Placental Volume Measurements Research Articles

A new method for placental volume measurements using tracked 2D ultrasound and automatic image segmentation

Background Placental volume measurements can potentially identify high-risk pregnancies. We aimed to develop and validate a new method for placental volume measurements using tracked 2D ultrasound and automatic image segmentation. Methods We included 43 pregnancies at gestational week 27 and acquired placental images using a 2D ultrasound probe with position tracking, and trained a convolutional neural network (CNN) for automatic image segmentation. The automatically segmented 2D images were combined with tracking data to calculate placental volume. For 15 of the included pregnancies, placental volume was also estimated based on MRI examinations, 3D ultrasound and manually segmented 2D ultrasound images. The ultrasound methods were compared to MRI (gold standard). Results The CNN demonstrated good performance in automatic image segmentation (F1-score 0.84). The correlation with MRI-based placental volume was similar for tracked 2D ultrasound using automatically segmented images (absolute agreement intraclass correlation coefficient [ICC] 0.58, 95% CI 0.13–0.84) and manually segmented images (ICC 0.59, 95% CI 0.13–0.84). The 3D ultrasound method showed lower ICC (0.35, 95% CI −0.11 to 0.74) than the methods based on tracked 2D ultrasound. Conclusions Tracked 2D ultrasound with automatic image segmentation is a promising new method for placental volume measurements and has potential for further improvement.

A novel approach for the early prediction and prevention of placenta accreta spectrum and severe peripartum hemorrhage in patients with complete placenta previa: leveraging three-dimensional placental topography, cervical length, and dilatation parameters on magnetic resonance imaging

BackgroundTo evaluate the reliability of placental volume and other magnetic resonance imaging (MRI) markers for predicting placenta accreta spectrum and severe peripartum hemorrhage in patients with complete placenta previa.MethodsThis single-center retrospective cohort study was conducted at a tertiary care facility and included 216 pregnant women diagnosed with complete placenta previa. Two radiologists, blinded to each other’s assessments, independently evaluated the prenatal placental magnetic resonance imaging (pMRI) findings of 150 singleton pregnancies that met the inclusion criteria and were delivered in the third trimester. The three-dimensional placental volume (from the S1 and S2 sectors), cervical canal length (CCL), and degree of cervical canal dilatation (CCD) were compared with clinical and pathological findings. Univariate and multivariate logistic regression analyses identified risk factors for placenta accreta spectrum (PAS) and severe peripartum hemorrhage (SPPH). Receiver operating characteristic (ROC) curve analysis determined the cutoff values of significant predictors.ResultsUnivariate analysis revealed significant risk factors for PAS, including decreased cervical canal length (odds ratio [OR] = 1.330, p < 0.001), increased cervical canal dilation (OR = 1.869, p < 0.001), decreased S1 volume (OR = 1.008, p < 0.001), and increased S2 volume (OR = 1.008, p < 0.001). Multivariate analysis confirmed that cervical canal length was an independent risk factor (odds ratio [OR] = 1.253, p = 0.03). Significant predictors of severe peripartum hemorrhage included decreased cervical canal length (odds ratio [OR] = 0.406, p = 0.006), increased cervical canal dilatation (OR = 3.22, p < 0.001), decreased S1 volume (OR = 1.079, p = 0.017), and increased S2 volume (OR = 1.032, p < 0.001), all of which were confirmed as independent risk factors. ROC analysis demonstrated high precision for MRI markers, with area under the curve values above 0.8 for critical predictors of PAS and severe peripartum hemorrhage, confirming their reliability (all p < 0.001).ConclusionThis study emphasizes the pivotal role of three-dimensional placental volume measurements in the S1 and S2 sectors, along with cervical canal length and dilation, in predicting PAS and severe peripartum hemorrhage in patients with complete placenta previa. Integrating these advanced MRI markers into prenatal care can enhance early detection, improve clinical decision-making, and ultimately improve maternal and fetal outcomes.

448 Deformable Medial Modeling to Generate Novel Shape Features of the Placenta Using Automated versus Manual Segmentations

OBJECTIVES/GOALS: In this study, we implemented deformable medial modeling as a morphometric approach in first trimester placentas to characterize morphometric differences between fully automated and manual segmentations. METHODS/STUDY POPULATION: Twenty placentas from singleton pregnancies between 11-14 weeks’ gestation were manually and automatically segmented from 3D ultrasound volumes. Automated segmentations were produced by a trained convolutional neural network pipeline. Dice overlap scores and volumes were computed between manual and automated segmentations. Deformable medial modeling was applied to both manual and automated segmentations to produce the following metrics: maternal and chorionic surface areas (SA), thickness, circumference, and diameter along the generated medial surface. Placental non-planarity was also determined as the greatest medial surface height difference. A paired t-test and simple linear regression was performed between manual and automated segmentations for each shape metric. RESULTS/ANTICIPATED RESULTS: Mean placental volume measurements between manual and automated segmentations were similar, with a percent difference of 3.28% and a mean Dice overlap score of 0.85 ± 0.07. There were strong, statistically significant (p &lt;0.01) linear correlations with chorionic and maternal SA, SA difference, thickness, circumference, medial surface diameter, and medial surface height difference. No significant differences were noted with chorionic SA, thickness, circumference, maximum medial surface diameter, or medial surface height difference. However, statistically significant differences (p &lt;0.01-0.03) were noted in maternal SA, SA difference, and mean medial surface diameter. Despite these differences, mean percent difference for all morphometric parameters was less than or equal to 10%. DISCUSSION/SIGNIFICANCE: A deformable medial model evaluate unique global and regional shape placental features with highly correlated values between manual versus automated placental segmentations. However, clinical studies are needed to determine if minor differences would impact the clinical utility of these features as potential indicators of placental function.

Role of Placental Volume Measurement in First Trimester and Uterine Artery Doppler in Second Trimester In The Prediction Of Intra Uterine Growth Retardation And Pregnancy Induced Hypertension

Role of Placental Volume Measurement in First Trimester and Uterine Artery Doppler in Second Trimester In The Prediction Of Intra Uterine Growth Retardation And Pregnancy Induced Hypertension

Utility of In Vivo Magnetic Resonance Imaging Is Predictive of Gestational Diabetes Mellitus During Early Pregnancy.

Gestational diabetes (GDM) imposes long-term adverse health effects on the mother and fetus. The role of magnetic resonance imaging (MRI) during early gestation in GDM has not been well-studied. To investigate the role of quantitative MRI measurements of placental volume and perfusion, with distribution of maternal adiposity, during early gestation in GDM. At UCLA outpatient antenatal obstetrics clinics, ∼200 pregnant women recruited in the first trimester were followed temporally through pregnancy until parturition. Two placental MRI scans were prospectively performed at 14 to 16 weeks and 19 to 24 weeks gestational age (GA). Placental volume and blood flow (PBF) were calculated from placental regions of interest; maternal adiposity distribution was assessed by subcutaneous fat area ratio (SFAR) and visceral fat area ratio (VFAR). Statistical comparisons were performed using the two-tailed t test. Predictive logistic regression modeling was evaluated by area under the curve (AUC). Of a total 186 subjects, 21 subjects (11.3%) developed GDM. VFAR was higher in GDM vs the control group, at both time points (P < 0.001 each). Placental volume was greater in GDM vs the control group at 19 to 24 weeks GA (P = 0.01). Combining VFAR, placental volume and perfusion, improved the AUC to 0.83 at 14 to 16 weeks (positive predictive value [PPV] = 0.77, negative predictive value [NPV] = 0.83), and 0.81 at 19 to 24 weeks GA (PPV = 0.73, NPV = 0.86). A combination of MRI-based placental volume, perfusion, and visceral adiposity during early pregnancy demonstrates significant changes in GDM and provides a proof of concept for predicting the subsequent development of GDM.

Evaluation of Spatial Attentive Deep Learning for Automatic Placental Segmentation on Longitudinal MRI.

Automated segmentation of the placenta by MRI in early pregnancy may help predict normal and aberrant placenta function, which could improve the efficiency of placental assessment and the prediction of pregnancy outcomes. An automated segmentation method that works at one gestational age may not transfer effectively to other gestational ages. To evaluate a spatial attentive deep learning method (SADL) for automated placental segmentation on longitudinal placental MRI scans. Prospective, single-center. A total of 154 pregnant women who underwent MRI scans at both 14-18 weeks of gestation and at 19-24 weeks of gestation, divided into training (N=108), validation (N=15), and independent testing datasets (N=31). A 3 T, T2-weighted half Fourier single-shot turbo spin-echo (T2-HASTE) sequence. The reference standard of placental segmentation was manual delineation on T2-HASTE by a third-year neonatology clinical fellow (B.L.) under the supervision of an experienced maternal-fetal medicine specialist (C.J. with 20 years of experience) and an MRI scientist (K.S. with 19 years of experience). The three-dimensional Dice similarity coefficient (DSC) was used to measure the automated segmentation performance compared to the manual placental segmentation. A paired t-test was used to compare the DSCs between SADL and U-Net methods. A Bland-Altman plot was used to analyze the agreement between manual and automated placental volume measurements. A P value < 0.05 was considered statistically significant. In the testing dataset, SADL achieved average DSCs of 0.83 ± 0.06 and 0.84 ± 0.05 in the first and second MRI, which were significantly higher than those achieved by U-Net (0.77 ± 0.08 and 0.76 ± 0.10, respectively). A total of 6 out of 62 MRI scans (9.6%) had volume measurement differences between the SADL-based automated and manual volume measurements that were out of 95% limits of agreement. SADL can automatically detect and segment the placenta with high performance in MRI at two different gestational ages. 4 TECHNICAL EFFICACY STAGE: 2.

441. Placental volume in gestational week 27 measured by three dimensional (3d) ultrasound and magnetic resonance imaging (mri)

Introduction and aims of the study: Ultrasound is the diagnostic tool of choice in pregnancy. We lack valid ultrasound methods for placental size measurements. Our aim was therefore to compare three-dimensional (3D) ultrasound with magnetic resonance imaging (MRI) for measurements of placental volume. Methods: We measured placental volume by 3D ultrasound and MRI in 100 unselected pregnancies at 27 weeks of gestation (25+4 - 28+4 weeks). The 3D ultrasound acquisitions were analysed offline, and the placental outline was manually traced using the virtual organ computer-aided analysis (VOCAL) 30° rotational technique.

Prediction of the degree of bleeding by placental volume measurement of the lower uterus using 3D transvaginal ultrasound in placenta previa

Prediction of the degree of bleeding by placental volume measurement of the lower uterus using 3D transvaginal ultrasound in placenta previa

Placental volume in gestational week 27 measured by three-dimensional ultrasound and magnetic resonance imaging.

Ultrasound is the diagnostic tool of choice in pregnancy. We lack valid ultrasound methods for placental size measurements. Our aim was therefore to compare three-dimensional (3D) ultrasound with magnetic resonance imaging (MRI) for measurements of placental volume. We measured placental volume by 3D ultrasound and MRI in 100 unselected pregnancies at 27weeks of gestation (25+4 -28+4 weeks). The 3D ultrasound acquisitions were analyzed offline, and the placental outline was manually traced using the virtual organ computer-aided analysis (VOCAL) 30° rotational technique. The MRI examinations included a T2-weighted gradient echo sequence in the sagittal plane, with 5-mm slices through the entire uterus. The placental outline was manually traced in each slice. The correlation between 3D ultrasound and MRI placental volumes was estimated by intraclass correlation coefficients. Bland-Altman analysis was applied to visualize systematic bias and limits of agreement, in which the ratio MRI placental volume/3D ultrasound placental volume was plotted against the average of the two methods. The intraclass correlation coefficient between 3D ultrasound and MRI measurements was 0.49 (95% confidence interval 0.33-0.63). In general, 3D ultrasound measured smaller placental volumes (median 373cm3 , interquartile range 309-434cm3 ) than MRI (median 507cm3 , interquartile range 429-595cm3 ) and the systematic bias was 1.44. The 95% limits of agreement between the two methods were wide (0.68-2.21). We found poor to moderate correlation between 3D ultrasound and MRI placental volume measurements. Generally, 3D ultrasound measured smaller placental volumes than MRI, suggesting that 3D ultrasound failed to visualize the entire placenta. Our findings may hopefully contribute to the improvement of ultrasound methods for placental measurements.

The Role of Measuring Placental Volume for the Prediction of Preeclampsia and Intrauterine Growth Restriction (IUGR)*

Preeclampsia is today one of the most important causes of perinatal and maternal death around the world. Vascular growth and development during placental process and the implantation are essential for successful pregnancy and outcome. Intrauterine growth restriction (IUGR), affecting 3–7% of all newborns, is the failure of the fetus to reach its growth potential in utero accordance with gestational week. IUGR, which has a negative effect on perinatal mortality and morbidity, is also the weight of the fetus being lower than expected. The most common cause of intrauterine growth restriction (IUGR) in the developed world is placental insufficiency. In this context, the aim of this study is to predict preeclampsia and IUGR in the first trimester with placental volume measurement by using 3D ultrasonography imaging methods in women who were pregnant between 11 and 14 weeks with CRL measurement between 45-84 mm. Quantitative analysis method was used to test the hypothesis of the research and to investigate the relationship between variables. Statistical analysis was done using SPSS 21. 450 pregnant women, who enrolled in the patient information management system, were the sample of our study. These women applied for the first three months screening test in the Perinatology Department of Manisa Celal Bayar University Hafsa Sultan Hospital and the sample was studied with permission from the ethics committee The relation between placental volume and smoking, weight, gravida, maternal age, gestational age, fetal weight, IUGR, and preeclampsia were found insignificant. In addition, the relationship between the weight of the baby, the relationship between maternal weight, age, gravida and the weeks of pregnancy were also found significant. Preeclampsia appeared in 16 out of 448 cases. Of these 16 cases, 11 (78.6%) had a placental volume of 0-32mm3 and the placenta volume of 5 cases (1.2%) was more than 32mm3. Thus, the relation between placental volume and preeclampsia was statistically found significant (p= 0.000). IUGR was also occurred in 16 out of 448 cases. In 14 cases of these, placental volume was between 0-32 mm3 and placenta volume was more than 32 mm3 in 2 cases. The relation between placental volume and IUGR was also statistically found significant (p = 0.000). The relation between placental volume and preeclampsia and IUGR was statistically found significant (p = 0.000).

Minimally interactive placenta segmentation from three-dimensional ultrasound images.

Purpose: Placental size in early pregnancy has been associated with important clinical outcomes, including fetal growth. However, extraction of placental size from three-dimensional ultrasound (3DUS) requires time-consuming interactive segmentation methods and is prone to user variability. We propose a semiautomated segmentation technique that requires minimal user input to robustly measure placental volume from 3DUS images. Approach: For semiautomated segmentation, a single, central 2D slice was manually annotated to initialize an automated multi-atlas label fusion (MALF) algorithm. The dataset consisted of 47 3DUS volumes obtained at 11 to 14 weeks in singleton pregnancies (28 anterior and 19 posterior). Twenty-six of these subjects were imaged twice within the same session. Dice overlap and surface distance were used to quantify the automated segmentation accuracy compared to expert manual segmentations. The mean placental volume measurements obtained by our method and VOCAL (virtual organ computer-aided analysis), a leading commercial semiautomated method, were compared to the manual reference set. The test-retest reliability was also assessed. Results: The overlap between our automated segmentation and manual (mean Dice: , median: 0.831) was within the range reported by other methods requiring extensive manual input. The average surface distance was . The correlation coefficient between test-retest volumes was , and the intraclass correlation was . Conclusions: MALF is a promising method that can allow accurate and reliable segmentation of the placenta with minimal user interaction. Further refinement of this technique may allow for placental biometry to be incorporated into clinical pregnancy surveillance.

Role of diffusion MR imaging (DWI) and three-dimensional ultrasound (3DUS) in the assessment of placental insufficiency in the gestational hypertension

BackgroundDWI is a non-invasive MR modality that is not contrast-based. In the current study, we aimed to evaluate DWI in correlation with 3DUS in the detection of placental insufficiency in high-risk pregnancies complicated with hypertension.This prospective analysis included 80 pregnancies; 40 hypertensive and 40 controls, gestational age ranged from 22 to 34 weeks. All cases had undergone 3DUS aided by power Doppler scanning and DWI. There is no given contrast. Data were correlated to histopathology.ResultsDoppler US showed a significant relation between RI of the right uterine artery of cases and control (P = 0.014). There was also a positive correlation between the presence of the diastolic notch and RI value. The mean ADC value in the controls was 1.87 ± 0.26 mm2/s, while in hypertensive was 1.36 ± 0.09 mm2/s. In DWI images, there was a significant difference between patients with normal and those with abnormal placental signals (P value = 0.047). Also, there was a significant difference between the measurement of placental volume by MRI and US among cases and controls (P values ≤0.001 and 0.017, respectively).ConclusionDiffusion-weighted imaging can detect early subtle findings and signs of placental dysfunction more than detected with 3DUS, so it can add to the diagnostic accuracy of US in imaging of pregnancies at high risk of placental insufficiency.

Measurement of Placental Volume by 3D Modeling of Ultrasound Placentometry Results

An original method of determining placental volume by 3D modeling of the results of ultrasound placentometry is presented. Calculations and methods for creating 3D models of the placenta are given and the effectiveness of using this method for measurement of placental volume is assessed.

First trimester 3D ultrasound placental volume for predicting preeclampsia and/or intrauterine growth restriction

The objective of the study was to determine the sensitivity of the placental volume for predicting preeclampsia and/or intrauterine growth restriction (IUGR) in the first trimester. A prospective observational study was conducted in pregnant women with a gestational age of 11 to 13+6 weeks. A 3 D transabdominal placental volume measurement was performed at the time of first-trimester aneuploidy screening. The predictive values of this test were calculated. The data from 360 pregnant women was analysed. Seventeen cases developed preeclampsia and/or IUGR. The 10th percentile of placental volume was used as the cut-off level. The sensitivity, specificity, positive predictive value and negative predictive value of placental volume less than the 10th percentile for prediction of preeclampsia and/or IUGR were 23.5%, 90.7%, 11.1% and 96%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value for prediction of early onset preeclampsia were 50%, 90.7%, 3.0% and 99.7%, respectively. This study demonstrated that the placental volume was lower in the cases with preeclampsia and/or IUGR. It was not an effective screening tool for preeclampsia and/or IUGR in the first trimester.IMPACT STATEMENTWhat is already known on this subject? Placental volume may reflect trophoblast invasion, but much earlier, in the first trimester. The estimation of a smaller early placental volume has been shown to be significantly associated with preeclampsia and IUGR.What do the results of this study add? The placental volume was lower in the cases with preeclampsia and/or IUGR. It was not an effective screening tool for preeclampsia and/or IUGR in the first trimester. But it might be used for predicting early onset preeclampsia.What are the implications of these findings for clinical practice and/or further research? Further research of placental volume in the first trimester for predicting an early onset preeclampsia should be conducted.

A dynamical systems model of intrauterine fetal growth

ABSTRACTThe underlying mechanisms for how maternal perinatal obesity and intrauterine environment influence foetal development are not well understood and thus require further understanding. In this paper, energy balance concepts are used to develop a comprehensive dynamical systems model for foetal growth that illustrates how maternal factors (energy intake and physical activity) influence foetal weight and related components (fat mass, fat-free mass, and placental volume) over time. The model is estimated from intensive measurements of foetal weight and placental volume obtained as part of Healthy Mom Zone (HMZ), a novel intervention for managing gestational weight gain in obese/overweight women. The overall result of the modelling procedure is a parsimonious system of equations that reliably predicts foetal weight gain and birth weight based on a sensible number of assessments. This model can inform clinical care recommendations as well as how adaptive interventions, such as HMZ, can influence foetal growth and birth outcomes.

First-trimester measurements of the three-dimensional ultrasound placental volume and uterine artery Doppler in early- and late-onset fetal growth restriction

Objectives: To clarify whether early-onset fetal growth restriction (EO-FGR) could be distinguished from late-onset (LO)-FGR using ultrasonographic evaluations of the uterine artery (UtA) Doppler indices and the three-dimensional (3D) ultrasound placental volume (PV) in the first trimester.Methods: Subjects with 1362 singleton pregnancies who underwent an ultrasound scan at 11–13 weeks were enrolled prospectively. The UtA Doppler and PV indices in cases with EO-FGR (<32 weeks at diagnosis) and LO-FGR (≥32 weeks at diagnosis) later in pregnancy were compared with the control group.Results: Twenty-eight EO-FGR, 73 LO-FGR, and 1261 control groups were analyzed. The crown-rump length (CRL) and PV were smaller in both EO and LO-FGR groups than in the control group. The UtA resistance index (RI) Z-score was significantly higher in the EO-FGR group than in the control group (0.723 versus 0.086, p < .001), but did not differ between LO-FGR and the control group. The area under the receiver operating characteristics curve for the prediction of EO-FGR by combining the uterine artery resistance index (UtA-RI) and CRL was 0.760 (95% CI: 0.654–0.865). The detection rate for EO-FGR was 45.8%, with a 10% false-positive rate.Conclusions: Both EO- and LO-FGR are associated with a small CRL in the first trimester. High UtA-RI is associated with EO-FGR, while a small maternal height and PV are associated with LO-FGR.

New imaging markers for preconceptional and first-trimester utero-placental vascularization

IntroductionThe availability of imaging makers of early placental circulation development is limited. This study aims to develop a feasible and reliable method to assess preconceptional and early first-trimester utero-placental vascular volumes using three-dimensional power Doppler (3D PD) ultrasound on two different Virtual Reality (VR) systems. Methods3D PD ultrasound images of the uterine and placental vasculature were obtained in 35 women, either preconceptionally (n = 5), or during pregnancy at 7 (n = 10), 9 (n = 10) or 11 (n = 10) weeks of gestation. Preconceptional uterine vascular volume (UVV), first-trimester placental vascular volume (PVV) and embryonic vascular volume (EVV) were measured by two observers on two VR systems, i.e., a Barco I-Space and VR desktop. Intra- and inter-observer agreement and intersystem agreement were assessed by intra-class correlation coefficients (ICC) and absolute and relative differences. ResultsUterine-, embryonic- and placental vascular volume measurements showed good to excellent intra- and inter-observer agreement and inter-system reproducibility with most ICC above 0.80 and relative differences of less than 20% preconceptionally and almost throughout the entire gestational age range. Inter-observer agreement of PVV at 11 weeks gestation was suboptimal (ICC 0.69, relative difference 50.1%). DiscussionPreconceptional and first-trimester 3D PD ultrasound utero-placental and embryonic vascular volume measurements using VR are feasible and reliable. Longitudinal cohort studies with repeated measurements are needed to further validate this and assess their value as new imaging markers for placental vascular development and ultimately for the prediction of placenta-related pregnancy complications.

Measurement of placental volume using 2D and 3D ultrasound as compared to MRI – a pilot study

To investigate whether pregestational diabetes mellitus (DM) induces changes in vascular placental development detectable at first trimester.This was a prospective case–control study in 69 women with pregestational DM and 94 controls undergoing first-trimester combined screening for aneuploidies. Maternal characteristics, fetal nuchal translucency thickness, maternal serum pregnancy-associated plasma protein A (PAPP-A) and free β human chorionic gonadotrophin (β-hCG) were evaluated. Three-dimensional ultrasound was used to measure placental volume and three dimensional power Doppler (3D-PD) placental vascular indices including: vascularization index (VI), flow index (FI) and vascularization flow index (VFI). Pregnancy-associated hypertensive complications (PAHC) and perinatal outcomes were analyzed. The total group of diabetic women and the group of diabetic women without PAHC were compared separately with the control group.3D-PD placental vascular indexes were significantly lower in women with DM than in controls (VI p = 0.007, FI p = 0.003 and VFI p = 0.04). These differences remained on excluding cases with PAHC in the DM group. No differences were found in placental volumes between the DM group and controls. Serum PAPP-A levels were also lower in diabetic women (p < 0.02) and negatively correlated with the degree of maternal metabolic control at first trimester.Pregestational DM induces demonstrable alterations in first trimester placental development, with significantly reduced placental vascularization indices and PAPP-A values. This effect is independent of the later development of PAHC.

Role of the First Trimester Maternal Serum High Sensitivity C-Reactive Protein and Second Trimester Placental Volume Measurement by 3d Doppler Ultrasound in Early Detection of Preeclampsia

Background: Pre-eclampsia (PE) is a disorder of pregnancy characterized by the onset of high blood pressure and a significant amount of protein in the urine. It affects 2–8% of pregnancies worldwide. Complications include impaired liver function, kidney dysfunction, visual disturbances and red blood cell Breakdown. PE continues to be a major cause of maternal and fetal mortality. Thus, efforts at discovering reliable prediction models to identify those at risk at an early stage are critical. And since Placental maldevelopment plays a pivotal role in the pathogenesis of PE, therefore, evaluation of the placental volume and vascular flow indices using different techniques can contribute in the prediction of adverse pregnancy outcomes. Aim of the Work: to assess the ability of high sensitivity c reactive protein (Hs CRP) and 3D power Doppler of placental volume and vascular flow indices to predict Preeclampsia. Patients and methods: This is a prospective cohort study by multi operators conducted on 200 women with singleton pregnancy who underwent screening for eligibility and eventually included with respect to the inclusion criteria. The study has been done during the period from October 2015 till December 2016. 1st trimesteric serum level of HsCRP detection tests, 1st trimesteric abdominal ultrasonographic examination and 2nd trimesteric color-Doppler techniques were done and placental volume was measured and Follow up at delivery to confirm Pre-eclampsia has followed. Study Outcomes included the development of hypertention, limb edema or other of pre-eclampsia complication. Data were statistically analyzed using IBM© SPSS© Statistics version 23. Results: HsCRP was significantly (P≤ 0.05 and 0.01) high in Pre-eclampsia group compared to the normal pregnancy group. Moreover, Placental volume (PV), Vascularization index (VI), Flow index (FI) and Vascularization flow index (VFI) were significantly (P≤ 0.05 and 0.01) lower in Pre-eclampsia group than the normal pregnancy group.Conclusion: there was a statistically significant correlation between first-trimester HsCRP and the 2nd trimester placental volume and its vascular indices in the prediction of complications of uteroplacental insufficiency. Further studies with large number of patients have to be carried out to reach conclusive evidence of the significance Doppler in prediction of pre-eclampsi, .and HsCRP.

Early detection of intrauterine growth restriction by combined screening

Intrauterine growth restriction may greatly influence the neonatal period by increasing perinatal morbidity and mortality. First trimester serum screening is commonly used to identify chromosomal anomalies. In recent studies, many authors have described the potential for the detection of pathological placentation through these markers. Several potential predictive markers, such as the Doppler study, 3D placental volume measurements and maternal serum markers, were studied. Modern assessment proposes a combined algorithm that uses fetal ultrasound, the Doppler evaluation of uterine arteries as well as biochemical markers for improving the prediction rate of restricted fetuses.