ABSTRACT
OBJECTIVE: Placental anomalies visualized at midgestation by MRI are shown to be related to pregnancy outcome. We performed a prospective cohort study to investigate the influence of placental pathologies diagnosed with fetal MRI on long-term neurodevelopmental outcome. METHODS: In our hospital-based, cross-sectional study, all fetal MRI examinations of pregnancies with vascular placental pathology (i.e. infarction with/without hemorrhage, subchorionic thrombi/hemorrhages, intervillous thrombi/hemorrhages or retroplacental hematoma) between 2003 and 2007 were included. The extent of the pathology was expressed as the percentage of abnormality related to the whole placental volume. Pathohistological reports were correlated to MRI findings. Infants were prospectively investigated using Bayley developmental scales at the age of 2-3.5 years. Impairment was categorized as a Bayley scale two SDs below normal (<85 points). RESULTS: There were 31 singletons and 25 offspring of multiple pregnancies included in the analyses. Impairment rates were 32.2% in singletons and 32.0% in multiple births. No correlation between neuro/motor developmental outcome at 2-3.5 years and the type, extent or gestational week at the time of diagnoses of placental vascular pathologies was found. CONCLUSION: The long-term outcome of children with vascular placental pathologies on fetal MRI was associated with a high impairment rate after 2-3.5 years, both on motor- and neurodevelopmental Bayley scales. Neurological impairment did not correlate with the extent of placental involvement, intrauterine growth restriction, gestational age at birth or multiple state.
Subject(s)
Fetal Growth Retardation/pathology , Magnetic Resonance Imaging/methods , Placenta Diseases/diagnosis , Placenta/pathology , Child, Preschool , Cohort Studies , Female , Humans , Infant , Male , Outcome Assessment, Health Care , Pregnancy , Pregnancy Outcome , Prospective StudiesABSTRACT
While ultrasound is still the gold standard method of placental investigation, magnetic resonance imaging (MRI) has certain benefits. In advanced gestational age, obese women, and posterior placental location, MRI is advantageous due to the larger field of view and its multiplanar capabilities. Some pathologies are seen more clearly in MRI, such as infarctions and placental invasive disorders. The future development is towards functional placental MRI. Placental MRI has become an important complementary method for evaluation of placental anatomy and pathologies contributing to fetal problems such as intrauterine growth restriction.
Subject(s)
Magnetic Resonance Imaging , Placenta Diseases/diagnosis , Abruptio Placentae/diagnosis , Abruptio Placentae/physiopathology , Diffusion Magnetic Resonance Imaging , Female , Fetal Growth Retardation/diagnosis , Fetal Growth Retardation/physiopathology , Gestational Age , Humans , Hydatidiform Mole, Invasive/diagnosis , Hydatidiform Mole, Invasive/physiopathology , Infant, Newborn , Infarction/diagnosis , Infarction/physiopathology , Magnetic Resonance Angiography , Placenta/blood supply , Placenta/pathology , Placenta Accreta/diagnosis , Placenta Accreta/physiopathology , Placenta Diseases/physiopathology , Placenta Previa/diagnosis , Placenta Previa/physiopathology , Pregnancy , Pregnancy, Multiple/physiology , Regional Blood Flow/physiology , Uterine Neoplasms/diagnosis , Uterine Neoplasms/physiopathologyABSTRACT
OBJECTIVE: Twin-twin transfusion syndrome (TTTS) is a severe complication of monochorionic pregnancies. Placental hydrops might be a marker for TTTS. The purpose of this study was to evaluate whether differences in the placental parenchyma due to TTTS can be seen with fetal MRI. METHODS: In a retrospective study, 34 monochorionic pregnancies were investigated on a 1.5 Tesla MR. Seventeen pregnancies were affected by TTTS, and 17 showed no clinical signs of TTTS. Placental maturation and vascular pathologies, as well as the extent of the placental findings and allocation of placental tissue to each twin, were investigated. Placental findings were reported for origin, size, maturation, and placental thickness, and were correlated with the presence of TTTS. RESULTS: All placentas affected by TTTS showed abnormal maturation on MR scans, but only 64.7% of the non-TTTS group (p = 0.018). Vascular placental pathologies did not differ significantly between the TTTS and non-TTTS group. CONCLUSIONS: MR-signs of placental maturity in monochorionic twin pregnancies may indicate a lower risk of development of TTTS.
