Evaluation of Placental Blood Flow in Patients with Placental Insufficiency

ORIGINAL ARTICLE
Julia E. Dobrokhotova, PhD, ScD¹*; Sophia A. Zalesskaya¹; Elena A. Zubareva, PhD, ScD¹; Andrey R. Zubarev, PhD, ScD¹; Tatiana A. Rumyantseva, PhD¹,²

¹N.I. Pirogov Russian National Research Medical University, ²Central Research Institute of Epidemiology; Moscow, the Russian Federation

*Corresponding author: Professor Julia E. Dobrokhotova, PhD, ScD. Head of Department of Obstetrics and Gynecology, Medical Faculty, N.I. Pirogov Russian National Research Medical University, Moscow, the Russian Federation. E-mail: pr.dobrohotova@mail.ru

Published: March 17, 2017.  doi: 10.21103/Article7(1)_OA1

Abstract: 

Background: Placental insufficiency is a major problem of modern obstetrics due to its link to maternal and perinatal morbidity and mortality. Placental microcirculatory disorders play a decisive role in the pathogenesis of this condition. Thus, an evaluation of placental blood flow is of particular importance and crucial for appropriate diagnosis. The aim of this study was to evaluate placental blood flow in patients with placental insufficiency. SMI (superb microvascular imaging) was compared to color Doppler for that purpose.
Materials and Methods: Primigravida patients (n=91) at 15 to 16 weeks of gestation were enrolled. Inclusion criteria were spontaneous singleton pregnancy, age from 18 to 45 years. All participants were divided into 2 groups: Group 1 – control group (n=27) and Group 2 – threatened miscarriage group (n=64). Transvaginal ultrasound and color Doppler were performed to assess uteroplacental circulation. Placental blood flow was evaluated using a Toshiba Aplio™ 500 machine equipped with an SMI tool.
Results: Placental blood flow assessment in patients with normal pregnancy revealed homogenous placental tissue, normal distribution of vessels, and active blood flow; in patients with pregnancy complications, we found inhomogeneous placenta, decreased blood flow, sporadic vessels, and avascular areas. SMI demonstrated several benefits compared to color Doppler imaging. Color Doppler allows us to assess superficial vessels only, whereas SMI provides more comprehensive data on the overall vascularization of the placenta.
Conclusion: SMI by Aplio™ 500 (Toshiba) may be an effective tool in the assessment of placental blood flow and the diagnosis and prognosis of placental insufficiency. 

Keywords: 
superb microvascular imaging ● placental circulation ● threatened miscarriage ● placental insufficiency
References: 
  1. Shirokova VI, Filippiv OS, Guseva EV.  Women's health and the basic directions in the development of obstetric services in the Russian Federation. Zdravookhraneniye. 2009; 11:25-31
  2. Kuzmin VN. Fetoplacentar insufficiency: a problem of the modern obstetrics.  Lechashchii Vrach. 2011; 3:50-4.
  3. Milovanov AP, Savelyeva SV. The intrauterine development of a human. M.: MVV; 2006.
  4. Dobrokhotova YuE, Milovanov AP, Djobava EM, Dzeygova EA. The placental insufficiency in women with a chronic venous insufficiency: some aspects of the etiology, pathogenesis and diagnosis. Rossiyskiy Vestnik Akushera-Ginekologa. 2007;7(1):12-8.
  5. Burton GJ, Charnok-Jones DS, Jauniaux E. Regulation of vascular growth and function in the human placenta. Reproduction. 2009;138(6):895-902. doi: 10.1530/REP-09-0092.
  6. Medvedev MV. Prenatal echography: differential diagnosis and prognosis. М.: The Real Time; 2012: 480 pp.
  7. Ozerskaya IA. Echography in gynecology. М.: VIDAR; 2013.
  8. Andronova NV, Zaretskaya NV, Khodjaeva ZS, Shegolev AI, Khramtchenko NV, Voevodin SM. Placental pathology in fetal chromosome abnormalities. Akush Ginekol (Mosk). 2014; 3:4-8.
  9. Burton GJ, Jauniaux E, Charnock-Jones DS. The influence of the intrauterine environment on human placental development.  Int J Dev Biol. 2010;54(2-3):303-12. doi: 10.1387/ijdb.082764gb. Review.
  10. Titchenko LI, Pyrsikova JYu, Chechneva MA, Titchenko IP. Three-dimensional ultrasound examination for the functional assessment of intraplacentar vasculature. SonoAce Ultrasound. 2007; 16. http://www.medison.ru/si/art254.htm
  11. Mihu CM, Suşman S, Rus Ciucă D, Mihu D, Costin N. Aspects of placental morphogenesis and angiogenesis. Rom J Morphol Embryol. 2009;50(4):549-57.

The fully formatted PDF version is available.
Download Article
International Journal of Biomedicine. 2017;7(1):28-31. © 2017 International Medical Research and Development Corporation. All rights reserved