Placenta: angiogenesis and vascular assessment through three-dimensional power Doppler ultrasonography

Abstract

The placenta is fundamental for fetal development. It combines the functions of an endocrine organ, kidneys, lungs and intestines, purifying catabolites, oxygenating and nourishing the conceptus. Its fetal portion is the largest part develops from the chorionic sac. The maternal portion, which is smaller, is originated in the endometrium, more specifically in the decidua basalis. The placenta starts its function closer to the fourth week of gestation, when anatomical arrangements for the physiological exchanges are already established. The circulatory function of the placenta appears at an early stage of embryo-placental development and it is strongly related to fetal growth, to the placental size and to uterine and umbilical blood flows. Therefore, an adequate placental angiogenesis is critical for the establishment of a normal placental vascularization with consequent normal development of the fetus. In this review article, the authors discuss about placental ontogeny, focusing on the main aspects of its normal development, and about the recent advances in ultrasonography for the study of the vascular architecture of the placenta through three-dimensional power Doppler ultrasonography.

Reproducibility of Placental Volume and Vasculature Indices Obtained by 3-Dimensional Power Doppler Sonography

“…With improved 3-dimensional (3D) sonographic technology, it is now possible to evaluate the placental volume as well as vascularization status using power Doppler sonography. [1][2][3][4][5][6] The Doppler parameters derived from 3D interrogation are different from those using conventional sonography and include the vascularization index (VI), flow index (FI), and vascularization-flow index (VFI). [2][3][4] These indices have been reliably measured in the placenta and other gynecologic organs.…”

A longitudinal study of three-dimensional ultrasonographic assessment of the placenta in uncomplicated pregnancies

“…The circulatory function of the placenta appears at an early stage of embryo-placental development and is strongly related to fetal growth, placental volume, and uterine blood flow. Therefore, adequate placental angiogenesis is critical for the establishment of normal placental vascularization with subsequent normal development of the fetus [1,2]. Recent advances in technology allow the combination of 3-dimensional (3-D) ultrasound with power Doppler, making it possible to quantify Doppler signals in a volume obtained by 3D scanning and allowing investigation of the placental circulation.…”

Examinations of placental three-dimensional power Doppler indices in pregnancies complicated by diabetes mellitus and intrauterine growth restriction

“…3-DPD ultrasound can depict intraplacental vessel characteristics such as density of vessels, branching and changes in lumen [1,[44][45][46][47]. 3-DPD ultrasound examination was found to be more accurate than 2-D power Doppler (2-DPD) ultrasound examination for the detection of secondary and tertiary stem vessels in the placenta [46].…”

“…This should be relevant in clinical practice, because incomplete placental development is generally associated with IUGR [44]. The sonographic presence of thick heterogeneous placenta is strongly associated with perinatal death, hypertensive disorders, IUGR, and preterm delivery [48].…”