P. M. Nowak

Placenta: angiogenesis and vascular assessment through three-dimensional power Doppler ultrasonography.

The placenta is fundamental for fetal development. It combines the functions of an endocrine organ, kidneys, lungs and intestines, purifying catabolites, oxygenating and nourishing the conceptus. Its fetal portion is the largest part develops from the chorionic sac. The maternal portion, which is smaller, is originated in the endometrium, more specifically in the decidua basalis. The placenta starts its function closer to the fourth week of gestation, when anatomical arrangements for the physiological exchanges are already established. The circulatory function of the placenta appears at an early stage of embryo-placental development and it is strongly related to fetal growth, to the placental size and to uterine and umbilical blood flows. Therefore, an adequate placental angiogenesis is critical for the establishment of a normal placental vascularization with consequent normal development of the fetus. In this review article, the authors discuss about placental ontogeny, focusing on the main aspects of its normal development, and about the recent advances in ultrasonography for the study of the vascular architecture of the placenta through three-dimensional power Doppler ultrasonography.

Evaluation of Placental Volume at 7–10 + 6 Weeks of Pregnancy by 3D-Sonography

The aim of the study was to establish normative data for placental volume (PV) at 7-10+6 weeks of gestation using three-dimensional ultrasound (3DUS). The cross-sectional study involved 70 healthy pregnancies between 7 and 11 weeks. The VOCAL (Virtual Organ Computer-aided Analysis) method with a 30 degrees rotation angle and six planes was used for volumetric calculations. Regression models were constructed to assess the correlation between PV and crown-rump length (CRL) adjusted by the determination coefficient (R2). The method proposed by Royston and Wright was used to establish the 2.5th; 10th; 50th; 90th and 97.5th percentiles (percentile=mean+KxSD). The intraclass correlation coefficient (ICC), Bland-Altman graphs and Students paired t-tests were used to assess intra- and interobserver variability. PV ranged from 1.7 to 42.6 cm3, with a mean of 13.6cm3 (+/-9.4cm3). There was a strong correlation between PV and CRL; the exponential equation was the model that best expressed the correlation between them (R2=0.76). For CRL between 9 and 40 mm, the mean PV increased 10.5 times, while CRL increased only 4.4 times. Inter- and intraobserver correlation were excellent (ICC=0.979 and 0.971, respectively). Bland-Altman graphs indicated a good reproducibility with a mean intraobserver and interobserver difference of 0.2 cm3 (95% CI: -0.7-1.2cm3) and -0.2cm3 (95% CI: -1.3-0.9cm3), respectively. Reference limits were generated for first trimester PV assessed by 3DUS using the VOCAL method. There is a strong correlation between PV and CRL. Placental volume obtained through this method was highly reproducible.

Yolk sac volume assessed by three‐dimensional ultrasonography using the VOCAL method

Objectives. Establish normative data for yolk sac volume (YSV) at 7–10 weeks of gestation assessed by transvaginal three‐dimensional ultrasonography (3D‐US) using the VOCAL method and analyze its correlation with gestational age (GA) and crown‐rump length (CRL). Methods. A cross‐sectional study involving 62 normal pregnancies was performed to assess YSV from 7 to 10 weeks of gestational age. An endocavitary volumetric transducer (3D5‐8EK) was used for all measurements. The VOCAL (Virtual Organ Computer‐aided AnaLysis) method with a 30° rotation angle was used for volumetric calculations. Regression models were constructed to analyze the correlation between YSV and GA or CRL The mean, standard deviation, median, minimum and maximum values were calculated for each gestational age. Results. There was a poor correlation between YSV and GA or CRL. The quadratic regression was the model that best expressed the correlation between these variables: R2 = 0.188 for GA and R2 = 0.203 for CRL. The mean YSV went from 0.063 cm3 (95% CI: 0.047; 0.080) at 7 weeks to 0.164 cm3 (95% CI 0.095; 0.232) at 10 weeks. Conclusion. Reference limits were generated for first trimester YSV using 3D‐US. There was a poor correlation between YSV and GA or CRL.Objectives. Establish normative data for yolk sac volume (YSV) at 7–10 weeks of gestation assessed by transvaginal three-dimensional ultrasonography (3D-US) using the VOCAL method and analyze its correlation with gestational age (GA) and crown-rump length (CRL). Methods. A cross-sectional study involving 62 normal pregnancies was performed to assess YSV from 7 to 10 weeks of gestational age. An endocavitary volumetric transducer (3D5-8EK) was used for all measurements. The VOCAL (Virtual Organ Computer-aided AnaLysis) method with a 30° rotation angle was used for volumetric calculations. Regression models were constructed to analyze the correlation between YSV and GA or CRL The mean, standard deviation, median, minimum and maximum values were calculated for each gestational age. Results. There was a poor correlation between YSV and GA or CRL. The quadratic regression was the model that best expressed the correlation between these variables: R2=0.188 for GA and R2=0.203 for CRL. The mean YSV went from 0.06...

Comparison of gestational sac volume by 3D-sonography using planimetric, virtual organ computer-aided analysis and extended imaging virtual organ computer-aided analysis methods between 7 and 11 weeks of pregnancy.

Objective. To compare different three‐dimensional (3D) methods in the assessment of gestational sac volume (GSV). Design. Cross‐sectional study involving 74 normal pregnancies between 7 and 11 weeks. Setting. Department of Obstetrics, São Paulo Federal University (UNIFESP). Methods. GSV was measured through 3D ultrasound using the planimetric, virtual organ computer‐aided analysis (VOCAL) and extended imaging virtual organ computer‐aided analysis (XI VOCAL) methods. The planimetric method used a sequence of adjacent planes that are 3 mm thick. For the VOCAL methods, six adjacent planes and a 30° rotation were used. A total of 15 adjacent planes were used for the XI VOCAL method. Regression models with a determination coefficient (R2) were created to assess the correlation between GSV and gestational age (GA). Intraclass correlation coefficient (ICC) and Bland‐Altman graphs were used to assess the correlation between the three methods and ANOVA was used to compare means. Results. All three methods showed a correlation between GSV and GA (R2 = 0.65 for XI VOCAL, R2 = 0.65 for planimetric and R2 = 0.66 for VOCAL). There was a strong correlation between the three methods (XI VOCAL vs. planimetric ICC = 0.995; XI VOCAL vs. VOCAL ICC = 0.998 and planimetric vs. VOCAL ICC = 0.995) without any significant differences according to the Bland‐Altman graphs or ANOVA (p < 0.002). Conclusions. The three 3D ultrasound methods used for GSV assessment between 7 and 11 weeks are concordant. These methods can be used interchangeably during the first trimester of pregnancy to measure GSV.

Correlação do volume da vesícula vitelínica obtida por meio da ultrassonografia tridimensional com a idade gestacional entre a 7ª e a 10ª semanas usando o método multiplanar

OBJETIVO: Avaliar a correlacao do volume da vesicula vitelinica aferida por meio da ultrassonografia tridimensional com a idade gestacional entre a 7a e a 10a semanas. MATERIAIS E METODOS: Realizou-se um estudo do tipo corte transversal envolvendo 72 gestantes normais entre a 7a e a 10a semanas de gestacao. Para o calculo do volume da vesicula vitelinica, utilizou-se o metodo multiplanar com intervalo de 1,0 mm entre os planos. Para o volume da vesicula vitelinica foram determinadas medias, medianas, desvios-padrao e valores maximo e minimo. Para avaliar a correlacao entre o volume da vesicula vitelinica e a idade gestacional, foram criados modelos de regressao, sendo os ajustes realizados pelo coeficiente de determinacao (R2). RESULTADOS: O volume da vesicula vitelinica (VV) mostrou-se fracamente correlacionado com a idade gestacional (IG), melhor representado pela regressao quadratica, representada pela equacao: volume VV = 0,9757 - 0,2499 × IG + 0,0172 × IG2 (R2 = 0,234). O volume medio da vesicula vitelinica variou de 0,07 cm3 (0,02-0,11) a 0,20 cm3 (0,02-0,74) entre a 7a e a 10a semanas de gestacao, com media de 0,11 cm3 (± 0,10 cm3). CONCLUSAO: O volume da vesicula vitelinica correlacionou-se fracamente com a idade gestacional.

Embryo vascularization by three-dimensional power Doppler ultrasonography at 7-10 weeks of pregnancy

Abstract Aim: Assess vascular indices of 7–10 week embryos using three-dimensional power Doppler (3DPD) and correlate them with the crown-rump length (CRL). Methods: This cross-sectional study included 65 healthy pregnancies between 7 and 10 weeks. The three-dimensional volume of the embryo was obtained using an endocavitary volumetric transducer and the VOCAL (Virtual Organ Computer-aided Analysis) method, with a 12° rotation angle and 15 sequential planes. The vascularization (VI), flow (FI) and the vascular and flow (VFI) indices were obtained using 3DPD and the mean, median, standard deviation, maximum and minimum values were calculated for each gestational age. Pearsons correlation coefficient (r) was used to evaluate the correlation between vascular indices and CRL. Results: The VI ranged from 0.77 to 41.67, mean 14.68 (±8.60), the FI went from 25.71 to 139.50, mean 90.61 (±21.51) and the VFI from 0.20 to 81.57, mean 15.69 (±12.42). The correlation between CRL and all 3D power Doppler vascular indices was low (VI – r=−0.073, P=0.566; FI – r=0.173, P=0.168 and VFI – r=−0.004, P=0.974). Conclusion: 3D power Doppler vascular indices in 7–10 week embryos do not correlate with CRL.

Volume do embrião estimado pela ultra-sonografia tridimensional entre a sétima e a décima semana de gestação

PURPOSE: to evaluate the embryos volume (EV) between the seventh and the tenth gestational week, through tridimensional ultrasonography. METHODS: a transversal study with 63 normal pregnant women between the seventh and the tenth gestational week. The ultrasonographical exams have been performed with a volumetric abdominal transducer. Virtual Organ Computer-aided Analysis (VOCAL) has been used to calculate EV, with a rotation angle of 12o and a delimitation of 15 sequential slides. The average, median, standard deviation and maximum and minimum values have been calculated for the EV in all the gestational ages. A dispersion graphic has been drawn to assess the correlation between EV and the craniogluteal length (CGL), the adjustment being done by the determination coefficient (R2). To determine EVs reference intervals as a function of the CGL, the following formula was used: percentile=EV+K versus SD, with K=1.96. RESULTS: CGL has varied from 9.0 to 39.7 mm, with an average of 23.9 mm (±7.9 mm), while EV has varied from 0.1 to 7.6 cm3, with an average of 2.7 cm3 (±3.2 cm3). EV was highly correlated to CGL, the best adjustment being obtained with quadratic regression (EV=0.2-0.055 versus CGL+0.005 versus CGL2; R2=0.8). The average EV has varied from 0.1 (-0.3 to 0.5 cm3) to 6.7 cm3 (3.8 to 9.7 cm3) within the interval of 9 to 40 mm of CGL. EV has increased 67 times in this interval, while CGL, only 4.4 times. CONCLUSIONS: EV is a more sensitive parameter than CGL to evaluate embryo growth between the seventh and the tenth week of gestation.

Validation of Fetal Medicine Foundation algorithm for prediction of pre-eclampsia in the first trimester in an unselected Brazilian population

Abstract Objective: The objective of this study is to evaluate the predictive performance of the Fetal Medicine Foundation (FMF) algorithm for prediction of preeclampsia (PE) between 11 and 14 weeks of gestation in an unselected Brazilian population. Methods: We conducted a prospective cohort study with 617 singleton pregnancies of unselected risk. Biophysical markers (mean pulsatility index, mean arterial pressure) and biochemical markers (placental growth factor (PLGF) and PAPP-A) were inserted into the FMF software and converted into multiples of the median (MoM). The subjects were divided into five groups: early-onset PE, parturition <34 weeks’ gestation; preterm PE, parturition <37 weeks; PE, parturition at any gestational age; gestational hypertension (GH); and control group. Areas under the receiver operating characteristics curve (AUC) were calculated for the outcomes. Results: Among 617 patients, seven developed early-onset PE, 18 developed preterm PE (seven early PE plus 11 delivered between 34 and 36 + 6 weeks gestation), 34 developed PE (18 preterm PE plus 16 delivered after 37-week gestation), 12 pregnant women developed GH, and 517 women comprised the control group. The best predictive performance using the FMF algorithm occurred in the early-onset PE group, with AUC = 0.946 (95% CI 0.919–0.973) and the detection rate of 28.6% and 85.7% for 5% and 10% false-positive (FP), respectively. Conclusions: The FMF algorithm to predict PE was effective in a Brazilian population, mainly in the early-onset form of the disease at 10% FP.

OC10.04: Analysis of fetal ear rotation by three-dimensional rendering mode using a novel method: the ear angle - preliminary results

R. Deshpande1,2, D. Anblagan4, N. W. Jones1,2, N. Raine-Fenning1, G. Bugg2, P. Mansell3, P. Gowland4, L. Leach3 1School of Clinical Sciences, Division of Human Development, University of Nottingham, Nottingham, United Kingdom; 2Deparment of Obstetrics & Gynecology, Queens Medical Centre, Nottingham, United Kingdom; 3School of Biomedical Sciences, University of Nottingham, Nottingham, United Kingdom; 4Sir Peter Mansfield MRI Centre, University of Nottingham, Nottingham, United Kingdom

Reprodutibilidade interobservador dos índices vasculares do Doppler de amplitude tridimensional do embrião entre 7 e 10 semanas e 6 dias de gestação

OBJECTIVE: To evaluate the interobserver reproducibility of vascular indices obtained with three-dimensional power Doppler (3D power Doppler) ultrasonography at the first trimester of gestation. MATERIALS AND METHODS: The present reproducibility study involved 32 healthy pregnant women with 7 to 10 weeks and 6 days of gestation. The VOCAL (Virtual Organ Computer-aided AnaLysis) method was utilized to calculate embryos volume, with a 12° rotational angle. Subsequently, the software automatically displayed three 3D power Doppler vascular indices: vascularization index (VI), flow index (FI) and vascularization and flow index (VFI). In order to calculate the interobserver variability, an investigator performed a second blind measurement of the 32 embryos, and another investigator performed a third blind measurement of the same volumes. The interclass correlation coefficient (ICC) and Bland-Altman plots were utilized for statistical analysis. RESULTS: A good interobserver reproducibility was observed in relation to the three vascular indices. The VI presented ICC = 0.9 and mean difference between measurements = -1.1. For the FI, the ICC was 0.9 and mean difference = -0.5. The VFI presented ICC = 0.9 and mean difference = -1.1. CONCLUSION: The vascular indices, particularly the FI, obtained with 3D power Doppler ultrasonography at the first trimester of gestation demonstrated a high reproducibility.