Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2015

Open Access 01-12-2015 | Research article

Placental vascularization alterations in hypertensive disorders complicating pregnancy (HDCP) and small for gestational age with HDCP using three-dimensional power doppler in a prospective case control study

Authors: Ting Yuan, Ting Zhang, Zhen Han

Published in: BMC Pregnancy and Childbirth | Issue 1/2015

Login to get access

Abstract

Background

Hypertensive disorders complicating pregnancy (HDCP) continues to be a leading cause of maternal and neonatal mortality and morbidity. The clinical value of placental three-dimensional power Doppler (3DPD) in assessing HDCP requires further confirmation. The research was developed to assess changes of placental vascularity in HDCP using 3DPD and to investigate the placental vascularity in small for gestational age (SGA) compared with not-SGA in patients with HDCP.

Methods

There were 126 normotensive and 128 hypertensive pregnant women included in this prospective case–control study from March 2011 to March 2013. Pregnant women underwent 3DPD. Vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were obtained. The placental 3DPD indices, umbilical artery systolic and diastolic ratio (S/D) and pregnancy outcomes were compared between the groups.

Results

The placental VI and VFI were significantly lower in hypertensive women compared with normotensive women (P < 0.001 and P = 0.014, respectively), and these parameters were significantly reduced in severe preeclampsia (P < 0.001 and P = 0.003, respectively). A weak correlation was found between VI and umbilical artery S/D in HDCP group (r = -0.277, P = 0.001). In HDCP population, neonates who were postnatally diagnosed with SGA had lower VI (P = 0.041) and higher S/D (P < 0.001).

Discussion

The placental vascularity indices decreased in hypertensive women and the reduction inplacental perfusion was consistent with the severity of the hypertensive disorder. The associations betweenplacental vascularization and umbilical artery impedance may be valuable for further researches and arerequired confirmation. The significant differences in the 3DPD placental vascularization between SGA andnot-SGA in hypertensive pregnancy population may show some clinical importance that we could use tobetter assess or predict the progression and adverse outcomes in the future. Although 3DPD quantificationhas been widely used in multiple publications, we have to acknowledge its limitations.

Conclusions

The intraplacental vascularization was poor in HDCP, and especially in severe preeclampsia. Neonates with SGA had poor placental vascularization and higher umbilical artery S/D. Further studies should focus on the clinical assessment of placental 3DPD as well as a combination of placental 3DPD and other fetal Doppler indices to better predict the development and outcomes of preeclampsia.
Literature
1.
2.
Ye C, Ruan Y, Zou L, Li G, Li C, Chen Y, et al. The 2011 survey on hypertensive disorders of pregnancy (HDP) in China: prevalence, risk factors, complications, pregnancy and perinatal outcomes. PLoS One. 2014;9:e100180.CrossRefPubMedPubMedCentral
3.
Ghulmiyyah L, Sibai B. Maternal mortality from preeclampsia/eclampsia. Semin Perinatol. 2012;36:56–9.CrossRefPubMed
4.
Yigiter AB, Kavak ZN, Durukan B, Isci H, Uzuner A, Uyar E, et al. 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. J Perinat Med. 2011;39:137–41.CrossRefPubMed
5.
Schwartz N, Mandel D, Shlakhter O, Coletta J, Pessel C, Timor-Tritsch IE, et al. Placental morphologic features and chorionic surface vasculature at term are highly correlated with 3-dimensional sonographic measurements at 11 to 14 weeks. J Ultrasound Med. 2011;30:1171–8.PubMed
6.
Rizzo G, Silvestri E, Capponi A, Servadei F, Pietrolucci ME, Capece A, et al. Histomorphometric characteristics of first trimester chorionic villi in pregnancies with low serum pregnancy-associated plasma protein-A levels: relationship with placental three-dimensional power Doppler ultrasonographic vascularization. J Matern Fetal Neonatal Med. 2011;24:253–7.CrossRefPubMed
7.
Dikshit S. Fresh look at the Doppler changes in pregnancies with placental-based complications. J Postgrad Med. 2011;57:138–40.CrossRefPubMed
8.
Campbell S. Placental vasculature as visualized by 3D power Doppler angiography and 3D colour Doppler imaging. Ultrasound Obstet Gynecol. 2007;30:917–20.CrossRefPubMed
9.
Sibley CP, Turner MA, Cetin I, Ayuk P, Boyd CA, D’Souza SW, et al. Placental phenotypes of intrauterine growth. Pediatr Res. 2005;58:827–32.CrossRefPubMed
10.
Guimaraes FH, da Costa LL, Araujo JE, Nardozza LM, Nowak PM, Moron AF, et al. Placenta: angiogenesis and vascular assessment through three-dimensional power Doppler ultrasonography. Arch Gynecol Obstet. 2008;277:195–200.CrossRef
11.
Konje JC, Huppertz B, Bell SC, Taylor DJ, Kaufmann P. 3-dimensional colour power angiography for staging human placental development. Lancet. 2003;362:1199–201.CrossRefPubMed
12.
Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL. Hypertensive disorders. In: Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, editors. Williams Obstetrics. Chapter 40. 24th ed. New York: McGraw-Hill; 2014. p. 728–30.
13.
Guiot C, Gaglioti P, Oberto M, Piccoli E, Rosato R, Todros T. Is three-dimensional power Doppler ultrasound useful in the assessment of placental perfusion in normal and growth-restricted pregnancies? Ultrasound Obstet Gynecol. 2008;31:171–6.CrossRefPubMed
14.
Marsal K, Persson PH, Larsen T, Lilja H, Selbing A, Sultan B. Intrauterine growth curves based on ultrasonically estimated fetal weights. Acta Paediatr. 1996;85:843–8.CrossRefPubMed
15.
Merce LT, Barco MJ, Bau S, Kupesic S, Kurjak A. Assessment of placental vascularization by three-dimensional power Doppler “vascular biopsy” in normal pregnancies. Croat Med J. 2005;46:765–71.PubMed
16.
Guimaraes FH, Araujo JE, Mattar R, Da Costa LL, de Mello Junior CF, Nardozza LM, et al. Placental blood flow measured by three-dimensional power Doppler ultrasound at 26 to 35 weeks gestation in normal pregnancies. J Matern Fetal Neonatal Med. 2010;23:69–73.CrossRef
17.
Yu CH, Chang CH, Ko HC, Chen WC, Chang FM. Assessment of placental fractional moving blood volume using quantitative three-dimensional power Doppler ultrasound. Ultrasound Med Biol. 2003;29:19–23.CrossRefPubMed
18.
de Paula CF, Ruano R, Campos JA, Zugaib M. Quantitative analysis of placental vasculature by three-dimensional power Doppler ultrasonography in normal pregnancies from 12 to 40 weeks of gestation. Placenta. 2009;30:142–8.CrossRefPubMed
19.
de Almeida PE, de Paula CF S, Duarte Bonini Campos JA, Fox KA, Francisco R, Ruano R, et al. Three-dimensional sonographic assessment of placental volume and vascularization in pregnancies complicated by hypertensive disorders. J Ultrasound Med. 2014;33:483–91.CrossRef
20.
Mihu CM, Drugan T, Mihu D. Contribution of 3D power Doppler ultrasound to the evaluation of placental circulation in normal pregnancies and pregnancies complicated by preeclampsia. J Perinat Med. 2012;40:359–64.CrossRefPubMed
21.
Chen CY, Wang KG, Chen CP. Alteration of vascularization in preeclamptic placentas measured by three-dimensional power Doppler ultrasound. J Matern Fetal Neonatal Med. 2013;26:1616–22.CrossRefPubMed
22.
Costa J, Rice H, Cardwell C, Hunter A, Ong S. An assessment of vascularity and flow intensity of the placenta in normal pregnancy and pre-eclampsia using three-dimensional ultrasound. J Matern Fetal Neonatal Med. 2010;23:894–9.CrossRefPubMed
23.
Baschat AA, Weiner CP. Umbilical artery Doppler screening for the small for gestational age fetus in need of antenatal surveillance. Am J Obstet Gynecol. 2000;182:154–8.CrossRefPubMed
24.
Baschat AA, Gembruch U, Reiss I, Gortner L, Weiner CP, Harman CR. Relationship between arterial and venous Doppler and perinatal outcome in fetal growth restriction. Ultrasound Obstet Gynecol. 2000;16:407–13.CrossRefPubMed
25.
Pomorski M, Zimmer M, Florjanski J, Michniewicz J, Wiatrowski A, Fuchs T, et al. Comparative analysis of placental vasculature and placental volume innormal and IUGR pregnancies with the use of three-dimensional Power Doppler. Arch Gynecol Obstet. 2012;285:331–7.CrossRefPubMed
26.
Borges KJ, Hassan N, Hussain R, Akhtar MT. Effects of variation in umbilical artery resistive index on placental morphology and birth weight in pregnancy induced hypertension. J Ayub Med Coll Abbottabad. 2013;25:23–6.PubMed
27.
Ruiz-Quiñonez G, Reza-López SA, Chávez-Corral DV, Sánchez-Ramírez B, Leal-Berumen I, Levario-Carrillo M. Placental maturity, hypertensive disorders of pregnancyand birth weight. Hypertens Pregnancy. 2014;33:132–44.CrossRefPubMed
28.
Noguchi J, Tanaka H, Koyanagi A, Miyake K, Hata T. Three-dimensional power Doppler indices at 18–22 weeks’ gestation for prediction of fetal growth restriction or pregnancy-induced hypertension. Arch Gynecol Obstet. 2015;292:75–9.CrossRefPubMed
29.
Odibo AO, Goetzinger KR, Huster KM, Christiansen JK, Odibo L, Tuuli MG. Placental volume and vascular flow assessed by 3D power Doppler and adverse pregnancy outcomes. Placenta. 2011;32:230–4.CrossRefPubMedPubMedCentral
30.
Odeh M, Ophir E, Maximovsky O, Grinin V, Bornstein J. Placental volume and three-dimensional power Doppler analysis in prediction of pre-eclampsia and small for gestational age between week 11 and 13 weeks and 6 days of gestation. Prenat Diagn. 2011;31:367–71.CrossRefPubMed
31.
Hata T, Tanaka H, Noguchi J, Hata K. Three-dimensional ultrasound evaluation of the placenta. Placenta. 2011;32:105–15.CrossRefPubMed
32.
Mercé LT, Barco MJ, Bau S. Reproducibility of the study of placental vascularization by three-dimensional power Doppler. J Perinat Med. 2004;32:228–33.CrossRefPubMed
33.
Noguchi J, Hata K, Tanaka H, Hata T. Placental vascular sonobiopsy using three-dimensional power Doppler ultrasound in normal and growth restricted fetuses. Placenta. 2009;30:391–7.CrossRefPubMed
34.
Bujold E, Effendi M, Girard M, Gouin K, Forest JC, Couturier B, et al. Reproducibility of first trimester three-dimensional placental measurements in the evaluation of early placental insufficiency. J Obstet Gynaecol Can. 2009;31:1144–8.CrossRefPubMed
35.
Huster KM, Haas K, Schoenborn J, McVean D, Odibo AO. Reproducibility of placental volume and vasculature indices obtained by 3-dimensional power Doppler sonography. J Ultrasound Med. 2010;29:911–6.PubMed
36.
Morel O, Grangé G, Fresson J, Schaaps JP, Foidart JM, Cabrol D, et al. Vascularization of the placenta and the sub-placental myometrium: feasibility and reproducibility of a three dimensional power Doppler ultrasound quantification technique. A pilot study. J Matern Fetal Neonatal Med. 2011;24:284–90.CrossRefPubMed
37.
Guimarães Filho HA, Mattar R, Araujo Júnior E, da Costa LL, de Mello Junior CF, Nardozza LM, et al. Reproducibility of three-dimensional power Doppler placental vascular indices in pregnancies between 26 and 35 weeks. Arch Gynecol Obstet. 2011;283:213–7.CrossRefPubMed
38.
Lai PK, Wang YA, Welsh AW. Reproducibility of regional placental vascularity/perfusion measurement using 3D power Doppler. Ultrasound Obstet Gynecol. 2010;36:202–9.CrossRefPubMed
39.
Tuuli MG, Houser M, Odibo L, Huster K, Macones GA, Odibo AO. Validation of placental vascular sonobiopsy for obtaining representative placental vascular indices by three dimensional power Doppler. Placenta. 2010;31:192–6.CrossRefPubMed
40.
Nastri CO, Ferriani RA, Raine-Fenning N, Martins WP. Endometrial scratching performed in the non-transfer cycle and outcome of assisted reproduction: a randomized controlled trial. Ultrasound Obstet Gynecol. 2013;42:375–82.CrossRefPubMed
41.
Nandi A, Martins WP, Jayaprakasan K, Clewes JS, Campbell BK, Raine-Fenning NJ. Assessment of endometrial and subendometrial blood flow in women undergoing frozen embryo transfer cycles. Reprod Biomed Online. 2014;28:343–51.CrossRefPubMed
42.
Miyague AH, Raine-Fenning NJ, Pavan TZ, Polanski LT, Baumgarten MN, Nastri CO, et al. Influence of gain adjustment on 3-dimensional power Doppler indices and on spatiotemporal image correlation volumetric pulsatility indices using a flow phantom. J Ultrasound Med. 2013;32:1831–6.CrossRefPubMed
43.
Martins WP, Welsh AW, Lima JC, Nastri CO, Raine-Fenning NJ. The “volumetric” pulsatility index as evaluated by spatiotemporal imaging correlation (STIC): a preliminary description of a novel technique, its application to the endometrium and an evaluation of its reproducibility. Ultrasound Med Biol. 2011;37:2160–8.CrossRefPubMed
44.
Welsh AW, Hou M, Meriki N, Martins WP. Spatiotemporal image correlation-derived volumetric Doppler impedance indices from spherical samples of the placenta: intraobserver reliability and correlation with conventional umbilical artery Doppler indices. Ultrasound Obstet Gynecol. 2012;40:431–6.CrossRefPubMed
45.
Martins WP, Raine-Fenning NJ, Ferriani RA, Nastri CO. Quantitative three-dimensional power Doppler angiography: a flow-free phantom experiment to evaluate the relationship between colour gain, depth and signal artifact. Ultrasound Obstet Gynecol. 2010;35:361–8.CrossRefPubMed
46.
Miyague AH, Pavan TZ, Grillo FW, Teixeira DM, Nastri CO, Martins WP. Influence of attenuation on three-dimensional power Doppler indices and STIC volumetric pulsatility index: a flow phantom experiment. Ultrasound Obstet Gynecol. 2014;43:103–5.CrossRefPubMed
47.
Martins WP, Nastri CO. Reproducibility of 3D power Doppler placental vascular indices. Arch Gynecol Obstet. 2011;283:403–4.CrossRefPubMed
48.
Martins WP, Lima JC, Welsh AW, Araujo Junior E, Miyague AH, Filho FM, et al. Three-dimensional Doppler evaluation of single spherical samples from the placenta: intra- and interobserver reliability. Ultrasound Obstet Gynecol. 2012;40:200–6.CrossRefPubMed
49.
Miyague AH, Raine-Fenning NJ, Polanski L, Martinez LH, Araujo Junior E, Pavan TZ, et al. Assessing repeatability of 3D Doppler indices obtained by static 3D and STIC power Doppler: a combined in-vivo/in-vitro flow phantom study. Ultrasound Obstet Gynecol. 2013;42:571–6.
50.
Stevenson GN, Collins SL, Welsh AW, Impey LW, Noble JA. A technique for the estimation of fractional moving blood volume by using three-dimensional power Doppler US. Radiology. 2015;274:230–7.CrossRefPubMed
51.
Soares CA, Miyague AH, Filho FM, Raine-Fenning N, Martins WP. Fractional moving blood volume (FMBV) concept can be applied to 3D power Doppler quantification. Ultrasound Obstet Gynecol. 2013;41:98–9.CrossRefPubMed
52.
Rubin JM, Adler RS, Fowlkes JB, Spratt S, Pallister JE, Chen JF, et al. Fractional moving blood volume: estimation with power Doppler US. Radiology. 1995;197:183–90.CrossRefPubMed
53.
Rubin JM, Bude RO, Fowlkes JB, Spratt RS, Carson PL, Adler RS. Normalizing fractional moving blood volume estimates with power Doppler US:defining a stable intravascular point with the cumulative power distribution function. Radiology. 1997;205:757–65.CrossRefPubMed
54.
Welsh AW, Fisk NM. Picture of the month. Assessment of fetal renal perfusion by power Doppler digital analysis. Ultrasound Obstet Gynecol. 2001;17:89–91.CrossRefPubMed
55.
Zalud I, Shaha S. Three-dimensional sonography of the placental and uterine spiral vasculature: influence of maternal age and parity. J Clin Ultrasound. 2008;36:391–6.CrossRefPubMed
Metadata
Title
Placental vascularization alterations in hypertensive disorders complicating pregnancy (HDCP) and small for gestational age with HDCP using three-dimensional power doppler in a prospective case control study
Authors
Ting Yuan
Ting Zhang
Zhen Han
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2015
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-015-0666-1

Other articles of this Issue 1/2015

BMC Pregnancy and Childbirth 1/2015 Go to the issue

Research article

Knowledge on preconceptional folic acid supplementation and intention to seek for preconception care among men and women in an urban city: a population-based cross-sectional study

Research article

Obesity and normal birth: A qualitative study of clinician’s management of obese pregnant women during labour

Research article

Explanatory factors for first and second-generation non-western women’s inadequate prenatal care utilisation: a prospective cohort study

Research article

Cost-effectiveness of invitation to food supplementation early in pregnancy combined with multiple micronutrients on infant survival: analysis of data from MINIMat randomized trial, Bangladesh

Research article

Magnitude and factors associated with institutional delivery service utilization among childbearing mothers in Cheha district, Gurage zone, SNNPR, Ethiopia: a community based cross sectional study

Research article

Incidence of obstetrical thrombotic thrombocytopenic purpura in a retrospective study within thrombocytopenic pregnant women. A difficult diagnosis and a treatable disease