Samrat Ghosh1, Ankur Shah2, Ritwik Chakraborti3, Debraj Sen4
BACKGROUND
An important part of human placental development is the extensive modification
of maternal vasculature by trophoblasts. Fetal growth retardation (FGR) and preeclampsia
(PE) are associated with deficient trophoblastic invasion and
modification of the uterine spiral arteries leading to small-caliber vessels of high
resistance which impairs placental blood flow, creating a hypoxic environment and
subsequent oxidative stress. FGR and pre-eclampsia are important causes of
maternal and perinatal morbidity and mortality and it is important to identify such
‘at risk’ pregnancies during routine antenatal care. Ultrasonography (USG) and
colour-Doppler are readily available tools that may be used for identifying such ‘at
risk’ pregnancies. The purpose of this study was to evaluate the accuracy of 2-D
sonographic placental volumetry, umbilical arterial doppler and uterine arterial
doppler in predicting adverse fetomaternal outcomes and compare the accuracy
of these three tests with each other in terms of sensitivity and specificity.
METHODS
A total of 100 women were randomly selected from the antenatal clinics, and were
subject to serial ultrasounds at 12 - 16 weeks, 20 - 24 weeks, and 28 - 32 weeks.
The 2-D sonographic placental volume, umbilical and uterine arterial resistivity
index (RI), and pulsatility index (PI) were measured. The pregnancies were
followed up till delivery and the measurements were plotted against the actual
placental weight and development of FGR and/or pre-eclampsia.
RESULTS
In pregnancies with FGR or pre-eclampsia, the placental volumes were low, and
correspondingly the uterine and umbilical arterial RI and PI were high (increased
impedance) as compared to the normal pregnancies. For the prediction of adverse
outcomes, a receiver operating curve (ROC) analysis showed that placental volume
and umbilical artery RI and PI had high sensitivity in the 1st-trimester, and high
specificity in the 2nd-trimester.
CONCLUSIONS
2-D sonographic placental volumetry and umbilical arterial Doppler studies may be
used as 1st-trimester screening tools to predict adverse fetomaternal outcomes.
These patients may be subjected to more intensive follow-up to minimize maternal
and perinatal morbidity and mortality.
