Placental Elasticity as a New Non-invasive Predictive Marker of Pre-eclampsia.

Point shear wave elastography is an ultrasonography technique used to evaluate tissue elasticity. We examined whether placental elasticity is useful for predicting the onset of pre-eclampsia. Two hundred twenty-one participants were divided into two groups: one group at low risk (n = 185) and the other at high risk (n = 36) for pre-eclampsia. The two groups were compared with respect to shear wave velocity (SWV) of the placenta. Use of SWV as a predictor of pre-eclampsia was also investigated by creating a receiver operating characteristic (ROC) curve. The ROC curve was used to set a cutoff SWV value for predicting pre-eclampsia. The SWV of the high-risk group was significantly higher than that of the low-risk group (p < 0.001). Thirteen participants developed pre-eclampsia after SWV measurements, and the SWVs of these participants were significantly higher than those of participants in who pre-eclampsia did not develop. The cutoff value and area under the ROC curve were 1.188 m/s and 0.9118, respectively. Placental elasticity was significantly increased even before the onset of pre-eclampsia onset and, thus, may be a parameter used to predict the onset of pre-eclampsia.

Placental elasticity evaluation using virtual touch tissue quantification during pregnancy.

INTRODUCTION: Virtual touch tissue quantification (VTTQ) has been developed to evaluate tissue elasticity. Our previous study using delivered placentas showed increased elasticity in fetal growth restriction (FGR). Therefore, we investigated changes in placental elasticity during pregnancy, including complicated pregnancies. METHODS: Based on complications, 199 women were divided into 5 groups (normal, FGR, pregnancy induced hypertension (PIH), diabetes mellitus and collagen disease), and shear wave velocity (SWV) of the placenta, measured using VTTQ, was compared. A cross-sectional study was performed with the 143 normal cases to construct the reference range. The association between placental SWV and the expression ratio of collagen fibers in the placenta stained with Masson's trichrome was determined. RESULTS: The SWV was safely measured for all participants. The correlation between SWV and gestational weeks was not significant. The mean ± SD SWVs in the normal, FGR, and PIH groups were 0.98 ± 0.21, 1.28 ± 0.39, and 1.60 ± 0.45 m/sec, respectively. The FGR and PIH groups had significantly higher SWVs than that of the normal group. SWV and the expression ratio of collagen fibers were significantly correlated. DISCUSSION: Based on the present findings, changes in SWV during pregnancy were associated with placental fibrosis, and increased SWV in PIH and/or FGR cases might be influenced by infarction, ischemic changes, and inflammation, as well as fibrosis. In conclusion, the measurement of placental SWV is potentially useful to evaluate the condition of the placenta during pregnancy.

Clinical utility of augmentation index as a new parameter of peripheral circulation in human fetuses.

BACKGROUND: Augmentation index (AI) is calculated from the central arterial pressure or pulse waveform and known as a parameter to evaluate arterial vascular function in adults. Patients with deterioration of peripheral circulation will demonstrate increased AI values as well as those with cardiovascular risks. It is because increased AI is caused by the early timing of the reflection wave from the periphery. On the other hand, in fetuses, although arterial pressure waveforms are not available, pulse waveforms of fetal descending aorta are recordable by using an echo-tracking system. Therefore in this study we aimed to evaluate the utility of fetal AI calculated from aortic pulse waveforms for detecting the altered peripheral circulation in human fetuses. STUDY DESIGN: Fetal AI was calculated from pulse waveforms in the descending aorta using an echo-tracking system. In a cross-sectional study of 105 normal fetuses, the reference range was constructed using linear regression analysis. Retrospectively, 36 growth-restricted fetuses were divided into 2 subgroups, normal (n=21) and increased AIx (n=15), based on the 90th percentile value of normal fetuses. Clinical parameters were compared using Fisher's exact test or Mann-Whitney U test. RESULTS: Fetal AI decreased linearly with advancing gestational age (r(2)=0.820). The incidences of umbilical artery absent/reversed end-diastolic flow, brain-sparing effect, and oligohydramnios were significantly higher in the increased AI group than the normal AI group. CONCLUSION: Fetal AI has a possibility to detect deteriorated peripheral circulation in the fetal body as well as fetoplacental circulation.

Preload index of the inferior vena cava as a possible predictive marker of hydropic changes in fetuses with Ebstein anomaly.

OBJECTIVE: We aimed to investigate whether the preload index of the inferior vena cava (PLI-IVC) is of diagnostic value in predicting hydropic changes in fetuses with Ebstein anomaly. METHODS: Five cases of prenatally diagnosed Ebstein anomaly, which were managed at our institution between 1999 and 2008, were retrospectively reviewed. The PLI-IVC was calculated as the ratio between the reversed flow velocity from the right atrium and the forward velocity of the IVC. RESULTS: The PLI-IVC was high in all the cases. In 2 cases, PLI-IVC values tended to increase gradually before hydropic changes were recognized. In the cases without hydrops, PLI-IVC values exhibited a nonlinear trend throughout gestation and did not show any apparent increase. CONCLUSIONS: The upward trend of the PLI-IVC rather than the maintenance of a high value can be considered a sign of cardiac failure. The blood flow pattern in the IVC should be carefully monitored in fetuses with Ebstein anomaly for the early identification of fetal impairment.

Three-dimensional power Doppler sonography in the diagnosis of a cystic sacrococcygeal teratoma mimicking a meningomyelocele: A case report.

Sacrococcygeal teratomas have been diagnosed prenatally on sonograms as masses of cystic, solid, or mixed echogenicity from the sacral area and protruding through the perineum or buttocks. However, a cystic sacrococcygeal teratoma may be misdiagnosed as an anterior sacral meningomyelocele, especially when presenting as a posterior cystic mass. We report a case in which three-dimensional power Doppler imaging was helpful for making a correct prenatal diagnosis of a type 1 cystic sacrococcygeal teratoma, which mimicked a meningomyelocele.