Trimester Placental Volume Research Articles

First-trimester screening model for small-for-gestational-age using maternal clinical characteristics, serum screening markers, and placental volume: prospective cohort study

Objective To examine predictive value of first trimester placental volume, maternal clinical characteristics, and serum biomarkers in predicting small-for-gestational-age (SGA) singleton pregnancy Methods We conducted a prospective study to determine whether SGA is associated with maternal clinical factors. Between November 2016 to May 2018, 351 women were enrolled. We included pregnant women who underwent an integrated test for aneuploidy screening. Placental volume, maternal clinical characteristics, and maternal serum pregnancy-associated plasma protein A (PAPP-A) levels in the first trimester (at 10+0–13+6 weeks) and maternal serum biomarkers after 15+0–22+6 weeks were measured. We measured the width, height, and thickness of the placenta and calculated the placental volume using an established mathematical formula; then, we analyzed the association between SGA at delivery, estimated placental volume (EPV), maternal clinical characteristics, and maternal serum biomarkers by multiple logistic regression analysis. Results In this study, 12.3% (43/351) neonates were delivered before 37 weeks of gestation, and the birth weight of 23.6% (83/351) was below the 10th percentile according to gestational age. On multivariate logistic regression, the MSAFP multiples of the median (MoM) showed the strongest association with SGA in singleton pregnancy (p < .01), and the PAPP-A MoM showed a weaker association in the multiple logistic regression than in the univariate regression (p = .0073 and .0068, respectively). Our prediction model using maternal age, maternal smoking, PAPP-A, and EPV achieved an area under the curve of 0.668 in singleton pregnancy. Conclusion During the first trimester, maternal clinical characteristics, serum biomarkers, and EPV may be used for predicting the risk of SGA in singleton pregnancy.

First trimester placental volume and vascular indices in pregestational diabetic compared to nondiabetic pregnant women.

Comparing placental volume (PV) and vascular indices in pregestational diabetic and nondiabetic pregnant women at 11 and 13 weeks gestation. A case-control study conducted at Ain Shams University Maternity Hospital in collaboration with Feto-maternal Unit for Ultrasound Assessment, Ain Shams University Maternity Hospital, Egypt. Ninety-two pregnant women divided into two groups: Group A included 46 women with pregestational diabetes mellitus and group B included 46 nondiabetic pregnant women as control. All participants had PV, vascularization index (VI), flow index (FI) and vascularization flow index (VFI) calculated using three-dimensional (3D) ultrasonography and 3D power Doppler at 11 and 13 weeks of pregnancy. At 11 weeks, the mean VI, FI and VFI in diabetic group (17.70 ± 12.62, 40.72 ± 11.03 and 7.77 ± 6.37, respectively) were insignificantly higher than in nondiabetic group (12.14 ± 12.62, 34.59 ± 9.66 and 6.52 ± 14.20, respectively) while mean PV in diabetic group (26.90 ± 14.74) was insignificantly lower than in nondiabetic group (27.53 ± 17.46). Also at 13 weeks, the results were not different as the mean VI, FI and VFI in diabetic group (16.51 ± 9.81, 42.52 ± 7.47 and 8.12 ± 7.55, respectively) were insignificantly higher than in nondiabetic group (16.37 ± 14.17, 40.29 ± 17.52 and 7.08 ± 4.35, respectively), and mean PV in diabetic group (52.04 ± 17.95) was insignificantly lower than in nondiabetic group (54.46 ± 17.85). There was strong positive correlation between HbA1C level and VFI measured at 13 weeks gestation. Placental indices in early pregnancy do not seem to be useful markers to anticipate placental pathology in pregestational diabetes, however there might be a role for HbA1C level measurement to anticipate such complications.

EP03.01: Association between first trimester placental volume and pre‐eclampsia in twin pregnancy

EP03.01: Association between first trimester placental volume and pre‐eclampsia in twin pregnancy

First trimester placental volume is reduced in hypertensive disorders of pregnancy associated with small for gestational age fetus

Introduction Trophoblastic invasion and placental growth are critical for pregnancy outcome. The placental volume can be assessed by 3 D ultrasound using Virtual Organ Computer-aided Analysis (VOCAL). Epidemiological and clinical data suggest that there are two different clinical phenotypes of hypertensive disorders of pregnancy (HDP) that coexist at any gestational age: HDP associated to fetal growth impairment and HDP associated to appropriate for gestational age fetal growth. The aim of this study was to determine whether placental volume in the first trimester of pregnancy differs between women with HDP associated or not to fetal growth impairment and uncomplicated pregnancies. Methods This is a retrospective cross-sectional study of prospectively recruited data in which maternal characteristics, Doppler velocimetry of uterine arteries, and three-dimensional (3 D) volume of the placenta were collected at 11 + 1 − 13 + 6 gestational weeks. The placental quotient (PQ) was calculated as placental volume/crown rump length. Results In a 2-year period, we prospectively collected first trimester data of 1322 women. For the purposes of this cross-sectional study, 57 women that delivered a SGA fetus, 34 that developed HDP-AGA, and six that developed HDP-SGA, respectively, were included in the study as cases. The control group was made of 117 uncomplicated pregnancies. The PQ was higher in women with uncomplicated pregnancies (PQ median 16.36 cm3/cm) than in all other study groups (PQ in SGA: 13.02 cm3/cm, p < .001; PQ in HDP-AGA: 12.65 cm3/cm, p = .002; and PQ in women with HDP-SGA: 8.33 cm3/cm [IQR 6.50–10.13], p < .001). The lowest PQ was observed in women with HDP-SGA and was significantly lower than PQ in either women with SGA or those with HDP-AGA (p = .02 and p = .04, respectively). The mean uterine artery pulsatility index was the highest in women with HDP-SGA (median 2.30) compared to all other groups (uncomplicated pregnancies 1.48, p < .0001; women with SGA 1.59, p = .001; and women with HDP-AGA 1.75, p = .009). Discussion Our findings suggest that HDP associated with SGA is characterized by impaired placental growth and perfusion as soon as in the first trimester of pregnancy. The role of PQ, isolated or in association with other biophysical parameters, to predict HDP with fetal growth impairment remains to be evaluated.

First trimester placental vascular indices and volume by three-dimensional ultrasound in pre-gravid overweight women

ObjectivesTo investigate changes of placental vascular indices and volume in pre-gravid overweight Chinese women during the first trimester using three-dimensional power Doppler ultrasound. MethodsThis was a prospective observational study of the morphology of placentas in pre-gravid overweight (body mass index (BMI) ≥ 24 kg/m2) and non-overweight (BMI < 24 kg/m2) Chinese women during the first trimester of pregnancy. Data on placental vascular indices (vascularization index, flow index, and vascularization flow index (VFI)), placental volume, uterine artery pulsatility index (PI), and neonatal outcomes were obtained during the first trimester and analyzed. Linear regression analysis was used to evaluate confounding factors between BMI and ultrasound indices. ResultsOf the 429 pregnant women enrolled, 68 (15.9%) were pre-gravid overweight. Placental VFI was significantly lower in the overweight group (p = 0.037). Conversely, placental volume was significantly larger in the overweight group (p = 0.044), and uterine artery PI was significantly higher in the overweight group (p = 0.021). After adjustments for confounding factors, there were still significant differences in placental VFI (unstandardized coefficient (B) −0.666, 95% confidence interval (CI) −1.306 – (−0.025)), placental volume (B 2.458, 95% CI 0.071–4.844), and uterine artery PI (B 0.152, 95% CI 0.030–0.274) between the two groups. ConclusionsPlacental vascular indices using three-dimensional power Doppler ultrasound can provide an insight into placental vascularization in pre-gravid overweight women in early pregnancy. Alterations in placental VFI, placental volume, and uterine artery PI occur during the first trimester in pre-gravid overweight women.

Placental volume at 11 to 14 gestational weeks in pregnancies complicated with fetal growth restriction and preeclampsia.

The study aims to evaluate the predictive value of first trimester placental volume in pregnancies destined to develop fetal growth restriction (FGR) and preeclampsia (PE). Prospective observational study including placentas from 34 FGR, 12 PE, 15 GH (gestational hypertension) pregnancies, and 265 controls. Placental volume (PV) was obtained using VOCAL technique, and a z score was calculated (z-PV). The association of PV with other first trimester variables and maternal characteristics was assessed with Spearman's correlation. PV increased exponentially with crown-rump length (CRL) and was unrelated to maternal factors (weight, age, parity, and smoking status) as well as first trimester uterine artery Doppler, free β-hCG, nuchal translucency, or fetal heart rate. However, PV was positively associated with maternal height, CRL, PAPP-A, and birth weight. z-PV was a strong predictor for FGR with abnormal fetal Dopplers (AUC=0.9472, P<0.001). z-PV provided moderate prediction of FGR with normal fetal Dopplers (AUC=0.8396, P<0.001), PE (AUC=0.8312, P<0.001), and GH (AUC=0.7640, P<0.001). The addition of maternal weight, PAPP-A, β-hCG, and uterine artery Doppler improved our models. At 11 to 14weeks, PV is an independent predictor of pregnancy complications related to placental insufficiency, and the predictive ability is greater for FGR pregnancies with abnormal fetal Dopplers.

Comparison of placental three-dimensional power Doppler indices and volume in the first and the second trimesters of pregnancy complicated by gestational diabetes mellitus

Objective: To compare the changes of placental three-dimensional power Doppler indices and volume in the first and the second trimesters of pregnancy with gestational diabetes mellitus (GDM).Methods: This was a prospective case-control study of singleton pregnancies with risk factors for GDM. Data on placental vascular indices including vascularization index (VI), flow index (FI), and vascularization flow index (VFI), as well as placental volume were obtained and analyzed during the first and the second trimesters between pregnant women with and without GDM.Results: Of the 155 pregnant women enrolled, 31 developed GDM and 124 did not. VI and VFI were significantly lower in the GDM group during the first and second trimesters (VI: p = .023, and VFI: p = .014 in the first trimester; VI: p = .049, and VFI: p = .031 in the second trimester). However, the placental volume was similar in both the groups during the first trimester, while it was significantly increased in the GDM group during the second trimester (p = .022). There were no significant differences in FI and uterine artery pulsatility index between the two groups. After adjustments in multivariate logistic regression analysis, significant differences were observed in the first trimester VFI (adjusted odds ratio (OR) 0.76, 95% confidence interval (CI) 0.61–0.93), second trimester VFI (adjusted or 0.83, 95%CI 0.71–0.96), and second trimester placental volume (adjusted or 1.03, 95%CI 1.01–1.05).Conclusions: Placental vascular indices can provide an insight into placental vascularization in GDM during early pregnancy. VFI rather than placental volume may be a sensitive sonographic marker in the first trimester of GDM placentas.

First Trimester Placental Volume and Vascular Indices by 3D Ultrasonography and 3D Power Doppler in Pregestational Diabetic and Non-Diabetic Pregnant Patients

Background: 3D power Doppler ultrasonography enables quantitative analysis of region observed through vascular indices as VI (vascularization index), FI (flow index) and VFI (vascularization flow index), which show quantity of vessels, local blood flow and their combination and placental volume. These indices can be calculated using VOCAL program. Aim of Study: This study aimed at comparing placental volume and vascular indices using 3D ultrasonography and 3D power Doppler in pregestational diabetic and non-diabetic pregnant women at first trimester (11th week and 13th week). Patients and Methods: This current study was conducted at Antenatal care Clinic in cooperation with the feto-maternal Unit for ultrasound assessment, Ain-Shams University Maternity Hospital during period between November 2015 and April 2017, on 46 women at eleventh 11th week and thirteen 13th week of gestation. They were divided into two groups: Group (A) included 23 women with pregestational diabetes mellitus and group (B) included 23 non-diabetic pregnant women as a control group after respecting certain inclusion and exclusion criteria. Results: There was no statistically significant difference between pregestational diabetic and non - diabetic group as regard placental volume and vascular indices (VI, FI and VFI). Conclusion: There was no statistically significant difference as regard placental volume and vascular indices (FI,VI and VFI) in pregestational diabetic compared to non-diabetic pregnant patients at first trimester of pregnancy especially with good glycemic control but changes may be present with poor glycaemic control. Recommendations: Further studies are recommend as regard evaluating placental volume and vascular indices (FI,VI and VFI) in pregestational diabetic at second and third trimester of pregnancy giving more time for pathological effect of diabetes mellitus to appear.

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.

The utility of first trimester uterine artery Doppler, placental volume and PAPP-A levels alone and in combination to predict preeclampsia.

In this study, we aimed to evaluate the detection of pre-eclampsia (PE) by integrating uterine artery Doppler, placental volume, and pregnancy-associated plasma protein A (PAPP-A) levels in the first trimester. We prospectively recruited 602 women that underwent 11-13weeks' aneuploidy screening. The mean pulsatility index (PI) of the uterine arteries and the placental volume were measured by ultrasonography. Measurement of PAPP-A levels has been performed at the same day of ultrasonographic examinations. The 90th percentile of uterine artery PI and the 10th percentile of placental volume and PAPP-A levels were used as cut-offs. Uterine artery PI, placental volume, and PAPP-A levels had similar sensitivities in predicting PE (53.66%, 63.41%, and 70.73%, respectively). Use of the parameters in combination had better sensitivity. If one parameter was positive, the sensitivity was 92.68% with 85.20% specificity. If at least two parameters were positive, the sensitivity was 85.37% with 98.89% specificity. In conclusion, the combination of increased PI of uterine artery with low placental volume and low PAPP-A levels in the first trimester achieved better results than either test alone in the prediction of PE.

Third trimester placental volume and biometry measurement: A method-development study

ObjectivesTo test the hypothesis that third trimester placental biometry and volume can be measured by two-dimensional (2D) and three-dimensional (3D) ultrasound in utero, determining which method of measurement was most strongly correlated with true placental size ex vivo. MethodsSingleton pregnancies underwent placental ultrasound within seven days of delivery (n = 87, 29+3–41+5 weeks). Length and width (linear and curvilinear) and depth were estimated. Placental volume (PV) was estimated using 2D ellipse and shell techniques and 3D rotational (15⁰ and 30⁰ rotation angles) and multiplanar (5 and 10 mm slicing intervals) techniques. Measurements were compared to their true correlates following delivery. Intra- and inter-observer reliabilities of candidate placental size estimates were assessed by intraclass correlation coefficient (ICC). ResultsCurvilinear placental length (Rs = 0.24, p = 0.031), width (Rs = 0.27, p = 0.013) and depth (Rs = 0.31, p = 0.0056) correlated well with ex vivo measurements. All methods of PV estimation were related to ex vivo volume (Rs ≥ 0.32, p < 0.01) but not placental weight (p > 0.05); 30° rotational estimation demonstrated the strongest biological correlation (Rs = 0.40, p = 0.0004). Intra- and inter-observer placental size measurements intraclass correlation coefficients were suboptimal (0.59–0.70 and 0.10–0.58 respectively). DiscussionWe have demonstrated that it is possible to obtain information about the size of the third trimester placenta in utero using 2D and 3D ultrasound. However it is essential that the reliability (particularly interobserver reliability) of these estimates is improved prior to prospective studies to determine their predictive value.

First trimester placental volume and vascular indices in pregnancies complicated by preeclampsia.

To analyze placental volume and vascularization at first trimester in women with pre-eclampsia, and secondarily, the effect of maternal characteristics on placental development and perinatal outcomes. This was a prospective cohort study including women seen between 11 and 14 weeks of pregnancy. Biophysical and biochemical markers included in the screening program for aneuploidy were recorded. Placental volume and vascularization indices were obtained using three-dimensional power-Doppler imaging and Virtual Organ Computer-aided Analysis (VOCAL) techniques. We compared 84 women with pre-eclampsia versus 904 non-affected. Placental volume and all vascular indices were lower in those with pre-eclampsia. Multivariate analysis showed that parity and maternal weight had a significant effect on placental volume and vascularization indices (p = 0.004 and p = 0.011). In women with pre-eclampsia, multiparity showed a negative effect on placental volume, gestational age, birth weight and Apgar test score. By contrast, in the non-affected group, multiparity had a protective effect. Low maternal weight had a significantly worse effect on placental vascularization and perinatal outcomes in women with pre-eclampsia. Women with pre-eclampsia showed significantly lower placental volume and vascularization indices at first trimester. Multiparity and low maternal weight independently exacerbated the negative effects of pre-eclampsia on placental characteristics and perinatal outcomes. © 2015 John Wiley & Sons, Ltd.

Differences in 1st trimester placental volume based on mode of conception

Assisted Reproductive Technologies (ART), specifically in vitro fertilization (IVF), has been associated with small for gestational age babies, which may be the result of placental insufficiency, either due to the IVF itself or the underlying infertility. To determine if this is a phenomenon that starts early in gestation, we measured placental volumes in the first trimester to detect differences between pregnancies conceived with IVF compared to pregnancies conceived with less invasive fertility treatments (in vivo fertilization) and spontaneous conceptions.

Second trimester placental volume and uterine artery pulsatility index for the prediction of preterm labor

ObjectiveTo evaluate the usefulness of a second trimester three dimensional (3D)-ultrasound measurement of placental volume and uterine artery Doppler indices in the prediction of preterm labor.Participants and methodsThe study included 150 pregnant women with a single living fetus between 20 and 24

First trimester placental volume and three dimensional power doppler ultrasonography in type I diabetic pregnancies

This study aimed to investigate the placental volume and three dimensional (3D) power Doppler vascularization in type I diabetic pregnancies during the first trimester 3D-power Doppler ultrasonography of the placenta was performed at 11+0-13+6 weeks in 32 pregnancies complicated by type I diabetes. Placental volume, vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were calculated using a standardized setting. In nine pregnancies, a poor first trimester glycemic control was present as expressed by HbA1c levels ≥ 7%, whereas in the remaining 23 mothers, the HbA1c concentrations were <7%. No differences were found in the placental volumes of diabetic mothers when compared with reference limits. 3D Doppler placental vascular indices were significantly higher in diabetic mothers (VI delta value 0.99, p=0.0012; FI delta value 0.64, p=0.0008; VFI delta value 1.28, p=0.0039) when compared with reference limits. Pregnancies with HbA1c ≥ 7% exhibited higher placental vascular indices when compared with diabetic mothers with better glycemic control. In type I diabetic mothers, placental vascular indices are increased and these modifications are more evident in pregnancies with poor first trimester glycemic control.

352: Intra- and inter-observer variability in the evaluation of first trimester placental volume by 3D ultrasound

352: Intra- and inter-observer variability in the evaluation of first trimester placental volume by 3D ultrasound

353: Impact of a required remediation program on nuchal translucency measurements: experience of the Nuchal Translucency Quality Review (NTQR) Program

69 patients enrolled. A normal distribution of placental volumes for each observer was confirmed by the Shapiro-Wilk test. The overall mean placental volume ranged from 16.9 cm3 151.9 cm3. The interobserver CC was 0.94(0.88-0.97) with a CV of 12%. Intra-observer correlation results are summarized in the table below. CONCLUSION: There is a high degree of correlation in the intraand inter-observer assessment of first trimester placental volume using 3D ultrasound. It is possible for placental volume assessment to be easily incorporated into first trimester pregnancy ultrasound evaluation and may assist in identifying pregnancies at increased risk for adverse outcome.

357: Association between first trimester placental volume, uterine artery resistance index, PAPP-A and total β-HCG and birthweight in a low risk population

357: Association between first trimester placental volume, uterine artery resistance index, PAPP-A and total β-HCG and birthweight in a low risk population

Placental volume and vascularization flow indices by 3D power Doppler US using VOCAL technique and correlation with IGF-1, free beta-hCG, PAPP-A, and uterine artery Doppler at 11–14 weeks of pregnancy

The purpose of this study was to investigate correlations between first trimester placental volume (PV) and blood flow indexes (FIs), bilateral uterine artery pulsatility indexes, notching, and biochemical parameters: pregnancy-associated plasma protein-A (PAPP-A), free beta-human chorionic gonadotropin (f-β-hCG), and insulin-like growth factor-1 (IGF-1) to predict the high-risk pregnancies in the first trimester. We prospectively examined 310 patients at 11-14 weeks of pregnancy using transabdominal 3D gray scale and power Doppler ultrasound for assessing PV, vascularization index, FI, and vascularization FI (VFI). The acquired volumes were analyzed using VOCAL™ imaging software. The results were correlated with biochemical parameters. We found significant correlations between PV and biochemical parameters, and between placental blood flow studies and other parameters. Finally, PV/crown-rump length so called the placental quotient is also related to both PAPP-A and VFI. Placental volumetry, uterine artery Doppler studies, blood flow calculations and biochemical parameters, such as f-β-hCG, PAPP-A, and IGF-1 could be important in the early and rapid diagnosis of high-risk pregnancies. Thus, they may be useful in first trimester prediction of fetal growth restriction presenting with alterations in PV and vascularity.

OP38.03: Sonographer standardization of fetal biometry for improving quality and consistency in a prospective large multi‐centre study

and different amniotic fluid parameters are associated with birth weight. Methods: 210 patients with singleton pregnancy and gestational age between 15+0 and 17+6 weeks were included in our study. Fetal biometry with regard to biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL) was routinely performed. Placental volume and vascularization were assessed by 3D ultrasound and 3D power Doppler. Placental volume (PV), four placental ratios (PR1 = PV/BPD; PR2 = PV/HC; PR3 = PV/AC, PR4 = PV/FL) and vascularization indices (VI, FI, VFI) were calculated. Visfatin, leptin, endoglin, VEGF and PIGF were measured in the amniotic fluid. Results: While in linear regression analysis both PV, the four placental ratios, VI and VFI had a significant influence on birth weight only FI significantly predicted birth weight below the 10th percentile in logistic regression analysis. Leptin and Visfatin in the amniotic fluid were significantly associated with birth weight in linear regression analysis. The same applied to VEGF and PV/FI. Conclusions: Second trimester placental volume and vascularization parameters correlate with birth weight. Additionally, leptin and visfatin in the amniotic are associated with fetal development. Placental volumetry and vacularization may be early markers for fetal growth anomalies.