INTRODUCTION: This study aimed to determine the effect and clinical impact of physiological characteristics on the 95th/5th centile of the umbilical artery (UA) Doppler and the cerebroplacental ratio (CPR), at 36+ weeks. METHODS: From the multicenter randomized trial "Ratio37," we selected 4,505 low-risk pregnant women between June 2016 and January 2020. We registered physiological characteristics and the pulsatility indexes (PI) of the UA and middle cerebral artery (36-39 weeks). The 95th/5th centile of the UA PI and CPR was modeled by quantile regression. To evaluate the clinical impact of adjusting Doppler, we retrospectively applied gestational age (GA) and fully adjusted standards to 682 small for gestational age (SGA)-suspected fetuses (37 weeks) from a cohort of consecutive patients obtained between January 2010 and January 2020. RESULTS: Several physiological characteristics significantly influenced the 95th/5th centile of the UA and CPR PI. The fully adjusted 95th centile of the UA was higher, and the 5th centile of the CPR was lower than GA-only-adjusted standards. Of the 682 SGA fetuses, 150 (22%) were classified as late fetal growth restricted only by GA and 112 (16.4%) when we adjusted Doppler. These 38 fetuses had similar perinatal outcome than the SGA group. DISCUSSION: The 95th/5th centile of the UA and CPR PI is significantly influenced by physiological characteristics. Adjusting Doppler standards could differentiate better between FGR and SGA.
- MeSH
- arteria cerebri media diagnostické zobrazování MeSH
- arteriae umbilicales diagnostické zobrazování MeSH
- gestační stáří MeSH
- hypotrofický novorozenec MeSH
- lidé MeSH
- novorozenec MeSH
- placenta * diagnostické zobrazování MeSH
- plod MeSH
- pulzatilní průtok MeSH
- retrospektivní studie MeSH
- růstová retardace plodu * diagnostické zobrazování MeSH
- těhotenství MeSH
- ultrasonografie dopplerovská MeSH
- ultrasonografie prenatální MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- randomizované kontrolované studie MeSH
- MeSH
- chorion embryologie MeSH
- dvojčata monozygotní * genetika MeSH
- fetofetální transfuze diagnostické zobrazování patologie terapie MeSH
- fetoskopie MeSH
- hodnocení rizik MeSH
- lidé MeSH
- nemoci u dvojčat MeSH
- placenta anatomie a histologie diagnostické zobrazování MeSH
- prenatální péče MeSH
- růstová retardace plodu diagnostické zobrazování terapie MeSH
- těhotenství MeSH
- ultrasonografie prenatální MeSH
- vrozené vady diagnostické zobrazování epidemiologie MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
INTRODUCTION: Remodeling of human placental membranes (amniochorionic or fetalmembrane) throughout gestation, a necessity to accommodate increasing uterine volume, involves continuous alterations (replacement of cells and remodeling of extracellular matrix). Methodologic limitations have obscured microscopic determination of cellular and layer-level alterations. This study used a combination of advanced imaging by multiphoton autofluorescence microscopy (MPAM) and second harmonic generation (SHG) microscopy along with tissue optical clearing to characterize the 3Dimensional multilayer organization of placental membranes. METHODS: Placental membranes biopsies (6 mm) collected from term, not-in-labor cesarean deliveries (n = 7) were fixed in 10% formalin (native) or treated with 2,2'-thiodiethanol to render them transparent for deeper imaging. Native and cleared tissues were imaged using MPAM (cellular autofluorescence) and SHG (fibrillar collagen). Depth z-stacks captured the amnion epithelium, underlying matrix layers, and in the cleared biopsies, the decidua layer. RESULTS: MPAM and SHG revealed fetal membrane epithelial topography and collagen organization in multiple matrix layers. Term amnion layers showed epithelial shedding and gaps. Optical clearing provided full-depth imaging with improved visualization of collagen structure, mesenchymal cells in extracellular matrix layers, and decidua morphology. Layer thicknesses measured by imaging corroborated with histology. Mosaic tiling of MPAM/SHG image stacks allowed large area visualization of entire biopsies. CONCLUSION: MPAM-SHG microscopy allowed for study of this multi-layered tissue and revealed shedding, gap formation, and other structural changes. This approach could be used to study structural changes associated with membranes as well as other uterine tissues to better understand events in normal and abnormal parturition.
- MeSH
- extracelulární matrix MeSH
- extraembryonální obaly anatomie a histologie diagnostické zobrazování MeSH
- histocytologické preparační techniky MeSH
- lidé MeSH
- mikroskopie fluorescenční multifotonová * MeSH
- mikroskopie generování druhé harmonické * MeSH
- placenta anatomie a histologie diagnostické zobrazování MeSH
- těhotenství MeSH
- zobrazování trojrozměrné MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- časové faktory MeSH
- kardiovaskulární komplikace v těhotenství diagnostické zobrazování patofyziologie MeSH
- lidé MeSH
- placenta diagnostické zobrazování fyziologie krevní zásobení patofyziologie MeSH
- preeklampsie * diagnostické zobrazování etiologie klasifikace MeSH
- pulzatilní průtok MeSH
- rizikové faktory MeSH
- růstová retardace plodu diagnostické zobrazování etiologie klasifikace MeSH
- těhotenství MeSH
- ultrasonografie dopplerovská MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
