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Intra‐placental arterial Doppler: A marker of fetoplacental vascularity in late‐onset placental disease?
| Content Provider | Scilit |
|---|---|
| Author | Higgins, Lucy E. Heazell, Alexander E. P. Simcox, Louise E. Johnstone, Edward D. |
| Copyright Year | 2020 |
| Description | Journal: Acta Obstetricia et Gynecologica Scandinavica |
| Abstract | Introduction Late gestation adverse pregnancy outcome is associated with reduced placental villous vascularity but rarely with a frankly abnormal umbilical artery Doppler waveform. The clinical utility of umbilical artery Doppler velocimetry in late gestation is limited by poor understanding of what aspect(s) of placental structure and function the impedance reflects. We hypothesized that placental arterial circulation impedance reflects placental vascularity and arterial function. Material and methods This was a secondary analysis of data from the FEMINA2 study, a study of pregnancy outcome after reduced fetal movement. Forty‐three pregnancies that delivered within seven days of ultrasound assessment were examined. Impedance was quantified by pulsatility index (PI) from umbilical, chorionic plate arteries and intra‐placental arteries. Site‐specific PI was compared to villous vascularity (CD31 immunostaining) and placental arterial function (wire myography) by regression analysis (P2). Results: PI decreased with proximity to the placental microvasculature (P<0.0001). Intra‐placental artery PI correlated significantly with vessel number $(R^{2}$=0.40, p=0.0007). No significant relation between umbilical or chorionic plate artery PI and villous vascularity were found (P≥0.11 and P≥0.042). No significant covariance was suggested between PI at any Doppler sampling site and ex vivo placental arterial function indices. Measurement reliability (Intraclass correlation coefficient) was highest in the umbilical artery (PI: 0.75 and 0.50 for intra‐ and inter‐operator reliability respectively) and lowest in the intra‐placental arteries (PI 0.55 and 0.41 respectively). Systematic bias in umbilical artery PI was observed between observers, but not at other Doppler sampling sites. Conclusions More vascular placentas ex vivo are associated with reduced intra‐placental artery Doppler impedance in utero. Although umbilical (but not intra‐placental) artery Doppler PI is associated with adverse outcome after reduced fetal movement, this predictive ability does not appear to be through assessment of placental vascularity or chorionic plate arterial function. The inferior reliability of intra‐placental artery Doppler, although similar to previously published reliability of umbilical artery Doppler, impairs its ability to detect subtle differences in placental vascularity, and must be significantly improved before it could be considered a clinically useful test. |
| Ending Page | 874 |
| Starting Page | 865 |
| ISSN | 00221295 |
| e-ISSN | 16000412 |
| DOI | 10.1111/aogs.13807 |
| Journal | Acta Obstetricia et Gynecologica Scandinavica |
| Issue Number | 7 |
| Volume Number | 99 |
| Language | English |
| Publisher | Wiley-Blackwell |
| Publisher Date | 2020-01-14 |
| Access Restriction | Open |
| Subject Keyword | Journal: Acta Obstetricia et Gynecologica Scandinavica Obstetrics and Gynecology Fetal Growth Restriction Vascular Function |
| Content Type | Text |
| Resource Type | Article |
| Subject | Obstetrics and Gynecology |
