Developmental changes in spiral artery blood flow in the human placenta observed with colour Doppler ultrasonography

摘要

Objectives: Our current knowledge of the physiological dilatation of spiral arteries in pregnancy, is based on histology. Real-time ultrasound visualisation of these changes may aid understanding of abnormal placentation. This study aimed to investigate if changes in the spiral artery blood flow can be followed 'in vivo' and explore the novel phenomenon of the larger 'mega-jets'. Methods: Colour Doppler ultrasonography was used to identify the most prominent jets at blood from the spiral artery into the intervillous space. Their velocity, width and length were recorded seven set time points during pregnancy. Results: Fifty two uncomplicated, term normotensive pregnancies were studied. Width and length of the jets' Doppler signals increased with gestation, the velocity decreased. The length of the jets shows a bi-modal frequency distribution. The width of the signals of longer ('mega') jets was significantly greater (p = 0.001) than that of the jets (mean 4.3 mm (3.1-5.9) versus 3.8 mm (1.8-5.8) respectively) at 34 weeks. However, there was no significant difference in the peak systolic velocity (p = 0.2). Conclusion: This study confirms that ultrasound can be used to study the gestation dependent changes in the haemodynamics of the placental basal plate predicted, but not proven, by histologic data. The bi-modal distribution of jet lengths suggests that mega-jets are a separate entity to 'normal' jets. That they are significantly wider than 'normal' jets and yet maintain the same velocity of blood flow suggests that they have a greater volume of blood flow. The mechanism for this is hypothesised and their apparent relationship with simple placental lakes discussed.