Document Detail


Prognostic value of placental ultrasound in pregnancies complicated by absent end-diastolic flow velocity in the umbilical arteries.
MedLine Citation:
PMID:  15450392     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Our objective was to evaluate the utility of gray-scale placental ultrasound for the detection of pathological lesions in the placentas of preterm pregnancies with abnormal fetoplacental blood flow (defined by absent or reversed end-diastolic flow velocities [ARED] in the umbilical arteries) before 32 weeks of gestation. Sixty consecutive structurally and chromosomally normal singleton pregnancies were evaluated. Pre-defined criteria were used to describe placental appearances using gray-scale real-time ultrasound. Proximal uterine artery Doppler waveforms were recorded using pulsed and color Doppler ultrasound. Each patient had a thrombophilia profile. Following delivery, a single perinatal pathologist reviewed each placenta at a gross and microscopic level blinded to the placental ultrasound findings. Placental shape or texture was abnormal on gray-scale ultrasound in 43/59 (73%) and echogenic cystic lesions (ECL) were found in 16 (27%). Uterine artery Doppler was abnormal in 47/60 (78%) cases. Thirty-eight pregnancies were subsequently delivered by planned Caesarean section in the fetal and/or maternal interest (birthweights 540-2300 g, mean gestational age 30.6 weeks) and 21 pregnancies resulted in the vaginal delivery of a stillborn fetus where fetal weight and/or gestational age did not justify Caesarean section (birthweights 85-600 g, mean gestational age 24.9 weeks). ECL had a low positive predictive value for both villous infarcts (63%) and for focal/massive perivillous fibrin deposition (40%). Nevertheless, the combination of abnormal uterine artery Doppler and abnormal gray-scale findings (abnormal placental morphology or ECL) was strongly predictive of stillbirth (17/21; sensitivity 81%, PPV 52%, p = 0.006 Fisher's exact test). Pregnancies with ARED in the umbilical arteries have a high perinatal mortality associated with pathology of the placental villi. Ultrasound examination of the placenta and its maternal blood supply may contribute to the perinatal management of these pregnancies.
Authors:
S Viero; V Chaddha; F Alkazaleh; M J Simchen; A Malik; E Kelly; R Windrim; J C P Kingdom
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Placenta     Volume:  25     ISSN:  0143-4004     ISO Abbreviation:  Placenta     Publication Date:    2004 Sep-Oct
Date Detail:
Created Date:  2004-09-28     Completed Date:  2005-02-03     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8006349     Medline TA:  Placenta     Country:  England    
Other Details:
Languages:  eng     Pagination:  735-41     Citation Subset:  IM    
Affiliation:
Department of Laboratory Medicine and Pathobiology, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Toronto, Ontario, Canada M5G 1X5.
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MeSH Terms
Descriptor/Qualifier:
Adult
Blood Flow Velocity
Diastole
Female
Fetal Growth Retardation / physiopathology*
Gestational Age
Hemodynamics
Humans
Infant, Newborn
Infant, Small for Gestational Age
Laser-Doppler Flowmetry
Placenta / blood supply*,  ultrasonography*
Placental Circulation*
Pregnancy
Pregnancy Complications, Cardiovascular / physiopathology*
Prognosis
Ultrasonography, Doppler, Color
Ultrasonography, Prenatal*
Umbilical Arteries / physiopathology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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