Reduced placental volume and flow in severe growth restricted fetuses

Abstract

OBJECTIVES:To evaluate placental volume and vascular indices in pregnancies with severe fetal growth restriction and determine their correlations to normal reference ranges and Doppler velocimetry results of uterine and umbilical arteries.METHODS:Twenty-seven fetuses with estimated weights below the 3rd percentile for gestational age were evaluated. Placental volume and vascular indices, including vascularization, flow, and vascularization flow indices, were measured by three-dimensional ultrasound using a rotational technique and compared to a previously described nomogram. The observed-to-expected placental volume ratio for gestational age and observed-to-expected placental volume ratio for fetal weight were calculated. Placental parameters correlated with the Doppler velocimetry results of uterine and umbilical arteries.RESULTS:The mean uterine artery pulsatility index was negatively correlated with the observed-to-expected placental volume ratio for gestational age, vascularization index and vascularization flow index. The observed-to-expected placental volume ratio for gestational age and observed-to-expected placental volume ratio for fetal weight and vascularization index were significantly lower in the group with a bilateral protodiastolic notch. No placental parameter correlated with the umbilical artery pulsatility index.CONCLUSIONS:Pregnancies complicated by severe fetal growth restriction are associated with reduced placental volume and vascularization. These findings are related to changes in uterine artery Doppler velocimetry. Future studies on managing severe fetal growth restriction should focus on combined results of placental three-dimensional ultrasound and Doppler studies of uterine arteries.

The Reproducibility of 3D power Doppler in Intrauterine Growth Restriction

“…Also, our findings were noticed by Artunc Ulkumen et al, on 2014 and Abule´ et al, on 2016 where they also noticed decrease the placental volume and placental vascular indicies in growth restricted fetuses [33,34].…”

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

“…Several investigators were concerned about measuring the placental volume using 3D ultrasound to predict infants who could be small for gestational age [17][18][19]. Also, for the same purpose, the placental volume was assessed by MRI [16].…”

Ex‐VivoMRI of the Normal Human Placenta: Structural–Functional Interplay and the Association With Birth Weight

“…1b,c. The setup included components in the console room [1][2][3][4][5][6] and within the scanner 7,8 : 1) bath made of polycarbonate model WB-3 (MRC Lab) with a capacity of 2.7 liter, containing working fluid for placental perfusion; 2) miniature gear pump with maximum flow rate of 2.5 liter/minute, working voltage of 12 VDC (0574-07012-20, El Hamma instruments); 3) custom made controller for controlling the pump; 4) flow meter (Kobold KFR-4150, Manoraz Ltd.), which is a rotameter type acrylic flow meter with a range of 0-400 mL/minute and accuracy of AE3%; 5) digital pressure sensor (DPG1000B-15G), 0-15 PSIG with a range of 0-750 mmHg and accuracy of AE0.25%, battery supply (Omega Engineering Ltd.), indicating the inflow pressure in PSIG (1 PSIG = 51.7 mmHg); 6) Panel Mount Peristalic DC pump 100 rpm (RS Stock No. 705-6662), with a maximum flow rate of 0.375 liter/minute, 12 V DC, The Central Company for Components Ltd.), for returning the fluid to a container after perfusion from the tray located inside the magnet; 7) custom made tray for the placenta to be located inside the magnet, made of Perspex, with a support for umbilical cord (made of white Derlin); 8) pipes: a 5-m inflow pipe inflowing fluid from the bath to the placenta, a 5-m outflow pipe outflowing fluid from the placental tray to a container (both the inflow and the outflow pipes are controlled by the pump), an extra outflow pipe that mechanically drains fluid in case of overflow (not controlled by the pump).…”

“…Several structural characteristics are associated with normal or abnormal placental development and function. Placental volume is known to increase with gestational age (GA) in normal development, 3 and smaller placental volumes were found to be associated with abnormal placental function, low estimated fetal weight, and low birth weight (BW) 4 . The location of the umbilical cord insertion in most placentas is para‐central, as compared with marginal cord insertion, where the insertion is near the outer boundary of the placenta 5 .…”

“…Placental volume is known to increase with gestational age (GA) in normal development, 3 and smaller placental volumes were found to be associated with abnormal placental function, low estimated fetal weight, and low birth weight (BW). 4 The location of the umbilical cord insertion in most placentas is paracentral, as compared with marginal cord insertion, where the insertion is near the outer boundary of the placenta. 5 Placentas with marginal cord insertion are associated with fetal growth restriction (FGR), congenital heart disease, preterm delivery, low BW, stillbirth, and neonatal death.…”