Dataset Information

3D fractional moving blood volume (3D-FMBV) demonstrates decreased first trimester placental vascularity in pre-eclampsia but not the term, small for gestation age baby.

ABSTRACT:

Objective

To undertake an observational study to see whether first trimester placental vascularity, measured with a standardized power Doppler index: 3D-FMBV, is different in pregnancies which either develop pre-eclampsia or lead to term, normotensive small for gestational age (SGA) babies.

Methods

Women were scanned between 11 and 13+6 weeks. The placental volume (sPlaV) was estimated using our previously validated semi-automated tool. Estimates of 3D-FMBV were generated from the raw power Doppler signal for the whole utero-placental interface, UPI (FMBV-UPI) and 5mm into the placenta (FMBV-IVS). Differences in the placental volume and FMBV for pregnancies developing pre-eclampsia and resulting in term, normotensive SGA babies were compared with term, normotensive, appropriate for gestational age (AGA), controls.

Results

Results were available for 143 women. The placental volume (sPlaV) was reduced in both pre-eclampsia (p = 0.007) and term, normotensive SGA (p = 0.001) when compared with term normotensive AGA controls. 3D-FMBV estimates were significantly lower for pregnancies developing pre-eclampsia (FMBV-UPI, p = 0.03, FMBV-IVS, p = 0.01) but not for the normotensive SGA pregnancies (FMBV-UPI, p = 0.16, FMBV-IVS, p = 0.27).

Conclusion

Pregnancies destined to develop pre-eclampsia are more likely to have small placentas with significantly reduced vascularity at 11-13 weeks. Those pregnancies which were normotensive throughout but resulted in an SGA baby delivered at term, had significantly smaller placentas but with similar vascularity to normotensive AGA pregnancies.

SUBMITTER: Collins SL

PROVIDER: S-EPMC5453560 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Publications

3D fractional moving blood volume (3D-FMBV) demonstrates decreased first trimester placental vascularity in pre-eclampsia but not the term, small for gestation age baby.

Collins Sally L SL Welsh Alec W AW Impey Lawrence L Noble J Alison JA Stevenson Gordon N GN

PloS one 20170601 6

<h4>Objective</h4>To undertake an observational study to see whether first trimester placental vascularity, measured with a standardized power Doppler index: 3D-FMBV, is different in pregnancies which either develop pre-eclampsia or lead to term, normotensive small for gestational age (SGA) babies.<h4>Methods</h4>Women were scanned between 11 and 13+6 weeks. The placental volume (sPlaV) was estimated using our previously validated semi-automated tool. Estimates of 3D-FMBV were generated from the ...[more]

PMID: 28570600

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Project description:ObjectivesPreterm birth (PTB) is a major public health problem worldwide. It can occur spontaneously or be medically indicated for obstetric complications, such as pre-eclampsia (PE) or fetal growth restriction. The main objective of this study was to investigate whether there is a shared uteroplacental etiology in the first trimester of pregnancy across PTB subtypes.MethodsThis was a retrospective cohort study of singleton pregnancies that underwent screening for preterm PE as part of their routine first-trimester ultrasound assessment at a tertiary center in London, UK, between March 2018 and December 2020. Screening for preterm PE was performed using the Fetal Medicine Foundation algorithm, which includes maternal factors, mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI) and pregnancy-associated plasma protein-A (PAPP-A). Women with a risk of ≥ 1 in 50 for preterm PE were classified as high risk and offered prophylactic aspirin (150 mg once a day) and serial ultrasound assessments. The following delivery outcomes were evaluated: PTB < 37 weeks, iatrogenic PTB (iPTB) and spontaneous PTB (sPTB). Logistic regression analyses were performed to assess the association of PTB, iPTB and sPTB with an increased risk of preterm PE. A model for prediction of PTB < 37 weeks and < 33 weeks was developed and its performance was compared with that of an existing model in the literature.ResultsA total of 11 437 women were included in the study, of whom 475 (4.2%) had PTB. Of these, 308 (64.8%) were sPTB and 167 (35.2%) were iPTB. Patients with PTB had a higher body mass index, were more likely to be of black or Asian ethnicity, be smokers, have pregestational hypertension or diabetes, or have a history of previous PTB. They also had higher MAP (87.7 vs 86.0 mmHg, P < 0.0001), higher UtA-PI multiples of the median (MoM) (0.99 vs 0.92, P < 0.0001) and lower PAPP-A MoM (0.89 vs 1.08, P < 0.0001) compared to women with a term birth. In women at high risk of PE, the odds ratio for iPTB was 6.0 (95% CI, 4.29-8.43; P < 0.0001) and that for sPTB was 2.0 (95% CI, 1.46-2.86; P < 0.0001). A prediction model for PTB < 37 weeks and < 33 weeks, developed based on this cohort, included previous PTB, black ethnicity, chronic hypertension, diabetes mellitus, PAPP-A MoM and UtA-PI MoM. The performance of the model was similar to that of an existing first-trimester prediction model for PTB < 33 weeks (area under the curve, 0.704 (95% CI, 0.653-0.754) vs 0.694 (95% CI, 0.643-0.746)).ConclusionsIncreased first-trimester risk for uteroplacental dysfunction was associated with both iPTB and sPTB, implying a shared etiological pathway. The same factors used to predict PE risk show acceptable discrimination to predict PTB at < 33 weeks. Women at high risk of uteroplacental dysfunction may warrant additional monitoring and management for an increased risk of sPTB. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Project description:BackgroundPre-eclampsia (PE) is a major cause of maternal and perinatal morbidity and mortality worldwide. It is defined by new onset of hypertension and proteinuria after the 20th week of gestation and characterized by systemic exaggerated inflammatory response. D6 is a chemokines scavenger receptor that binds with high affinity CC chemokines, internalizes and targets the ligands for degradation. It is expressed in trophoblast-derived tissues and prevents excessive placenta leukocyte infiltration.The aim of this study was to investigate the expression and function of D6 in human placentae from pre-eclamptic and healthy pregnant women.Methods and resultsPlasma levels of D6-binding CC chemokines (CCL-2, CCL-3, CCL-4, CCL-7, CCL-11) and pro-inflammatory cytokines (IL-6, TNF-?, CRP) were analyzed in 37 healthy pregnant women and 38 patients with PE by multiplex bead assay. Higher circulating levels of CCL7, CCL11, IL-6, (p<0.0001) and CRP (p<0.05) were observed in PE women compared to controls. Levels of circulating CCL4 were decreased in PE (p<0.001), while no significant differences of CCL2, CCL3 or TNF-? levels were detected. Immunofluorescent staining of placental sections showed higher expression of D6 receptor in the PE syncytiotrophoblast. Confocal and Western blot (WB) analyses revealed a prevalent distribution of D6 in trophoblast cells membranes in PE. Increased activation of D6 intracellular pathway was observed by Western blot analyses of p-LIMK and p-cofilin in trophoblast cell lysates. D6 functional assays showed reduced scavenging of CCL2 in PE cells compared to controls. Since actin filaments spatial assembling is essential for D6 intracellular trafficking and scavenging activity, we investigated by confocal microscopy trophoblast cytoskeleton organization and we observed a dramatic disarrangement in PE compared to controls.Conclusionsour results suggest membrane distribution of D6 receptor on trophoblast cell membranes in PE, together with reduced functionality, probably due to cytoskeleton impairment.

Dataset Information

3D fractional moving blood volume (3D-FMBV) demonstrates decreased first trimester placental vascularity in pre-eclampsia but not the term, small for gestation age baby.

Objective

Methods

Results

Conclusion

Publications

3D fractional moving blood volume (3D-FMBV) demonstrates decreased first trimester placental vascularity in pre-eclampsia but not the term, small for gestation age baby.

Similar Datasets

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