Predictive Value Of Placental Volume And Microvascular Ultrasound Parameters For Fetal Growth Restriction

Objectives:（1）To investigate the predictive value of placental volume for fetal growth restriction;（2）To investigate the predictive value of placental microvascular ultrasound parameters for fetal growth restriction.Methods:195 consecutive pregnant women who underwent regular prenatal ultrasound examinations at the First Affiliated Hospital of Shihezi University from October 2021 to October 2022 were collected,and placental volume（PV）measurements were performed in early gestation(11～13⁺⁶weeks)using three-dimensional ultrasound virtual computer-aided analysis（VOCAL）,and placental quotient（PQ=PV/CRL）,and the placental microvascular ultrasound parameters（VI,FI,VFI）were measured at different periods of pregnancy(11～13⁺⁶weeks,24～28 weeks,and 32～36 weeks)using three-dimensional energy Doppler（3DPD）technique,and all pregnant women were followed up until after delivery,and the ultrasound findings,pregnancy outcomes,and perinatal conditions were recorded.We analyzed the correlation between placental volume in early pregnancy and placental microvascular ultrasound parameters at different stages of pregnancy and FGR,and explored the predictive value of placental volume and placental microvascular ultrasound parameters for FGR according to the ultrasound diagnostic criteria.Results:（1）The results of univariate analysis at 11～13⁺⁶weeks of gestation showed that placental volume（PV）,placental quotient（PQ）and placental microvascular ultrasound parameters（VI,FI,VFI）in FGR group were lower than those in normal group,and the differences were statistically significant（P<0.05）.Multivariate regression analysis showed that VI and FI were the protective factors for FGR,and the OR（95%CI）were 0.7124（0.5320-0.8786）and 0.4760（0.3073-0.6300）,respectively.VFI was the risk factor of FGR group,OR（95%CI）was 3.2392（1.7824-7.4092）,P<0.05.The AUC（95%CI）of FGR predicted by each parameter separately were VI:0.7508（0.6597-0.8420）,FI:0.9607（0.9339-0.9875）,VFI:0.7682（0.6694-0.8670）,PV:0.7160（0.5867-0.8453）,PQ:0.7022（0.5667-0.8378）were lower than VI+FI+VFI combined prediction,and AUC（95%CI）was 0.9856（0.9695-1.0000）.（2）The results of univariate analysis at 24 to 28 weeks of gestation showed that fetal double parietal diameter（BPD）,head circumference（HC）,abdominal circumference（AC）and placental microvascular ultrasound parameters（VI,FI,VFI）were significantly different between FGR group and normal group（P<0.05）,and the FGR group was lower than the normal group.The AUC（95%CI）of FGR predicted by VI+FI+VFI was 0.9955（0.9885～1.0000）,which was higher than that of all independent factors.（3）The results of univariate analysis at 32 to 36 weeks of gestation showed that the ultrasound parameters（VI,FI,VFI）of placental microvascular were significantly different between the two groups（P<0.05）,and the FGR group was lower than the normal group.The AUC（95%CI）of FGR predicted by VI was 0.9446（0.9026～0.9866）,which was higher than that of FI and VFI,indicating that VI had the best prediction effect.The AUC of FGR predicted by VI+FI+VFI was 0.9422（0.8678～1.0000）.（4）There were significant differences in fetal birth weight,proportion of low birth weight infants,1min APGAR score of the fetus,neonatal breathing rate,postpartum hemorrhage and postpartum hemorrhage between the two groups（P<0.05）.The birth weight and 1min APGAR score of the fetus in the FGR group were lower than those in the normal group.The proportion of low birth weight infants,neonatal asphyxia,postpartum bleeding and postpartum bleeding volume were higher than normal group.Conclusions:（1）placental volume was a sensitive predictor of fetal growth restriction in early pregnancy;（2）placental microvascular ultrasound parameters VI,FI and VFI could be used as reference indicators for predicting fetal growth restriction at different stages of pregnancy;（3）FGR was correlated with low neonatal weight,neonatal asphyxia and maternal postpartum hemorrhage..