Prognostic value of placental ultrasound in pregnancies complicated by absent end-diastolic flow velocity in the umbilical arteries

Viero, Sandra; Chaddha, Vandana; Alkazaleh, Fawaz; Simchen, Michal J.; Malik, Aqsa; Kelly, E. N.; Windrim, Rory; Kingdom, John

doi:10.1016/j.placenta.2004.03.002

Cited by 116 publications

(88 citation statements)

References 29 publications

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“…4 A combination of umbilical artery Doppler and ultrasound findings has a sensitivity of 81%. 6 The use of umbilical artery Doppler in high-risk pregnancies reduces the odds of perinatal death by 38%. 7 In 1986, Pattinson et al identified the leading primary obstetric causes of TPRL as being antepartum haemorrhage (APH), spontaneous PTL, unexplained IUD, infection and fetal abnormalities (Table VI).…”

Section: Discussionmentioning

confidence: 99%

Total perinatally related losses at Tygerberg Hospital – a comparison between 1986, 1993 and 2006

et al. 2010

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Section: Discussionmentioning

confidence: 99%

Total perinatally related losses at Tygerberg Hospital – a comparison between 1986, 1993 and 2006

et al. 2010

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“…22 Echogenic cystic lesions were defined according to Viero. 23 The fetal weight was estimated (EFW) according to Hadlock 24 using the biparietal diameter, head and abdomen circumference and femur length. A head/abdominal circumference ratio above the 95th centile indicated asymmetric growth; 25 an AFI less than 5 cm oligohydramnios; a subjectively increased cardiothoracic ratio or pericardial effusion were considered abnormal cardiac findings; bowel was considered echogenic when comparable to bone; a middle cerebral artery PI below the fifth percentile or a placentocerebral ratio greater than 1 ( ¼ umbilical artery PI divided by middle cerebral artery PI) indicated redistribution.…”

Section: Methodsmentioning

confidence: 99%

“…This is in keeping with other studies showing a high incidence of Prognostic value of placental insufficiency indicators L Geerts and HJ Odendaal increased uterine artery PI before the onset of pre-eclampsia as well as in established disease, more so in severe early-onset pre-eclampsia (as in this cohort) compared to milder forms near term. 36,37 Abnormal uterine artery waveforms are strongly associated with histological abnormalities in the placenta 23,38 (that is decidual vasculopathy, accelerated villous maturation, ischemic-thrombotic lesions and infarctions) that correlate with ultrasound characteristics 23 and occur more frequently at earlier GA. 29 This is in keeping with the current findings: only 49% of placentas had a normal appearance on ultrasound and with a jelly-like placenta the pregnancies were approximately 1 week less advanced (207.3±9.9 versus 215.5±13.2 days).…”

Section: Uterine Artery Waveformsmentioning

confidence: 99%

Severe early onset pre-eclampsia: prognostic value of ultrasound and Doppler assessment

Geerts

Odendaal

2007

J Perinatol

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Objective: Assess the prognostic value of ultrasound and Doppler parameters in severe preterm pre-eclampsia.Study design: Prospective cohort study in Cape Town, South Africa, involving 113 women with severe pre-eclampsia between 24 and 34 weeks of gestation and managed expectantly when suitable. Serial ultrasound and multivessel Doppler assessments were performed 2 to 3 times weekly. Observations included fetal weight estimation, growth pattern, amniotic fluid volume, appearance of the heart and bowel, pulsatility index of the uterine, umbilical and middle cerebral arteries and ductus venosus. Perinatal outcome (death or neurological compromise, n ¼ 12) and major morbidity (n ¼ 62) were related to findings at recruitment and on the last assessment preceding delivery.Results: In univariate analysis, fetal growth asymmetry and waveform analysis of all three fetal vessels significantly correlated with both end points. The initial fetal weight estimation with a cutoff weight of 1080 g had the highest sensitivity (83.3%) and negative predictive value (97.5%) for poor outcome (P<0.001) while the final ductus venosus pulsatility index had the highest specificity (92%) and positive predictive value (33%). The combination of a raised placentocerebral ratio and ductus venosus pulsatility index close to delivery had the highest (57.1%) positive predictive value. Logistic regression showed the best overall predictive model for poor outcome to be a combination of initial fetal weight estimation and final ductus venosus pulsatility index (overall accuracy 94.6%, RR 20.20 (7.36, 55.41)). The initial fetal weight estimation with a cutoff weight of 1283 g provided the best correct prediction of major morbidity (83.2% overall accuracy, sensitivity 79.0%, specificity 88.2%, positive and negative predictive values of 89.1 and 77.6% respectively). This was better than using the gestational age at recruitment or delivery, birth weight or any of the Doppler results. The prediction of morbidity was not improved by the addition of any other variable in logistic regression analysis. Conclusion:For the short-term outcome measures assessed in this study, the estimated fetal weight at the time of diagnosis is the most important prognostic factor in severe pre-eclampsia with some additional value of ductus venosus assessment.

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“…4 In the most severe forms of human placental pathology resulting in fetal death, such as severe intrauterine growth restriction (IUGR), premature placental separation (abruption) and severe preeclampsia arising before 32 weeks of gestation, defects in both pathways of trophoblast development have been observed. 5,6 These defects include poor EV-CT invasion and transformation of the spiral arteries in severe early-onset preeclampsia, 5,7 and reduced elaboration of chorionic villous trees 8,9 with reduced numbers of proliferating V-CT in severe early-onset IUGR. 10 As arrest of mitosis is a common feature in both pathways of trophoblast differentiation (EV-CT and V-CT), we hypothesize that common defects in cell-cycle regulation and trophoblast differentiation underlie these pathological conditions.…”

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confidence: 99%

Glial cell missing-1 transcription factor is required for the differentiation of the human trophoblast

et al. 2009

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Mammalian placentation is a highly regulated process and is dependent on the proper development of specific trophoblast cell lineages. The two major types of trophoblast, villous and extravillous, show mitotic arrest during differentiation. In mice, the transcription factor, glial cell missing-1 (Gcm1), blocks mitosis and is required for syncytiotrophoblast formation and morphogenesis of the labyrinth, the murine equivalent of the villous placenta. The human homolog GCM1 has an analogous expression pattern, but its function is presently unknown. We studied GCM1 function in the human-derived BeWo choriocarcinoma cell line and in first trimester human placental villous and extravillous explants. The GCM1 expression was either inhibited by siRNA and antisense oligonucleotides methods or upregulated by forskolin treatment. Inhibition of GCM1 resulted in an increased rate of proliferation, but prevented de novo syncytiotrophoblast formation in syncytially denuded floating villous explants. GCM1 inhibition prevented extravillous differentiation along the invasive pathway in extravillous explants on matrigel. By contrast, forskolin-induced expression of GCM1 reduced the rate of proliferation and increased the rate of syncytialization in the floating villous explant model. Our studies show that GCM1 has a distinct role in the maintenance, development and turnover of the human trophoblast. Alterations in GCM1 expression or regulation may explain several aspects of two divergent severe placental insufficiency syndromes, namely preeclampsia and intrauterine growth restriction, which cause extreme preterm birth. Successful mammalian pregnancy demands two key steps in placental development, both of which are regulated by differentiation of the epithelial trophoblast lineage. 1 First, maternal blood flow to the implantation site must increase exponentially to serve the demands of the rapidly growing fetus. This is achieved through the invasion of extravillous cytotrophoblasts (EV-CTs) from the base of the placenta into the maternal uterine stroma, where they surround and dilate the distal portions of the utero-placental arteries. 2 Second, the increased delivery of maternal blood to the placenta must be matched by an exchanger organ to transfer nutrients, remove waste products and respiratory gases between the mother and the developing fetus. This requirement is achieved through the expansion and differentiation of the chorionic villous trees of the placenta. These villi are covered by a villous trophoblast compartment comprising of villous cytotrophoblasts (V-CTs) beneath a continuous multinucleated layer of syncytiotrophoblast (SCT), which is in direct contact with maternal blood. 3 In the human placenta, EV-CTs of the proximal portion of the anchoring villus cell column are proliferative, but more distal cells differentiate, as they invade and disperse into the uterine stroma. Here these cells surround and replace the smooth muscle cells of maternal uterine arteries, converting them into high-flow dilated sinusoids. The ar...

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Prognostic value of placental ultrasound in pregnancies complicated by absent end-diastolic flow velocity in the umbilical arteries

Cited by 116 publications

References 29 publications

Total perinatally related losses at Tygerberg Hospital – a comparison between 1986, 1993 and 2006

Total perinatally related losses at Tygerberg Hospital – a comparison between 1986, 1993 and 2006

Severe early onset pre-eclampsia: prognostic value of ultrasound and Doppler assessment

Glial cell missing-1 transcription factor is required for the differentiation of the human trophoblast

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