Prediction Of Fetal Growth Restriction In First Trimester By 3-dimensional Ultrasoud

Objective:A prospective study was conducted to study the reference range of placental vascular index in first trimester.To explore the application value of placental volume(PV),placental quotient(PQ),placental vascular index(VI,FI,VFI)in first trimester to the prediction of fetal growth restriction(FGR)in first trimester.Through the three-dimensional ultrasound combined with Power Doppler examination,so as to early detection,early diagnosis and early intervention for fetal growth restriction,reducing or delaying the appearance of fetal growth restriction,reducing the morbidity and mortality of perinatal children,and improving the quality of the population.Methods:Pregnant women of normal singleton pregnancy who have Down's screening in early pregnancy at the Nanfang Hospital of Southern Medical University between April 2016 and December 2017,collected continuously,.Inclusion criteria:11-13+6 weeks;45mm ? CRL ? 84mm;singleton pregnancy.Exclusion criteria:Multiple pregnancy;Pregnant women have any internal diseases or external diseases(such as Chronic hypertension,nephropathy)and pregnancy-specific disorders(such asHypertensive disorder,SLE)that can cause FGR.;Fetal anomalies.All pregnant women who participated in the study signed the informed consent and approved by the ethics committee of the declaration unit.All pregnant women's last menstruation was clear or verified,pregnant women were healthy,non-toxic,radiation exposure,no pregnancy complications such as hypertension,diabetes and chronic disease history.Ultrasonic instrument GE Voluson E8 with three-dimensional color Doppler,used NT model,to exclude fetal dysplasia with per abdomen at early period,according to guidelines for performance of the routine first-trimester fetal ultrasound scan[International Society for Ultrasound in Obstetrics and Gynecology,ISUOG].Crown-rump Length(CRL)was collected by 2D ultrasound during the first trimester.In the PD mode,three dimensional ultrasound was used to collect placental energy Doppler volume data,and the angle of acquisition was greater than 65 degrees.The data on standard CRL and 3D placental capacity were collected,and placental volume(PV)was calculated using VOCALTM technology,and Placental quotient(PQ)was calculated by placental volume/crown-rump length.The offline measurement of placental volume and the calculation of placental vascular indexes(VI,FI,VFI)were performed using GE 4D View software by VOCALTM method,with an angle of rotation of 15°.The numbered placental data were handed over to two researchers to complete measurements independently,with measurement results unknown to each other.Trace to 32 weeks EFW and Birth weight.FGR diagnostic criteria:According to the form?La of Hadlock,fetal growth restriction was diagnosed when fetal weight was estimated to be less than the 10th percentile of the same gestational age,or birth weight<2500g after 37 weeks of gestation.The differences of placental volume,placental quotient and placental blood vessel index between FGR group and non FGR group were compared.Homogeneity test(F-test)and t test were performed using SPSS 22.0.P<0.05 thought the difference was statistically significant.The sensitivity,specificity and likelihood ratio of each parameter were tested.Result:1)InFGR group,the PV,PQ,VI,FI,VFI was on average 35.49 cm3,0.90,27.81,8.23,lower than in normal group which averaged58.54cm3,0.59,16.42,4.71;the difference was significant between FGR and normal pregnancies,all of them P<0.05.2)Receiver operating characteristic(ROC)curves were used to evaluate the clinical usefulness of placental vascular indices and placental volume for discriminating FGR and normal pregnancies.It was concluded that the PV,PQ,VI,VFI parameters are the best discriminants,with the AUC of 0.85,0.84,0.72,and 0.71,the cut-off values of 40.99,0.56,18.85 and 5.63,Sensitivity(%)of 81.82%,72.73%,72.74%and 81.82%,Specificity(%)of 8.18%,95.91%,70.91%and 62.56%,+LR of 6.92,17.78,2.5 and 2.19,-LR of 0.21,0.28,0.38 and 0.29,Youden index of 0.70,0.69,0.44 and 0.44 respectively.The diagnostic test results show that the four parameters of PV,PQ,VI,VFI,could be used for prediction of FGR in the first trimester,PQ and PV were superior to VI and VFI.However,there was no significant difference between PV and PQ or between VI and PV.Specificity and positive likelihood ratio of PQ were significantly higher than other reference values.The positive rate of PQ was superior than that of PV,and both of them were superior than those of VI and VFI,but there was no significant difference between VI and VFI.Conclusion:In this study,the placenta of the FGR group in the first trimester,placental volume(PV),placental quotient(PQ),placental vascular index(VI,VFI)were lower than those in normal group(P<0.05),Our findings further suggest that the placental volume(PV),placental quotient(PQ),vascularization index(VI)and vascularization flow index(VFI)are the best parameters with the most favorable discriminating potential for proper identification of IUGR pregnancies.The quantitative assessment of placental vasculature and placental volume by means of 3D Power Doppler and VOCAL technique is an adjunctive modality for differentiation between normal and IUGR pregnancies.In order to explore a new noninvasive diagnosis of fetal growth restriction in the first trimester provides an important theoretical basis of practice.Through non-invasive,fast and economical examination method of early detection and early diagnosis,early intervention,to reduce or delay the fetal growth restriction in a large extent,reduce the perinatal morbidity and mortality,improve the population quality and the quality of life in the future,saving social resources,reduce birth defects.