title: Placental vascularization alterations in hypertensive disorders complicating pregnancy (HDCP) and small for gestational age with HDCP using three-dimensional power doppler in a prospective case control study.
abstract: BACKGROUND
  Hypertensive disorders complicating pregnancy (HDCP) continues to be a leading cause of maternal and neonatal mortality and morbidity. The clinical value of placental three-dimensional power Doppler (3DPD) in assessing HDCP requires further confirmation. The research was developed to assess changes of placental vascularity in HDCP using 3DPD and to investigate the placental vascularity in small for gestational age (SGA) compared with not-SGA in patients with HDCP.
  
  
  METHODS
  There were 126 normotensive and 128 hypertensive pregnant women included in this prospective case-control study from March 2011 to March 2013. Pregnant women underwent 3DPD. Vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were obtained. The placental 3DPD indices, umbilical artery systolic and diastolic ratio (S/D) and pregnancy outcomes were compared between the groups.
  
  
  RESULTS
  The placental VI and VFI were significantly lower in hypertensive women compared with normotensive women (P < 0.001 and P = 0.014, respectively), and these parameters were significantly reduced in severe preeclampsia (P < 0.001 and P = 0.003, respectively). A weak correlation was found between VI and umbilical artery S/D in HDCP group (r = -0.277, P = 0.001). In HDCP population, neonates who were postnatally diagnosed with SGA had lower VI (P = 0.041) and higher S/D (P < 0.001).
  
  
  CONCLUSIONS
  The placental vascularity indices decreased in hypertensive women and the reduction inplacental perfusion was consistent with the severity of the hypertensive disorder. The associations betweenplacental vascularization and umbilical artery impedance may be valuable for further researches and arerequired confirmation. The significant differences in the 3DPD placental vascularization between SGA andnot-SGA in hypertensive pregnancy population may show some clinical importance that we could use tobetter assess or predict the progression and adverse outcomes in the future. Although 3DPD quantificationhas been widely used in multiple publications, we have to acknowledge its limitations.
  
  
  CONCLUSIONS
  The intraplacental vascularization was poor in HDCP, and especially in severe preeclampsia. Neonates with SGA had poor placental vascularization and higher umbilical artery S/D. Further studies should focus on the clinical assessment of placental 3DPD as well as a combination of placental 3DPD and other fetal Doppler indices to better predict the development and outcomes of preeclampsia.
authors.affiliation: Department of Obstetrics and Gynecology, First Affiliated Hospital of Xi'an Jiaotong University College of Medicine, Shaanxi, China. y.t.1109@qq.com.
authors.forename: Ting
authors.initials: T
authors.lastname: Yuan
authors.affiliation: Department of Obstetrics and Gynecology, First Affiliated Hospital of Xi'an Jiaotong University College of Medicine, Shaanxi, China. tingting711@stu.xjtu.edu.cn.
authors.forename: Ting
authors.initials: T
authors.lastname: Zhang
authors.affiliation: Department of Obstetrics and Gynecology, First Affiliated Hospital of Xi'an Jiaotong University College of Medicine, Shaanxi, China. hanamy02@163.com.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Han
mesh_terms: D000328:Adult; D062186:Arterial Pressure; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D010920:Placenta / Q000098:blood supply* / Q000000981:diagnostic imaging; D011225:Pre-Eclampsia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011247:Pregnancy; D011446:Prospective Studies; D012720:Severity of Illness Index; D018608:Ultrasonography, Doppler / Q000379:methods; D014469:Umbilical Arteries / Q000503:physiopathology; D055815:Young Adult