Accuracy of Prenatal Ultrasound in Evaluating Placental Pathology Using Superb Microvascular Imaging: A Prospective Observation Study

Furuya, Natsumi; Hasegawa, Junichi; Doi, Masatomo; Koike, Junki; Suzuki, Nao

doi:10.1016/j.ultrasmedbio.2021.09.002

Cited by 12 publications

(5 citation statements)

References 9 publications

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“…20 Doppler ultrasound including Superb Microvascular Imaging (SMI) has been demonstrated to be a useful method for evaluating both fetal and placental circulations, and magnetic resonance imaging (MRI) of the placenta using advanced methods such as T2-weighted Rapid Acquisition with Relaxation Enhancement (RARE) imaging has been used to detect placental vascular abnormalities, including hemorrhages and infarctions. [87][88][89][90] An additional clinical consideration arises with the improvement in methods for vaccination and specific antiviral treatments. As our study indicates that the major cause of perinatal deaths among fetuses and neonates having placentas compromised by SARS-CoV-2 is due to placental insufficiency, and not direct viral infection of the fetal organs, reducing maternal SARS-CoV-2 viral burden either through immunization or antiviral therapy could conceivably decrease the risk of developing SARS-CoV-2 placentitis.…”

Section: Discussionmentioning

confidence: 99%

Placental Tissue Destruction and Insufficiency From COVID-19 Causes Stillbirth and Neonatal Death From Hypoxic-Ischemic Injury

Schwartz¹,

Avvad-Portari

Babál

et al. 2022

Archives of Pathology &Amp; Laboratory Medicine

163

142

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Context.— Perinatal death is an increasingly important problem as the COVID-19 pandemic continues, but the mechanism of death has been unclear. Objective.— To evaluate the role of the placenta in causing stillbirth and neonatal death following maternal infection with COVID-19 and confirmed placental positivity for SARS-CoV-2. Design.— Case-based retrospective clinico-pathological analysis by a multinational group of 44 perinatal specialists from 12 countries of placental and autopsy pathology findings from 64 stillborns and 4 neonatal deaths having placentas testing positive for SARS-CoV-2 following delivery to mothers with COVID-19. Results.— All 68 placentas had increased fibrin deposition and villous trophoblast necrosis and 66 had chronic histiocytic intervillositis, the three findings constituting SARS-CoV-2 placentitis. Sixty-three placentas had massive perivillous fibrin deposition. Severe destructive placental disease from SARS-CoV-2 placentitis averaged 77.7% tissue involvement. Other findings included multiple intervillous thrombi (37%; 25/68) and chronic villitis (32%; 22/68). The majority (19, 63%) of the 30 autopsies revealed no significant fetal abnormalities except for intrauterine hypoxia and asphyxia. Among all 68 cases, SARS-CoV-2 was detected from a body specimen in 16 of 28 cases tested, most frequently from nasopharyngeal swabs. Four autopsied stillborns had SARS-CoV-2 identified in internal organs. Conclusions.— The pathology abnormalities composing SARS-CoV-2 placentitis cause widespread and severe placental destruction resulting in placental malperfusion and insufficiency. In these cases, intrauterine and perinatal death likely results directly from placental insufficiency and fetal hypoxic-ischemic injury. There was no evidence that SARS-CoV-2 involvement of the fetus had a role in causing these deaths.

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Section: Discussionmentioning

confidence: 99%

Placental Tissue Destruction and Insufficiency From COVID-19 Causes Stillbirth and Neonatal Death From Hypoxic-Ischemic Injury

Schwartz¹,

Avvad-Portari

Babál

et al. 2022

Archives of Pathology &Amp; Laboratory Medicine

163

142

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“…In addition, ultrasound Doppler analysis can detect evidence of impaired uterine artery blood fow and placental perfusion before clinical manifestations of preeclampsia appear and has become an efective method to predict adverse pregnancy outcomes such as preeclampsia [31]. Uterine artery blood fow can refect the hemodynamic status of the mother.…”

Section: Discussionmentioning

confidence: 99%

[Retracted] Clinical Value of Serum SIRT1 Combined with Uterine Hemodynamics in Predicting Disease Severity and Fetal Growth Restriction in Preeclampsia

Kong

2023

Evidence-Based Complementary and Alternative Medicine

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Objective. The sirtuin regulator 1-related enzyme (SIRT1) has been shown to play an important role in various pathophysiological processes. Our aim was to investigate the effect and correlation of serum SIRT1 combined with uterine hemodynamic parameters on disease severity and fetal uterine growth restriction in the progression of preeclampsia and to evaluate its clinical value as a potential marker. Methods. A total of 100 patients with preeclampsia who were hospitalized in Qufu Normal University Hospital from June 2017 to June 2021 were selected as the research objects. According to the severity, they were divided into the mild (62 cases) and severe groups (38 cases), and according to whether the fetal growth restriction was combined or not, they were divided into the combined fetal growth restriction group (56 cases) and the uncomplicated fetal growth restriction group (44 cases). Serum SIRT1 expression and uterine artery hemodynamic parameters were detected, and Spearman analysis was used to evaluate the association of serum SIRT1 expression and uterine artery hemodynamic parameters (the peak-to-trough ratio of arterial blood velocity, the pulsatility index, and the resistance index) with disease severity (systolic blood pressure, diastolic blood pressure, and random urinary protein levels) and fetal growth restriction (femoral length, biparietal diameter, head circumference, and neonatal weight); unsupervised principal component analysis (PCA), supervised partial least-squares discrimination analysis (PLS-DA), cluster heat map analysis, the receiver operating characteristic (ROC) curve, and the area under curve (AUC) were used to evaluate the diagnostic value of serum SIRT1 expression combined with uterine artery hemodynamic parameters in the severity of disease and fetal growth restriction in patients with preeclampsia. Results. Compared with patients with mild preeclampsia, serum SIRT1 expression was lower in patients with severe preeclampsia ( p < 0.0001 ), the arterial blood flow velocity peak-to-trough ratio, pulsatility index, and resistance index were higher ( p < 0.001 ; p < 0.0001 ); and serum SIRT1 expression and uterine artery hemodynamic parameters were closely related to disease severity ( p < 0.001 ; p < 0.0001 ). In addition, the expression of serum SIRT1 in patients with preeclampsia combined with fetal growth restriction was lower than patients without preeclampsia ( p < 0.0001 ); the peak-to-trough ratio of arterial blood flow velocity, the pulsatility index, and the resistance index were higher ( p < 0.0001 ); and serum SIRT1 expression and uterine artery hemodynamics were closely related to fetal growth restriction ( p < 0.0001 ). Unsupervised PCA analysis and supervised PLS-DA analysis showed that patients with different severity of disease and patients with or without fetal growth restriction were similar within the groups, and there were significant differences between the groups; cluster heat map analysis showed that the mild and severe groups were stratified clustering, and the combined fetal growth restriction group and the uncombined group were hierarchically clustered; ROC curve showed that the AUC of serum SIRT1 expression combined with uterine artery hemodynamic parameters was 0.776 in identifying the severity of preeclampsia and 0.956 in identifying the preeclampsia complicated by fetal growth restriction. Conclusion. Serum SIRT1 combined with uterine hemodynamic parameters in preeclampsia is closely related to disease severity and fetal growth restriction and is expected to become a potential biomarker for early clinical intervention in patients.

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“…Although the conclusions made are to be taken cautiously, the results of this study were promising [26]. A recent study made by Furuya et al [27] evaluated the accuracy of SMI Doppler to properly visualize placental pathologic findings. They found that the highest accuracy was for the detection of placental infarction in cases of IUGR, with a positive predictive value of 100% and sensitivity of 89% (area under the curve of 0.945).…”

Section: Discussionmentioning

confidence: 62%

Intra- and Interobserver Reliability of Superb Microvascular Imaging (SMI) Doppler for Assessing Placental Microvasculature

García-Jiménez¹,

García‐Mejido²,

Valero³

et al. 2022

Clin. Exp. Obstet. Gynecol.

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Objective: Superb Microvascular Imaging (SMI) Doppler is a novel technique. We aim to evaluate intra-and interobserver reliability of SMI Doppler for the assessment of normal placental microvasculature. Materials and Methods: A prospective observational study was conducted including 11 pregnant patients. Ultrasonography placental assessment was performed on 28-weeks pregnant patients, by two expert examiners using SMI Doppler in one single visit. To evaluate interobserver reliability, the first examiner took measurements using SMI Doppler, followed then by the second examiner. Afterwards, the first examiner performed a second evaluation, in order to assess intraobserver reliability. Intraclass correlation coefficients (ICC) and Cohen's Kappa coefficient, and their 95% confidence intervals, were estimated for quantitative and qualitative parameters, respectively. Results: Intraobserver reliability was found to be excellent for all quantitative parameters, with all ICC values above 0.97. For qualitative variables, excellent reliability was obtained for the number of secondary villi, while the number of tertiary villi had an adequate reliability with a Cohen's Kappa coefficient of 0.792 (95% CI 0.38-1.17; p = 0.007). Interobserver ICCs ranged from 0.92 to 1.00 for all quantitative parameters, thus finding excellent interobserver reliability for all of them. An excellent reliability was also obtained for the number of secondary villi, while the reliability for the number of tertiary villi was found to be adequate. Conclusions: Our findings show that placental microvasculature measurements obtained by a single or two different examiners are reliable and reproducible. The good intra-and interobserver reliability results of SMI Doppler showed in our study stress the value of this technique in the evaluation of placental microvasculature, and thus research in this field is the step forward for the assessment of placental insufficiency.

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Accuracy of Prenatal Ultrasound in Evaluating Placental Pathology Using Superb Microvascular Imaging: A Prospective Observation Study

Cited by 12 publications

References 9 publications

Placental Tissue Destruction and Insufficiency From COVID-19 Causes Stillbirth and Neonatal Death From Hypoxic-Ischemic Injury

Placental Tissue Destruction and Insufficiency From COVID-19 Causes Stillbirth and Neonatal Death From Hypoxic-Ischemic Injury

[Retracted] Clinical Value of Serum SIRT1 Combined with Uterine Hemodynamics in Predicting Disease Severity and Fetal Growth Restriction in Preeclampsia

Intra- and Interobserver Reliability of Superb Microvascular Imaging (SMI) Doppler for Assessing Placental Microvasculature

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