Volume and vascularity: Using ultrasound to unlock the secrets of the first trimester placenta. (1st September 2019) - Mathewlynn, S.
Abstract: Fetal growth restriction (FGR) is a major cause of perinatal morbidity and mortality. Identifying which pregnancies are at risk of FGR facilitates enhanced surveillance and early delivery before fetal demise can ensue. However, existing risk stratification strategies yield an unacceptably low detection rate. A robust and reliable first trimester screening test for FGR would not only enable high-risk women to be appropriately monitored but would facilitate future trials for possible interventions to enhance fetal growth. Both the volume and vascularity of the first trimester placenta has been demonstrated to be linked to adverse pregnancy outcomes including FGR and pre-eclampsia. The investigation of novel ultrasound markers for FGR are discussed along with the development of methods for fully automatic placental volume estimation which has the potential for use as part of a multi-variable population-based screening test. Highlights: Both placental volume and vascularity measurements have utility in the prediction of pre-eclampsia and fetal growth restriction. It is now possible to measure first trimester placental volume in real-time using the fully automated and validated tool, OxNNet. Standardised ultrasound measurement of placental vascularity is possible using 3D fractional moving blood volume. A fully automated, multivariable screening test for growth restriction is now a realistic possibility.