Wave reflections in the umbilical artery measured by Doppler ultrasound as a novel predictor of placental pathology
Background: The umbilical artery (UA) Doppler pulsatility index is used clinically to detect elevated feto-placental vascular resistance. However, this metric is confounded by variation in fetal cardiac function and is only moderately predictive of placental pathology. Our group developed a novel ul...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-05-01
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| Series: | EBioMedicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352396421001195 |
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Article |
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DOAJ |
| language |
English |
| format |
Article |
| sources |
DOAJ |
| author |
Lindsay S. Cahill Greg Stortz Anjana Ravi Chandran Natasha Milligan Shiri Shinar Clare L. Whitehead Sebastian R. Hobson Viji Ayyathurai Anum Rahman Rojan Saghian Karl J. Jobst Cyrethia McShane Dana Block-Abraham Viola Seravalli Melissa Laurie Sarah Millard Cassandra Delp Denise Wolfson Ahmet A. Baschat Kellie E. Murphy Lena Serghides Eric Morgen Christopher K. Macgowan W.Tony Parks John C. Kingdom John G. Sled |
| spellingShingle |
Lindsay S. Cahill Greg Stortz Anjana Ravi Chandran Natasha Milligan Shiri Shinar Clare L. Whitehead Sebastian R. Hobson Viji Ayyathurai Anum Rahman Rojan Saghian Karl J. Jobst Cyrethia McShane Dana Block-Abraham Viola Seravalli Melissa Laurie Sarah Millard Cassandra Delp Denise Wolfson Ahmet A. Baschat Kellie E. Murphy Lena Serghides Eric Morgen Christopher K. Macgowan W.Tony Parks John C. Kingdom John G. Sled Wave reflections in the umbilical artery measured by Doppler ultrasound as a novel predictor of placental pathology EBioMedicine Fetal vascular malperfusion Maternal vascular malperfusion Placenta Doppler ultrasound Umbilical artery Wave reflection |
| author_facet |
Lindsay S. Cahill Greg Stortz Anjana Ravi Chandran Natasha Milligan Shiri Shinar Clare L. Whitehead Sebastian R. Hobson Viji Ayyathurai Anum Rahman Rojan Saghian Karl J. Jobst Cyrethia McShane Dana Block-Abraham Viola Seravalli Melissa Laurie Sarah Millard Cassandra Delp Denise Wolfson Ahmet A. Baschat Kellie E. Murphy Lena Serghides Eric Morgen Christopher K. Macgowan W.Tony Parks John C. Kingdom John G. Sled |
| author_sort |
Lindsay S. Cahill |
| title |
Wave reflections in the umbilical artery measured by Doppler ultrasound as a novel predictor of placental pathology |
| title_short |
Wave reflections in the umbilical artery measured by Doppler ultrasound as a novel predictor of placental pathology |
| title_full |
Wave reflections in the umbilical artery measured by Doppler ultrasound as a novel predictor of placental pathology |
| title_fullStr |
Wave reflections in the umbilical artery measured by Doppler ultrasound as a novel predictor of placental pathology |
| title_full_unstemmed |
Wave reflections in the umbilical artery measured by Doppler ultrasound as a novel predictor of placental pathology |
| title_sort |
wave reflections in the umbilical artery measured by doppler ultrasound as a novel predictor of placental pathology |
| publisher |
Elsevier |
| series |
EBioMedicine |
| issn |
2352-3964 |
| publishDate |
2021-05-01 |
| description |
Background: The umbilical artery (UA) Doppler pulsatility index is used clinically to detect elevated feto-placental vascular resistance. However, this metric is confounded by variation in fetal cardiac function and is only moderately predictive of placental pathology. Our group developed a novel ultrasound methodology that measures wave reflections in the UA, thereby isolating a component of the Doppler signal that is specific to the placenta. The present study examined whether wave reflections in the UA are predictive of placental vascular pathology. Methods: Standard clinical Doppler ultrasound of the UAs was performed in 241 pregnant women. Of these, 40 women met narrowly defined preset criteria for the control group, 36 had maternal vascular malperfusion (MVM) and 16 had fetal vascular malperfusion (FVM). Using a computational procedure, the Doppler waveforms were decomposed into a pair of forward and backward propagating waves. Findings: Compared to controls, wave reflections were significantly elevated in women with either MVM (p<0.0001) or FVM pathology (p = 0.02). In contrast, the umbilical and uterine artery pulsatility indices were only elevated in the MVM group (p<0.0001) and there were no differences between women with FVM and the controls. Interpretation: The measurement of wave reflections in the UA, combined with standard clinical ultrasound parameters, has the potential to improve the diagnostic performance of UA Doppler to detect placental vascular pathology. Identifying women with FVM pathology is particularly challenging prenatally and future investigations will determine if women at risk of this specific placental disease could benefit from this novel diagnostic technique. |
| topic |
Fetal vascular malperfusion Maternal vascular malperfusion Placenta Doppler ultrasound Umbilical artery Wave reflection |
| url |
http://www.sciencedirect.com/science/article/pii/S2352396421001195 |
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doaj-60f995996da94d7ca8cbbbae22a9cb322021-05-28T05:02:37ZengElsevierEBioMedicine2352-39642021-05-0167103326Wave reflections in the umbilical artery measured by Doppler ultrasound as a novel predictor of placental pathologyLindsay S. Cahill0Greg Stortz1Anjana Ravi Chandran2Natasha Milligan3Shiri Shinar4Clare L. Whitehead5Sebastian R. Hobson6Viji Ayyathurai7Anum Rahman8Rojan Saghian9Karl J. Jobst10Cyrethia McShane11Dana Block-Abraham12Viola Seravalli13Melissa Laurie14Sarah Millard15Cassandra Delp16Denise Wolfson17Ahmet A. Baschat18Kellie E. Murphy19Lena Serghides20Eric Morgen21Christopher K. Macgowan22W.Tony Parks23John C. Kingdom24John G. Sled25Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Chemistry, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada; Corresponding author at: Department of Chemistry, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada.Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, CanadaDepartment of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, CanadaDivision of Cardiology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, CanadaDepartment of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, CanadaDepartment of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada; Pregnancy Research Centre, Department of Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, AustraliaDepartment of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, CanadaDepartment of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, CanadaMouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, CanadaMouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, CanadaDepartment of Chemistry, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, CanadaCenter for Fetal Therapy, Johns Hopkins Medicine, Baltimore, MD, USACenter for Fetal Therapy, Johns Hopkins Medicine, Baltimore, MD, USACenter for Fetal Therapy, Johns Hopkins Medicine, Baltimore, MD, USA; Department of Health Sciences, Division of Obstetrics and Gynecology, University of Florence, ItalyCenter for Fetal Therapy, Johns Hopkins Medicine, Baltimore, MD, USACenter for Fetal Therapy, Johns Hopkins Medicine, Baltimore, MD, USACenter for Fetal Therapy, Johns Hopkins Medicine, Baltimore, MD, USACenter for Fetal Therapy, Johns Hopkins Medicine, Baltimore, MD, USACenter for Fetal Therapy, Johns Hopkins Medicine, Baltimore, MD, USADepartment of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, CanadaToronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; Department of Immunology and Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, CanadaDepartment of Pathology, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, CanadaTranslational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, CanadaDepartment of Pathology, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, CanadaDepartment of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, CanadaMouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, CanadaBackground: The umbilical artery (UA) Doppler pulsatility index is used clinically to detect elevated feto-placental vascular resistance. However, this metric is confounded by variation in fetal cardiac function and is only moderately predictive of placental pathology. Our group developed a novel ultrasound methodology that measures wave reflections in the UA, thereby isolating a component of the Doppler signal that is specific to the placenta. The present study examined whether wave reflections in the UA are predictive of placental vascular pathology. Methods: Standard clinical Doppler ultrasound of the UAs was performed in 241 pregnant women. Of these, 40 women met narrowly defined preset criteria for the control group, 36 had maternal vascular malperfusion (MVM) and 16 had fetal vascular malperfusion (FVM). Using a computational procedure, the Doppler waveforms were decomposed into a pair of forward and backward propagating waves. Findings: Compared to controls, wave reflections were significantly elevated in women with either MVM (p<0.0001) or FVM pathology (p = 0.02). In contrast, the umbilical and uterine artery pulsatility indices were only elevated in the MVM group (p<0.0001) and there were no differences between women with FVM and the controls. Interpretation: The measurement of wave reflections in the UA, combined with standard clinical ultrasound parameters, has the potential to improve the diagnostic performance of UA Doppler to detect placental vascular pathology. Identifying women with FVM pathology is particularly challenging prenatally and future investigations will determine if women at risk of this specific placental disease could benefit from this novel diagnostic technique.http://www.sciencedirect.com/science/article/pii/S2352396421001195Fetal vascular malperfusionMaternal vascular malperfusionPlacentaDoppler ultrasoundUmbilical arteryWave reflection |