Abstract
As the placenta plays a central role in many adverse pregnancy outcomes, we sought to investigate the utility of 3-dimensional (3D) sonographic measures of second trimester placental growth as predictors of intrauterine growth restriction and pregnancy related hypertension (PRH). We conducted a prospective cohort study investigating the role of 3D placental ultrasound in the prediction of adverse pregnancy outcomes. In order to focus on 2nd trimester placental growth, this analysis was limited to subjects with a 3D volume available at both 11-14 weeks and 18-24 weeks. The VOCAL application of 4DVIEW (GE) was used to calculate placental volume (PV) which was normalized to gestational age to yield placental quotient (PQ). Then, the maternal surface of the placenta was measured every 45 degrees around the circumference; the mean of these 4 values, mean placental diameter (MPD), represents the surface area of the utero-placental interface. The rate of placental growth from 1st to 2nd trimester was analyzed as volume change per week (VOL/WK). These variables, as well as mean uterine artery Doppler PI (UPI), were analyzed as predictors of SGA10 (birthweight <10th %ile), SGA5 (<5th %ile) and PRH. Of 257 subjects, 26 (10.1%) were SGA10, 13 (5.1%) were SGA5 and 32 (12.5%) developed PRH. Mean PV, PQ and MPD were all significantly lower for both SGA10 and SGA5 compared to non-SGA subjects. VOL/WK was significantly lower for SGA10, but not SGA5. The AUCs demonstrated moderate predictive value for SGA10 and SGA5 (Table). The sonographic parameters were not significant predictors of PRH. In this cohort, UPI was not predictive of either SGA or PRH.Tabled 1Prediction of SGA by placental 3D ultrasound parameters Placental size and growth in the 2nd trimester are significantly associated with the development of SGA. Further investigation is needed to determine whether such measurements can be useful in the early prediction of intrauterine growth restriction.
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