First-Trimester Placental and Myometrial Blood Perfusion Measured by Three-Dimensional Power Doppler in Preeclampsia

Abstract

Objective The study aims to evaluate first-trimester vascularization of the placenta and subplacental myometrium in women who subsequently develop preeclampsia.

Study Design A case–control study nested in a prospective cohort was conducted in women with singleton pregnancy between 11 and 14 weeks' gestation. Three-dimensional standardized acquisition of the placenta and subplacental myometrium volumes with and without power Doppler was undertaken, and all participants were followed up until delivery. Each woman diagnosed with preeclampsia was matched with three controls who delivered at term without pregnancy complications. First-trimester volume, vascularization index (VI), flow index (FI), and vascular flow index (VFI) of the entire placenta and subplacental myometrium were measured separately. The results were stratified for preterm and term preeclampsia, respectively.

Results A total of 1,034 women were recruited, including 16 (1.5%) who developed term preeclampsia and 4 (0.4%) who developed preterm preeclampsia. Preeclampsia was associated with a significantly lower placental VI, placental VFI, subplacental VI, and subplacental VFI in the first trimester than with the controls (all p < 0.05). All cases (4/4) of preterm preeclampsia, 56% (9/16) of term preeclampsia, and 28% (17/60) of the controls had a subplacental VI below 18% (p < 0.01).

Conclusion First-trimester placental and subplacental myometrium vascularizations are significantly reduced in women who subsequently develop preeclampsia.

Keywords

pregnancy - preeclampsia - placenta - ultrasound - Doppler

Note

An oral version of this article was presented at: 34th Annual Meeting of the Society of Maternal-Fetal Medicine; February 2014; New Orleans, LA.

• References

• 1 World Health Organization International Collaborative Study of Hypertensive Disorders of Pregnancy. Geographic variation in the incidence of hypertension in pregnancy. Am J Obstet Gynecol 1988; 158 (1) 80-83
• 2 Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol 2009; 33 (3) 130-137
• 3 Steegers EA, von Dadelszen P, Duvekot JJ, Pijnenborg R. Pre-eclampsia. Lancet 2010; 376 (9741) 631-644
• 4 Brosens I, Pijnenborg R, Vercruysse L, Romero R. The “Great Obstetrical Syndromes” are associated with disorders of deep placentation. Am J Obstet Gynecol 2011; 204 (3) 193-201
• 5 Ogge G, Chaiworapongsa T, Romero R , et al. Placental lesions associated with maternal underperfusion are more frequent in early-onset than in late-onset preeclampsia. J Perinat Med 2011; 39 (6) 641-652
• 6 Lisonkova S, Joseph KS. Incidence of preeclampsia: risk factors and outcomes associated with early- versus late-onset disease. Am J Obstet Gynecol 2013; 209 (6) 544.e1-544.e12
• 7 Espinoza J, Romero R, Mee Kim Y , et al. Normal and abnormal transformation of the spiral arteries during pregnancy. J Perinat Med 2006; 34 (6) 447-458
• 8 Cnossen JS, Morris RK, ter Riet G , et al. Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis. CMAJ 2008; 178 (6) 701-711
• 9 Papageorghiou AT, Yu CK, Nicolaides KH. The role of uterine artery Doppler in predicting adverse pregnancy outcome. Best Pract Res Clin Obstet Gynaecol 2004; 18 (3) 383-396
• 10 Poon LC, Volpe N, Muto B, Yu CK, Syngelaki A, Nicolaides KH. Second-trimester uterine artery Doppler in the prediction of stillbirths. Fetal Diagn Ther 2013; 33 (1) 28-35
• 11 Poon LC, Staboulidou I, Maiz N, Plasencia W, Nicolaides KH. Hypertensive disorders in pregnancy: screening by uterine artery Doppler at 11-13 weeks. Ultrasound Obstet Gynecol 2009; 34 (2) 142-148
• 12 Demers S, Bujold E, Arenas E, Castro A, Nicolaides KH. Prediction of recurrent preeclampsia using first-trimester uterine artery Doppler. Am J Perinatol 2014; 31 (2) 99-104
• 13 Hata T, Tanaka H, Noguchi J, Hata K. Three-dimensional ultrasound evaluation of the placenta. Placenta 2011; 32 (2) 105-115
• 14 Gebb J, Dar P. Colour Doppler ultrasound of spiral artery blood flow in the prediction of pre-eclampsia and intrauterine growth restriction. Best Pract Res Clin Obstet Gynaecol 2011; 25 (3) 355-366
• 15 Effendi M, Demers S, Giguère Y , et al. Association between first-trimester placental volume and birth weight. Placenta 2014; 35 (2) 99-102
• 16 Hafner E, Metzenbauer M, Stümpflen I, Waldhör T, Philipp K. First trimester placental and myometrial blood perfusion measured by 3D power Doppler in normal and unfavourable outcome pregnancies. Placenta 2010; 31 (9) 756-763
• 17 Hafner E, Metzenbauer M, Stümpflen I, Waldhör T. Measurement of placental bed vascularization in the first trimester, using 3D-power-Doppler, for the detection of pregnancies at-risk for fetal and maternal complications. Placenta 2013; 34 (10) 892-898
• 18 The American College of Obstetricians and Gynecologists. Diagnosis and Management of Preeclampia and Eclampsia, ACOG Practice Bulletin no 33. 2002; 99 (1) 1-9
• 19 Brown MA, Lindheimer MD, de Swiet M, Van Assche A, Moutquin JM. The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertens Pregnancy 2001; 20 (1) IX-XIV
• 20 Roberge S, Villa P, Nicolaides K , et al. Early administration of low-dose aspirin for the prevention of preterm and term preeclampsia: a systematic review and meta-analysis. Fetal Diagn Ther 2012; 31 (3) 141-146
• 21 Moldenhauer JS, Stanek J, Warshak C, Khoury J, Sibai B. The frequency and severity of placental findings in women with preeclampsia are gestational age dependent. Am J Obstet Gynecol 2003; 189 (4) 1173-1177
• 22 Kovo M, Schreiber L, Ben-Haroush A, Gold E, Golan A, Bar J. The placental component in early-onset and late-onset preeclampsia in relation to fetal growth restriction. Prenat Diagn 2012; 32 (7) 632-637
• 23 Girard M, Demers S, Lefebvre J, Brassard N, Bujold E. Interacquisition reliability of 11–13 weeks sub-placental myometrium vasculature obtained by 3D ultrasound. Ultrasound Obstet Gynecol 2012; 40 (S1): 117
• 24 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 (3) 230-234
• 25 Plasencia W, Akolekar R, Dagklis T, Veduta A, Nicolaides KH. Placental volume at 11-13 weeks' gestation in the prediction of birth weight percentile. Fetal Diagn Ther 2011; 30 (1) 23-28
• 26 Rizzo G, Capponi A, Cavicchioni O, Vendola M, Arduini D. First trimester uterine Doppler and three-dimensional ultrasound placental volume calculation in predicting pre-eclampsia. Eur J Obstet Gynecol Reprod Biol 2008; 138 (2) 147-151
• 27 Dar P, Gebb J, Reimers L, Bernstein PS, Chazotte C, Merkatz IR. First-trimester 3-dimensional power Doppler of the uteroplacental circulation space: a potential screening method for preeclampsia. Am J Obstet Gynecol 2010; 203 (3) 238.e1-238.e7
• 28 Hannaford K, Goetzinger K, Tuuli M , et al. 3D power Doppler vascularization indices of the whole placenta vs placental bed in the prediction of adverse pregnancy outcomes. Am J Obstet Gynecol 2014; 210 (S1): S95-96
• 29 Jamal A, Milani F, Al-Yasin A. Evaluation of the effect of metformin and aspirin on utero placental circulation of pregnant women with PCOS. Iran J Reprod Med 2012; 10 (3) 265-270
• 30 Bujold E, Roberge S, Lacasse Y , et al. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol 2010; 116 (2 Pt 1) 402-414
• 31 Roberge S, Giguère Y, Villa P , et al. Early administration of low-dose aspirin for the prevention of severe and mild preeclampsia: a systematic review and meta-analysis. Am J Perinatol 2012; 29 (7) 551-556
• 32 Rey E, Rivard GE. Is testing for aspirin response worthwhile in high-risk pregnancy?. Eur J Obstet Gynecol Reprod Biol 2011; 157 (1) 38-42
• 33 Boucoiran I, Suarthana E, Rey E, Delvin E, Fraser WB, Audibert F. Repeated measures of placental growth factor, placental protein 13, and a disintegrin and metalloprotease 12 at first and second trimesters for preeclampsia screening. Am J Perinatol 2013; 30 (8) 681-688
• 34 Boucoiran I, Thissier-Levy S, Wu Y , et al; MIROS Study Group. Risks for preeclampsia and small for gestational age: predictive values of placental growth factor, soluble fms-like tyrosine kinase-1, and inhibin A in singleton and multiple-gestation pregnancies. Am J Perinatol 2013; 30 (7) 607-612
• 35 Goetzinger KR, Tuuli MG, Cahill AG, Macones GA, Odibo AO. Development and Validation of a Risk Factor Scoring System for First-Trimester Prediction of Preeclampsia. Am J Perinatol 2014; ; (Apr) 4
• 36 Ruifrok AE, van Poppel MN, van Wely M , et al. Association between weight gain during pregnancy and pregnancy outcomes after dietary and lifestyle interventions: a meta-analysis. Am J Perinatol 2014; 31 (5) 353-364
• 37 Robinson CJ, Wagner CL, Hollis BW, Baatz JE, Johnson DD. Association of maternal vitamin D and placenta growth factor with the diagnosis of early onset severe preeclampsia. Am J Perinatol 2013; 30 (3) 167-172
• 38 Puschett JB. Marinobufagenin predicts and resibufogenin prevents preeclampsia: a review of the evidence. Am J Perinatol 2012; 29 (10) 777-785
• 39 Qi HP, Fraser WD, Luo ZC, Julien P, Audibert F, Wei SQ. Endothelial nitric oxide synthase gene polymorphisms and risk of preeclampsia. Am J Perinatol 2013; 30 (10) 795-804
• 40 August EM, Salihu HM, Biroscak BJ, Rahman S, Bruder K, Whiteman VE. Systematic review on sleep disorders and obstetric outcomes: scope of current knowledge. Am J Perinatol 2013; 30 (4) 323-334