Evaluation of placental vascularization by three-dimensional ultrasound examination in second and third trimester of pregnancies complicated by chronic hypertension, gestational hypertension or pre-eclampsia

摘要

Objectives: The purpose of this study was to assess three-dimensional placental power Doppler indices in second and third trimester of pregnancies complicated by chronic-, gestational hypertension or pre-eclampsia. Methods: We analyzed 226 pregnancies prospectively measuring three-dimensional placental power Doppler indices (vascularization index, flow index, vascularization flow index) in cases of normal blood pressure (N = 109), chronic hypertension (N = 43), gestational hypertension (N = 57) and pre-eclampsia (N = 17). We evaluated the correlation among vascularization indices, flow characteristics of uterine arteries and perinatal outcome. We assessed the influence of maternal factors (pregestational body mass index, previous pregnancies/deliveries, maternal age) on vascularization indices, and analyzed histolog-ical findings of placenta from pregnancy hypertension groups. Results: Vascularization index was significantly higher (p = 0.010) in pregnancies with chronic- and lower (p = 0.152) in pregnancies with gestational hypertension and preeclampsia compared to the normal group. Flow index was significantly lower in all three pathological groups compared to normal group. Placental volume was significantly smaller (p< 0.001) in all three pathological groups than in normal pregnancies at the time of delivery, and there was no significant difference between the three affected groups. The rate of adverse pregnancy outcomes showed no significant difference between the normal and chronic hypertension groups. We observed significantly lower 1', 5' and 10' APGAR scores (p< 0..001), and birth weight in preeclampsia compared to chronic-, gestational hypertension, and normal groups. Maternal factors had no influence on the development of the power Doppler indices. Conclusion: Vascularization indices seem good markers for the prediction of risks and adverse outcomes in case of pregnancy hypertension.