الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 185 |  |  |
| | | from | 185 | | |
Abstract
H
ypertension with pregnancy remains a major health issue for women and neonates worldwide. Pre-eclampsia (PE) complicates 2–5% of all pregnancies and is a leading cause of maternal and neonatal mortality and morbidity. PE and eclampsia are responsible for approximately 14% of maternal mortality. PE is also associated with later-life cardiovascular disease among women and their offspring. Gestational hypertension affects 5–10% of pregnancies, but its complications are less severe. Different from pre-existing hypertension with or without superimposed PE, both gestational hypertension and PE are characterized by de novo hypertension developing in pregnancy. In addition, PE is defined by new-onset proteinuria or other end-organ dysfunctions.
First trimester assessment for pregnant woman is done at 11 to 13 weeks for dating purposes or in the context of aneuploidy screening; it also can allow early identification of high-risk pregnancies for complications related to placental insufficiency, and HELLP implementation of preventative therapies.
Placental dysfunction plays a crucial role in the pathogenesis of related pregnancy complications. Therefore, placental volume, weight, surface area, and insufficiency, and vascular indices are significant when investigating early FGR and gestational complications. Additionally, proper fetal growth and the subsequent average of birth weight are dependent on normal placental function with normal structure and morphometry (size and shape). Impairments in placental development, such as a reduced placental size or vascular index capability showing placental dysfunction, lead to FGR and other related placental complications.
Three-dimensional (3D) ultrasound has an important role in women’s reproductive lives. Starting with the evaluation of infertility cases, such as estimation of antral follicle count and ovarian volume, up to its valuable role during prenatal care.
In this study, we aimed to determine the value of first trimester placental volume in predicting pre-eclampsia in high-risk pregnant women.
This Prospective observational study was conducted at tertiary care hospital at Ain Shams University hospitals from September 2019 till November 2021 and performed on a total of 125 pregnant women with high risk of PE at 12 to 12+6 week of gestation attending Fetal care unit, Ain Shams University Maternity Hospital.
The current study revealed that maternal outcomes included that 24 women developed pregnancy induced hypertension (19.2%) and 13 women developed pre-eclampsia (10.4%) while neonatal outcomes included 22.4% of neonates with small for gestational age and 24.8% admitted in NICU.
Regarding pregnancy induced hypertension, our results revealed that Placental volume statistically was significantly lower in cases with pregnancy-induced hypertension (p value<0.001). BMI and DBP statistically were significantly higher in cases with pregnancy-induced hypertension (p value=0.030, <0.001). respectively.
Consequently, DBP statistically had significant high diagnostic performance in predicting pregnancy-induced hypertension with DBP cut-off value ≥79.0 mmHg had highest diagnostic characteristics of 91.7% sensitivity and 80.2% specificity in predicting pregnancy-induced hypertension while those of BMI and placental volume statistically were significantly low.
Regarding pre-eclampsia, our results revealed that placental volume statistically was significantly lower in cases with preeclampsia (p value<0.001) and DBP statistically was significantly higher in cases with preeclampsia (p value<0.001).
Consequently, DBP and placental volume statistically had significant moderate diagnostic performance in predicting preeclampsia with sensitivity of 84.6% and 61.5% and specificity of 72.3% and 88.4% respectively with a cut off value of ≥79.0 mmHg and ≤46.7 mm3 respectively.
Regarding maternal complications, our results revealed that DBP statistically was significantly higher in cases with HELLP syndrome, renal impairment and ICU admission (p value=0.001, 0.009, 0.012). respectively.
Consequently, DBP statistically had significant high diagnostic performance with DBP cut-off value of ≥79.0 mmHg in predicting HELLP syndrome and had significant low diagnostic performance in predicting ICU admission while those of BMI and placental volume statistically were non-significant in predicting HELLP syndrome and ICU admission with DBP sensitivity of 100%, 66.7% and specificity of 68.6%, 69% in predicting HELLP syndrome and ICU admission respectively.
Regarding fetal outcomes, our results revealed Placental volume statistically was significantly lower in cases with preterm delivery, SGA and NICU admission, and BMI and DBP statistically were significantly higher in cases with preterm delivery and NICU admission.
Consequently, DBP statistically had significant moderate diagnostic performance with DBP cut-off value of ≥79.0 mmHg in predicting preterm delivery and SGA with significant low diagnostic performance in predicting NICU admission with DBP sensitivity of 83.3%, 67.9%, 64.5% and specificity of 74.8%, 76.3% and 76.6% in predicting preterm delivery, SGA and NICU admission respectively.
We concluded that Placental volume and diastolic blood pressure (DBP) were significantly lower in cases with preeclampsia and predictive of maternal complications of HELLP syndrome, Renal impairment, ICU admission and predictive of preterm labor, SGA and NICU admission.
Consequently, 3D Ultrasound placental volume measurement in first trimester at 12 to 12+6 weeks of high-risk group pregnancy could increase the predictive accuracy for pre-eclampsia. Especially, when the former assessment is made in combination with other parameter of diastolic blood pressure (DBP) assessment.
Placental volume assessment alone is not reliable for the prediction of pre-eclampsia. However, placental volume may have a role when combined with diastolic blood pressure.
Consequently, Placental volume with diastolic blood pressure (DBP) assessment are recommended for prediction of pre-eclampsia.