title: Placental volume, vasculature and calcification in pregnancies complicated by pre-eclampsia and intra-uterine growth restriction.
abstract: OBJECTIVE
  Pre-eclampsia (PET) and intrauterine growth restriction (IUGR), often associated with impaired placental function, are among the most common conditions contributing to increased perinatal mortality and morbidity. This study investigates if three dimensional power Doppler (3DPD) of the placenta and computerised analysis of placental calcification is different between PET/IUGR and normal pregnancies.
  
  
  METHODS
  This was a prospective cohort study involving 50 women with pre-eclampsia and/or IUGR, or with IUGR only from 24 to 40 weeks' gestation. 3DPD ultrasound was used to calculate placental volume, vascularisation index (VI), flow index (FI) and vascularisation-flow index (VFI). Following each scan the percentage of placental calcification was also calculated, by computer analysis. Results were compared with normal (control) values, and findings correlated with maternal and fetal Doppler parameters and placental histology.
  
  
  RESULTS
  Volume, VI, and VFI are not influenced by gestational age in PET/IUGR pregnancies. FI was found to increase with gestational age (p=0.009) and was lower than normal in the total study group from 24 to 30 weeks (p=0.006). In the pregnancies affected by PET, whether or not IUGR was present, all three indices were lower than normal values between 24 and 30 weeks (VI: p=0.038, FI: p=0.004, VFI: p=0.015). Vascularisation and flow indices were less than the normal 50th centile in the majority of cases of utero-placental insufficiency (p=0.047), and vascularisation and vascularisation flow indices were lower in cases of accelerated placental maturation (p=0.016 and 0.041 respectively). Placental volume greater than the 50th centile between 24 and 30 weeks was associated with the presence of infarction on histology (p=0.021). Flow index (p=0.002) and vascularisation flow index (p=0.036) were lower in the presence of bilateral uterine artery notches. Calcification, similar to the control group, was related to an increasing UAPI (p=0.041) and MCA PI <5th centile (p=0.010).
  
  
  CONCLUSIONS
  The study findings suggest that there may be a role for 3DPD placental assessment of volume, vascularisation and blood flow and computer analysis of placental calcification in the identification and management of PET/IUGR pregnancy.
authors.affiliation: Diagnostic Imaging, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. Electronic address: moran.mary@ucd.ie.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Moran
authors.affiliation: UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, UCD, National Maternity Hospital, Dublin, Ireland.
authors.forename: Cecelia
authors.initials: C
authors.lastname: Mulcahy
authors.affiliation: Diagnostic Imaging, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
authors.forename: Gergely
authors.initials: G
authors.lastname: Zombori
authors.affiliation: UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, UCD, National Maternity Hospital, Dublin, Ireland.
authors.forename: John
authors.initials: J
authors.lastname: Ryan
authors.affiliation: UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, UCD, National Maternity Hospital, Dublin, Ireland.
authors.forename: Paul
authors.initials: P
authors.lastname: Downey
authors.affiliation: UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, UCD, National Maternity Hospital, Dublin, Ireland.
authors.forename: Fionnuala M
authors.initials: FM
authors.lastname: McAuliffe
mesh_terms: D000293:Adolescent; D000328:Adult; D002114:Calcinosis / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging*; D005865:Gestational Age; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008137:Longitudinal Studies; D018919:Neovascularization, Physiologic; D009929:Organ Size; D010920:Placenta / Q000000981:diagnostic imaging*; D021041:Placental Circulation; D010927:Placental Insufficiency / Q000000981:diagnostic imaging*; D011225:Pre-Eclampsia / Q000000981:diagnostic imaging*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D011446:Prospective Studies; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D055988:Uterine Artery / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: Calcification of calcification; Intrauterine growth restriction; Placental vasculature; Placental volume; Pre-eclampsia