Wave reflections in the umbilical artery measured by Doppler ultrasound as a novel predictor of placental pathology
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
Affiliations
Lindsay S. Cahill
Mouse 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.
Greg Stortz
Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
Anjana Ravi Chandran
Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada
Natasha Milligan
Division of Cardiology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
Shiri Shinar
Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada
Clare L. Whitehead
Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada; Pregnancy Research Centre, Department of Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Australia
Sebastian R. Hobson
Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada
Viji Ayyathurai
Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada
Anum Rahman
Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
Rojan Saghian
Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
Karl J. Jobst
Department of Chemistry, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
Cyrethia McShane
Center for Fetal Therapy, Johns Hopkins Medicine, Baltimore, MD, USA
Dana Block-Abraham
Center for Fetal Therapy, Johns Hopkins Medicine, Baltimore, MD, USA
Viola Seravalli
Center for Fetal Therapy, Johns Hopkins Medicine, Baltimore, MD, USA; Department of Health Sciences, Division of Obstetrics and Gynecology, University of Florence, Italy
Melissa Laurie
Center for Fetal Therapy, Johns Hopkins Medicine, Baltimore, MD, USA
Sarah Millard
Center for Fetal Therapy, Johns Hopkins Medicine, Baltimore, MD, USA
Cassandra Delp
Center for Fetal Therapy, Johns Hopkins Medicine, Baltimore, MD, USA
Denise Wolfson
Center for Fetal Therapy, Johns Hopkins Medicine, Baltimore, MD, USA
Ahmet A. Baschat
Center for Fetal Therapy, Johns Hopkins Medicine, Baltimore, MD, USA
Kellie E. Murphy
Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
Lena Serghides
Toronto 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, Canada
Eric Morgen
Department of Pathology, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
Christopher K. Macgowan
Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
W.Tony Parks
Department of Pathology, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
John C. Kingdom
Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
John G. Sled
Mouse 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, Canada
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.
