Three‐Dimensional Sonographic Assessment of Placental Volume and Vascularization in Pregnancies Complicated by Hypertensive Disorders

Pimenta, E.; Paula, Carla Fagundes Silva de; Campos, Juliana Álvares Duarte Bonini; Fox, Karin A.; Francisco, Rossana Pulcineli Vieira; Ruano, Rodrigo; Zugaib, Marcelo

doi:10.7863/ultra.33.3.483

Cited by 19 publications

(10 citation statements)

References 19 publications

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“…In GHT and PE group, both VI and FI were significantly lower (26), as a proof of placental maldevelopment.…”

Section: Discussionmentioning

confidence: 90%

“…Because of the chronic intrauterine hypoxia the placental alterations are presented from first trimester Similarly to previous first trimester findings (26). In case of hypertensive disorders of pregnancy (CHT, GHT or PE) placental vascularization, which is characterized by FI, is significantly lower compared to NBP cases in the second and third trimesters, and it becomes even more affected when hypertension is associated with gestational diabetes (CHT+GDM, GHT+GDM) and correlated with the lenght of pathological lenght of gestation.…”

Section: Discussionmentioning

confidence: 99%

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Use of placental vascularization indices and uterine artery peak systolic velocity in early detection of pregnancies complicated by gestational diabetes, chronic or gestational hypertension, and preeclampsia at risk

et al. 2017

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AimWe aimed to investigate correlations between uterine artery peak systolic velocity (AUtPSV), and placental vascularization in groups of normal blood pressure (NBP) and hypertensive disorders of pregnancy (chronic hypertension (CHT), gestational hypertension (GHT) and preeclampsia (PE)) alone or in combination with gestational diabetes mellitus (GDM), and hypothesized that AUtPSV rises when GDM complicates pregnancy hypertension.MethodsPlacental 3-dimensional power Doppler indices, such as vascularization index (VI), flow index (FI), and vascularization-flow index (VFI), and uterine artery peak systolic velocity (AUtPSV) were measured in CHT (N = 43), CHT+GDM (N = 15), GHT (N = 57), GHT+GDM (N = 23) and PE (N = 17) pregnancies, and compared to NBP (N = 109). Correlations were analyzed between vascularization indices, AUtPSV, pregestational BMI and adverse pregnancy outcome rates.ResultsIn our results VI was higher in CHT (P = 0.010), while FI was lower in CHT (P = 0.009), GHT and PE (P = 0.001) compared to NBP. In case of VFI, significant difference was found between CHT and GHT (P = 0.002), and NBP and PE (P = 0.001). FI was found prognostic for umbilical pH and neonatal birth weight. Pre-gestational BMI was significantly higher in GHT+GDM compared to GHT, and in CHT+GDM compared to the CHT group. As for AUtPSV, significant difference was found between NBP and CHT (P = 0.012), NBP and CHT+GDM (P = 0.045), NBP and GHT+GDM (P = 0.007), NBP and PE (P = 0.032), and GHT and GHT+GDM (P = 0.048) groups.ConclusionOur study revealed that vascularization indices and AUtPSV show significant differences due to gestational pathology, and can be useful in detection of pregnancies at risk.

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“…In GHT and PE group, both VI and FI were significantly lower (26), as a proof of placental maldevelopment.…”

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Use of placental vascularization indices and uterine artery peak systolic velocity in early detection of pregnancies complicated by gestational diabetes, chronic or gestational hypertension, and preeclampsia at risk

et al. 2017

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“…The authors suggested that the increase in VI noted in women with CH may represent a placental response ─ elevated vascularization rate ─ to increased maternal blood pressure and hypothesised that the reduction in FI seen throughout the groups reflected impaired perfusion in the placenta [34]. Within obese cohorts, it has been suggested that flow indices are relatively unreliable for prediction of PE [9], and that future research should focus only on the role of vascularization indices (VI and VFI) [9,36]. Flow indices are depth dependent and, in the obese population, there is an increased distance from the placenta to the abdominal surface which may influence performance of FI.…”

Section: Discussionmentioning

confidence: 99%

Placental vascularization indices and prediction of pre-eclampsia in high-risk women

et al. 2018

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Objective: To assess ability of first and second trimester Placental Vascularization Indices (PVIs); Vascularization Index (VI), Flow Index (FI) and Vascularization Flow Index (VFI) to predict pre-eclampsia (PE) in high-risk pregnancies. Method: PVIs derived from 3-Dimensional power Doppler imaging were measured at 11+0-13+6 (n=194) and 19+0-21+6 weeks (n=195). Logistic regression (LR) models used PE as the outcome. To quantify added value of PVIs to baseline characteristics in predicting PE, integrated discrimination improvement (IDI) and net reclassification improvement (NRI) indices were calculated. Results: Overall rate of PE was 12% (n=26). Lower first trimester PVIs were seen in women with PE (mean, SD);

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“…This influence probably occurs because the number of vessels is affected, whereas the flow is not affected in this specific point of gestation. Studies that have evaluated placental vascularization in the first trimester and have predicted pregnancy complications observed that women with diminished VI and VFI showed an increased tendency to have pregnancies that were later complicated with preeclampsia and fetal growth restriction (de Almeida Pimenta et al 2014; Odeh et al 2011; Odibo et al 2011). Short-term exposure to air pollution seems to affect the same indexes, which indicates the possible pathway by which air pollution may provoke these complications (Olsson et al 2013; Pedersen et al 2014; Romão et al 2013; Sapkota et al 2012; Shah et al 2011; van den Hooven et al 2011; Yorifuji et al 2015).…”

Section: Discussionmentioning

confidence: 99%

Short-Term Exposure to Urban Air Pollution and Influences on Placental Vascularization Indexes

Hettfleisch¹,

Bernardes²,

Carvalho³

et al. 2017

Environ Health Perspect

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Background:It has been widely demonstrated that air pollution can affect human health and that certain pollutant gases lead to adverse obstetric outcomes, such as preeclampsia and fetal growth restriction.Objectives:We evaluated the influence of individual maternal exposure to air pollution on placental volume and vascularization evaluated in the first trimester of pregnancy.Methods:This was a cross-sectional study on low-risk pregnant women living in São Paulo, Brazil. The women carried passive personal NO2 and O3 monitors in the week preceding evaluation. We employed the virtual organ computer-aided analysis (VOCAL) technique using three-dimensional power Doppler ultrasound to evaluate placental volume and placental vascular indexes [vascularization index (VI), flow index (FI), and vascularization flow index (VFI)]. We analyzed the influence of pollutant levels on log-transformed placental vascularization and volume using multiple regression models.Results:We evaluated 229 patients. Increased NO2 levels had a significant negative association with log of VI (p = 0.020 and beta = –0.153) and VFI (p = 0.024 and beta = –0.151). NO2 and O3 had no influence on the log of placental volume or FI.Conclusions:NO2, an estimator of primary air pollutants, was significantly associated with diminished VI and VFI in the first trimester of pregnancy.Citation:Hettfleisch K, Bernardes LS, Carvalho MA, Pastro LD, Vieira SE, Saldiva SR, Saldiva P, Francisco RP. 2017. Short-term exposure to urban air pollution and influences on placental vascularization indexes. Environ Health Perspect 125:753–759; http://dx.doi.org/10.1289/EHP300

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Three‐Dimensional Sonographic Assessment of Placental Volume and Vascularization in Pregnancies Complicated by Hypertensive Disorders

Cited by 19 publications

References 19 publications

Use of placental vascularization indices and uterine artery peak systolic velocity in early detection of pregnancies complicated by gestational diabetes, chronic or gestational hypertension, and preeclampsia at risk

Use of placental vascularization indices and uterine artery peak systolic velocity in early detection of pregnancies complicated by gestational diabetes, chronic or gestational hypertension, and preeclampsia at risk

Placental vascularization indices and prediction of pre-eclampsia in high-risk women

Short-Term Exposure to Urban Air Pollution and Influences on Placental Vascularization Indexes

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