Abstract
Objective The aim of this study was to investigate placental blood perfusion in middle and late pregnancy and explore its predictive value for fetal growth restriction (FGR). Methods All pregnant women included in the study were examined using placental intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI). Three IVIM parameters (D, f, D*) were obtained for each pregnant woman and analyzed using Image J software. Perfusion fraction f is a radiological marker of placental perfusion. The pulsatility index (PI) of the uterine artery is used to indirectly evaluate placental function. Results f-values were significantly lower in the late-onset FGR group compared to the normal late pregnancy group (19.07 vs. 27.78%). In addition, uterine artery PI values were markedly increased in the late-onset FGR group compared to the normal late pregnancy group (1.96 vs. 1.03), and neonatal weight was significantly lower in the late-onset FGR group (2.75 vs. 3.18 kg). There was a significant positive correlation between f-value, uterine artery PI and neonatal weight (r = 0.968, p < 0.01; r = 0.959, p < 0.01). There was a significant negative correlation between f-value and age of gestation (r = − 0.534, p < 0.01). Conclusion Perfusion fraction f was strongly correlated with uterine artery blood flow resistance as measured by color Doppler and had a certain predictive value for late-onset FGR.
Highlights
Fetal growth restriction (FGR) is considered late onset when it occurs after 32 weeks of gestation
Uterine artery pulsatility index (PI) values were markedly increased in the late-onset fetal growth restriction (FGR) group compared to the normal late pregnancy group (1.96 vs. 1.03), and neonatal weight was significantly lower in the late-onset FGR group (2.75 vs. 3.18 kg)
The current study found that the perfusion fraction was significantly lower in the late-onset FGR group compared to the normal late pregnancy group, which was in accordance with the hemodynamic changes caused by the pathological changes of FGR
Summary
Fetal growth restriction (FGR) is considered late onset when it occurs after 32 weeks of gestation. Late-onset FGR is mainly asymmetrical because of its close relationship with utero-placental insufficiency and insufficient microcirculation of the placental villi [1, 2]. Prenatal and intrapartum treatment can improve the prognosis of FGR, while successful treatment of FGR during pregnancy depends on early diagnosis. Color Doppler is currently used during middle and late pregnancy to measure the resistance index of uterine artery blood flow, which serves as an indirect measurement of placental perfusion. Because of problems such as angle dependence and aliasing and a low sensitivity to low velocity blood flow, color Doppler can only provide indirect parameters of blood flow resistance. The technique depends on the experience of the operator, and repeatability is poor. Polyhydramnios, maternal obesity and posterior wall placenta significantly reduce the accuracy of this technique
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