Comparison of ultrasonographic and Doppler mapping of the intervillous circulation in normal and abnormal early pregnancies

Abstract

Objective To assess the value of ultrasonography and Doppler imaging in characterizing the intervillous circulation in normal and abnormal early pregnancy. Design Cross-sectional study. Setting Tertiary care academic hospital. Patient(s) Eighty-five normal pregnancies and 125 missed miscarriages at 7 to 13 weeks of gestation. Intervention(s) Grey-scale ultrasonography was used to evaluate the placental anatomy and detect moving echoes inside the intervillous space, and color power Doppler imaging was used to detect continuous venous-like flow in the placental tissue. Main outcome measure(s) Degree of agreement between two investigators for use of grey-scale imaging, comparison of detection of moving echoes in normal and abnormal pregnancies, and comparison of detection of intervillous circulation with grey-scale and color Doppler imaging in abnormal pregnancies. Result(s) The overall degree of agreement between the two investigators was good. A significantly different distribution of blood flow was found between normal and abnormal pregnancies at 7 to 9 weeks and 10 to 11 weeks but not at 12 to 13 weeks. Intervillous moving echoes were detected by grey-scale imaging significantly more frequently than an intervillous blood flow was detected with color Doppler imaging. Conclusion(s) In early pregnancy failure, there is a premature and diffuse onset of intervillous blood flow that can be detected by grey-scale imaging. This abnormal blood flow pattern may increase the oxidative stress on the early placental tissue and subsequently impair placental development.