Combination of three‐dimensional placental vascular indices and volume and uterine artery pulsatility index at 10–13 weeks of gestation could improve the prediction of adverse pregnancy outcomes

Abstract

Aim To evaluate whether three‐dimensional (3D) placental vascular indices and volumes during the first trimester of pregnancy can be used as predictors of subsequent adverse outcomes. Methods This was a prospective cohort study including women with singleton pregnancies between 10 and 13 weeks. 3D placental volume and vascular indices and uterine artery pulsatility index (UtA‐PI) were measured. Adverse outcomes were defined whether there was any of the following complications: small for gestational age pregnancy, preterm delivery, and preeclampsia. The serum pregnancy‐associated plasma protein‐A (PAPP‐A) and free beta‐human chorionic gonadotropin (β‐hCG) levels were also compared. We analyzed the screening performances of these parameters for prediction of any of adverse outcomes. Results Of 348 women screened, 300 women were completed follow‐up. Overall, 57 (19.0%) of 300 women developed any of adverse pregnancy outcomes. Multiple logistic regression analysis demonstrated that gestational age—adjusted z‐scores of log10 placental volume (odds ratio [OR], 0.572; 95% confidence interval [CI], 0.416–0.788), log10 placental vascularization flow index (VFI; OR, 0.676; 95% CI, 0.496–0.921), and log10 UtA‐PI (OR, 1.910; 95% CI, 1.335–2.731) were significantly associated adverse pregnancy outcomes. The multivariate model combining placental VFI, placental volume, UtA‐PI, and underweight or obese body mass index exhibited the highest screening performances (AUC = 0.77) and PAPP‐A and β‐hCG did not add any significance to multivariate model. Conclusions Placental volume and vascular indices at 10–13 weeks of gestation are significantly associated with adverse pregnancy outcomes. Combination of these placental indices and UtA‐PI could improve the screening performance for adverse outcomes.