应用超声剪切波弹性成像技术对健康妊娠与子痫前期患者胎盘硬度进行特征描述。
Characterizing placental stiffness using ultrasound shear-wave elastography in healthy and preeclamptic pregnancies.
机构信息
Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, D.C., USA.
Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA.
出版信息
Arch Gynecol Obstet. 2020 Nov;302(5):1103-1112. doi: 10.1007/s00404-020-05697-x. Epub 2020 Jul 16.
PURPOSE
To measure the stiffness of the placenta in healthy and preeclamptic patients in the second and third trimesters of pregnancy using ultrasound shear-wave elastography (SWE). We also aimed to evaluate the effect of age, gestational age, gravidity, parity and body mass index (BMI) on placental stiffness and a possible correlation of stiffness with perinatal outcomes.
METHODS
In a case-control study, we recruited a total of 47 singleton pregnancies in the second and third trimesters of which 24 were healthy and 23 were diagnosed with preeclampsia. In vivo placental stiffness was measured once at the time of recruitment for each patient. Pregnancies with posterior placentas, multiple gestation, gestational hypertension, chronic hypertension, diabetes, autoimmune disease, fetal growth restriction and congenital anomalies were excluded.
RESULTS
The mean placental stiffness was significantly higher in preeclamptic pregnancies compared to controls in the third trimester (difference of means = 16.8; 95% CI (9.0, 24.5); P < 0.001). There were no significant differences in placental stiffness between the two groups in the second trimester or between the severe preeclampsia and preeclampsia without severe features groups (difference of means = 9.86; 95% CI (-5.95, 25.7); P ≥ 0.05). Peripheral regions of the placenta were significantly stiffer than central regions in the preeclamptic group (difference of means = 10.67; 95% CI (0.07, 21.27); P < 0.05), which was not observed in the control group (difference of means = 0.55; 95% CI (- 5.25, 6.35); P > 0.05). We did not identify a correlation of placental stiffness with gestational age, maternal age, gravidity or parity. However, there was a statistically significant correlation with BMI (P < 0.05). In addition, pregnancies with higher placental stiffness during the 2nd and 3rd trimesters had significantly reduced birth weight (2890 ± 176 vs. 2420 ± 219 g) and earlier GA (37.8 ± 0.84 vs. 34.3 ± 0.98 weeks) at delivery (P < 0.05).
CONCLUSION
Compared to healthy pregnancies, placentas of preeclamptic pregnancies are stiffer and more heterogeneous. Placental stiffness is not affected by gestational age or the severity of preeclampsia but there is a correlation with higher BMI and poor perinatal outcomes.
目的
使用超声剪切波弹性成像（SWE）测量健康孕妇和子痫前期患者在妊娠第二和第三孕期的胎盘硬度。我们还旨在评估年龄、孕龄、孕次、产次和体重指数（BMI）对胎盘硬度的影响，以及硬度与围产结局的可能相关性。
方法
在病例对照研究中，我们共招募了 47 例处于妊娠第二和第三孕期的单胎妊娠，其中 24 例为健康孕妇，23 例为子痫前期患者。每位患者在招募时均对胎盘硬度进行了一次活体测量。排除了后位胎盘、多胎妊娠、妊娠期高血压、慢性高血压、糖尿病、自身免疫性疾病、胎儿生长受限和先天性异常的妊娠。
结果
与对照组相比，子痫前期患者在第三孕期的胎盘硬度明显更高（平均差值为 16.8；95%CI（9.0，24.5）；P<0.001）。两组在第二孕期或严重子痫前期与无严重特征子痫前期组之间的胎盘硬度无显著差异（平均差值为 9.86；95%CI（-5.95，25.7）；P≥0.05）。子痫前期组胎盘的外周区域明显比中央区域硬（平均差值为 10.67；95%CI（0.07，21.27）；P<0.05），而对照组则无此现象（平均差值为 0.55；95%CI（-5.25，6.35）；P>0.05）。我们没有发现胎盘硬度与孕龄、产妇年龄、孕次或产次之间的相关性。然而，它与 BMI 有统计学上的显著相关性（P<0.05）。此外，在第二和第三孕期胎盘硬度较高的妊娠，分娩时的出生体重显著降低（2890±176 vs. 2420±219g），GA 更早（37.8±0.84 vs. 34.3±0.98 周）（P<0.05）。
结论
与健康妊娠相比，子痫前期患者的胎盘更硬且更不均匀。胎盘硬度不受孕龄或子痫前期严重程度的影响，但与较高的 BMI 和较差的围产结局相关。
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