Novel Ultrasound Technologies in Assessing the State of the Mother–Placenta–Fetus System

DOI: 10.47026/2413-4864-2023-3-24-32

UDC: 618
BBC: 57.16

Zalesskaia S.A., Zubareva E.A., Dobrokhotova Yu.E., Iljenko L.I., Sencha A.N., Koreev A.L.

Novel Ultrasound Technologies in Assessing the State of the Mother–Placenta–Fetus System

Keywords: placental blood flow, Superb Micro-Vascular Imaging, placental insufficiency

The leading process in early pregnancy is forming the mother–placenta–fetus system. The central link of the mother–placenta–fetus system is the placenta. The structural features of the placenta reflect complex relationship between the mother's body and the fetus. Disorder in forming and functioning of the placenta underlies the development of complications such as early termination of pregnancy, placental insufficiency, fetal growth retardation syndrome, preeclampsia, premature birth. In this regard, an integrated approach in studying the hemodynamic system of mother–placenta–fetus is of particular importance. Ultrasound examination remains one of the most promising diagnostic methods. The aim of the study is to increase the effectiveness of diagnosis and prediction of gestational complications associated with violation of hemodynamic parameters in the mother–placenta–fetus system. Materials and methods. The study included 40 patients between the 30^th and 32^nd weeks of pregnancy with a singleton spontaneous pregnancy: 20 patients with normal course of pregnancy and 20 patients with a diagnosis of placental insufficiency. Ultrasound examination included standard echography in B-mode, color Doppler mapping and the use of modern techniques – three-dimensional imaging technology and innovative techniques of high-precision microvascular imaging SMI (Superb Micro-Vascular Imaging). Results and discussion. In patients with normal pregnancy, a variant of a three-dimensional model of the vascular network with a complex massive vascular network prevailed, whereas in the group with placental insufficiency, a three-dimensional vascular model looked simple: several intertwined vessels. Visual assessment of the placental vascular tree using SMI technology revealed the absence of a clear vascular pattern in the area of interest in patients with placental insufficiency, whereas active placental blood flow was determined in patients with normal pregnancy. Conclusions. The use of modern ultrasound technologies enables to obtain information about the state of placental blood flow, which gives the opportunity to diagnose the development of placental insufficiency in a timely manner.

References

Voevodin S.M., Shemanaeva T.V., Shchegolev A.I. Platsentarnaya nedostatochnost’ i ugroza preryvaniya beremennosti: sovremennyi vzglyad na problemu [Placental insufficiency and threatened miscarriage: a modern view on the problem]. Ginekologiya, 2017, no. 4, pp. 50–52.
Voevodin S.M., Shemanaeva T.V., Shchegolev A.I., Parkhomenko Yu.G. Platsentarnaya disfunktsiya u VICh-infitsirovannykh beremennykh [Placental dysfunction in HIV-infected pregnant women]. Akusherstvo i ginekologiya, 2018, no. 9, pp. 41–47.
Dindyaev S.V., Vinogradov S.Yu. Meditsinskaya embriologiya [Medical Embryology]. Moscow, Yurait Publ., 2020, 347 p.
Zakharov S.M., Chechneva M.A., Budykina T.S. Vozmozhnosti ul’trazvukovoi diagnostiki strukturnykh narushenii platsenty [Possibilities of ultrasound diagnostics of structural disorders of placenta]. Rossiiskii vestnik akushera-ginekologa, 2019, no. 19(6), pp. 16–22.
Zubarev A.R. Novye ul’trazvukovye tekhnologii v angiologii: rukovodstvo dlya vrachei [New Ultrasound Technologies in Angiology: A Guide for Physicians]. Moscow, Strom Publ., 2017, 144 p.
Medvedev M.V., Altynnik N.A., Shatokha Yu.V. Ul’trazvukovaya diagnostika v ginekologii: mezhdunarodnye konsensusy i ob”emnaya ekhografiya [Ultrasound diagnostics in gynecology: international consensus and volumetric ultrasonography]. Moscow, Real’noe vremya Publ., 2018, 200 p.
Milovanov A.P. Tsitotrofoblasticheskaya invaziya – vazhneishii mekhanizm platsentatsii i progressii beremennosti [Cytotrophoblastic invasion is the most important mechanism of placentation and pregnancy progressio]. Arkhiv patologii, 2019, no. 81(4), pp. 5–10.
Ozerskaya I.A. Ekhografiya v ginekologii. 3-e izd., pererab. i dop. [Ultrasonography in gynecology. 3^rd ]. Moscow, Vidar Publ., 2020, 704 p.
Dobrokhotova Yu.E., Trofimov D.Yu., Shchegolev A.I. et al. Osobennosti ekspressii mRNK gena progesteronindutsirovannogo blokiruyushchego faktora v platsente pri prezhdevremennykh rodakh [Placental PIBF1 gene mRNA expression during preterm labor]. Akusherstvo i ginekologiya, 2017, no. 7, pp. 62–67.
Belousova V.S., Strizhakov A.N., Svitich O.A. et al. Prezhdevremennye rody: prichiny, patogenez, taktika [Preterm birth: causes, pathogenesis, and management]. Akusherstvo i ginekologiya, 2020, no. 2, pp. 82–87.
Nizyaeva N.V., Amiraslanov E.Yu., Lomova N.A. et al. Ul’trastrukturnye i immunogistokhimicheskie osobennosti platsenty pri preeklampsii v sochetanii s zaderzhkoi rosta ploda [Placental ultrastructural and immunohistochemical changes in preeclampsia with concomitant fetal growth restriction]. Akusherstvo i ginekologiya, 2019, no. 11, pp. 97–106.
Kholin A.M., Khodzhaeva Z.S., Gus A.I. Trekhmernaya energeticheskaya dopplerovskaya otsenka vaskulyarizatsii platsentarnogo lozha v prognozirovanii preeklampsii v pervom trimestre [3D power doppler placental bed vascularization in the first trimester prediction of preeclampsia]. Akusherstvo i ginekologiya, 2018, no. 2, pp. 36–43.
Shchegolev A.I., Serov V.N. Klinicheskaya znachimost’ porazhenii platsenty [Clinical significance of placental lesions]. Akusherstvo i ginekologiya, 2019, no. 3, pp. 54–62.
Shchegolev A.I., Tumanova U.N., Lyapin V.M., Serov V.N. Narusheniya struktury i vaskulyarizatsii vorsin platsenty pri zaderzhke rosta ploda [Disorder of the structure and vascularization of the villi of placenta at the fetal growth restriction]. Sovremennye problemy nauki i obrazovaniya, 2018, no. 4, pp. 12–18.
Shchegolev A.I., Tumanova U.N., Lyapin V.M., Serov V.N. Sintsitiotrofoblast vorsin platsenty v norme i pri preeklampsii [The syncytiotrophoblast of the placental villi in health and in preeclampsia]. Akusherstvo i ginekologiya, 2020, no. 6, pp. 21–28.
Akolekar R., Syngelaki A., Sarquis R. et al. Prediction of early, intermediate and late pre-eclampsia form maternal factors, biophysical and biochemical markers at 11-13 weeks. Prenatal diagnosis, 2011, vol. 31(1), pp. 66–74. DOI: https://doi.org/10.1001/pd.2660.
Binder J. De-novo abnormal uteroplacental circulation in third trimester: pregnancy outcome and pathological implications. Ultrasound in Obstetrics & Gynecology, 2018, vol. 52(1), pp. 60–65. DOI: https://doi.org/10.1002/uog.17564.
Di Renzo G.C., Roura L.C., Faccbintti F. et al. Guidelines for the management of spontaneous preterm labor: identification of spontaneous preterm labor, diagnosis of preterm premature rupture of membranes, and preventive tools for preterm birth. Matern. Fetal Neonatal Med., 2017, vol. 24(5), pp.659–667. DOI: https://doi.org/10.3109/14767058.2011.553694.
Pellaers D. Assessment and validation of a novel three-dimensional power Doppler VOCAL sonobiopsy technique. Ultrasound Obstet. Gynecol., 2017, vol. 50, p. 210. DOI: https://doi.org/10.1002/uog.18173.
Sainz J.A. Study of the Development of Placental Microvascularity by Doppler SMI (Superb Microvascular Imaging): A Reality Today. Ultrasound Med Biol., 2020, vol. 46(12), pp. 3257–3267. DOI: https://doi.org/10.1016/j.ultrasmedbio.2020.08.017.
Sperling R. Obstetrics and Gynecology. John Wiley & Sons Inc., 2020, 400 p.
Sun B., Parks W.T., Simhan H.N. et al. Early pregnancy immune profile and preterm birth classified according to uteroplacental lesions. Placenta, 2020, vol. 89, pp. 99–106. DOI: https://doi.org/10.1016/j.placenta.2019.12.007.

About authors

Zalesskaia Sofia A.: Candidate of Medical Sciences, Assistant Lecturer, Department of Obstetrics and Gynecology, Department of Ultrasound Diagnostics, N.I. Pirogov Russian National Research Medical University, Russia, Moscow (sofia.zalesskaya@bk.ru; ORCID: https://orcid.org/0000-0003-2881-0788)

Zubareva Elena A.: Doctor of Medical Sciences, Head of the Department of Ultrasound Diagnostics, N.I. Pirogov Russian National Research Medical University, Russia, Moscow (zubareva-elena@mail.ru; ORCID: https://orcid.org/0000-0002-9997-4715)

Dobrokhotova Yulia E.: Doctor of Medical Sciences, Head of the Department of Obstetrics and Gynecology, N.I. Pirogov Russian National Research Medical University, Russia, Moscow (pr.dobrohotova@mail.ru; ORCID: https://orcid.org/0000-0003-2786-6181)

Iljenko Lidia I.: Doctor of Medical Sciences, Head of the Department of Hospital Pediatrics № 2, N.I. Pirogov Russian National Research Medical University, Russia, Moscow (dpfrsmu@yandex.ru; ORCID: https://orcid.org/0000-0001-8375-4569)

Sencha Alexander N.: Doctor of Medical Sciences, Head of Visual Diagnostics Department, National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov, Russia, Moscow (senchavyatka@mail.ru; ORCID: https://orcid.org/0000-0002-1188-8872)

Koreev Alexander L.: Assistant Lecturer, Department of Ultrasound Diagnostics, N.I. Pirogov Russian National Research Medical University, Russia, Moscow (koreev.a@mail.ru; ORCID: https://orcid.org/0009-0002-7693-593X)

Article link

Zalesskaia S.A., Zubareva E.A., Dobrokhotova Yu.E., Iljenko L.I., Sencha A.N., Koreev A.L. Novel Ultrasound Technologies in Assessing the State of the Mother–Placenta–Fetus System [Electronic resource] // Acta medica Eurasica. – 2023. – №3. P. 24-32. – URL: https://acta-medica-eurasica.ru/en/single/2023/3/3/. DOI: 10.47026/2413-4864-2023-3-24-32.

Single article

Zalesskaia S.A., Zubareva E.A., Dobrokhotova Yu.E., Iljenko L.I., Sencha A.N., Koreev A.L.