3-D volumetric MRI evaluation of the placenta in fetuses with complex congenital heart disease

Abstract

Introduction Placental insufficiency remains a common cause of perinatal mortality and neurodevelopmental morbidity. Congenital heart disease (CHD) in the fetus and its relationship to placental function is unknown. This study explores placental health and its relationship to neonatal outcomes by comparing placental volumes in healthy pregnancies and pregnancies complicated by CHD using in vivo three-dimensional MRI studies. Methods In a prospective observational study, pregnant women greater than 18 weeks gestation with normal pregnancies or pregnancies complicated by CHD were recruited and underwent fetal MR imaging. The placenta was manually outlined and the volume was calculated in cm3. Brain volume was also calculated and clinical data were also collected. Relationships, including interactive effects, between placental and fetal growth, including brain growth, were evaluated using longitudinal multiple linear regression analysis. Results 135 women underwent fetal MRI between 18 and 39 weeks gestation (mean 31.6 ± 4.4). Placental volume increased exponentially with gestational age (p=0.041). Placental volume was positively associated with birth weight (p <0.001) and increased more steeply with birth weight in CHD-affected fetuses (p=0.046). Total brain and cerebral volumes were smaller in the CHD group (p<0.001), but brainstem volume (p<0.001) was larger. Placental volumes were not associated with brain volumes. Discussion Impaired placental growth in CHD is associated with gestational age and birth weight at delivery. Abnormalities in placental development may contribute to the significant morbidity in this high-risk population. Assessment of placental volume by MRI allows for in vivo assessments of placental development.

Characterization of the Placenta in the Newborn with Congenital Heart Disease: Distinctions Based on Type of Cardiac Malformation

“…Doppler-derived volumetric calculations of umbilical venous flow as an absolute measure of placental blood flow, or perhaps as a relative fraction of overall fetal combined cardiac output may be more informative [30]. Other methodologies such as MRI techniques will add to the capacity to better gauge the relationship between blood flow and placental structure and function during pregnancy, which will complement fetal echocardiography and add important insights to our understanding [10, 31]. …”

Placental Growth during Normal Pregnancy - A Magnetic Resonance Imaging Study

“…In this population, the placenta was shown to grow logarithmically from 363 cm 3 at 24 GA to 515 cm 3 at 29 GA. Andescavage et al . [17] performed a total of 112 MRI scans on 94 healthy pregnant controls with mixed parity (and on 41 pregnancies complicated by congenital heart disease) between 18 GA and 39 GA. The growth in the normal population was exponential from an estimated mean of 225 cm 3 at 18 GA to an estimated mean of 1,050 cm 3 at 39 GA. Duncan et al [10] performed a longitudinal study consisting of between 2 and 5 scans on 56 singleton (18 first time) pregnancies included over 2 years.…”

Neurodevelopmental Abnormalities and Congenital Heart Disease

“…Advanced fetal MRI allows determination of the association between placental health and brain maturation 50 . For instance, a prospective study reported that placental growth was associated with birth weight but not with brain volumes in CHD 51 . These studies emphasize the utility and need for further investigations into complex brain pathologies associated with CHD prior to birth.…”