title: Patient-specific estimates of vascular and placental properties in growth-restricted fetuses based on a model of the fetal circulation.
abstract: BACKGROUND
  Intrauterine growth restriction (IUGR) due to placental insufficiency is associated with blood-flow redistribution in order to maintain perfusion to the brain. However, some hemodynamic parameters that might be more directly related to staging of the disease cannot be measured non-invasively in clinical practice. For this, we developed a patient-specific model of the fetal circulation to estimate vascular properties of each individual.
  
  
  METHODS
  A lumped model of the fetal circulation was developed and personalized using measured echographic data from 37 normal and IUGR fetuses to automatically estimate model-based parameters. A multivariate regression analysis was performed to evaluate the association between the Doppler pulsatility indices (PI) and the model-based parameters. The correlation between model-based parameters and the placental lesions was analyzed in a set of 13 IUGR placentas. A logistic regression analysis was done to assess the added value of the model-based parameters relative to Doppler indices, for the detection of fetuses with adverse perinatal outcome.
  
  
  RESULTS
  The estimated model-based placental and brain resistances were respectively increased and reduced in IUGR fetuses while placental compliance was increased in IUGR fetus. Umbilical and middle cerebral arteries PIs were most associated with both placental resistance and compliance, while uterine artery PI was more associated with the placental compliance. The logistic regression analysis showed that the model added significant information to the traditional analysis of Doppler waveforms for predicting adverse outcome in IUGR.
  
  
  CONCLUSIONS
  The proposed patient-specific computational model seems to be a good approach to assess hemodynamic parameters than cannot be measured clinically.
authors.affiliation: Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, Spain; Physense, DTIC, Universitat Pompeu Fabra, Barcelona, Spain. Electronic address: patricia.garciac@upf.edu.
authors.forename: Patricia
authors.initials: P
authors.lastname: Garcia-Canadilla
authors.affiliation: Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, Spain; Centre for Biomedical Research on Rare Diseases (CIBER-ER), Spain.
authors.forename: Fatima
authors.initials: F
authors.lastname: Crispi
authors.affiliation: Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, Spain.
authors.forename: Monica
authors.initials: M
authors.lastname: Cruz-Lemini
authors.affiliation: Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, Spain.
authors.forename: Stefania
authors.initials: S
authors.lastname: Triunfo
authors.affiliation: Department of Pathology, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Alfons
authors.initials: A
authors.lastname: Nadal
authors.affiliation: Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, Spain.
authors.forename: Brenda
authors.initials: B
authors.lastname: Valenzuela-Alcaraz
authors.affiliation: Physense, DTIC, Universitat Pompeu Fabra, Barcelona, Spain.
authors.forename: Paula A
authors.initials: PA
authors.lastname: Rudenick
authors.affiliation: Fetal i+D Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, Spain; Centre for Biomedical Research on Rare Diseases (CIBER-ER), Spain.
authors.forename: Eduard
authors.initials: E
authors.lastname: Gratacos
authors.affiliation: Physense, DTIC, Universitat Pompeu Fabra, Barcelona, Spain; ICREA, Barcelona, Spain.
authors.forename: Bart H
authors.initials: BH
authors.lastname: Bijnens
mesh_terms: D016022:Case-Control Studies; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D005333:Fetus / Q000098:blood supply*; D006801:Humans; D008955:Models, Cardiovascular; D010920:Placenta / Q000473:pathology; D021041:Placental Circulation; D057285:Precision Medicine; D011247:Pregnancy; D018608:Ultrasonography, Doppler
keywords: Computational model; Doppler; Fetal circulation; Placental resistance