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  • Original Article
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Intraplacental villous artery resistance indices and identification of placenta-mediated diseases

Journal of Perinatology volume 35, pages 793–798 (2015)Cite this article

Subjects

Abstract

Objective:

Placenta-mediated diseases (PMDs) including preeclampsia and fetal growth restriction are often characterized by shallow trophoblast invasion and incomplete spiral artery remodeling leading to impaired placental perfusion. In this context, umbilical artery (UA) Doppler can be used to detect high resistance to flow characteristic of very late-stage placental disease. We propose that evaluation of intraplacental villous artery (IPVA) resistance can provide earlier detection of increased resistance in placental flow.

Study Design:

Seventy-five patients were recruited from the Ottawa Hospital. All had scans at 18 to 20, 28 and 34 weeks of gestation. IPVAs arising perpendicular to the chorionic plate in three regions (placental tips 4 cm away from cord insertion and within 1 cm from cord insertion) were sampled at each gestational age for resistance index (RI) and pulsatility index (PI). UA Doppler was also obtained from a free loop of cord. Pregnancy outcomes were collected from a chart review. Data were analyzed using SAS version 9.4 and standard statistic tests (mean±s.d., Student's t-test, mixed-effects modeling).

Result:

A total of 53 patients completed the study. Of these, 38 had normal pregnancy outcomes (controls) and 15 (cases) developed PMD (preeclampsia, n=8 and low birth weight/intrauterine growth restriction, n=7). Mean birth weight in the study group was 2482.1±518.85 g. At 18 to 20, 28 and 34 weeks gestation, the mean IPVA resistance indices in the control group were 0.86±0.16, 0.81±0.12 and 0.71±0.12 for PI and 0.57±0.07, 0.55±0.06 and 0.49±0.06 for RI, respectively. However, in the cases developing PMDs, the PIs were 1.09±0.17, 0.95±0.21 and 0.78±0.07 and RIs 0.66±0.07, 0.60±0.07 and 0.54±0.04, respectively (P<0.05). UA PI and RI Doppler did not differ between the groups as early as 18 to 20 weeks gestation.

Conclusion:

Doppler measures of IPVA appear superior to UA in detecting early changes related to PMD. IPVA PI and RI Doppler may be useful in the early identification of patients at risk of PMD.

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Acknowledgements

The study was funded by The Physicians' Services Incorporated (PSI) Foundation (Grant No. R08-15). ZMF is supported by a Canadian Institute of Health Research (CIHR) Postdoctoral Fellowship. We also want thank our research team sonographers: Kelly Gray and Lynne Brosseau (Ottawa Hospital, Canada) as well as Elham Sabri, MSc, for her statistical assistance and Dr David Grynspan, MD, FRCPC, for critically reviewing the manuscript.

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Author notes

  1. A Gruslin: Dr Gruslin passed away before publication of this manuscript.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology and Newborn Care, Division of Maternal-Fetal Medicine, Obstetrics and Gynecology, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada

    I Babic, Z M Ferraro, F Moretti & A Gruslin

  2. First Steps Fertility, Toronto, ON, Canada

    K Garbedian

  3. Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada

    A Oulette

  4. Department of Pathology and Laboratory Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada

    C G Ball

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  1. I Babic
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Correspondence to F Moretti.

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Babic, I., Ferraro, Z., Garbedian, K. et al. Intraplacental villous artery resistance indices and identification of placenta-mediated diseases. J Perinatol 35, 793–798 (2015). https://doi.org/10.1038/jp.2015.85

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