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To evaluate the vascularization of the placenta and the sub-placental myometrium at 11-13 weeks in women who will develop term or preterm preeclampsia.
A case-control study nested in a prospective cohort study was conducted in women with singleton pregnancy undergoing an 11-13 weeks ultrasound. A three-dimensional (3D) standardized acquisition of the placenta and the subplacental myometrium volumes with and without power Doppler was collected at the first visit. All participants were followed until delivery. Each woman who had a preeclampsia was matched with one woman who delivered at term without pregnancy complications. First-trimester placental volume; vascularization index (VI); flow index (FI); and vascular flow index (VFI) of the entire placenta and the subplacental myometrium as well as mean uterine artery PI were separately measured for all cases and controls by an ultrasound technician blinded to the pregnancy outcome. Analyses were performed using non-parametric tests and area under the ROC curves were used to compared each marker for the prediction of preterm and term preeclampsia.
1034 women were recruited over a 1-year period including 16 (1.5%) women who developed term preeclampsia and 4 (0.4%) who developed preterm preeclampsia. Women who developed preterm preeclampsia showed significant lower placental VI, placental VFI, subplacental VI and subplacental VFI compared to controls (all with p<0.05). However, women who developed term preeclampsia did not show any difference in terms of placental volume, placental vascularization or subplacental vascularization compared to controls. Measurements of AUC suggest that placental VI (0.87; 95%CI: 0.75-0.99; p=0.02) and placental VFI (0.83; 95%CI: 0.70-0.95; p=0.04) could be useful for the prediction of preterm preeclampsia.
First trimester placental and subplacental myometrium vascularization are significantly reduced in women who will subsequently developed preterm but not term preeclampsia.