Role of Placental Volume Measurement in First Trimester and Uterine Artery Doppler in Second Trimester In The Prediction Of Intra Uterine Growth Retardation And Pregnancy Induced Hypertension

Background: preeclampsia (pe) and intrauterine growth restriction (iugr) are causes of considerable maternal and fetal morbidity and mortality with partly understood etiology. Evaluation of utero- placental vascular modification during pregnancy using non-invasive methods such as ultrasound recently became possible. Uterine artery doppler measurements showed that impedance to flow in the urine arteries decreases with gestational age in normal pregnancies, that impedance to flow is increased in established iugr and that this increased impedance predates the onset of the clinical syndrome of iugr.
Objectives: to evaluate 3d placental volume in the first trimester and  uterine artery doppler velocimetry in the second trimester in the prediction of pregnancies that subsequently develop pre-eclampsia and intrauterine fetal growth restriction.
Methods: 500 pregnant women attending the antenatal care clinic of benha university hospital were subjected to first trimester (between 11-13 weeks) 3d ultrasound for measurement of placental volume then second trimester (at 22-24 weeks) color flow mapping was used to identify the uterine arteries at the level of the uterine isthmus and pulsed wave doppler was used to obtain the waveforms by the abdominal transducer.participating women were then followed up for development of adverse pregnancy outcomes (preeclampsia or frtal growth restriction).
Results: this study included 465  pregnant ladies. The placental volume of the 465 patient was 62.1 cm3 ±10.9, uterine artery pulsatility index was  1.85±0.24. From  those 38 patients, 28 patients had  iugr alone and 10 patient had iugr with pet. Uterine artery p.i. Was significantly higher  in iugr with pet  and iugr complicated pregnancies versus normal pregnancies. In this study, 4 cases out of 10 (40%) of iugr with pet group were  diagnosed at 32week which is significantly higher than iugr only pregnancies in which 2 cases only out of 28 cases had early onset iugr before 34 week . Placental volume and uterine artery pulsitility index showed significant correlation with estimated intrauterine fetal weight at 32, 34, and 36 weeks but all other studies comparing our results with focused only on the birth weight. There was significant decrease in gestational age between both iugr  ( mean 261 d ± 6.57 )  and  iugr with pet complicated pregnancies  (mean 248.4 d ±10.44), in comparison to normal pregnancies in which gestational age of labour ranged  (mean 270.9 d ±4.52); furthermore, iugr with pet cases showed significantly  decreased gestational age in comparison to iugr only cases.
Conclusions: the quantitative assessment of first trimester placental vasculature and placental volume in association with second trimester uterine artery doppler can be considered a promising modality for early prediction of adverse pregnancy outcomes (preeclampsia and fgr).