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Controlled Clinical Trial
. 2016 Mar 31;6(3):e009909.
doi: 10.1136/bmjopen-2015-009909.

Utero-placental vascularisation in normal and preeclamptic and intra-uterine growth restriction pregnancies: third trimester quantification using 3D power Doppler with comparison to placental vascular morphology (EVUPA): a prospective controlled study

Jie Duan  1 , Anne-Claire Chabot-Lecoanet  1 , Estelle Perdriolle-Galet  1 , Christophe Christov  2 , Gabriela Hossu  3 , Aboubaker Cherifi  3 , Olivier Morel  4
Affiliations
Controlled Clinical Trial

Utero-placental vascularisation in normal and preeclamptic and intra-uterine growth restriction pregnancies: third trimester quantification using 3D power Doppler with comparison to placental vascular morphology (EVUPA): a prospective controlled study

Jie Duan et al. BMJ Open. .

Abstract

Introduction: Preeclampsia (PE) and intra-uterine growth restriction (IUGR) are two major pregnancy complications related to chronic utero-placental hypoperfusion. Three-dimensional power Doppler (3DPD) angiography has been used for the evaluation of utero-placental vascularisation and three vascular indices have been calculated: the vascularisation index (VI), flow index (FI) and vascularisation-FI (VFI). However, several technical endpoints hinder the clinical use of 3DPD as physical characteristics and machine settings may affect 3DPD indices, and so its clinical significance is not yet clear.

Objectives: The primary objective is to better understand the clinical significance of 3DPD indices by evaluating the relationship between these indices and placental morphometry. Secondary objectives are (i) to determine the impact of machine settings and physical characteristics on 3DPD indices, and (ii) to evaluate physio-pathological placental vascularisation patterns.

Methods and analysis: This is a prospective controlled study. We expect to include 112 women: 84 with normal pregnancies and 28 with PE and/or IUGR (based on our former cohort study on 3DPD indices for PE and/or IUGR prediction (unpublished data)). Within 72 h before planned or semi-urgent caesarean section, utero-placental 3DPD images with five different machine settings will be acquired. Placentas will be collected and examined after surgery and stereological indices (volume density, surface density, length density) calculated. The 3DPD indices (VI, FI and VFI) of the placenta and adjacent myometrium will be calculated. Correlation between Doppler and morphological indices will be evaluated by Pearson or Spearman tests. Agreement between 3DPD indices and morphological indices will be assessed by Bland and Altman plots. The impact of Doppler settings and maternal characteristics on 3DPD indices will be evaluated with a multivariate linear regression model.

Ethics: The study and related consent forms have been approved by the French Ethics Committee (CPP, Comité de Protection des Personnes) Est III on 4 March 2014.

Keywords: 3D power Doppler; intra-uterine growth restriction; placental morphology; preeclampsia; utero-placental vascularization.

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Figures

Figure 1
Figure 1
Three-dimensional power Doppler (3DPD) volume analysis. After automated 3DPD acquisition of the utero-placental unit with predetermined machine settings, the volume of interest (VOI) is defined by manual segmentation with 30° rotation. In our study, the placenta and adjacent myometrium will be separately traced (the placenta is shown here). After tracing, the 3D VOI is reconstructed using VOCAL software and 3DPD indices (vascularisation index (VI), flow index (FI) and vascularisation-FI (VFI)) are then calculated and displayed as histograms.
Figure 2
Figure 2
Placental tissue sampling. After fixation, systematic uniform random sampling of placenta will be performed with the help of a plastic grid. Six sample cubes with whole placental thickness will be taken (≈1.5×1.5×1.5 cm3). A vertical uniform random (VUR) section will be prepared and then stained with H&E. Several pictures will be taken at different magnifications for stereology analysis. The volume density (Vv), surface density (Sv) and length density (Lv) of different placental structures will be calculated using STEPanizer software.
Figure 3
Figure 3
Flowchart of participating women through the study. IUGR, intra-uterine growth restriction; PE, preeclampsia.
See this image and copyright information in PMC

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