placental ultrasound parameters were significantly related with birthweight centile. Inhibin A showed a significant (P < 0.005) correlation with birthweight centiles. The basal plate surface area and MS PAPP-A were significantly (P < 0.01 and P < 0.001, respectively) lower and MS inhibin A significantly (P < 0.01) higher in PE than in controls. No changes were found in pregnancies complicated by PTD. CONCLUSION The basal plate surface area at 11-14 weeks reflects indirectly normal and abnormal placentation and development of the definitive placenta. Combined with MS PAPP-A and/or inhibin A levels this parameter could be useful in identifying from the end of the first trimester, pregnancies subsequently complicated with PE.
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Affiliation(s)
- S Suri
- UCL EGA Institute for Women's Health, University College London, London, UK
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Collins SL, Stevenson GN, Noble JA, Impey L. Elsevier Trophoblast Research Award Lecture: Searching for an early pregnancy 3-D morphometric ultrasound marker to predict fetal growth restriction. Placenta 2013; 34 Suppl:S85-9. [PMID: 23306068 DOI: 10.1016/j.placenta.2012.11.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 11/28/2012] [Accepted: 11/29/2012] [Indexed: 10/27/2022]
Abstract
Fetal growth restriction (FGR) is a major cause of perinatal morbidity and mortality, even in term babies. An effective screening test to identify pregnancies at risk of FGR, leading to increased antenatal surveillance with timely delivery, could decrease perinatal mortality and morbidity. Placental volume, measured with commercially available packages and a novel, semi-automated technique, has been shown to predict small for gestational age babies. Placental morphology measured in 2-D in the second trimester and ex-vivo post delivery, correlates with FGR. This has also been investigated using 2-D estimates of diameter and site of cord insertion obtained using the Virtual Organ Computer-aided AnaLysis (VOCAL) software. Data is presented describing a pilot study of a novel 3-D method for defining compactness of placental shape. We prospectively recruited women with a singleton pregnancy and BMI of <35. A 3-D ultrasound scan was performed between 11 and 13 + 6 weeks' gestation. The placental volume, total placental surface area and the area of the utero-placental interface were calculated using our validated technique. From these we generated dimensionless indices including sphericity (ψ), standardised placental volume (sPlaV) and standardised functional area (sFA) using Buckingham π theorem. The marker for FGR used was small for gestational age, defined as <10th customised birth weight centile (cSGA). Regression analysis examined which of the morphometric indices were independent predictors of cSGA. Data were collected for 143 women, 20 had cSGA babies. Only sPlaV and sFA were significantly correlated to birth weight (p < 0.001). Regression demonstrated all dimensionless indices were inter-dependent co-factors. ROC curves showed no advantage for using sFA over the simpler sPlaV. The generated placental indices are not independent of placental volume this early in gestation. It is hoped that another placental ultrasound marker based on vascularity can improve the prediction of FGR offered by a model based on placental volume.
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Affiliation(s)
- S L Collins
- The Nuffield Dept. of Obstetrics & Gynaecology, University of Oxford, Oxford, UK.
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Antsaklis A, Antsaklis P, Natsis S. Three-dimensional Evaluation of the Placenta: Review of the Literature. ACTA ACUST UNITED AC 2013. [DOI: 10.5005/jp-journals-10009-1272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
The introduction of the three-dimensional (3D) ultrasound made feasible the quantitative and qualitative evaluation of the placenta's characteristics like the volume, the surface rendered imaging, the vascularization and the blood flow. These novel techniques may assist the early detection of pregnancies at high risk for fetal growth restriction (FGR), pre-eclampsia (PET) and pregnancy-induced hypertension (PIH) and help clinicians to detect pregnancies at risk earlier and to assess new therapeutic strategies in order to prevent adverse pregnancy outcomes. However, in this new technique there are still limitations regarding the assessment of the placenta employing 3D ultrasound in everyday clinical practice. In the following article, we perform a review of the literature regarding the importance of 3D evaluation of the placenta in pregnancy.
How to cite this article
Natsis S, Antsaklis P, Antsaklis A, Kurjak A. Three-dimensional Evaluation of the Placenta: Review of the Literature. Donald School J Ultrasound Obstet Gynecol 2013;7(1):73-79.
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Schwartz N, Wang E, Parry S. Two-dimensional sonographic placental measurements in the prediction of small-for-gestational-age infants. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:674-679. [PMID: 22331557 DOI: 10.1002/uog.11136] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/30/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To determine the utility of two-dimensional (2D) sonographic placental measurements in the prediction of small-for-gestational-age (SGA) infants. METHODS The maximal diameter along the fetal surface of the placenta and the maximal placental thickness were measured at 18-24 weeks' gestation, and the measurements repeated in the orthogonal plane. 'Biometric lags' were calculated as the difference between sonographic gestational age, estimated using each of a number of fetal biometric measurements, and actual gestational age. These variables were analyzed individually and in combination as predictors of birth weight<10(th) percentile (SGA<10) and <5(th) percentile (SGA<5). RESULTS 1909 singleton pregnancies were included. Mean placental diameter (SGA<10, P<0.001; SGA<5, P=0.002) and thickness (SGA<10, P<0.006; SGA<5, P=0.065) were significantly smaller in SGA pregnancies. The biometric lags were greater in SGA pregnancies, the lag in abdominal circumference (AC) being the most predictive of SGA (P<0.0001). Multivariable models were significantly predictive of both SGA<10(th) percentile (area under the receiver-operating characteristics curve (AUC) =0.7404) and <5(th) percentile (AUC=0.7204), the best fitting models including AC lag and mean placental diameter and thickness. CONCLUSIONS 2D placental measurements taken in mid-gestation are significantly associated with the incidence of SGA. Biometric lags can improve the predictive ability further. These easily obtained variables should be considered in future efforts to develop a clinically useful predictive model for adverse outcome of pregnancy.
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Affiliation(s)
- N Schwartz
- Obstetrics and Gynecology; Maternal and Child Health Research Program, Hospital of the University of Pennsylvania, Philadelphia 19104, PA, USA. )
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Costantini D, Walker M, Milligan N, Keating S, Kingdom J. Pathologic basis of improving the screening utility of 2-dimensional placental morphology ultrasound. Placenta 2012; 33:845-9. [DOI: 10.1016/j.placenta.2012.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 06/22/2012] [Accepted: 07/13/2012] [Indexed: 01/05/2023]
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Salafia C, Yampolsky M, Shlakhter A, Mandel D, Schwartz N. Variety in placental shape: When does it originate? Placenta 2012; 33:164-70. [DOI: 10.1016/j.placenta.2011.12.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 12/01/2011] [Accepted: 12/01/2011] [Indexed: 11/25/2022]
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Scher MS. Developmental origins of cerebrovascular disease II: considering gene-environment interactions when developing neuroprotective strategies. J Child Neurol 2012; 27:238-50. [PMID: 22180566 DOI: 10.1177/0883073811417715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The second part of this review of the developmental origins of cerebrovascular disease discusses prenatal gene-environment interactions concerning maternal, placental, and fetal conditions that culminate in specific injuries such as perinatal stroke, as well as complications of intrauterine growth restriction and congenital heart disease. A greater understanding of gene-environment influences on cerebrovascular health and disease in early life will contribute to the successful development of neuroprotective strategies throughout the lifespan.
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Affiliation(s)
- Mark S Scher
- School of Medicine, Case Western Reserve University, and Division of Pediatric Neurology, Fetal/Neonatal Neurology Program, Rainbow Babies and Children's Hospital, Case Medical Center, University Hospitals of Cleveland, OH, USA.
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Rijken MJ, Moroski WE, Kiricharoen S, Karunkonkowit N, Stevenson G, Ohuma EO, Noble JA, Kennedy SH, McGready R, Papageorghiou AT, Nosten FH. Effect of malaria on placental volume measured using three-dimensional ultrasound: a pilot study. Malar J 2012; 11:5. [PMID: 22222152 PMCID: PMC3317826 DOI: 10.1186/1475-2875-11-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 01/05/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The presence of malaria parasites and histopathological changes in the placenta are associated with a reduction in birth weight, principally due to intrauterine growth restriction. The aim of this study was to examine the feasibility of studying early pregnancy placental volumes using three-dimensional (3D) ultrasound in a malaria endemic area, as a small volume in the second trimester may be an indicator of intra-uterine growth restriction and placental insufficiency. METHODS Placenta volumes were acquired using a portable ultrasound machine and a 3D ultrasound transducer and estimated using the Virtual Organ Computer-aided AnaLysis (VOCAL) image analysis software package. Intra-observer reliability and limits of agreement of the placenta volume measurements were calculated. Polynomial regression models for the mean and standard deviation as a function of gestational age for the placental volumes of uninfected women were created and tested. Based on these equations each measurement was converted into a z -score. The z-scores of the placental volumes of malaria infected and uninfected women were then compared. RESULTS Eighty-four women (uninfected = 65; infected = 19) with a posterior placenta delivered congenitally normal, live born, single babies. The mean placental volumes in the uninfected women were modeled to fit 5th, 10th, 50th, 90th and 95th centiles for 14-24 weeks' gestation. Most placenta volumes in the infected women were below the 50th centile for gestational age; most of those with Plasmodium falciparum were below the 10th centile. The 95% intra-observer limits of agreement for first and second measurements were ± 37.0 mL and ± 25.4 mL at 30 degrees and 15 degrees rotation respectively. CONCLUSION The new technique of 3D ultrasound volumetry of the placenta may be useful to improve our understanding of the pathophysiological constraints on foetal growth caused by malaria infection in early pregnancy.
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Affiliation(s)
- Marcus J Rijken
- Shoklo Malaria Research Unit (SMRU), PO Box 46, Mae Sot, Tak 63110, Thailand
| | - William E Moroski
- Shoklo Malaria Research Unit (SMRU), PO Box 46, Mae Sot, Tak 63110, Thailand
| | - Suporn Kiricharoen
- Shoklo Malaria Research Unit (SMRU), PO Box 46, Mae Sot, Tak 63110, Thailand
| | | | - Gordon Stevenson
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Eric O Ohuma
- Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Oxford, UK
| | - J Alison Noble
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Stephen H Kennedy
- Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Oxford, UK
| | - Rose McGready
- Shoklo Malaria Research Unit (SMRU), PO Box 46, Mae Sot, Tak 63110, Thailand
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, UK
| | - Aris T Papageorghiou
- Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Oxford, UK
| | - François H Nosten
- Shoklo Malaria Research Unit (SMRU), PO Box 46, Mae Sot, Tak 63110, Thailand
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, UK
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Schwartz N, Mandel D, Shlakhter O, Coletta J, Pessel C, Timor-Tritsch IE, Salafia CM. Placental morphologic features and chorionic surface vasculature at term are highly correlated with 3-dimensional sonographic measurements at 11 to 14 weeks. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:1171-1178. [PMID: 21876086 DOI: 10.7863/jum.2011.30.9.1171] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The purpose of this study was to examine the potential for 3-dimensional sonographic measurement of the early placenta in predicting ultimate placental morphologic features at delivery. METHODS In this prospective cohort study, we collected 3-dimensional sonographic volume sets of placentas at 11 to 14 weeks and then collected the placentas after delivery. The sonographic data were manipulated to obtain various novel measurements of early gross placental morphologic features and the umbilical cord insertion location. The placental weight, chorionic plate area, cord location, and mean chorionic vascular density were obtained from the delivered postpartum placentas. Analyses were performed to identify potential early placental characteristics that were correlated with the ultimate placental morphologic features. The placental weight, cord marginality, and mean chorionic vascular density served as the outcome measures of interest. RESULTS Measurements of the early placental volume correlated with the delivered placental weight. An irregular early placental shape, as measured by sonography, was significantly inversely correlated with placental weight (P < .05). The placental morphologic index, a measure of a flatter placenta, was inversely correlated with both the placental weight and chorionic plate area, possibly indicating the importance of placental thickness even in the first trimester before villous arborization. In addition, early sonographic measures of the location of the umbilical cord insertion were significantly correlated with the ultimate marginality of the cord insertion as well as the mean chorionic vascular density (P < .05). CONCLUSIONS Many important ultimate placental morphologic features are likely predetermined early in pregnancy. Three-dimensional sonography may play an increasing role in the in utero evaluation of the early placenta.
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Affiliation(s)
- Nadav Schwartz
- Department of Obstetrics and Gynecology, Hospital of University of Pennsylvania, 3400 Spruce St, 2000 Courtyard, Philadelphia, PA 19104, USA.
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Three-dimensional ultrasound evaluation of the placenta. Placenta 2011; 32:105-15. [PMID: 21115197 DOI: 10.1016/j.placenta.2010.11.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 11/02/2010] [Accepted: 11/03/2010] [Indexed: 11/24/2022]
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