title: Utero-placental vascularisation in normal and preeclamptic and intra-uterine growth restriction pregnancies: third trimester quantification using 3D power Doppler with comparison to placental vascular morphology (EVUPA): a prospective controlled study.
abstract: BACKGROUND
  Preeclampsia (PE) and intra-uterine growth restriction (IUGR) are two major pregnancy complications related to chronic utero-placental hypoperfusion. Three-dimensional power Doppler (3DPD) angiography has been used for the evaluation of utero-placental vascularisation and three vascular indices have been calculated: the vascularisation index (VI), flow index (FI) and vascularisation-FI (VFI). However, several technical endpoints hinder the clinical use of 3DPD as physical characteristics and machine settings may affect 3DPD indices, and so its clinical significance is not yet clear.
  
  
  OBJECTIVE
  The primary objective is to better understand the clinical significance of 3DPD indices by evaluating the relationship between these indices and placental morphometry. Secondary objectives are (i) to determine the impact of machine settings and physical characteristics on 3DPD indices, and (ii) to evaluate physio-pathological placental vascularisation patterns.
  
  
  METHODS
  This is a prospective controlled study. We expect to include 112 women: 84 with normal pregnancies and 28 with PE and/or IUGR (based on our former cohort study on 3DPD indices for PE and/or IUGR prediction (unpublished data)). Within 72 h before planned or semi-urgent caesarean section, utero-placental 3DPD images with five different machine settings will be acquired. Placentas will be collected and examined after surgery and stereological indices (volume density, surface density, length density) calculated. The 3DPD indices (VI, FI and VFI) of the placenta and adjacent myometrium will be calculated. Correlation between Doppler and morphological indices will be evaluated by Pearson or Spearman tests. Agreement between 3DPD indices and morphological indices will be assessed by Bland and Altman plots. The impact of Doppler settings and maternal characteristics on 3DPD indices will be evaluated with a multivariate linear regression model.
  
  
  METHODS
  The study and related consent forms have been approved by the French Ethics Committee (CPP, Comité de Protection des Personnes) Est III on 4 March 2014.
authors.affiliation: IADI, Inserm U947, University of Lorraine, Nancy, France Pôle de Gynécologie-Obstétrique, Service d'Obstétrique et Médecine Fœtale, CHRU Nancy, Nancy, France.
authors.forename: Jie
authors.initials: J
authors.lastname: Duan
authors.affiliation: IADI, Inserm U947, University of Lorraine, Nancy, France Pôle de Gynécologie-Obstétrique, Service d'Obstétrique et Médecine Fœtale, CHRU Nancy, Nancy, France.
authors.forename: Anne-Claire
authors.initials: AC
authors.lastname: Chabot-Lecoanet
authors.affiliation: IADI, Inserm U947, University of Lorraine, Nancy, France Pôle de Gynécologie-Obstétrique, Service d'Obstétrique et Médecine Fœtale, CHRU Nancy, Nancy, France.
authors.forename: Estelle
authors.initials: E
authors.lastname: Perdriolle-Galet
authors.affiliation: Service Commun de Microscopie, Faculté de Médecine, University of Lorraine, Vandoeuvre-Lès-Nancy, France Laboratory of Fetal and Placental Pathology, CHRU Nancy, Nancy, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Christov
authors.affiliation: CHRU Nancy, CIC-IT Inserm CIC 1433, Nancy, France.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Hossu
authors.affiliation: CHRU Nancy, CIC-IT Inserm CIC 1433, Nancy, France.
authors.forename: Aboubaker
authors.initials: A
authors.lastname: Cherifi
authors.affiliation: IADI, Inserm U947, University of Lorraine, Nancy, France Pôle de Gynécologie-Obstétrique, Service d'Obstétrique et Médecine Fœtale, CHRU Nancy, Nancy, France PremUp Foundation, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Morel
mesh_terms: D000792:Angiography; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging*; D005602:France; D005865:Gestational Age; D006801:Humans; D021621:Imaging, Three-Dimensional; D010920:Placenta / Q000000981:diagnostic imaging*; D011225:Pre-Eclampsia / Q000000981:diagnostic imaging*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging*; D011263:Pregnancy Trimester, Third; D011446:Prospective Studies; D018608:Ultrasonography, Doppler
keywords: 3D power Doppler; intra-uterine growth restriction; placental morphology; preeclampsia; utero-placental vascularization