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- PublicationIs there a role for Placental Volume, Vasculature and Calcification in monitoring Post-term Pregnancies?Objectives: This study aims to assess if three dimensional power Doppler (3DPD) ultrasound of the placenta, evaluating placental volume, vascularisation, and blood flow in post-term pregnancies differs from normal. It also examines whether computer analysis identifies the increased calcification normally present in the placenta after 40 weeks. Methods: This was a prospective cohort study involving 50 women with post-term pregnancies. Gestational age (GA) ranged from 40-41+6 weeks gestation. 3DPD ultrasound was used to evaluate placental volume, vascularisation index (VI), flow index (FI) and vascularisation-flow index (VFI). Following each scan the percentage of calcification was also calculated, by computer analysis. Results were compared with previously determined normal values (36-40 weeks gestation) and correlated with Doppler values and placental histology. Results: Results showed that placental volume, VI, FI and VFI are not influenced by GA when the pregnancy has advanced beyond 40 weeks and that values are similar between post-term pregnancies and normal pregnancies between 36 and 40 weeks. Placental volume was seen to decrease in post-term pregnancies as the mean UtA PI increased (P=0.047). FI was reduced in cases where chorangiosis was found at histology (P=0.033), identifying the increased vessel number associated with these cases. Computer analysis of placental calcification identified the increased calcification expected after 40 weeks, and also showed that calcification continues to increase between 40 and 42 weeks (P=0.029). Conclusion: This study suggests that 3DPD placental assessment may provide additional information, assisting clinicians in decision making in post-term pregnancies.
- PublicationNovel placental ultrasound assessment: Potential role in pre-gestational diabetic pregnancyObjectives: Management of women with pre-gestational diabetes continues to be challenging for clinicians. This study aims to determine if 3D power Doppler (3DPD) analysis of placental volume and flow, and calculation of placental calcification using a novel software method, differ between pregnancies with type 1 or type 2 diabetes and normal controls, and if there is a relationship between these ultrasound placental parameters and clinical measures in diabetics. Methods: This was a prospective cohort study of 50 women with diabetes and 250 controls (12–40 weeks gestation). 3DPD ultrasound was used to evaluate placental volume, vascularisation index (VI), flow index (FI) and vascularisation-flow index (VFI). Placental calcification was calculated by computer analysis. Results in diabetics were compared with control values, and correlated with early pregnancy HbA1c, Doppler results and placental histology. Results: Placental calcification and volume increased with advancing gestation in pre-gestational diabetic placentae. Volume was also found to be significantly higher than in normal placentae. VI and VFI were significantly lower in diabetic pregnancies between 35 and 40 weeks gestation. A strong relationship was seen between a larger placental volume and both increasing umbilical artery pulsatility index and decreasing middle cerebral artery pulsatility index. FI was significantly lower in cases which had a booking HbA1c level ≥6.5%. Ultrasound assessed placental calcification was reduced with a histology finding of delayed villous maturation. No other correlation with placental histology was found. Conclusions: This study shows a potential role for 3D placental evaluation, and computer analysis of calcification, in monitoring pre-gestational diabetic pregnancies.
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