1
|
de Ganzo Suárez T, de Paco Matallana C, Plasencia W. Spiral, uterine artery doppler and placental ultrasound in relation to preeclampsia. Best Pract Res Clin Obstet Gynaecol 2024; 92:102426. [PMID: 38039843 DOI: 10.1016/j.bpobgyn.2023.102426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/18/2023] [Accepted: 08/06/2023] [Indexed: 12/03/2023]
Abstract
Preeclampsia (PE) is a multiorgan disorder that complicates around 2-8% of pregnancies and is a major cause of perinatal and maternal morbidity and mortality. PE is a clinical syndrome characterized by hypertension secondary to systemic inflammation, endothelial dysfunction, and syncytiotrophoblast stress leading to hypertension and multiorgan dysfunction. The uterine arteries are the main blood vessels that supply blood to the uterus. They give off branches and plays an important role in maintaining blood supply during pregnancy. The arcuate artery originates from the uterine artery and runs medially through the myometrium. The arcuate arteries divide almost directly into anterior and posterior branches, from which the radial artery leads directly to the uterine cavity during their course. Near the endometrium-myometrium junction, the radial artery generates spiral arteries within the basal layer and functional endometrium. The walls of radial and spiral arteries are rich in smooth muscle, which is lost when trophoblast cells invade and become large-caliber vessels. This physiological transformation of uteroplacental spiral arteries is critical for successful placental implantation and normal placental function. In normal pregnancy, the luminal diameter of the spiral arteries is greatly increased, and the vascular smooth muscle is replaced by trophoblast cells. This process and changes in the spiral arteries are called spiral artery remodeling. In PE, this genetically and immunologically governed process is deficient and therefore there is decreased vascular capacitance and increased resistance in the uteroplacental circulation. Furthermore, this defect in uteroplacental spiral artery remodeling is not only associated with early onset PE, but also with fetal growth restriction, placental abruption, and spontaneous premature rupture of membranes. Doppler ultrasound allows non-invasive assessment of placentation, while the flow impedance decreases as the pregnancy progresses in normal pregnancies, in those destined to develop preeclampsia the impedance is increased.
Collapse
Affiliation(s)
- Tania de Ganzo Suárez
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Nuestra Señora de la Candelaria, Tenerife, Canary Islands, Spain.
| | - Catalina de Paco Matallana
- Department of Obstetrics and Gynecology, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain; Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar, Murcia, Spain; Faculty of Medicine, Universidad de Murcia, Murcia, Spain.
| | - Walter Plasencia
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario de Canarias, Tenerife. Canary Islands, Spain.
| |
Collapse
|
2
|
Sun B, Smith N, Dixon AJ, Osei-Owusu P. Phosphodiesterases Mediate the Augmentation of Myogenic Constriction by Inhibitory G Protein Signaling and is Negatively Modulated by the Dual Action of RGS2 and 5. Function (Oxf) 2024; 5:zqae003. [PMID: 38486977 PMCID: PMC10935470 DOI: 10.1093/function/zqae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 03/17/2024] Open
Abstract
G protein regulation by regulators of G protein signaling (RGS) proteins play a key role in vascular tone maintenance. The loss of Gi/o and Gq/11 regulation by RGS2 and RGS5 in non-pregnant mice is implicated in augmented vascular tone and decreased uterine blood flow (UBF). RGS2 and 5 are closely related and co-expressed in uterine arteries (UA). However, whether and how RGS2 and 5 coordinate their regulatory activities to finetune G protein signaling and regulate vascular tone are unclear. Here, we determined how the integrated activity of RGS2 and 5 modulates vascular tone to promote UBF. Using ultrasonography and pressure myography, we examined uterine hemodynamics and myogenic tone (MT) of UA of wild type (WT), Rgs2-/-, Rgs5-/-, and Rgs2/5 dbKO mice. We found that MT was reduced in Rgs5-/- relative to WT or Rgs2-/- UA. Activating Gi/o with dopamine increased, whereas exogenous cAMP decreased MT in Rgs5-/- UA to levels in WT UA. Dual deletion of Rgs2 and 5 abolished the reduced MT due to the absence of Rgs5 and enhanced dopamine-induced Gi/o effects in Rgs2/5 dbKO UA. Conversely, and as in WT UA, Gi/o inhibition with pertussis toxin or exogenous cAMP decreased MT in Rgs2/5 dbKO to levels in Rgs5-/- UA. Inhibition of phosphodiesterases (PDE) concentration-dependently decreased and normalized MT in all genotypes, and blocked dopamine-induced MT augmentation in Rgs2-/-, Rgs5-/-, and Rgs2/5 dbKO UA. We conclude that Gi/o augments UA MT in the absence of RGS2 by a novel mechanism involving PDE-mediated inhibition of cAMP-dependent vasodilatation..
Collapse
Affiliation(s)
- Bo Sun
- Department of Physiology and Biophysics, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Nia Smith
- Department of Physiology and Biophysics, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Alethia J Dixon
- Department of Physiology and Biophysics, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Patrick Osei-Owusu
- Department of Physiology and Biophysics, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| |
Collapse
|
3
|
Turan OM, Babischkin JS, Aberdeen GW, Turan S, Pepe GJ, Albrecht ED. B-Flow/Spatiotemporal Image Correlation M-Mode and Contrast-Enhanced/Microbubble Ultrasonography Quantification of Spiral Artery Distensibility and Placental Intervillous Perfusion in the First Trimester in a Primate Model of Impaired Spiral Artery Remodeling. Ultrasound Med Biol 2023; 49:2557-2564. [PMID: 37749012 PMCID: PMC10591761 DOI: 10.1016/j.ultrasmedbio.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/17/2023] [Accepted: 08/28/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE During early human pregnancy, placental trophoblasts remodel spiral arteries into distensible low-resistance vessels to promote placental perfusion. We have established a model of impaired spiral artery remodeling (SAR) by elevating estradiol levels in the first trimester of baboon pregnancy. In the present study, B-flow/spatiotemporal image correlation (STIC) M-mode ultrasonography, a non-Doppler technology for sharp rendering of vessel dimensions, was used to determine whether spiral artery distensibility was altered in SAR-suppressed baboons. Contrast-enhanced ultrasound/microbubble imaging was also performed to determine whether it detected changes in placenta intervillous space perfusion in SAR-suppressed baboons. METHODS The two imaging procedures were performed in the first trimester in baboons not treated or treated with estradiol to suppress SAR. RESULTS Spiral artery distensibility, that is, luminal diameter at systole minus diameter at diastole, and volume flow as quantified by B-flow/STIC M-mode were 26% (p = 0.03) and 55% (p = 0.059) lower, respectively, in SAR-suppressed baboons. However, placental intervillous space flow rate and video intensity plateau levels reflecting blood perfusion, quantified by contrast-enhanced ultrasound/microbubble imaging, were unaltered in SAR-suppressed baboons. CONCLUSION The results indicate that B-flow/STIC M-mode ultrasonography provides a non-invasive method to detect reduced distensibility and, thus, function of spiral arteries across the cardiac cycle in the first trimester in a primate model of impaired SAR. This study represents a first step in determining whether B-flow/STIC M-mode detects a similar defect in SAR early in adverse human pregnancy. This would provide an avenue to develop therapeutic modalities to prevent the devastating consequences of impaired SAR.
Collapse
Affiliation(s)
- Ozhan M Turan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jeffery S Babischkin
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Graham W Aberdeen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sifa Turan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Gerald J Pepe
- Department of Physiological Sciences, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Eugene D Albrecht
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
4
|
Allerkamp HH, Leighton S, Pole T, Clark AR, James JL. Synergistic regulation of uterine radial artery adaptation to pregnancy by paracrine and hemodynamic factors. Am J Physiol Heart Circ Physiol 2023; 325:H790-H805. [PMID: 37539447 PMCID: PMC10643003 DOI: 10.1152/ajpheart.00205.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/05/2023]
Abstract
Fetal growth throughout pregnancy relies on delivery of an increasing volume of maternal blood to the placenta. To facilitate this, the uterine vascular network adapts structurally and functionally, resulting in wider blood vessels with decreased flow-mediated reactivity. Impaired remodeling of the rate-limiting uterine radial arteries has been associated with fetal growth restriction. However, the mechanisms underlying normal or pathological radial artery remodeling are poorly understood. Here, we used pressure myography to determine the roles of hemodynamic (resistance, flow rate, shear stress) and paracrine [β-estradiol, progesterone, placental growth factor (PlGF), vascular endothelial growth factor] factors on rat radial artery reactivity. We show that β-estradiol, progesterone, and PlGF attenuate flow-mediated constriction of radial arteries from nonpregnant rats, allowing them to withstand higher flow rates in a similar manner to pregnant vessels. This effect was partly mediated by nitric oxide (NO) production. To better understand how the combination of paracrine factors and shear stress may impact human radial artery remodeling in the first half of gestation, computational models of uterine hemodynamics, incorporating physiological parameters for trophoblast plugging and spiral artery remodeling, were used to predict shear stress in the upstream radial arteries across the first half of pregnancy. Human microvascular endothelial cells subjected to these predicted shear stresses demonstrated higher NO production when paracrine factors were added. This suggests that synergistic effects of paracrine and hemodynamic factors induce uterine vascular remodeling and that alterations in this balance could impair radial artery adaptation, limiting blood flow to the placenta and negatively impacting fetal growth.NEW & NOTEWORTHY Placenta-specific paracrine factors β-estradiol, progesterone, and placental growth factor attenuate flow-mediated constriction of the rate-limiting uterine radial arteries, enabling higher flow rates in pregnancy. These paracrine factors induce their actions in part via nitric oxide mediated mechanisms. A synergistic combination of paracrine factors and shear stress is likely necessary to produce sufficient levels of nitric oxide during early human pregnancy to trigger adequate uterine vascular adaptation.
Collapse
Affiliation(s)
- H. H. Allerkamp
- Department of Obstetrics and Gynecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - S. Leighton
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - T. Pole
- Department of Obstetrics and Gynecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - A. R. Clark
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - J. L. James
- Department of Obstetrics and Gynecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
5
|
Murtada SI, Latorre M, Humphrey JD. Remodeling of the uterine artery during and early after pregnancy in the mouse. Biomech Model Mechanobiol 2023; 22:1531-1540. [PMID: 36550244 DOI: 10.1007/s10237-022-01674-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
Pregnancy associates with dramatic changes in maternal cardiovascular physiology that ensure that the utero-placental circulation can support the developing fetus. Particularly striking is the marked flow-induced remodeling of uterine arteries during pregnancy and their recovery following birth. Whereas details are available in the literature on alterations in hemodynamics within and changes in the dimensions of uterine arteries during and following pregnancy in mice, we report here the first biaxial biomechanical phenotyping of these arteries during this dynamic period of growth and remodeling (G&R). To gain additional insight into the measured G&R, we also use a computational constrained mixture model to describe and predict findings, including simulations related to complications that may arise during pregnancy. It is found that dramatic pregnancy-induced remodeling of the uterine artery is largely, but not completely, reversed in the postpartum period, which appears to be driven by increases in collagen turnover among other intramural changes. By contrast, data on the remodeling of the ascending aorta, an elastic artery, reveal modest changes that are fully recovered postpartum. There is strong motivation to continue biomechanical studies on this critical aspect of women's health, which has heretofore not received appropriate consideration from the biomechanics community.
Collapse
Affiliation(s)
- Sae-Il Murtada
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Marcos Latorre
- Center for Research and Innovation in Bioengineering, Universitat Politècnica de València, Valencia, Spain
| | - Jay D Humphrey
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA.
- Vascular Biology and Therapeutics Program, Yale School of Medicine, New Haven, CT, USA.
| |
Collapse
|
6
|
Zhang L, Liu J, Feng X, Lash GE. Unraveling the mysteries of spiral artery remodeling. Placenta 2023; 141:51-56. [PMID: 37308346 DOI: 10.1016/j.placenta.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/11/2023] [Accepted: 05/17/2023] [Indexed: 06/14/2023]
Abstract
Spiral artery remodeling is the process by which the uterine vessels become large bore low resistance conduits, allowing delivery of high volumes of maternal blood to the placenta to nourish the developing fetus. Failure of this process is associated with the pathophysiology of most of the major obstetric complications, including late miscarriage, fetal growth restriction and pre-eclampsia. However, the point at which remodeling 'fails' in these pathological pregnancies is not yet clear. Spiral artery remodeling has predominantly been described in terms of its morphological features, however we are starting to understand more about the cellular and molecular triggers of the different aspects of this process. This review will discuss the current state of knowledge of spiral artery remodeling, in particular the processes involved in loss of the vascular smooth muscle cells, and consider where in the process defects would lead to a pathological pregnancy.
Collapse
Affiliation(s)
- Lindong Zhang
- Department of Gynecology, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Liu
- Department of Gynecology, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoqian Feng
- Department of Gynecology, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Gendie E Lash
- Department of Gynecology, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Division of Uterine Vascular Biology, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, 510623, China.
| |
Collapse
|
7
|
Clark AR, Fontinha H, Thompson J, Couper S, Jani D, Mirjalili A, Bennet L, Stone P. Maternal Cardiovascular Responses to Position Change in Pregnancy. Biology (Basel) 2023; 12:1268. [PMID: 37759669 PMCID: PMC10525953 DOI: 10.3390/biology12091268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/07/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023]
Abstract
The maternal cardiovascular-circulatory system undergoes profound changes almost from the conception of a pregnancy until the postpartum period to support the maternal adaptions required for pregnancy and lactation. Maintenance of cardiovascular homeostasis requires changes in the cardiovascular autonomic responses. Here, we present a longitudinal study of the maternal cardiovascular autonomic responses to pregnancy and maternal position. Over a normal gestation, in the left lateral position there are significant changes in both time and frequency domain parameters reflecting heart rate variability. We show that cardiovascular autonomic responses to physiological stressors (standing and supine positions in late pregnancy) became significantly different with advancing gestation. In the third trimester, 60% of the subjects had an unstable heart rate response on standing, and these subjects had a significantly reduced sample entropy evident in their heart rate variability data. By 6 weeks, postpartum function returned to near the non-pregnant state, but there were consistent differences in high-frequency power when compared to nulligravid cases. Finally, we review complementary evidence, in particular from magnetic resonance imaging, that provides insights into the maternal and fetal impacts of positioning in pregnancy. This demonstrates a clear relationship between supine position and maternal hemodynamic parameters, which relates to compression of the inferior vena cava (p = 0.05). Together, these studies demonstrate new understanding of the physiology of physiological stressors related to position.
Collapse
Affiliation(s)
- Alys R. Clark
- Auckland Bioengineering Institute, University of Auckland, Auckland 1010, New Zealand
| | - Hanna Fontinha
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand
| | - John Thompson
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand
| | - Sophie Couper
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand
| | - Devanshi Jani
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand
| | - Ali Mirjalili
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand
| | - Laura Bennet
- Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand
| | - Peter Stone
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand
| |
Collapse
|
8
|
May RW, Maso Talou GD, Clark AR, Mynard JP, Smolich JJ, Blanco PJ, Müller LO, Gentles TL, Bloomfield FH, Safaei S. From fetus to neonate: A review of cardiovascular modeling in early life. WIREs Mech Dis 2023:e1608. [DOI: 10.1002/wsbm.1608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 01/31/2023] [Accepted: 03/03/2023] [Indexed: 04/03/2023]
|
9
|
Fogarty S, Werner R, James JL. Applying Scientific Rationale to the Current Perceptions and Explanations of Massage and Miscarriage in the First Trimester. Int J Ther Massage Bodywork 2023; 16:30-43. [PMID: 36866184 PMCID: PMC9949615 DOI: 10.3822/ijtmb.v16i1.771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Miscarriage is a relatively common occurrence, impacting 8-15% of clinically recognised pregnancies, and up to 30% of all conceptions. The public perception of the risk factors associated with miscarriage does not match the evidence. Evidence indicates that there are very few modifiable factors to prevent miscarriage, and the majority of the time little could have been done to prevent a spontaneous miscarriage. However, the public perception is that consuming drugs, lifting a heavy object, previous use of an intrauterine device, or massage can all contribute to miscarriage. While misinformation about the causes and risk factors of miscarriage continues to circulate, pregnant women will experience confusion about what activities they can (and cannot) do in early pregnancy, including receiving a massage. Pregnancy massage is an important component of massage therapy education. The resources that underpin pregnancy massage coursework consist of educational print content that includes direction and caution that massage in the first trimester, if done 'incorrectly' or in the 'wrong' location, can contribute to adverse outcomes such as miscarriage. The most common statements, perceptions and explanations for massage and miscarriage cover three broad areas: 1) maternal changes from massage affects the embryo/fetus; 2) massage leads to damage of the fetus/placenta; and 3) aspects of the massage treatment in the first trimester initiate contractions. The goal of this paper is to use scientific rationale to critically consider the validity of the current perceptions and explanations of massage therapy and miscarriage. Whilst direct evidence from clinical trials was lacking, considerations of physiological mechanisms regulating pregnancy and known risk factors associated with miscarriage provide no evidence that massage in pregnancy would increase a patient's risk of miscarriage. This scientific rationale should be addressed when teaching pregnancy massage courses.
Collapse
Affiliation(s)
- Sarah Fogarty
- Department of Medicine, School of Medicine, Western Sydney University, Sydney, Australia,Corresponding author: Sarah Fogarty, Department of Medicine, School of Medicine, Western Sydney University Campbelltown Campus, Narellan Road & Gilchrist Drive, Campbelltown, NSW 2560, Australia,
| | - Ruth Werner
- Author of A Massage Therapist’s Guide to Pathology, and Board Certified in Therapeutic Massage and Bodywork, USA
| | - Joanna L James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
10
|
Kliewer MA, Bagley AR, Sadowski EA, Beninati MJ, Iruretagoyena JI. Placenta accreta spectrum: the pattern and character of intraplacental blood flow by color and spectral Doppler. Abdom Radiol (NY) 2023; 48:377-86. [PMID: 36273328 DOI: 10.1007/s00261-022-03708-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE To characterize intraplacental blood flow patterns in placenta accreta spectrum (PAS) with color and spectral Doppler imaging. METHODS Thirty-two patients at risk for PAS underwent ultrasound imaging with both color and spectral Doppler. The placenta was inspected for areas of vascularity by color Doppler, particularly within the lower uterine segment. Spectral Doppler waveforms were obtained from these vessels and categorized as either intraplacental or subplacental (myometrial), venous or arterial, fetal or maternal (based on heart rate). Arterial waveforms were measured for heart rate, peak systolic velocity, end diastolic velocity, and resistive index. Statistical comparisons were made between cases with and without PAS using Fisher exact tests (categorical variables) and Mann-Whitney U tests (numerical indices). Interobserver agreement was characterized with kappa coefficients. RESULTS At delivery, there were 19 cases with PAS and 13 without PAS. On ultrasound studies, clustered intraplacental vascularity was found in the lower uterine segment in 66% of cases (95% of PAS cases and 23% cases without PAS; p < 0.0001). Maternal arterial waveforms were found within the vascular cluster in 84% of PAS cases and 15% of cases without PAS (p < 0.0001). A traversing fetal artery was found within the vascular cluster in 56% of cases (84% PAS cases and 15% cases without PAS; p = 0.001). Venous waveforms were found in 84% of PAS cases and 15% of cases without PAS. Interobserver agreement was good to excellent. CONCLUSION Intraplacental blood flow pattern in PAS is characterized by an intraplacental vascular cluster containing low-resistance maternal arterial flow and transplacental fetal arteries.
Collapse
|
11
|
Yapan P, Tachawatcharapunya S, Surasereewong S, Thongkloung P, Pooliam J, Poon LC, Wataganara T. Uterine artery Doppler indices throughout gestation in women with and without previous Cesarean deliveries: a prospective longitudinal case-control study. Sci Rep 2022; 12:20913. [PMID: 36463315 DOI: 10.1038/s41598-022-25232-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/28/2022] [Indexed: 12/07/2022] Open
Abstract
To determine whether a history of previous Cesarean delivery (CD) impacts uterine artery (UtA) Doppler indices throughout pregnancy. Women with and without CD (NCD) were prospectively enrolled for sequential assessments of the UtA mean/median pulsatility index (UtA-PI), resistance index (UtA-RI), and systolic/diastolic ratio (UtA-S/D) at 11-13 + 6, 14-19 + 6, 30-34 + 6, and 35-37 + 6 weeks' gestation. Data from 269/269, 246/257, 237/254, and 219/242 CD/NCD participants from each gestational period were available for analysis. Multiples of the median (MoMs) of UtA Doppler indices showed biphasic temporal (Δ) pattern; with an initial dropping until the second trimester, then a subsequent elevation until late in pregnancy (p < 0.05). The measurements and Δs of the UtA indices between CD and NCD were not different (p > 0.05). Mixed-effects modelling ruled out effects from nulliparity (n = 0 and 167 for CD and NCD, respectively) (p > 0.05). History of CD neither influenced the measurements nor the temporal changes of the UtA Doppler indices throughout pregnancy. The biphasic Δs of UtA Doppler indices added to the longitudinal data pool, and may aid in future development of a more personalized prediction using sequential/contingent methodologies, which may reduce the false results from the current cross-sectional screening.
Collapse
|
12
|
Kissas G, Hwuang E, Thompson EW, Schwartz N, Detre JA, Witschey WR, Perdikaris P. Feasibility of Vascular Parameter Estimation for Assessing Hypertensive Pregnancy Disorders. J Biomech Eng 2022; 144:121011. [PMID: 36128759 PMCID: PMC9836050 DOI: 10.1115/1.4055679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 08/23/2022] [Indexed: 01/19/2023]
Abstract
Hypertensive pregnancy disorders (HPDs), such as pre-eclampsia, are leading sources of both maternal and fetal morbidity in pregnancy. Noninvasive imaging, such as ultrasound (US) and magnetic resonance imaging (MRI), is an important tool for predicting and monitoring these high risk pregnancies. While imaging can measure hemodynamic parameters, such as uterine artery pulsatility and resistivity indices (PI and RI), the interpretation of such metrics for disease assessment relies on ad hoc standards, which provide limited insight to the physical mechanisms underlying the emergence of hypertensive pregnancy disorders. To provide meaningful interpretation of measured hemodynamic data in patients, advances in computational fluid dynamics can be brought to bear. In this work, we develop a patient-specific computational framework that combines Bayesian inference with a reduced-order fluid dynamics model to infer parameters, such as vascular resistance, compliance, and vessel cross-sectional area, known to be related to the development of hypertension. The proposed framework enables the prediction of hemodynamic quantities of interest, such as pressure and velocity, directly from sparse and noisy MRI measurements. We illustrate the effectiveness of this approach in two systemic arterial network geometries: an aorta with branching carotid artery and a maternal pelvic arterial network. For both cases, the model can reconstruct the provided measurements and infer parameters of interest. In the case of the maternal pelvic arteries, the model can make a distinction between the pregnancies destined to develop hypertension and those that remain normotensive, expressed through the value range of the predicted absolute pressure.
Collapse
Affiliation(s)
- Georgios Kissas
- Department of Mechanical Engineering Applied Mechanics,
University of Pennsylvania, Philadelphia, PA
19104
| | - Eileen Hwuang
- Department of Bioengineering, University of
Pennsylvania, Philadelphia, PA 19104
| | | | - Nadav Schwartz
- Maternal Fetal Medicine, Department of Obstetrics and
Gynecology, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, PA 19104
| | - John A. Detre
- Department of Radiology, Perelman School of Medicine,
University of Pennsylvania, Philadelphia, PA
19104; Department of Neurology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, PA
19104
| | - Walter R. Witschey
- Department of Radiology, Perelman School of Medicine,
University of Pennsylvania, Philadelphia, PA
19104
| | - Paris Perdikaris
- Department of Mechanical Engineering and Applied Mechanics,
University of Pennsylvania, Philadelphia, PA
19104
| |
Collapse
|
13
|
van Ochten M, Westerhof BE, Spaanderman MEA, Antonius TAJ, van Drongelen J. Modeling renal autoregulation in a hemodynamic, first-trimester gestational model. Physiol Rep 2022; 10:e15484. [PMID: 36200318 PMCID: PMC9535437 DOI: 10.14814/phy2.15484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/06/2022] Open
Abstract
The maternal cardiovascular system, led by renal volume regulatory responses, changes during pregnancy to ensure an adequate circulation for fetal development and growth. Circulatory maladjustment predisposes to hypertensive complications during pregnancy. Mathematical models can be used to gain insight in the gestational cardiovascular physiology. In this study, we developed an accurate, robust, and transparent model for renal autoregulation implemented in an existing circulatory gestational model. This renal autoregulation model aims to maintain steady glomerular pressure by the myogenic response, and glomerular filtration rate by tubuloglomerular feedback, both by inducing a change in the radius, and thus resistance, of the afferent arteriole. The modeled response of renal blood flow and the afferent arteriole following blood pressure increase were compared to published observations in rats. With solely the myogenic response, our model had a maximum deviation of 7% in change in renal blood flow and 7% in renal vascular resistance. When both the myogenic response and tubuloglomerular feedback were concurrently activated, the maximum deviation was 7% in change in renal blood flow and 5% in renal vascular resistance. These results show that our model is able to represent renal autoregulatory behavior comparable to empirical data. Further studies should focus on extending the model with other regulatory mechanisms to understand the hemodynamic changes in healthy and complicated pregnancy.
Collapse
Affiliation(s)
- Maaike van Ochten
- Department of Gynecology and ObstetricsRadboud University Medical CenterNijmegenThe Netherlands
- Department of Gynecology and ObstetricsMaastricht University Medical CenterMaastrichtThe Netherlands
- Division of Neonatology, Department of PerinatologyRadboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's HospitalNijmegenThe Netherlands
| | - Berend E. Westerhof
- Division of Neonatology, Department of PerinatologyRadboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's HospitalNijmegenThe Netherlands
- Department of Pulmonary MedicineAmsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - Marc E. A. Spaanderman
- Department of Gynecology and ObstetricsRadboud University Medical CenterNijmegenThe Netherlands
- Department of Gynecology and ObstetricsMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Tim A. J. Antonius
- Division of Neonatology, Department of PerinatologyRadboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's HospitalNijmegenThe Netherlands
| | - Joris van Drongelen
- Department of Gynecology and ObstetricsRadboud University Medical CenterNijmegenThe Netherlands
| |
Collapse
|
14
|
Flouri D, Darby JRT, Holman SL, Cho SKS, Dimasi CG, Perumal SR, Ourselin S, Aughwane R, Mufti N, Macgowan CK, Seed M, David AL, Melbourne A, Morrison JL. Placental MRI Predicts Fetal Oxygenation and Growth Rates in Sheep and Human Pregnancy. Adv Sci (Weinh) 2022; 9:e2203738. [PMID: 36031385 PMCID: PMC9596844 DOI: 10.1002/advs.202203738] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/05/2022] [Indexed: 06/09/2023]
Abstract
Magnetic resonance imaging (MRI) assessment of fetal blood oxygen saturation (SO2 ) can transform the clinical management of high-risk pregnancies affected by fetal growth restriction (FGR). Here, a novel MRI method assesses the feasibility of identifying normally grown and FGR fetuses in sheep and is then applied to humans. MRI scans are performed in pregnant ewes at 110 and 140 days (term = 150d) gestation and in pregnant women at 28+3 ± 2+5 weeks to measure feto-placental SO2 . Birth weight is collected and, in sheep, fetal blood SO2 is measured with a blood gas analyzer (BGA). Fetal arterial SO2 measured by BGA predicts fetal birth weight in sheep and distinguishes between fetuses that are normally grown, small for gestational age, and FGR. MRI feto-placental SO2 in late gestation is related to fetal blood SO2 measured by BGA and body weight. In sheep, MRI feto-placental SO2 in mid-gestation is related to fetal SO2 later in gestation. MRI feto-placental SO2 distinguishes between normally grown and FGR fetuses, as well as distinguishing FGR fetuses with and without normal Doppler in humans. Thus, a multi-compartment placental MRI model detects low placental SO2 and distinguishes between small hypoxemic fetuses and normally grown fetuses.
Collapse
Affiliation(s)
- Dimitra Flouri
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonSE1 7EUUK
- Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonWC1E 6BTUK
| | - Jack R. T. Darby
- Early Origins of Adult Health Research GroupHealth and Biomedical InnovationUniSA Clinical and Health SciencesUniversity of South AustraliaAdelaideSA 5001Australia
| | - Stacey L. Holman
- Early Origins of Adult Health Research GroupHealth and Biomedical InnovationUniSA Clinical and Health SciencesUniversity of South AustraliaAdelaideSA 5001Australia
| | - Steven K. S. Cho
- Early Origins of Adult Health Research GroupHealth and Biomedical InnovationUniSA Clinical and Health SciencesUniversity of South AustraliaAdelaideSA 5001Australia
- Department of PhysiologyThe Hospital for Sick ChildrenUniversity of TorontoTorontoON M5G 1X8Canada
| | - Catherine G. Dimasi
- Early Origins of Adult Health Research GroupHealth and Biomedical InnovationUniSA Clinical and Health SciencesUniversity of South AustraliaAdelaideSA 5001Australia
| | - Sunthara R. Perumal
- South Australian Health & Medical Research InstitutePreclinicalImaging & Research LaboratoriesAdelaideSA 5001Australia
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonSE1 7EUUK
| | - Rosalind Aughwane
- Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonWC1E 6BTUK
- Elizabeth Garrett Anderson Institute for Women's HealthUniversity College LondonLondonWC1E 6AUUK
| | - Nada Mufti
- Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonWC1E 6BTUK
- Elizabeth Garrett Anderson Institute for Women's HealthUniversity College LondonLondonWC1E 6AUUK
| | - Christopher K. Macgowan
- Division of Translational MedicineThe Hospital for Sick ChildrenUniversity of TorontoTorontoON M5G 1X8Canada
- Department of Medical BiophysicsUniversity of TorontoTorontoON M5S 1A1Canada
| | - Mike Seed
- Department of PaediatricsDivision of CardiologyThe Hospital for Sick ChildrenUniversity of TorontoTorontoON M5G 1X8Canada
- Department of Diagnostic ImagingThe Hospital for Sick ChildrenUniversity of TorontoTorontoON M5G 1X8Canada
| | - Anna L. David
- Elizabeth Garrett Anderson Institute for Women's HealthUniversity College LondonLondonWC1E 6AUUK
- NIHR Biomedical Research CentreUniversity College London HospitalsLondonW1T 7DNUK
| | - Andrew Melbourne
- School of Biomedical Engineering and Imaging SciencesKing's College LondonLondonSE1 7EUUK
- Department of Medical Physics and Biomedical EngineeringUniversity College LondonLondonWC1E 6BTUK
- Early Origins of Adult Health Research GroupHealth and Biomedical InnovationUniSA Clinical and Health SciencesUniversity of South AustraliaAdelaideSA 5001Australia
| | - Janna L. Morrison
- Early Origins of Adult Health Research GroupHealth and Biomedical InnovationUniSA Clinical and Health SciencesUniversity of South AustraliaAdelaideSA 5001Australia
| |
Collapse
|
15
|
King VJ, Bennet L, Stone PR, Clark A, Gunn AJ, Dhillon SK. Fetal growth restriction and stillbirth: Biomarkers for identifying at risk fetuses. Front Physiol 2022; 13:959750. [PMID: 36060697 PMCID: PMC9437293 DOI: 10.3389/fphys.2022.959750] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
Fetal growth restriction (FGR) is a major cause of stillbirth, prematurity and impaired neurodevelopment. Its etiology is multifactorial, but many cases are related to impaired placental development and dysfunction, with reduced nutrient and oxygen supply. The fetus has a remarkable ability to respond to hypoxic challenges and mounts protective adaptations to match growth to reduced nutrient availability. However, with progressive placental dysfunction, chronic hypoxia may progress to a level where fetus can no longer adapt, or there may be superimposed acute hypoxic events. Improving detection and effective monitoring of progression is critical for the management of complicated pregnancies to balance the risk of worsening fetal oxygen deprivation in utero, against the consequences of iatrogenic preterm birth. Current surveillance modalities include frequent fetal Doppler ultrasound, and fetal heart rate monitoring. However, nearly half of FGR cases are not detected in utero, and conventional surveillance does not prevent a high proportion of stillbirths. We review diagnostic challenges and limitations in current screening and monitoring practices and discuss potential ways to better identify FGR, and, critically, to identify the “tipping point” when a chronically hypoxic fetus is at risk of progressive acidosis and stillbirth.
Collapse
Affiliation(s)
- Victoria J. King
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Laura Bennet
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Peter R. Stone
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand
| | - Alys Clark
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand
- Auckland Biomedical Engineering Institute, The University of Auckland, Auckland, New Zealand
| | - Alistair J. Gunn
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Simerdeep K. Dhillon
- Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
- *Correspondence: Simerdeep K. Dhillon,
| |
Collapse
|
16
|
Cui H, Yu L, Li H, Wang H, Liang W, Wang H, Wang H. Evaluation of placental growth potential and placental bed perfusion by 3D ultrasound for early second-trimester prediction of preeclampsia. J Assist Reprod Genet 2022. [PMID: 35670921 DOI: 10.1007/s10815-022-02530-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/26/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE This study aimed to investigate whether placental parameters measured by three-dimensional ultrasound are associated with preeclampsia (PE) and small-for-gestational-age (SGA). METHODS In total, 1163 pregnancies at 11-14 weeks of gestation were recruited between October 8, 2020, and April 30, 2021. Placenta volume (PV), placental bed vascularization flow index (PBVFI), and uterine arteries pulse index (UtA-PI) were measured. Placental quotient (PQ = PV/weeks of gestation) was calculated. All participants were re-examined 4 weeks later. The placental volume growth rate (PVGR = placental volume difference between the two examinations/interval days) was also calculated. Patients were divided into four groups by the gestational age at the onset of PE and birth weight: early-onset PE (E-PE, n = 18), late-onset PE (L-PE, n = 36), isolated SGA5 (birth weight less than the fifth percentile for gestational age without PE, n = 9), and unaffected (n = 1100) groups. RESULTS A predictive model for E-PE was established, which consisted of unnatural conception, chronic hypertension, PBVFI (of second examination), and PVGR for E-PE; 94.4% sensitivity and 96.7% specificity by receiver operating characteristic curve analysis. CONCLUSIONS Overall, decreased placental growth potential and low placental bed perfusion in the early second trimester have potential in predicting E-PE.
Collapse
|
17
|
Akalin EE, Akalin M, Ayvaci Tasan H, Koyuncu K. Short-term effects of first trimester low-dose aspirin therapy on uterine artery flow in women at high risk for preeclampsia. J OBSTET GYNAECOL 2022; 42:1950-1955. [DOI: 10.1080/01443615.2022.2054688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Emine Eda Akalin
- Department of Obstetrics and Gynaecology, Bahcesehir University School of Medicine, Istanbul, Turkey
| | - Munip Akalin
- Department of Obstetrics and Gynaecology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Habibe Ayvaci Tasan
- Department of Obstetrics and Gynaecology, University of Health Sciences Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey
| | - Kazibe Koyuncu
- Department of Obstetrics and Gynaecology, Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey
| |
Collapse
|
18
|
Shao X, Yu W, Yang Y, Wang F, Yu X, Wu H, Ma Y, Cao B, Wang YL. The mystery of the life tree: the placenta. Biol Reprod 2022; 107:301-316. [PMID: 35552600 DOI: 10.1093/biolre/ioac095] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/20/2022] [Accepted: 05/21/2022] [Indexed: 11/13/2022] Open
Abstract
The placenta is the interface between the fetal and maternal environments during mammalian gestation, critically safeguarding the health of the developing fetus and the mother. Placental trophoblasts origin from embryonic trophectoderm that differentiates into various trophoblastic subtypes through villous and extravillous pathways. The trophoblasts actively interact with multiple decidual cells and immune cells at the maternal-fetal interface and thus construct fundamental functional units, which are responsible for blood perfusion, maternal-fetal material exchange, placental endocrine, immune tolerance, and adequate defense barrier against pathogen infection. Various pregnant complications are tightly associated with the defects in placental development and function maintenance. In this review, we summarize the current views and our recent progress on the mechanisms underlying the formation of placental functional units, the interactions among trophoblasts and various uterine cells, as well as the placental barrier against pathogen infections during pregnancy. The involvement of placental dysregulation in adverse pregnancy outcomes is discussed.
Collapse
Affiliation(s)
- Xuan Shao
- State Key Laboratory of Stem cell and Reproductive Biology, Institute of Zoology; Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China.,Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, China.,University of the Chinese Academy of Sciences, Beijing, China
| | - Wenzhe Yu
- Fujian Provincial Key Laboratory of Reproductive Health Research, Department of Obstetrics and Gynecology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yun Yang
- State Key Laboratory of Stem cell and Reproductive Biology, Institute of Zoology; Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China.,University of the Chinese Academy of Sciences, Beijing, China
| | - Feiyang Wang
- State Key Laboratory of Stem cell and Reproductive Biology, Institute of Zoology; Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China.,University of the Chinese Academy of Sciences, Beijing, China
| | - Xin Yu
- State Key Laboratory of Stem cell and Reproductive Biology, Institute of Zoology; Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China.,University of the Chinese Academy of Sciences, Beijing, China
| | - Hongyu Wu
- State Key Laboratory of Stem cell and Reproductive Biology, Institute of Zoology; Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China.,University of the Chinese Academy of Sciences, Beijing, China
| | - Yeling Ma
- Medical College, Shaoxing University, Shaoxing, China
| | - Bin Cao
- Fujian Provincial Key Laboratory of Reproductive Health Research, Department of Obstetrics and Gynecology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yan-Ling Wang
- State Key Laboratory of Stem cell and Reproductive Biology, Institute of Zoology; Institute for Stem Cell and Regeneration, Chinese Academy of Sciences, Beijing, China.,Beijing Institute for Stem Cell and Regenerative Medicine, Beijing, China.,University of the Chinese Academy of Sciences, Beijing, China
| |
Collapse
|
19
|
Allerkamp HH, Pole T, Boukham A, James JL, Clark AR. Predicting pregnancy specific uterine vascular reactivity: A data driven computational model of shear-dependent, myogenic, and mechanical radial artery features. Am J Physiol Heart Circ Physiol 2022; 323:H72-H88. [PMID: 35452318 DOI: 10.1152/ajpheart.00693.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The entire maternal circulation adapts to pregnancy, and this adaption is particularly extensive in the uterine circulation where the major vessels double in size to facilitate an approximately 15-fold increase in blood supply to this organ over the course of pregnancy. Several factors may play a role in both the remodelling and biomechanical function of the uterine vasculature including the paracrine microenvironment, passive properties of the vessel wall, and active components of vascular function (incorporating the myogenic response and response to shear stress induced by intravascular blood flow). However, the interplay between these factors, and how this plays out in an organ-specific manner to induce the extent of remodelling observed in the uterus is not well understood. Here we present an integrated assessment of the uterine radial arteries, likely rate-limiters to flow of oxygenated maternal blood to the placental surface, via computational modelling and pressure myography. We show that uterine radial arteries behave differently to other systemic vessels (higher compliance and shear mediated constriction) and that their properties change with the adaptation to pregnancy (higher myogenic tone, higher compliance, and ability to tolerate higher flow rates before constricting). Together, this provides a useful tool to improve our understanding of the role of uterine vascular adaptation in normal and abnormal pregnancies and highlights the need for vascular bed specific investigations of vascular function in health and disease.
Collapse
Affiliation(s)
- Hanna Helene Allerkamp
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.,Department of Obstetrics and Gynecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Teagan Pole
- Department of Obstetrics and Gynecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Ali Boukham
- Mechanics and Engineering Institute (I2M), Environmental and Civil Engineering Department (GCE), University of Bordeaux, Talence, France
| | - Joanna L James
- Department of Obstetrics and Gynecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Alys R Clark
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| |
Collapse
|
20
|
Gleason RL Jr, Sedaghati F. A mathematical model of maternal vascular growth and remodeling and changes in maternal hemodynamics in uncomplicated pregnancy. Biomech Model Mechanobiol 2022. [PMID: 35112224 DOI: 10.1007/s10237-021-01555-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 12/26/2021] [Indexed: 11/02/2022]
Abstract
The maternal vasculature undergoes tremendous growth and remodeling (G&R) that enables a > 15-fold increase in blood flow through the uterine vasculature from conception to term. Hemodynamic metrics (e.g., uterine artery pulsatility index, UA-PI) are useful for the prognosis of pregnancy complications; however, improved characterization of the maternal hemodynamics is necessary to improve prognosis. The goal of this paper is to develop a mathematical framework to characterize maternal vascular G&R and hemodynamics in uncomplicated human pregnancies. A validated 1D model of the human vascular tree from the literature was adapted and inlet blood flow waveforms at the ascending aorta at 4 week increments from 0 to 40 weeks of gestation were prescribed. Peripheral resistances of each terminal vessel were adjusted to achieve target flow rates and mean arterial pressure at each gestational age. Vessel growth was governed by wall shear stress (and axial lengthening in uterine vessels), and changes in vessel distensibility were related to vessel growth. Uterine artery velocity waveforms generated from this model closely resembled ultrasound results from the literature. The literature UA-PI values changed significantly across gestation, increasing in the first month of gestation, then dramatically decreasing from 4 to 20 weeks. Our results captured well the time-course of vessel geometry, material properties, and UA-PI. This 1D fluid-G&R model captured the salient hemodynamic features across a broad range of clinical reports and across gestation for uncomplicated human pregnancy. While results capture available data well, this study highlights significant gaps in available data required to better understand vascular remodeling in pregnancy.
Collapse
|
21
|
Clark AR, Yoshida K, Oyen ML. Computational modeling in pregnancy biomechanics research. J Mech Behav Biomed Mater 2022. [DOI: 10.1016/j.jmbbm.2022.105099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/11/2022] [Accepted: 01/18/2022] [Indexed: 11/24/2022]
|
22
|
James JL, Boss AL, Sun C, Allerkamp HH, Clark AR. From stem cells to spiral arteries: A journey through early placental development. Placenta 2021; 125:68-77. [PMID: 34819240 DOI: 10.1016/j.placenta.2021.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/11/2021] [Accepted: 11/14/2021] [Indexed: 12/19/2022]
Abstract
Early placental development lays the foundation of a healthy pregnancy, and numerous tightly regulated processes must occur for the placenta to meet the increasing nutrient and oxygen exchange requirements of the growing fetus later in gestation. Inadequacies in early placental development can result in disorders such as fetal growth restriction that do not present clinically until the second half of gestation. Indeed, growth restricted placentae exhibit impaired placental development and function, including reduced overall placental size, decreased branching of villi and the blood vessels within them, altered trophoblast function, and impaired uterine vascular remodelling, which together combine to reduce placental exchange capacity. This review explores the importance of early placental development across multiple anatomical aspects of placentation, from the stem cells and lineage hierarchies from which villous core cells and trophoblasts arise, through extravillous trophoblast invasion and spiral artery remodelling, and finally remodelling of the larger uterine vessels.
Collapse
Affiliation(s)
- Joanna L James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand.
| | - Anna L Boss
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Cherry Sun
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Hanna H Allerkamp
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand; Auckland Bioengineering Institute, University of Auckland, New Zealand
| | - Alys R Clark
- Auckland Bioengineering Institute, University of Auckland, New Zealand
| |
Collapse
|
23
|
Carson J, Warrander L, Johnstone E, van Loon R. Personalising cardiovascular network models in pregnancy: A two-tiered parameter estimation approach. Int J Numer Method Biomed Eng 2021; 37:e3267. [PMID: 31799783 PMCID: PMC9286682 DOI: 10.1002/cnm.3267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/07/2019] [Accepted: 09/07/2019] [Indexed: 05/26/2023]
Abstract
Uterine artery Doppler waveforms are often studied to determine whether a patient is at risk of developing pathologies such as pre-eclampsia. Many uterine waveform indices have been developed, which attempt to relate characteristics of the waveform with the physiological adaptation of the maternal cardiovascular system, and are often suggested to be an indicator of increased placenta resistance and arterial stiffness. Doppler waveforms of four patients, two of whom developed pre-eclampsia, are compared with a comprehensive closed-loop model of pregnancy. The closed-loop model has been previously validated but has been extended to include an improved parameter estimation technique that utilises systolic and diastolic blood pressure, cardiac output, heart rate, and pulse wave velocity measurements to adapt model resistances, compliances, blood volume, and the mean vessel areas in the main systemic arteries. The shape of the model-predicted uterine artery velocity waveforms showed good agreement with the characteristics observed in the patient Doppler waveforms. The personalised models obtained now allow a prediction of the uterine pressure waveforms in addition to the uterine velocity. This allows for a more detailed mechanistic analysis of the waveforms, eg, wave intensity analysis, to study existing clinical indices. The findings indicate that to accurately estimate arterial stiffness, both pulse pressure and pulse wave velocities are required. In addition, the results predict that patients who developed pre-eclampsia later in pregnancy have larger vessel areas in the main systemic arteries compared with the two patients who had normal pregnancy outcomes.
Collapse
Affiliation(s)
- Jason Carson
- Zienkiewicz Centre for Computational Engineering, College of EngineeringSwansea UniversitySwanseaUK
- Data Science Building, Swansea University Medical SchoolSwansea UniversitySwanseaUK
- HDR UK Wales and Northern IrelandHealth Data Research UKLondonUK
| | - Lynne Warrander
- Maternal and Fetal Health Research Centre, Division of Developmental Biology, Faculty of Medicine Biology and HealthUniversity of ManchesterManchesterUK
| | - Edward Johnstone
- Maternal and Fetal Health Research Centre, Division of Developmental Biology, Faculty of Medicine Biology and HealthUniversity of ManchesterManchesterUK
| | - Raoul van Loon
- Zienkiewicz Centre for Computational Engineering, College of EngineeringSwansea UniversitySwanseaUK
| |
Collapse
|
24
|
Hwuang E, Wu PH, Rodriguez-Soto A, Langham M, Wehrli FW, Vidorreta M, Moon B, Kochar K, Parameshwaran S, Koelper N, Tisdall MD, Detre JA, Witschey W, Schwartz N. Cross-modality and in-vivo validation of 4D flow MRI evaluation of uterine artery blood flow in human pregnancy. Ultrasound Obstet Gynecol 2021; 58:722-731. [PMID: 32898295 PMCID: PMC8072518 DOI: 10.1002/uog.23112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 08/06/2020] [Accepted: 08/23/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Clinical assessment of uterine artery (UtA) hemodynamics is currently limited to Doppler ultrasound (US) velocimetry. We have demonstrated previously the feasibility of applying four-dimensional (4D) flow magnetic resonance imaging (MRI) to evaluate UtA hemodynamics during pregnancy, allowing flow quantification of the entire course of the vessel. In this study, we sought to further validate the physiological relevance of 4D flow MRI measurement of UtA blood flow by exploring its association with pregnancy outcome relative to US-based metrics. METHODS Recruited into this prospective, cross-sectional study were 87 women with a singleton pregnancy who underwent 4D flow MRI between May 2016 and April 2019 to measure the UtA pulsatility index (MRI-PI) and blood flow rate (MRI-flow, in mL/min). UtA-PI was also measured using US (US-PI). The primary outcome was a composite (COMP) of pre-eclampsia (PE) and/or small-for-gestational-age (SGA) neonate, and secondary outcomes were PE and SGA neonate individually. We assessed the ability of MRI-flow, MRI-PI and US-PI to distinguish between outcomes, and evaluated whether MRI-flow changed as gestation progressed. RESULTS Following 4D flow postprocessing and exclusions from the analysis, 74 women had 4D flow MRI data analyzed for both UtAs. Of these, 18 developed a COMP outcome: three developed PE only, 11 had a SGA neonate only and four had both. A comparison of the COMP group vs the no-COMP group found no differences in maternal age, body mass index, nulliparity, gravidity or race. For 66 of the 74 subjects, US data were also available. In these subjects, both median MRI-PI (0.95 vs 0.70; P < 0.01) and median US-PI (0.95 vs 0.73; P < 0.01) were significantly increased in subjects in the COMP group compared with those in the no-COMP group. The UtA blood-flow rate, as measured by MRI, did not increase significantly from the second to the third trimester (median flow (interquartile range (IQR)), 543 (419-698) vs 575 (440-746) mL/min; P = 0.77), but it was significantly lower overall in the COMP compared with the no-COMP group (median flow (IQR), 486 (366-598) vs 624 (457-749) mL/min; P = 0.04). The areas under the receiver-operating-characteristics curves for MRI-flow, MRI-PI and US-PI in predicting COMP were not significantly different (0.694, 0.737 and 0.731, respectively; P = 0.87). CONCLUSIONS 4D flow MRI can yield physiological measures of UtA blood-flow rate and PI that are associated with adverse pregnancy outcome. This may open up new avenues in the future to expand the potential of this technique as a robust tool with which to evaluate UtA hemodynamics in pregnancy. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- E Hwuang
- Department of Biomedical Engineering, University of Pennsylvania, Philadelphia, PA, USA
| | - P H Wu
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - A Rodriguez-Soto
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - M Langham
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - F W Wehrli
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - B Moon
- Department of Biomedical Engineering, University of Pennsylvania, Philadelphia, PA, USA
| | - K Kochar
- Drexel School of Medicine, Philadelphia, PA, USA
| | - S Parameshwaran
- Maternal and Child Health Research Center, University of Pennsylvania, Philadelphia, PA, USA
| | - N Koelper
- Center for Research on Reproduction and Women's Health, University of Pennsylvania, Philadelphia, PA, USA
| | - M D Tisdall
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - J A Detre
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - W Witschey
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - N Schwartz
- Maternal and Child Health Research Center, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
25
|
Melbourne A. On the use of multicompartment models of diffusion and relaxation for placental imaging. Placenta 2021; 112:197-203. [PMID: 34392172 DOI: 10.1016/j.placenta.2021.07.302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/27/2021] [Accepted: 07/27/2021] [Indexed: 12/14/2022]
Abstract
Multi-compartment models of diffusion and relaxation are ubiquitous in magnetic resonance research especially applied to neuroimaging applications. These models are increasingly making their way into the world of placental imaging. This review provides a framework for their motivation and implementation and describes some of the outstanding questions that need to be answered before they can be routinely adopted.
Collapse
|
26
|
Srinivasan V, Melbourne A, Oyston C, James JL, Clark AR. Multiscale and multimodal imaging of utero-placental anatomy and function in pregnancy. Placenta 2021; 112:111-122. [PMID: 34329969 DOI: 10.1016/j.placenta.2021.07.290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 06/09/2021] [Accepted: 07/19/2021] [Indexed: 12/12/2022]
Abstract
Placental structures at the nano-, micro-, and macro scale each play important roles in contributing to its function. As such, quantifying the dynamic way in which placental structure evolves during pregnancy is critical to both clinical diagnosis of pregnancy disorders, and mechanistic understanding of their pathophysiology. Imaging the placenta, both exvivo and invivo, can provide a wealth of structural and/or functional information. This review outlines how imaging across modalities and spatial scales can ultimately come together to improve our understanding of normal and pathological pregnancies. We discuss how imaging technologies are evolving to provide new insights into placental physiology across disciplines, and how advanced computational algorithms can be used alongside state-of-the-art imaging to obtain a holistic view of placental structure and its associated functions to improve our understanding of placental function in health and disease.
Collapse
Affiliation(s)
| | - Andrew Melbourne
- School of Biomedical Engineering & Imaging Sciences, Kings College London, UK
| | - Charlotte Oyston
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Joanna L James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Alys R Clark
- Auckland Bioengineering Institute, University of Auckland, New Zealand
| |
Collapse
|
27
|
Allerkamp HH, Clark AR, Lee TC, Morgan TK, Burton GJ, James JL. Something old, something new: digital quantification of uterine vascular remodelling and trophoblast plugging in historical collections provides new insight into adaptation of the utero-placental circulation. Hum Reprod 2021; 36:571-586. [PMID: 33600565 DOI: 10.1093/humrep/deaa303] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/08/2020] [Indexed: 01/27/2023] Open
Abstract
STUDY QUESTION What is the physiological extent of vascular remodelling in and trophoblast plugging of the uterine circulation across the first half of pregnancy? SUMMARY ANSWER All levels of the uterine vascular tree (arcuate, radial and spiral arteries (SAs)) dilate ∼2.6- to 4.3-fold between 6 and 20 weeks of gestation, with significant aggregates of trophoblasts persisting in the decidual and myometrial parts of SAs beyond the first trimester. WHAT IS KNOWN ALREADY In early pregnancy, endovascular trophoblasts form 'plugs' in the SAs, transiently inhibiting blood flow to the placenta, whilst concurrently the uterine vasculature undergoes significant adaption to facilitate increased blood delivery to the placenta later in gestation. These processes are impaired in pregnancy disorders, but quantitative understanding of the anatomical changes even in normal pregnancy is poor. STUDY DESIGN, SIZE, DURATION Serial sections of normal placentae in situ (n = 22) of 6.1-20.5 weeks of gestation from the Boyd collection and Dixon collection (University of Cambridge, UK) were digitalized using a slide scanner or Axio Imager.A1 microscope. PARTICIPANTS/MATERIALS, SETTING, METHODS Spiral (n = 45), radial (n = 40) and arcuate (n = 39) arteries were manually segmented. Using custom-written scripts for Matlab® software, artery dimensions (Feret diameters; major axes; luminal/wall area) and endovascular trophoblast plug/aggregate (n = 24) porosities were calculated. Diameters of junctional zone SAs within the myometrium (n = 35) were acquired separately using a micrometre and light microscope. Decidual thickness and trophoblast plug depth was measured using ImageJ. MAIN RESULTS AND THE ROLE OF CHANCE By all measures, radial and arcuate artery dimensions progressively increased from 6.1 to 20.5 weeks (P < 0.01). The greatest increase in SA calibre occurred after 12 weeks of gestation. Trophoblast aggregates were found to persist within decidual and myometrial parts of SA lumens beyond the first trimester, and up to 18.5 weeks of gestation, although those present in the second trimester did not appear to prevent the passage of red blood cells to the intervillous space. Trophoblasts forming these aggregates became more compact (decreased in porosity) over gestation, whilst channel size between cells increased (P = 0.01). Decidual thickness decreased linearly over gestation (P = 0.0003), meaning plugs occupied an increasing proportion of the decidua (P = 0.02). LARGE SCALE DATA N/A. LIMITATIONS, REASONS FOR CAUTION Although serial sections were assessed, two-dimensional images cannot completely reflect the three-dimensional properties and connectivity of vessels and plugs/aggregates. Immersion-fixation of the specimens means that vessel size may be under-estimated. WIDER IMPLICATIONS OF THE FINDINGS Uterine vascular remodelling and trophoblast plug dispersion is a progressive phenomenon that is not completed by the end of the first trimester. Our quantitative findings support the concept that radial arteries present a major site of resistance until mid-gestation. Their dimensional increase at 10-12 weeks of gestation may explain the rapid increase in blood flow to the placenta observed by others at ∼13 weeks. Measured properties of trophoblast plugs suggest that they will impact on the resistance, shear stress and nature of blood flow within the utero-placental vasculature until mid-gestation. The presence of channels within plugs will likely lead to high velocity flow streams and thus increase shear stress experienced by the trophoblasts forming the aggregates. Quantitative understanding of utero-placental vascular adaptation gained here will improve in silico modelling of utero-placental haemodynamics and provide new insights into pregnancy disorders, such as fetal growth restriction. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by a Royal Society Te Aparangi Marsden Grant [18-UOA-135]. A.R.C. is supported by a Rutherford Discovery Fellowship [14-UOA-019]. The authors have no conflict of interest to declare.
Collapse
Affiliation(s)
- Hanna H Allerkamp
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Alys R Clark
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Tet Chuan Lee
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Terry K Morgan
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA
| | - Graham J Burton
- Centre for Trophoblast Research, University of Cambridge, Cambridge, UK
| | - Joanna L James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
28
|
Saghian R, Cahill L, Rahman A, Steinman J, Stortz G, Kingdom J, Macgowan C, Sled J. Interpretation of wave reflections in the umbilical arterial segment of the feto-placental circulation: computational modeling of the feto-placental arterial tree. IEEE Trans Biomed Eng 2021; 68:3647-3658. [PMID: 34010124 DOI: 10.1109/tbme.2021.3082064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Placental vascular abnormalities are associated with a host of pregnancy complications including placenta mediated fetal growth restriction (FGR). Umbilical arterial (UA) Doppler ultrasound velocity waveforms are widely used in the diagnosis of underlying placental vascular abnormalities in pregnancies with suspected FGR, which greatly help prevent stillbirth via ongoing fetal monitoring and timely delivery. However, the sensitivity of UA Doppler diagnosis diminishes late in gestation. Our goal was to present a generalized wave decomposition method to compute forward and reflected components from UA waveforms. A detailed anatomical based model was also developed to explain observed UA flow waveform and to explore how vascular properties affect the shape of flow wave components. Using pregnant mice and high frequency ultrasound microscopy, we obtained in utero Doppler and M- mode ultrasound measurements in 15 fetuses UA. Following ultrasound, the placentas were collected and perfused with contrast agent to obtain high-resolution 3D images of the feto-placental arteries. Model results indicate the significant role of terminal load impedance (capillary and/or veins) in creating positive or negative reflected waveforms. A negative reflected waveform is obtained when terminal impedance increases. This is consistent with the elongated and non-branching terminal villi that are proposed cause the highly abnormal UA waveforms found in early-onset FGR. The significance of these findings for the diagnostic utility of UA Doppler in human pregnancy is that the identification and measurement of wave reflections may aid in discriminating between healthy and abnormal placental vasculature in pregnancies with suspected late-onset FGR.
Collapse
|
29
|
Winship A, Donoghue J, Houston BJ, Martin JH, Lord T, Adwal A, Gonzalez M, Desroziers E, Ahmad G, Richani D, Bromfield EG. Reproductive health research in Australia and New Zealand: highlights from the Annual Meeting of the Society for Reproductive Biology, 2019. Reprod Fertil Dev 2021; 32:637-647. [PMID: 32234188 DOI: 10.1071/rd19449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 12/13/2019] [Indexed: 12/19/2022] Open
Abstract
The 2019 meeting of the Society for Reproductive Biology (SRB) provided a platform for the dissemination of new knowledge and innovations to improve reproductive health in humans, enhance animal breeding efficiency and understand the effect of the environment on reproductive processes. The effects of environment and lifestyle on fertility and animal behaviour are emerging as the most important modern issues facing reproductive health. Here, we summarise key highlights from recent work on endocrine-disrupting chemicals and diet- and lifestyle-induced metabolic changes and how these factors affect reproduction. This is particularly important to discuss in the context of potential effects on the reproductive potential that may be imparted to future generations of humans and animals. In addition to key summaries of new work in the male and female reproductive tract and on the health of the placenta, for the first time the SRB meeting included a workshop on endometriosis. This was an important opportunity for researchers, healthcare professionals and patient advocates to unite and provide critical updates on efforts to reduce the effect of this chronic disease and to improve the welfare of the women it affects. These new findings and directions are captured in this review.
Collapse
Affiliation(s)
- Amy Winship
- Biomedicine Discovery Institute, Department of Anatomy and Developmental Biology, Stem Cells and Development Program, Monash University, Vic. 3800, Australia
| | - Jacqueline Donoghue
- The University of Melbourne, Department of Obstetrics and Gynaecology, Gynaecology Research Centre, Royal Women's Hospital, Parkville, Vic. 3052, Australia
| | - Brendan J Houston
- School of Biological Sciences, Monash University, Vic. 3800, Australia
| | - Jacinta H Martin
- Hunter Medical Research Institute, Pregnancy and Reproduction Program, New Lambton Heights, NSW 2305, Australia
| | - Tessa Lord
- Hunter Medical Research Institute, Pregnancy and Reproduction Program, New Lambton Heights, NSW 2305, Australia; and Priority Research Centre for Reproductive Science, Discipline of Biological Sciences, The University of Newcastle, Callaghan, NSW 2300, Australia
| | - Alaknanda Adwal
- The University of Adelaide Robinson Research Institute, Adelaide Medical School, North Adelaide, SA 5005, Australia
| | - Macarena Gonzalez
- The University of Adelaide Robinson Research Institute, School of Medicine, Faculty of Health and Medical Sciences, Adelaide, SA 5005, Australia
| | - Elodie Desroziers
- Department of Physiology and Centre for Neuroendocrinology, University of Otago, Dunedin, New Zealand
| | - Gulfam Ahmad
- The University of Sydney Medical School, Discipline of Pathology, School of Medical Sciences, Sydney, NSW 2006, Australia
| | - Dulama Richani
- School of Women's and Children's Health, Fertility and Research Centre, University of New South Wales, Sydney, NSW 2052 Australia
| | - Elizabeth G Bromfield
- Priority Research Centre for Reproductive Science, Discipline of Biological Sciences, The University of Newcastle, Callaghan, NSW 2300, Australia; and Department of Biochemistry and Cell Biology, Faculty of Veterinary Medicine, Utrecht University, Netherlands; and Corresponding author:
| |
Collapse
|
30
|
Lloyd-Davies C, Collins SL, Burton GJ. Understanding the uterine artery Doppler waveform and its relationship to spiral artery remodelling. Placenta 2021; 105:78-84. [PMID: 33556717 DOI: 10.1016/j.placenta.2021.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/31/2020] [Accepted: 01/03/2021] [Indexed: 12/16/2022]
Abstract
Analysis of the uterine artery (UtA) Doppler waveform is frequently used in high-risk pregnancies to assess the likelihood of adverse pregnancy outcomes, including preeclampsia and fetal growth restriction. Whilst abnormal UtA waveforms at 18-20 weeks are associated with adverse outcomes, the underlying cause of these waveform changes remains unknown. Current evidence suggests the long-held dogma that the UtA waveform is merely a reflection of trophoblast-induced spiral artery remodelling is incorrect. Hence, the origins of the waveform changes must be reassessed. Recent data from human and animal models suggests that the arcuate arteries, placental bed arterio-venous anastomoses and, most notably, the radial arteries may be more important in determining the UtA waveform profile than previously appreciated. Furthermore, there is increasing evidence implicating the maternal cardiovascular system in the pathophysiology of the complications predicted by the waveform changes, particularly preeclampsia, and therefore its underlying association with the UtA waveform warrants further investigation.
Collapse
Affiliation(s)
- Claire Lloyd-Davies
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Sally L Collins
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK and Fetal Medicine Unit, John Radcliffe Hospital, Oxford, UK
| | - Graham J Burton
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK; Centre for Trophoblast Research, University of Cambridge, Cambridge, UK.
| |
Collapse
|
31
|
Abstract
Placentation in humans is precocious and highly invasive compared to other mammals. Implantation is interstitial, with the conceptus becoming completely embedded within the endometrium towards the end of the second week post-fertilization. Villi initially form over the entire surface of the chorionic sac, stimulated by histotrophic secretions from the endometrial glands. The secondary yolk sac never makes contact with the chorion, and a choriovitelline placenta is never established. However, recent morphological and transcriptomic analyses suggest that the yolk sac plays an important role in the uptake of nutrients from the coelomic fluid. Measurements performed in vivo demonstrate that early development takes place in a physiological, low-oxygen environment that protects against teratogenic free radicals and maintains stem cells in a multipotent state. The maternal arterial circulation to the placenta is only fully established around 10-12 weeks of gestation. By then, villi have regressed over the superficial, abembryonic pole, leaving the definitive discoid placenta, which is of the villous, hemochorial type. Remodeling of the maternal spiral arteries is essential to ensure a high-volume but low-velocity inflow into the mature placenta. Extravillous trophoblast cells migrate from anchoring villi and surround the arteries. Their interactions with maternal immune cells release cytokines and proteases that are key to remodeling, and a successful pregnancy.
Collapse
Affiliation(s)
- Graham J Burton
- Centre for Trophoblast Research, Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK.
| | - Eric Jauniaux
- Faculty of Population Health Sciences, EGA Institute for Women's Health, University College London, London, UK
| |
Collapse
|
32
|
Conrad KP. Evidence for Corpus Luteal and Endometrial Origins of Adverse Pregnancy Outcomes in Women Conceiving with or Without Assisted Reproduction. Obstet Gynecol Clin North Am 2020; 47:163-181. [PMID: 32008666 DOI: 10.1016/j.ogc.2019.10.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Preeclampsia may arise from impaired decidualization in some women. Transcriptomics of mid-secretory biopsy endometrial stromal cells decidualized in vitro and of early gestation choriodecidua from women who experienced preeclampsia with severe features overlapped significantly with the classical endometrial disorders giving rise to the concept of "endometrium spectrum disorders". That is, recurrent implantation failure and miscarriage, endometriosis, normotensive intrauterine growth restriction, preeclampsia and preterm birth may all lie on a continuum of decidual dysregulation, in which phenotypic expression is determined by the specific molecular pathway(s) disrupted and severity of disruption. Women conceiving by programmed IVF protocols showed widespread dysregulation of cardiovascular function and increased rates of adverse pregnancy outcomes including preeclampsia. Programmed cycles preclude development of a corpus luteum (CL), a major regulator of endometrial function. Lack of circulating CL product(s) that are not replaced in programmed cycles (eg, relaxin) could adversely impact the maternal cardiovascular system directly and/or compromise decidualization, thereby increasing preeclampsia risk.
Collapse
Affiliation(s)
- Kirk P Conrad
- Department of Physiology and Functional Genomics, D.H. Barron Reproductive and Perinatal Biology Research Program, University of Florida College of Medicine, 1600 Southwest Archer RD, PO Box 100274, M552, Gainesville, FL 32610-0274, USA; Department of Obstetrics and Gynecology, University of Florida College of Medicine, 1600 Southwest Archer RD, PO Box 100294, N3-9, Gainesville, FL 32610-0274, USA.
| |
Collapse
|
33
|
Abstract
The use of contrast agents as signal enhancers during ultrasound improves visualization and the diagnostic utility of this technology in medical imaging. Although widely used in many disciplines, contrast ultrasound is not routinely implemented in obstetrics, largely due to safety concerns of administered agents for pregnant women and the limited number of studies that address this issue. Here the microbubble characteristics that make them beneficial for enhancement of the blood pool and the quantification of real-time imaging are reviewed. Literature from pregnant animal model studies and safety assessments are detailed, and the potential for contrast-enhanced ultrasound to provide clinically relevant data and benefit our understanding of early placental development and detection of placental dysfunction is discussed.
Collapse
|
34
|
Abstract
Normal pregnancy is a complex and dynamic process that requires significant adaptation from the maternal system. Failure of this adaptive process in pregnancy contributes to many pregnancy related disorders, including the hypertensive disorders of pregnancy. This article discusses placental development and how abnormalities in the process of vascular remodeling contribute to the multisystem maternal and fetal disease that is preeclampsia and fetal growth restriction. We review some of the consequences of this condition on the mother and fetus, aspects of the clinical management of preeclampsia and how it can influence both mother and infant in the postnatal period and beyond.
Collapse
|
35
|
Clark AR, Lee TC, James JL. Computational modeling of the interactions between the maternal and fetal circulations in human pregnancy. WIREs Mech Dis 2020; 13:e1502. [PMID: 32744412 DOI: 10.1002/wsbm.1502] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 12/14/2022]
Abstract
In pregnancy, fetal growth is supported by its placenta. In turn, the placenta is nourished by maternal blood, delivered from the uterus, in which the vasculature is dramatically transformed to deliver this blood an ever increasing volume throughout gestation. A healthy pregnancy is thus dependent on the development of both the placental and maternal circulations, but also the interface where these physically separate circulations come in close proximity to exchange gases and nutrients between mum and baby. As the system continually evolves during pregnancy, our understanding of normal vascular anatomy, and how this impacts placental exchange function is limited. Understanding this is key to improve our ability to understand, predict, and detect pregnancy pathologies, but presents a number of challenges, due to the inaccessibility of the pregnant uterus to invasive measurements, and limitations in the resolution of imaging modalities safe for use in pregnancy. Computational approaches provide an opportunity to gain new insights into normal and abnormal pregnancy, by connecting observed anatomical changes from high-resolution imaging to function, and providing metrics that can be observed by routine clinical ultrasound. Such advanced modeling brings with it challenges to scale detailed anatomical models to reflect organ level function. This suggests pathways for future research to provide models that provide both physiological insights into pregnancy health, but also are simple enough to guide clinical focus. We the review evolution of computational approaches to understanding the physiology and pathophysiology of pregnancy in the uterus, placenta, and beyond focusing on both opportunities and challenges. This article is categorized under: Reproductive System Diseases >Computational Models.
Collapse
Affiliation(s)
- Alys R Clark
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Tet Chuan Lee
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Joanna L James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
36
|
Sun C, Groom KM, Oyston C, Chamley LW, Clark AR, James JL. The placenta in fetal growth restriction: What is going wrong? Placenta 2020; 96:10-18. [PMID: 32421528 DOI: 10.1016/j.placenta.2020.05.003] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/17/2020] [Accepted: 05/07/2020] [Indexed: 02/06/2023]
Abstract
The placenta is essential for the efficient delivery of nutrients and oxygen from mother to fetus to maintain normal fetal growth. Dysfunctional placental development underpins many pregnancy complications, including fetal growth restriction (FGR) a condition in which the fetus does not reach its growth potential. The FGR placenta is smaller than normal placentae throughout gestation and displays maldevelopment of both the placental villi and the fetal vasculature within these villi. Specialized epithelial cells called trophoblasts exhibit abnormal function and development in FGR placentae. This includes an altered balance between proliferation and apoptotic death, premature cellular senescence, and reduced colonisation of the maternal decidual tissue. Thus, the placenta undergoes aberrant changes at the macroscopic to cellular level in FGR, which can limit exchange capacity and downstream fetal growth. This review aims to compile stereological, in vitro, and imaging data to create a holistic overview of the FGR placenta and its pathophysiology, with a focus on the contribution of trophoblasts.
Collapse
Affiliation(s)
- Cherry Sun
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand.
| | - Katie M Groom
- Liggins Institute, The University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Charlotte Oyston
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Lawrence W Chamley
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Alys R Clark
- Auckland Bioengineering Institute, The University of Auckland, Auckland Bioengineering, House, Level 6/70 Symonds Street, Grafton, Auckland, 1010, New Zealand
| | - Joanna L James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| |
Collapse
|
37
|
Badachhape AA, Devkota L, Stupin IV, Sarkar P, Srivastava M, Tanifum EA, Fox KA, Yallampalli C, Annapragada AV, Ghaghada KB. Nanoparticle Contrast-enhanced T1-Mapping Enables Estimation of Placental Fractional Blood Volume in a Pregnant Mouse Model. Sci Rep 2019; 9:18707. [PMID: 31822711 DOI: 10.1038/s41598-019-55019-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/15/2019] [Indexed: 11/24/2022] Open
Abstract
Non-invasive methods for estimating placental fractional blood volume (FBV) are of great interest for characterization of vascular perfusion in placentae during pregnancy to identify placental insufficiency that may be indicative of local ischemia or fetal growth restriction (FGR). Nanoparticle contrast-enhanced magnetic resonance imaging (CE-MRI) may enable direct placental FBV estimation and may provide a reliable, 3D alternative to assess maternal-side placental perfusion. In this pre-clinical study, we investigated if placental FBV at 14, 16, and 18 days of gestation could be estimated through contrast-enhanced MRI using a long circulating blood-pool liposomal gadolinium contrast agent that does not penetrate the placental barrier. Placental FBV estimates of 0.47 ± 0.06 (E14.5), 0.50 ± 0.04 (E16.5), and 0.52 ± 0.04 (E18.5) were found through fitting pre-contrast and post-contrast T1 values in placental tissue using a variable flip angle method. MRI-derived placental FBV was validated against nanoparticle contrast-enhanced computed tomography (CE-CT) derived placental FBV, where signal is directly proportional to the concentration of iodine contrast agent. The results demonstrate successful estimation of the placental FBV, with values statistically indistinguishable from the CT derived values.
Collapse
|
38
|
Lorca RA, Lane SL, Bales ES, Nsier H, Yi H, Donnelly MA, Euser AG, Julian CG, Moore LG. High Altitude Reduces NO-Dependent Myometrial Artery Vasodilator Response During Pregnancy. Hypertension 2019; 73:1319-1326. [PMID: 31006328 DOI: 10.1161/hypertensionaha.119.12641] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The chronic hypoxia of high-altitude (HA) residence reduces uterine artery blood flow during pregnancy, likely contributing to an increased frequency of preeclampsia and intrauterine growth restriction. We hypothesized that this lesser pregnancy blood flow rise was due, in part, to reduced vasodilation of myometrial arteries (MAs). Here, we assessed MA vasoreactivity in healthy residents of high (2902±39 m) or low altitude (LA; 1669±10 m). MA contractile responses to potassium chloride, phenylephrine, or the thromboxane A2 agonist U46619 did not differ between LA and HA women. Acetylcholine vasodilated phenylephrine or U466119 preconstricted MAs at LA, yet had no effect on HA MAs. In contrast, another vasodilator, bradykinin, relaxed MAs from both altitudes similarly. At LA, the NO synthase inhibitor L-NG-nitroarginine methyl ester decreased both acetylcholine and bradykinin vasodilation by 56% and 33%, respectively. L-NG-nitroarginine methyl ester plus the COX (cyclooxygenase) inhibitor indomethacin had similar effects on acetylcholine and bradykinin vasodilation (68% and 42% reduction, respectively) as did removing the endothelium (78% and 50% decrease, respectively), suggesting a predominantly NO-dependent vasodilation at LA. However, at HA, L-NG-nitroarginine methyl ester did not change bradykinin vasodilation, whereas indomethacin or endothelium removal decreased it by 28% and 72%, respectively, indicating impaired NO signaling at HA. Suggesting that the impairment was downstream of eNOS (endothelial NO synthase), HA attenuated the vasodilation elicited by the NO donor sodium nitroprusside. We concluded that reduced NO-dependent MA vasodilation likely contributes to diminished uteroplacental perfusion in HA pregnancies.
Collapse
Affiliation(s)
- Ramón A Lorca
- From the Division of Reproductive Sciences (R.A.L., S.L.L., E.S.B., L.G.M.), University of Colorado Denver, Aurora
| | - Sydney L Lane
- From the Division of Reproductive Sciences (R.A.L., S.L.L., E.S.B., L.G.M.), University of Colorado Denver, Aurora
| | - Elise S Bales
- From the Division of Reproductive Sciences (R.A.L., S.L.L., E.S.B., L.G.M.), University of Colorado Denver, Aurora
| | - Hisham Nsier
- BA/BS-MD Program, College of Liberal Arts and Sciences (H.N., H.Y.), University of Colorado Denver, Aurora
| | - HeaMi Yi
- BA/BS-MD Program, College of Liberal Arts and Sciences (H.N., H.Y.), University of Colorado Denver, Aurora
| | - Meghan A Donnelly
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (M.A.D., A.G.E.), University of Colorado Denver, Aurora
| | - Anna G Euser
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology (M.A.D., A.G.E.), University of Colorado Denver, Aurora
| | - Colleen G Julian
- Division of Bioinformatics and Personalized Medicine, Department of Medicine (C.G.J.), University of Colorado Denver, Aurora
| | - Lorna G Moore
- From the Division of Reproductive Sciences (R.A.L., S.L.L., E.S.B., L.G.M.), University of Colorado Denver, Aurora
| |
Collapse
|
39
|
Saghian R, Bogle G, James JL, Clark AR. Establishment of maternal blood supply to the placenta: insights into plugging, unplugging and trophoblast behaviour from an agent-based model. Interface Focus 2019; 9:20190019. [PMID: 31485310 DOI: 10.1098/rsfs.2019.0019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2019] [Indexed: 12/14/2022] Open
Abstract
The ability of the baby to receive nutrients and oxygen in utero depends on the healthy development of the placenta. For maternal blood to adequately perfuse the placenta, it dramatically alters the arteries in the uterus that supply it with nutrient-rich blood right from the start of pregnancy. Placental cells (trophoblasts) invade both into the tissue of the uterus and into the maternal blood vessels nearest to the site of implantation (the spiral arteries (SAs)) and transform these allowing a relatively high and steady flow of nutrient-rich blood to perfuse the placenta. Trophoblasts also form plugs that occlude SAs, preventing maternal blood flow to the placenta until the late first trimester, at which point these plugs dislodge or disintegrate. Here we present an agent-based model of trophoblast migration within plugged SAs to tease apart the impact of chemical signals and mechanical factors on trophoblast behaviour. The model supports our previous in vitro hypothesis that plugging of the maternal arteries in early pregnancy can act to promote trophoblast invasion by providing a 'low flow' environment and extends our understanding by suggesting 'weak spots' in plug structure can lead to plug degeneration, allowing increased blood flow through the materno-fetal circulation.
Collapse
Affiliation(s)
- Rojan Saghian
- Auckland Bioengineering Institute, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Gib Bogle
- Auckland Bioengineering Institute, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Joanna L James
- Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Alys R Clark
- Auckland Bioengineering Institute, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
40
|
Abstract
Pre-eclampsia is a common disorder that particularly affects first pregnancies. The clinical presentation is highly variable but hypertension and proteinuria are usually seen. These systemic signs arise from soluble factors released from the placenta as a result of a response to stress of syncytiotrophoblast. There are two sub-types: early and late onset pre-eclampsia, with others almost certainly yet to be identified. Early onset pre-eclampsia arises owing to defective placentation, whilst late onset pre-eclampsia may center around interactions between normal senescence of the placenta and a maternal genetic predisposition to cardiovascular and metabolic disease. The causes, placental and maternal, vary among individuals. Recent research has focused on placental-uterine interactions in early pregnancy. The aim now is to translate these findings into new ways to predict, prevent, and treat pre-eclampsia.
Collapse
Affiliation(s)
- Graham J Burton
- Department of Physiology, Development & Neuroscience, University of Cambridge, UK
- Centre for Trophoblast Research, University of Cambridge, UK
| | | | - James M Roberts
- Magee-Womens Research Institute, Depts. Obstetric Gynecology and Reproductive Sciences, Epidemiology, and Clinical and Translational Research, University of Pittsburgh, USA
| | - Ashley Moffett
- Centre for Trophoblast Research, University of Cambridge, UK
- Dept of Pathology, University of Cambridge, UK
| |
Collapse
|
41
|
Mathewlynn S, Collins SL. Volume and vascularity: Using ultrasound to unlock the secrets of the first trimester placenta. Placenta 2019; 84:32-36. [PMID: 31279487 DOI: 10.1016/j.placenta.2019.06.379] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 06/19/2019] [Accepted: 06/22/2019] [Indexed: 11/19/2022]
Abstract
Fetal growth restriction (FGR) is a major cause of perinatal morbidity and mortality. Identifying which pregnancies are at risk of FGR facilitates enhanced surveillance and early delivery before fetal demise can ensue. However, existing risk stratification strategies yield an unacceptably low detection rate. A robust and reliable first trimester screening test for FGR would not only enable high-risk women to be appropriately monitored but would facilitate future trials for possible interventions to enhance fetal growth. Both the volume and vascularity of the first trimester placenta has been demonstrated to be linked to adverse pregnancy outcomes including FGR and pre-eclampsia. The investigation of novel ultrasound markers for FGR are discussed along with the development of methods for fully automatic placental volume estimation which has the potential for use as part of a multi-variable population-based screening test.
Collapse
Affiliation(s)
- S Mathewlynn
- Department of Obstetrics and Gynaecology, Milton Keynes University Hospital, Milton Keynes, UK
| | - S L Collins
- Nuffield Department of Women's and Reproductive Health, University of Oxford, UK; Fetal Medicine Unit, The Women's Centre, John Radcliffe Hospital, Oxford, UK.
| |
Collapse
|
42
|
Knöfler M, Haider S, Saleh L, Pollheimer J, Gamage TKJB, James J. Human placenta and trophoblast development: key molecular mechanisms and model systems. Cell Mol Life Sci 2019; 76:3479-3496. [PMID: 31049600 PMCID: PMC6697717 DOI: 10.1007/s00018-019-03104-6] [Citation(s) in RCA: 333] [Impact Index Per Article: 66.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/08/2019] [Accepted: 04/11/2019] [Indexed: 12/16/2022]
Abstract
Abnormal placentation is considered as an underlying cause of various pregnancy complications such as miscarriage, preeclampsia and intrauterine growth restriction, the latter increasing the risk for the development of severe disorders in later life such as cardiovascular disease and type 2 diabetes. Despite their importance, the molecular mechanisms governing human placental formation and trophoblast cell lineage specification and differentiation have been poorly unravelled, mostly due to the lack of appropriate cellular model systems. However, over the past few years major progress has been made by establishing self-renewing human trophoblast stem cells and 3-dimensional organoids from human blastocysts and early placental tissues opening the path for detailed molecular investigations. Herein, we summarize the present knowledge about human placental development, its stem cells, progenitors and differentiated cell types in the trophoblast epithelium and the villous core. Anatomy of the early placenta, current model systems, and critical key regulatory factors and signalling cascades governing placentation will be elucidated. In this context, we will discuss the role of the developmental pathways Wingless and Notch, controlling trophoblast stemness/differentiation and formation of invasive trophoblast progenitors, respectively.
Collapse
Affiliation(s)
- Martin Knöfler
- Reproductive Biology Unit, Department of Obstetrics and Gynaecology, Medical University of Vienna, Währinger Gürtel 18-20, 5Q, 1090 Vienna, Austria
| | - Sandra Haider
- Reproductive Biology Unit, Department of Obstetrics and Gynaecology, Medical University of Vienna, Währinger Gürtel 18-20, 5Q, 1090 Vienna, Austria
| | - Leila Saleh
- Reproductive Biology Unit, Department of Obstetrics and Gynaecology, Medical University of Vienna, Währinger Gürtel 18-20, 5Q, 1090 Vienna, Austria
| | - Jürgen Pollheimer
- Reproductive Biology Unit, Department of Obstetrics and Gynaecology, Medical University of Vienna, Währinger Gürtel 18-20, 5Q, 1090 Vienna, Austria
| | - Teena K. J. B. Gamage
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Joanna James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
43
|
Carson J, Lewis M, Rassi D, Van Loon R. A data-driven model to study utero-ovarian blood flow physiology during pregnancy. Biomech Model Mechanobiol 2019; 18:1155-1176. [PMID: 30838498 PMCID: PMC6647440 DOI: 10.1007/s10237-019-01135-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 02/20/2019] [Indexed: 12/30/2022]
Abstract
In this paper, we describe a mathematical model of the cardiovascular system in human pregnancy. An automated, closed-loop 1D-0D modelling framework was developed, and we demonstrate its efficacy in (1) reproducing measured multi-variate cardiovascular variables (pulse pressure, total peripheral resistance and cardiac output) and (2) providing automated estimates of variables that have not been measured (uterine arterial and venous blood flow, pulse wave velocity, pulsatility index). This is the first model capable of estimating volumetric blood flow to the uterus via the utero-ovarian communicating arteries. It is also the first model capable of capturing wave propagation phenomena in the utero-ovarian circulation, which are important for the accurate estimation of arterial stiffness in contemporary obstetric practice. The model will provide a basis for future studies aiming to elucidate the physiological mechanisms underlying the dynamic properties (changing shapes) of vascular flow waveforms that are observed with advancing gestation. This in turn will facilitate the development of methods for the earlier detection of pathologies that have an influence on vascular structure and behaviour.
Collapse
Affiliation(s)
- Jason Carson
- College of Engineering, Swansea University, Bay Campus, Fabian Way, Swansea, SA1 8EN UK
| | - Michael Lewis
- College of Engineering, Swansea University, Bay Campus, Fabian Way, Swansea, SA1 8EN UK
| | - Dareyoush Rassi
- College of Human and Health Sciences, Swansea University, Singleton Campus, Singleton Park, Swansea, SA2 8PP UK
| | - Raoul Van Loon
- College of Engineering, Swansea University, Bay Campus, Fabian Way, Swansea, SA1 8EN UK
| |
Collapse
|
44
|
James JL, Saghian R, Perwick R, Clark AR. Trophoblast plugs: impact on utero-placental haemodynamics and spiral artery remodelling. Hum Reprod 2018; 33:1430-1441. [DOI: 10.1093/humrep/dey225] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/28/2018] [Accepted: 06/02/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Joanna L James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand
| | - Rojan Saghian
- Auckland Bioengineering Institute, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand
| | - Rebecca Perwick
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand
- Auckland Bioengineering Institute, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand
| | - Alys R Clark
- Auckland Bioengineering Institute, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand
| |
Collapse
|