Dataset Information

Magnetic resonance imaging measurement of placental perfusion and oxygen saturation in early-onset fetal growth restriction.

ABSTRACT:

Objective

We hypothesised that a multi-compartment magnetic resonance imaging (MRI) technique that is sensitive to fetal blood oxygenation would identify changes in placental blood volume and fetal blood oxygenation in pregnancies complicated by early-onset fetal growth restriction (FGR).

Design

Case-control study.

Setting

London, UK.

Population

Women with uncomplicated pregnancies (estimated fetal weight [EFW] >10th centile for gestational age [GA] and normal maternal and fetal Doppler ultrasound, n = 12) or early-onset FGR (EFW <3rd centile with or without abnormal Doppler ultrasound <32 weeks GA, n = 12) were studied.

Methods

All women underwent MRI examination. Using a multi-compartment MRI technique, we quantified fetal and maternal blood volume and feto-placental blood oxygenation.

Main outcome measures

Disease severity was stratified according to Doppler pulsatility index and the relationship to the MRI parameters was investigated, including the influence of GA at scan.

Results

The FGR group (mean GA 27⁺⁵ weeks, range 24⁺² to 33⁺⁶ weeks) had a significantly lower EFW compared with the control group (mean GA 29⁺¹ weeks; -705 g, 95% CI -353 to -1057 g). MRI-derived feto-placental oxygen saturation was higher in controls compared with FGR (75 ± 9.6% versus 56 ± 16.2%, P = 0.02, 95% CI 7.8-30.3%). Feto-placental oxygen saturation estimation correlated strongly with GA at scan in controls (r = -0.83).

Conclusion

Using a novel multimodal MRI protocol we demonstrated reduced feto-placental blood oxygen saturation in pregnancies complicated by early-onset FGR. The degree of abnormality correlated with disease severity defined by ultrasound Doppler findings. Gestational age-dependent changes in oxygen saturation were also present in normal pregnancies.

Tweetable abstract

MRI reveals differences in feto-placental oxygen saturation between normal and FGR pregnancy that is associated with disease severity.

SUBMITTER: Aughwane R

PROVIDER: S-EPMC7613436 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

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Publications

Magnetic resonance imaging measurement of placental perfusion and oxygen saturation in early-onset fetal growth restriction.

Aughwane R R Mufti N N Flouri D D Maksym K K Spencer R R Sokolska M M Kendall G G Atkinson D D Bainbridge A A Deprest J J Vercauteren T T Ourselin S S David A L AL Melbourne A A

BJOG : an international journal of obstetrics and gynaecology 20200805 2

<h4>Objective</h4>We hypothesised that a multi-compartment magnetic resonance imaging (MRI) technique that is sensitive to fetal blood oxygenation would identify changes in placental blood volume and fetal blood oxygenation in pregnancies complicated by early-onset fetal growth restriction (FGR).<h4>Design</h4>Case-control study.<h4>Setting</h4>London, UK.<h4>Population</h4>Women with uncomplicated pregnancies (estimated fetal weight [EFW] >10th centile for gestational age [GA] and normal matern ...[more]

PMID: 32603546

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Project description:Fetal growth restriction (FGR) occurs when the fetus does not reach its genetically programmed intrauterine potential for growth and affects ~5‑10% of pregnancies. This condition is one of the leading causes of perinatal mortality and morbidity associated with obstetric and neonatal complications. Placental dysfunction in FGR causes an impairment in the transfer of nutrients and oxygen from the mother to the developing fetus. Maternal adaptations to placental insufficiency may also play a role in the pathophysiology of FGR. The present study aimed to compare the proteome of the placentas of 18 women with the physiological course of pregnancy and eutrophic fetus [estimated fetal weight (EFW) >10th percentile; control group] and 18 women with late FGR (EFW <10th percentile) diagnosed after 32 weeks of pregnancy, according to the Delphi consensus (study group). The U. Mann‑Whitney test was used to compare two independent groups. The R. Spearman correlation coefficient significance test was used to assess the existence of a relationship between the analyzed measurable parameters. P<0.05 was considered to indicate a statistically significant difference. The tests showed the presence of 356 different proteins which were responsible for the regulation of gene transcription control, inhibiting the activity of proteolytic enzymes, regulation of trophoblast proliferation and angiogenesis and inflammatory response. In the FGR placental proteome, other detected proteins were mostly involved in response to oxidative stress, cellular oxidation and detoxication, apoptosis, hemostatic and catabolic processes, energy transduction protein interactions, cell proliferation, differentiation and intracellular signaling. The present study used chromatographic mass‑spectrometry to compare the placental proteome profiles in pregnancies complicated by late‑onset FGR and normal pregnancy. Comparative analysis of proteomes from normal and FGR placentas showed significant differences. Further research is needed to clarify maternal and fetal adaptations to FGR.

Project description:BackgroundThe current standard method to measure intracardiac oxygen (O2 ) saturation is by invasive catheterization. Accurate noninvasive blood O2 saturation by MRI could potentially reduce the duration and risk of invasive diagnostic procedures.PurposeTo noninvasively determine blood oxygen saturation in the heart with MRI and compare the accuracy with catheter measurements.Study typeProspective.SubjectsThirty-two patients referred for right heart catheterization (RHC) and five healthy subjects.Field strength/sequenceT2-prepared single-shot balanced steady-state free-precession at 1.5T.AssessmentMR signals in venous and arterial blood, hematocrit, and arterial O2 saturation from a pulse oximeter were jointly processed to fit the Luz-Meiboom model and estimate blood O2 saturation in the right heart. Interstudy reproducibility was evaluated in volunteers and patients. Interobserver reproducibility among three readers was assessed using data from volunteers and 10 patients. Accuracy of MR oximetry was compared to RHC in all patients.Statistical testsCoefficient of variation, intraclass correlation coefficient, Bland-Altman analysis, Pearson's correlation.ResultsThe coefficient of variation for interstudy reproducibility of O2 saturation was 2.6% on average in volunteers and 3.2% in patients. Interobserver reproducibility among three observers yielded intraclass correlation coefficients of 0.81 and 0.87 respectively for RV and MPA O2 saturation. O2 saturation (y = 0.85x + 0.13, R = 0.78) and (a-v)O2 difference (y = 0.71x + 0.90, R = 0.69) by MR and RHC were significantly correlated (N = 32, P < 0.05 in both cases) in patients. MR slightly overestimated O2 saturation compared to RHC with 2% ± 5% bias and limits of agreement between -7% and 12%.Data conclusionMR oximetry is repeatable and reproducible. Good agreement was shown between MR and catheter venous O2 saturation and (a-v)O2 difference in a cohort whose venous O2 ranged from abnormally low to high levels, with most values in the normal physiological range.Level of evidence2.Technical efficacy stage2.

Project description:ObjectiveTo analyze the ability to predict perinatal survival and severe neonatal morbidity of cases with early-onset fetal growth restriction (eoFGR) using maternal variables, ultrasound parameters and angiogenic markers at the time of diagnosis.MethodsThis was a prospective observational study in a cohort of singleton pregnancies with a diagnosis of eoFGR (< 32 weeks of gestation). At diagnosis of eoFGR, complete assessment was performed, including ultrasound examination (anatomy, biometry and Doppler assessment) and maternal serum measurement of the angiogenic biomarkers, soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF). Logistic regression models for the prediction of perinatal survival (in cases diagnosed at < 28 weeks) and severe neonatal morbidity (in all liveborn cases) were calculated.ResultsIn total, 210 eoFGR cases were included, of which 185 (88.1%) survived perinatally. The median gestational age at diagnosis was 27 + 0 weeks. All cases diagnosed at ≥ 28 weeks survived. In cases diagnosed < 28 weeks, survivors (vs non-survivors) had a higher gestational age (26.1 vs 24.4 weeks), estimated fetal weight (EFW; 626 vs 384 g), cerebroplacental ratio (1.1 vs 0.9), PlGF (41 vs 18 pg/mL) and PlGF multiples of the median (MoM; 0.10 vs 0.06) and lower sFlt-1/PlGF ratio (129 vs 479) at the time of diagnosis (all P < 0.001). The best combination of two variables for predicting perinatal survival was provided by EFW and PlGF MoM (area under the receiver-operating-characteristics curve (AUC), 0.84 (95% CI, 0.75-0.92)). These were also the best variables for predicting severe neonatal morbidity (AUC, 0.73 (95% CI, 0.66-0.80)).ConclusionsA model combining EFW and maternal serum PlGF predicts accurately perinatal survival in eoFGR cases diagnosed before 28 weeks of gestation. Prenatal prediction of severe neonatal morbidity in eoFGR cases is modest regardless of the model used. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Dataset Information

Magnetic resonance imaging measurement of placental perfusion and oxygen saturation in early-onset fetal growth restriction.

Objective

Design

Setting

Population

Methods

Main outcome measures

Results

Conclusion

Tweetable abstract

Publications

Magnetic resonance imaging measurement of placental perfusion and oxygen saturation in early-onset fetal growth restriction.

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