Vascular imaging of placenta

• Research type

  Research Study

• Full title

  Investigating the use of novel ultrasound Doppler imaging techniques for vascular imaging of placentas

• IRAS ID

  277253

• Contact name

  Christoph C Lees

• Contact email

  christoph.lees@nhs.net

• Sponsor organisation

  Imperial College London

• Duration of Study in the UK

  2 years, months, days

• Research summary

  The 7th CEMACH report ‘Saving Mothers’ Lives’; 2011, highlighted the challenges and the importance of accurate antenatal diagnosis of abnormally invasive placentas (AIP). Prenatal diagnosis and stratification of risk with AIP is fundamental to avoid well documented catastrophic feto-maternal complications. Although Ultrasound (USS) is the primary tool for the diagnosis of AIP, there is considerable variability in the performance of the 2D and 3D USS markers in literature with sensitivities ranging from 50% to 87%. Combining 2D with colour Doppler improves prediction.
  Despite its excellent performance in diagnosis of AIP, ultrasound is still limited in predicting the degree of the AIP. 3D USS is an evolving field and there is emerging evidence of newer signs that may contribute to accurate prediction of the degree of AIP. Recent studies, have demonstrated that identifying abnormal hypervascularity and complex vascular networks in the placenta, the parametrium and the UV interface may improve the predictive potential of USS in AIP.
  Our aim is to translate newer ultrasound imaging technologies into patient benefit by improving the predictive value of USS in diagnosing the degree of AIP. We will image the vascular networks in the UV interface, the parametrium and the placenta using novel and advanced techniques with enhanced 2D image processing, 3D rendering and colour signal processing techniques. We aim to recruit 20-40 women with Placenta previa or AIP between 16-36 weeks of gestation. They will be offered transabdominal (TA) 2D and three-dimensional (3D) USS and 3D colour Doppler examination using different ultrasound technologies. We request a proportionate review for an observational imaging study with no interventions. These ultrasound scans will not affect/replace the NICE recommended routine antenatal scan schedule and he imaging results of this study will, if requested, be made available to the patient and her direct care team.

  Summary of results
  This study titled’’ Investigating the use of novel ultrasound Doppler imaging techniques for vascular imaging of placentas’ ’investigated if newer ultrasound techniques, looking at the blood vessels around the placenta, would help improve the diagnosis in AIP. This study is important because accurate prediction of the degree of penetration of the placenta can help plan care and improve outcomes

  The research team was led by Dr Christoph Lees, Head of Fetal Medicine at Centre for Fetal Care, Queen Charlotte’s and Chelsea Hospital. He is a fetal medicine expert with extensive research experience. Dr Deepa Srinivasan and Dr Caroline Shaw both obstetricians, also formed part of the research team. The study was funded by Samsung unrestricted educational grant, code NN0992

  This study led to the development of the new 3V technique using different ultrasound techniques to assess the uterine-bladder interface. This uses different Ultrasound modalities to assess uterine- bladder interface to diagnose PAS.
  We recruited 26 women between 16-26 weeks of gestation with anterior low lying or placenta previa. AIP was diagnosed and confirmed at Caesarean section in 12/26 women. AIP was excluded by 3V technique in 14/26 cases and diagnosis confirmed at Caesarean section. 1 case of AIP was not diagnosed as such but was managed conservatively and did not require hysterectomy. In all cases identified as AIP, the diagnosis was strongly associated with increased operative complexity.
  This study demonstrated the sensitivity of 3V technique is 92% with specificity 100% in diagnosis of PAS. The PPV is 100% and NPV is 93% which highlights the potential of this algorithm. Furthermore, the technique has the potential for predicting operative complexity in women at risk of PAS. This study will contribute to existing and further information on PAS.

  You can find out more about how we use your information in this research study by contacting Professor Christoph Lees or a member of his team, Institute of Reproductive and Developmental Biology, Imperial College London, W12 0HS.

• REC name

  West Midlands - Solihull Research Ethics Committee

• REC reference

  20/WM/0232

• Date of REC Opinion

  16 Nov 2020

• REC opinion

  Further Information Favourable Opinion