Markey Stephanie, Demers Suzanne, Girard Mario, Tétu Amélie, Gouin Katy, Bujold Emmanuel
Department of Obstetrics and Gynaecology, Faculty of Medicine, Université Laval, Québec QC.
Centre de Recherche du CHU de Québec, Québec QC.
J Obstet Gynaecol Can. 2016 Nov;38(11):1003-1008. doi: 10.1016/j.jogc.2016.09.003. Epub 2016 Oct 6.
Low placental vascularization measured by three-dimensional (3-D) ultrasound with power Doppler can predict preeclampsia. We evaluated the reliability and reproducibility of the ultrasonic sphere biopsy (USSB) technique to evaluate placental and subplacental myometrium vascularization in the first trimester.
We performed a secondary analysis of a case-control study nested in a prospective cohort of women with a singleton pregnancy undergoing ultrasound at 11 to 14 weeks' gestation. Women who developed preeclampsia (n = 20) and randomly selected controls (n = 60) were compared. Other controls (n = 60) were also randomly selected to evaluate intra- and inter-observer reproducibility. Using 3-D power Doppler, the vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were measured from the volume of the whole placenta and the subplacental myometrium and from their respective USSB. Pearson's correlation coefficients (cc) with their P-values were calculated.
We observed that USSB is reliable in estimating the vascularization of the whole placenta in the first trimester (cc of VI 0.83; of FI 0.62; and of VFI 0.78; P < 0.001 for all) but was not as reliable for estimating subplacental myometrium vascularization (cc of VI 0.71; of FI 0.35; and of VFI 0.73). Measurement of placental vascularization using USSB showed good to excellent intra- and inter-observer reproducibility (cc of VI 0.86 and 0.85, respectively; of FI 0.75 and 0.75, respectively; and of VFI 0.83 and 0.83, respectively; P < 0.001 for all). Finally, we observed that women who subsequently developed preeclampsia had lower placental USSB VI (2.1 vs 4.8, P = 0.02), FI (32.4 vs. 42.5, P = 0.002), and VFI (0.8 vs. 2.1, P = 0.01) than controls.
First-trimester USSB of the placenta using 3-D power Doppler is a reliable and reproducible procedure for estimating placental vascularization and could be used to predict preeclampsia.
采用三维（3-D）超声联合能量多普勒测量胎盘低血管化可预测子痫前期。我们评估了超声球体活检（USSB）技术在孕早期评估胎盘及胎盘下肌层血管化的可靠性和可重复性。
我们对一项病例对照研究进行了二次分析，该研究嵌套于一个前瞻性队列中，该队列中的单胎妊娠女性在妊娠11至14周时接受超声检查。比较发生子痫前期的女性（n = 20）和随机选择的对照组（n = 60）。还随机选择了其他对照组（n = 60）来评估观察者内和观察者间的可重复性。使用三维能量多普勒，从整个胎盘和胎盘下肌层的体积及其各自的USSB中测量血管化指数（VI）、血流指数（FI）和血管化血流指数（VFI）。计算Pearson相关系数（cc）及其P值。
我们观察到，USSB在估计孕早期整个胎盘的血管化方面是可靠的（VI的cc为0.83；FI的cc为0.62；VFI的cc为0.78；所有P均<0.001），但在估计胎盘下肌层血管化方面不太可靠（VI的cc为0.71；FI的cc为0.35；VFI的cc为0.73）。使用USSB测量胎盘血管化显示观察者内和观察者间具有良好至极好的可重复性（VI的cc分别为0.86和0.85；FI的cc分别为0.75和0.75；VFI的cc分别为0.83和0.83；所有P均<0.001）。最后，我们观察到，随后发生子痫前期的女性胎盘USSB的VI（2.1对4.8，P = 0.02）、FI（32.4对42.5，P = 0.002）和VFI（0.8对2.1，P = 0.01）均低于对照组。
孕早期使用三维能量多普勒对胎盘进行USSB是一种评估胎盘血管化的可靠且可重复的方法，可用于预测子痫前期。
