279: First trimester 3D power doppler of the intervillous space in patients with decreased PAPP-A levels and increased uterine artery pulsatility index

Abstract Objective: To compare first trimester 2D conventional and 3D power Doppler angiography measures in twins and singletons following assisted reproduction. Methods: We prospectively evaluated 50 singleton and 47 twin pregnancies that eventually ended in live births. Patients were recruited from a single assisted reproductive technology (ART) center with standard treatment protocols. Obstetric ultrasound was performed at 8–9 weeks +6 days. Intervillous flow, uteroplacental circulation and uterine artery pulsatility (PI) and resistance index (RI) using two-dimensional (2D) ultrasound examination were evaluated. Using three-dimensional (3D) power Doppler angiography, placental volume and the 3D power Doppler indices from the intervillous and uteroplacental circulation were calculated. Results: Demographic and cycle characteristics were similar in mothers of singletons and twins. Placental volume was significantly (1.6-fold) larger in twins. Vascular density and blood perfusion in the intervillous space were lower in twins. The comparison of the other parameters did not show significant differences between singletons and twins. Conclusion: The data confirm the larger placental volume in twins, denoting a probable higher production of placental hormones that would support an early twin pregnancy. The lower vascular density and blood perfusion in the intervillous space in twins may also confer a reproductive advantage to them.

Download Full-text

Assessment of uteroplacental vascularisation in early first-trimester pregnancy with contrast-enhanced ultrasound and 3D power Doppler angiography: protocol for a prospective, cross-sectional, multicentre and non-randomised open study (“HOPE Study”)

BMJ Open ◽

10.1136/bmjopen-2019-030353 ◽

2019 ◽

Vol 9 (9) ◽

pp. e030353 ◽

Cited By ~ 3

Author(s):

Charline Bertholdt ◽

Marie-Laure Eszto ◽

Mathilde Tournier ◽

Gabriela Hossu ◽

Naoual Mellouki ◽

...

Keyword(s):

Open Study ◽

Power Doppler ◽

Three Dimensional ◽

Competent Authority ◽

First Trimester ◽

Placental Development ◽

Cross Sectional ◽

Intervillous Space ◽

Contrast Enhanced ◽

3D Power Doppler

IntroductionKnowledge about the mechanisms leading to the establishment of uteroplacental vascularisation is inadequate, and some of what has been thought to be known for decades has recently been challenged by showing that the intervillous space, the major area of maternal-fetal exchange, appears to be perfused by maternal blood at as early as 6 weeks of gestation. The vascular flow then seems relatively constant until 13 weeks when it appears to increase suddenly.ObjectivesThe principal objective is to quantify the perfusion of the intervillous space by contrast-enhanced ultrasonography (CEUS) during the first-trimester at three different gestational ages (8, 11 and 13 weeks). The secondary objectives are to: (1) describe the indicators of vascularisation of the placenta (intervillous space) and the myometrium at the three gestational ages, measured by CEUS and three-dimensional power Doppler (3DPD) angiography; (2) compare the diagnostic performance of CEUS and 3DPD for the demonstration and quantification of uteroplacental vascularisation and (3) establish a biological collection of placentas to increase knowledge about placental development and functions during pregnancy.Methods and analysisThis is a prospective, cross-sectional, multicentre and non-randomised open study. We will include 42 women with ongoing pregnancy and divided into three groups of gestational ages (ie, 14 women by per group): 8, 11 and 13 weeks of gestation. 3DPD and then CEUS will be performed and the data about the perfusion kinetics and the 3DPD indices will be calculated and then compared with each other and for each gestational age.Ethics and disseminationThe appropriate French Ethics Committee Est III approved this study and the related consent forms on 5 April 2016, and the competent authority (Agence Nationale de Sécurité du Médicament et des Produits de Santé) authorised the study on 21 June 2016. The results of this study will be published in a peer-reviewed journal and will be presented at relevant conferences.Trial registration numbersClinicalTrials.gov registry (NCT02884297); EudraCT registry (2015-005655-27).

Download Full-text

Three-Dimensional Power Doppler Analysis of Cerebral Circulation in Normal and Growth-Restricted Fetuses

Journal of Cerebral Blood Flow & Metabolism ◽

10.1038/jcbfm.2009.70 ◽

2009 ◽

Vol 29 (9) ◽

pp. 1609-1618 ◽

Cited By ~ 17

Author(s):

Jose L Bartha ◽

Eva M Moya ◽

Blas Hervías-Vivancos

Keyword(s):

Doppler Ultrasound ◽

Cerebral Circulation ◽

Pulsatility Index ◽

Power Doppler ◽

Three Dimensional ◽

Flow Index ◽

Power Doppler Ultrasound ◽

3D Power Doppler ◽

Doppler Indices ◽

Vascularization Index

The objective of the present study was to evaluate fetal cerebral circulation by using three-dimensional (3D) power Doppler ultrasound in normal and growth-restricted fetuses. A total of 100 normal grown fetuses were compared with other 25 with growth restriction (FGR). Three-dimensional power Doppler ultrasound was used to assess fetal cerebral 3D vascular indices: vascularization index, flow index (FI), and vascularization flow index (VFI). Both FI and VFI correlated positively with gestational age. On average, all the 3D vascular indices were increased in fetuses with FGR. The proportion of fetuses detected as having hemodynamic redistribution was higher when using 3D power Doppler indices than by means of the middle cerebral artery pulsatility index (52% versus 20%, P = 0.002). In conclusion, two of the three indices increased during gestation. All the fetal cerebral 3D vascular indices are increased in fetuses with FGR. In these fetuses, there were more cases suggesting hemodynamic redistribution than expected by conventional Doppler studies.

Download Full-text