Intervillous and uteroplacental circulation in normal early pregnancy and early pregnancy loss assessed by 3-dimensional power Doppler angiography.

OBJECTIVE: To assess intervillous and uteroplacental circulation in early normal pregnancies and miscarriages. STUDY DESIGN: One hundred normal pregnancies and 46 delayed miscarriages were evaluated by 3-dimensional vaginal ultrasound and power Doppler angiography. Volumes of the early placenta and the subplacental area were obtained between 5 and 12.6 weeks' gestation. The placental volume, vascularization index, flow index, and vascularization flow index was calculated. RESULTS: Intraclass correlation coefficients ranged from 0.961 for placental volume to 0.885 for intervillous flow index. Intervillous power Doppler signals were not detected before the sixth week. Placental volume (R(2) = 0.68), intervillous vascularization index (R(2) = 0.30), flow index (R(2) = 0.33) and vascularization flow index (R(2) = 0.35), uteroplacental flow index (R(2) = 0.34), and vascularization flow index (R(2) = 0.17) increase significantly (P < .001) throughout the first trimester of normal pregnancies. Uteroplacental vascularization index was not significantly related to gestational age. Intervillous vasculariztion index, flow index, and vascularization flow index were significantly raised in miscarriages, but there were no significant differences for uteroplacental vascularization index, flow index, or vascularization flow index. CONCLUSION: Intervillous and uteroplacental blood flow increases throughout the first trimester of normal pregnancies. Intervillous circulation is abnormally increased when a miscarriage is diagnosed.

Prediction of ovarian response and IVF/ICSI outcome by three-dimensional ultrasonography and power Doppler angiography.

OBJECTIVE: The objective was to evaluate whether three-dimensional ultrasonography (3D-US) and power Doppler angiography (PDA) measurements can predict ovarian response and/or are associated with IVF/ICSI outcome. STUDY DESIGN: A prospective clinical study in 65 women undergoing IVF cycles. Ovarian volume (OV), number of antral follicles > or =2mm (NAF) and PDA indices: vascularisation index (VI), flow index (FI), and vascularisation flow index (VFI) were evaluated by 3D-US and PDA on the day of pituitary suppression control. These measurements, age and BMI were correlated with the number of follicles>10mm on the hCG day and the number of oocytes retrieved. RESULTS: Ovarian volume, NAF, VI, FI and FVI correlate significantly (P<0.01) with the number of follicles and oocytes recovered. Ovarian volume and the number of antral follicles predicted significantly the number of follicles (R=0.67; adjusted R(2)=0.43) and oocytes retrieved (R=0.63; adjusted R(2)=0.37). The oestradiol peak and the number of follicles, oocytes and Grade 1 embryos transferred were higher in the pregnant group. CONCLUSIONS: Three-dimensional ultrasound and PDA make it easier to evaluate all the sonographic parameters implied in ovarian response. Ovarian volume and the number of antral follicles are the only independent predictors of the number of follicles developed and oocytes retrieved.

Three-dimensional volume sonographic study of fetal anatomy: intraobserver reproducibility and effect of examiner experience.

OBJECTIVE: The purpose of this study was to evaluate the accuracy of 3-dimensional (3D) sonography in assessing fetal anatomy and to determine the intraobserver reproducibility and the effect of examiner experience. METHODS: Three-dimensional volumes of the head, face, thorax, and abdomen were obtained for 40 fetuses. The volume data sets obtained were explored offline with multiplanar navigation and tomographic ultrasound imaging on a personal computer. Each case was examined twice by the same observer at least 3 months apart. The percentage for identification of fetal anatomic structures, 2-dimensional (2D) and 3D measurements, and the time spent on 2D and 3D examinations were calculated and compared. RESULTS: Ninety-two percent of fetal anatomic structures were identified with multiplanar navigation and tomographic ultrasound imaging. The genitals, the entry of the vena cava, and the ears were visualized in less than 70% of cases. Tomographic ultrasound imaging allowed viewing of 14 structures not seen in the multiplanar study. Intraobserver agreement for anatomic examinations was good (kappa = 0.78). Intraobserver agreement for fetal measurements showed differences between both examinations that approached 0 and intraclass correlation indices close to 0.9. The mean 2D scanning time +/- SD was 10.11 +/- 2.5 minutes, and the acquisition time for the 3D volumes was 1.54 +/- 0.35 minutes. The total time for the second 3D study was 7.23 +/- 1.17 minutes, significantly shorter than the 9.96 +/- 1.53 minutes spent on the first study (P < .001). CONCLUSIONS: Three-dimensional volumes are highly effective for complete fetal anatomic surveys. They show excellent intraobserver reproducibility and take less time to study as the examiner's experience increases.

Are endometrial parameters by three-dimensional ultrasound and power Doppler angiography related to in vitro fertilization/embryo transfer outcome?

OBJECTIVE: To evaluate whether endometrial parameters by three-dimensional ultrasonography and power Doppler angiography (3D US-PDA) can predict in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcome. DESIGN: Prospective clinical study. SETTING: Assisted reproduction unit in a referral hospital. PATIENT(S): Eighty women who underwent IVF cycles. INTERVENTION(S): Endometrial 3D US-PDA evaluated by VOCAL software (plane C and 9 degrees of rotational steps). MAIN OUTCOME MEASURE(S): Endometrial pattern, endometrial thickness (ET), endometrial volume (EV), and PDA indexes of vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were measured on the day of human chorionic gonadotropin (hCG) administration. These measurements were related to IVF/ICSI and embryo transfer outcome. RESULT(S): In the pregnant group, EV, VI, FI, and FVI but not triple-line pattern and ET were statistically significantly higher. The area under receiver operating characteristic (ROC) curve was statistically significant for EV (0.746), VI (0.724), FI (0.828), and VFI (0.800) when no grade 1 embryos or only one were transferred (43 cycles, 14 pregnancies) but not when two or three grade 1 embryos were transferred. Moreover, these parameters were statistically significant in predicting a normal pregnancy outcome (no early pregnancy loss) but were not related to multiple pregnancies. CONCLUSION(S): In IVF/ICSI cycles, 3D US-PDA is useful for evaluating endometrial receptivity. Endometrial volume and 3D power Doppler indexes are statistically significant in predicting the cycle outcome when one grade 1 or no grade 1 embryos are transferred, which could be helpful data in a single-embryo transfer policy.

Assessment of the ovarian volume, number and volume of follicles and ovarian vascularity by three-dimensional ultrasonography and power Doppler angiography on the HCG day to predict the outcome in IVF/ICSI cycles.

OBJECTIVE: The aim of this prospective study was to investigate whether ovarian blood flow is related to embryological parameters and whether it could be a predictor of outcomes of IVF/ICSI. METHODS: Eighty infertile women underwent ovarian stimulation with gonadotrophins after a long protocol with GnRH agonists. The ovarian volume (OV), number of follicles (NF) and follicular volume (FV) of all follicles >10 mm and vascularization index (VI), flow index (FI) and vascularization-flow index (VFI) were obtained by three-dimensional (3D) ultrasonography and power Doppler angiography (PDA) on the day of HCG administration. These parameters were tested for their relation with IVF laboratory parameters. RESULTS: The OV, FV, VI, FI and VFI were significantly greater in the pregnant group. The NF and FV were the only independent predictors of the number of oocytes retrieved, mature and fertilized, and the number of embryos developed and their cumulative embryo score. Nevertheless, the number of grade 1 embryos depends on the NF and the VI. The ovarian FI and the number of transferred grade 1 embryos can predict gestation in 76% of IVF patients. A low FI and non-grade 1 embryo transferred are also associated with an increased pregnancy loss. CONCLUSION: 3D ultrasonography and PDA allow for an easier ovarian assessment in IVF cycles. The predictive value of IVF outcome suggests a high clinical usefulness of this new technique.

Assessment of placental vascularization by three-dimensional power Doppler "vascular biopsy" in normal pregnancies.

AIM: To describe the evolution of placental vascularization during a normal course of gestation and the blood flow 3D power Doppler indices obtained by "placental vascular biopsy." METHODS: A prospective study was carried out on 99 normal singleton pregnancies from 14 to 40 weeks. Placental vascularization was evaluated by 3D power Doppler ("placental biopsy"). The spherical volume acquired was analyzed using the VOCAL imaging program (Virtual Organ Computer-aided AnaLysis). Three vascular indices, vascularization index (VI), flow index (FI), and vascularization-flow index (VFI), were calculated. Equations and regression coefficients for placental volume and vascular indices (VI, FI, VFI) of the placental biopsy were calculated according to gestational age. Relationships between 3D placental flow indices and fetal growth parameters: biparietal diameter, head circumference, abdominal circumference, femur length, estimated fetal body weight, maximum systolic velocity (US), and resistance index in the umbilical artery (URI) were evaluated by calculating their correlation coefficients. RESULTS: All 3D Doppler indices had a significant relationship with gestational age. The most significant relationship was observed for FI, and the least significant for VI (r=0.58, r=0.29, respectively; P<0.01 for both). The FI increased linearly with gestation, whereas the VI showed a dispersion of values with a plateau from the 30th week onwards and a decrease from 37th week to the end of pregnancy. The VFI behaved as a combination of both VI and FI indices from which it was derived. All 3D Doppler indices were significantly related to fetal biometric parameters, except VI and fetal weight. A significant correlation was observed between 3D Doppler indices and maximum systolic velocity and URI. CONCLUSIONS: 3D power Doppler technique of placental vascular "biopsy" is an appropriate tool for routine evaluation of the human placental vascular tree during gestation. 3D Doppler indices change as pregnancy progresses and are significantly related with fetal biometry and umbilical artery Doppler velocimetry.

Reproducibility of the study of placental vascularization by three-dimensional power Doppler.

AIMS: To assess the reproducibility of 3D power Doppler study of placental vascularization in order to establish its methodological bases for its further application in normal and pathological pregnancies. METHODS: A prospective study was carried on 30 normal singleton pregnancies from 14 to 40 weeks. To evaluate placental vascularization 3D power Doppler was applied to obtain a "placental biopsy". The spherical volume acquired was analyzed using the VOCAL imaging program. Two consecutive measurements were taken from each patient by a single observer, obtaining a total of 60 datasets. Placental volume (PV), Mean Gray (MG), Vascularization Index (VI), Flow Index (FI) and Vascularization Flow Index (VFI) were calculated. Intra-class correlation coefficient (ICC) and intra-observer agreement was evaluated. RESULTS: PV and MG presented an ICC of 0.98 and 0.94 respectively, with differences approaching zero. All 3D power Doppler vascular indices (VI, FI and VFI) showed a correlation greater than 0.85, with a better intra-observer agreement for the flow indices (FI and VFI). CONCLUSIONS: Placental vascular biopsy through 3D power Doppler is a new and simple tool to routinely study placental vascularization in human pregnancy. Our results provide the validation of the technique demonstrating a good reproducibility of the 3D power Doppler parameters when applied to the study of the placental vascular tree in normal pregnancies.