Comparison of Placental Three-Dimensional Power Doppler Vascular Indices and Placental Volume in Pregnancies with Small for Gestational Age Neonates.

Sue-Jar Chen,Fang-Ju Sun,Chen-Yu Chen,Chie-Pein Chen

doi:10.3390/jcm8101651

Sue-Jar Chen, Fang-Ju Sun + Show 2 more

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https://doi.org/10.3390/jcm8101651

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Abstract

This prospective observational study aimed to compare the changes in placental vascular indices and placental volume using three-dimensional power Doppler (3DPD) ultrasound in pregnancies with small for gestational age (SGA) neonates. We enrolled 396 women with singleton pregnancies from September 2013 to June 2016. Placental vascular indices, including the vascularization index (VI), flow index (FI), and vascularization flow index (VFI), and placental volume were obtained using 3DPD ultrasound in the first and second trimesters. Of the enrolled women, 21 delivered SGA neonates and 375 did not. In the first trimester, the SGA group had a significantly lower mean FI (25.10 ± 7.51 versus 33.10 ± 10.97, p < 0.001) and VFI (4.59 ± 1.95 versus 6.28 ± 2.35, p = 0.001) than the non-SGA group. However, there was no significant difference in the placental volume between the two groups during the first trimester. In the second trimester, the SGA group also had a significantly lower mean FI (27.08 ± 7.97 versus 31.54 ± 11.01, p = 0.022) and VFI (6.68 ± 1.71 versus 8.68 ± 3.09, p < 0.001) than the non-SGA group. In addition, a significantly smaller placental volume was noted in the SGA group (104.80 ± 24.23 cm3 versus 122.67 ± 26.35 cm3, p = 0.003) than in the non-SGA group during the second trimester. The results showed that a decreased placental VFI occurred earlier than a decreased placental volume in SGA pregnancies.

Highlights

Small for gestational age (SGA) and fetal growth restriction (FGR) both describe a neonatal birth weight or estimated fetal weight less than the 10th percentile for gestational age (GA) and are common complications associated with perinatal hypoxia, asphyxia, and even mortality [1]
GA was determined according to the last menstrual period and fetal crown-lump length (CRL), whereas biparietal diameter (BPD), abdominal circumference (AC), and femur length (FL) were used to estimate the size of the fetus in the second trimester
After excluding the cases of lost to follow-up (n = 7), miscarriage (n = 2, at 13 and 16 gestational weeks), periviable preterm birth (n = 2, at 21 and 22 gestational weeks), and pregnancies complicated with fetal chromosomal anomaly (n = 2, trisomy 21 and trisomy 18) and severe structural anomaly (n = 1, gastroschisis), 396 pregnant women were enrolled in this study, of whom 21 (5.3%) delivered SGA neonates

Summary

Introduction

Small for gestational age (SGA) and fetal growth restriction (FGR) both describe a neonatal birth weight or estimated fetal weight less than the 10th percentile for gestational age (GA) and are common complications associated with perinatal hypoxia, asphyxia, and even mortality [1]. SGA has been associated with both an increased risk of adverse perinatal outcomes and lifelong consequences [2,3]. Deficient remodeling of the spiral arteries supplying the placenta can occur from as early as the first trimester, and the severity of placental dysfunction has been associated with neonatal birthweight [5]. The early detection of placental vascular alterations or changes in placental volume may be helpful to predict SGA/FGR pregnancies. The early identification of SGA/FGR pregnancies can improve clinical outcomes, since it can prompt appropriate antenatal surveillance of the fetus, management, or the initiation of treatment strategies to preserve placental function [6,7]

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