New ultrasound signs for prediction of early placental Insufficiency

Background: Chronic placental insufficiency is a common condition that affects fetal growth and wellbeing. The response of the fetus to such stress depends on time and degree of placental affection. The acute placental insufficiency rapidly affects the fetal movements, amount of liquor and might lead to fetal demise while the chronic placental insufficiency is more deciduous and affects fetal weight and develops fetal growth restriction more slowly. The prophylaxis against the development of chronic placental insufficiency is more effective to protect growth and avoid perinatal morbidities and moralities.Aim: Evaluation of 2 new ultrasound signs (tent like placenta and turbid liquor) to predict early placental insufficiencyMaterials and Methods: One hundred pregnant women with gestational age between 16 weeks till 28 weeks were included in the study. This cohort of women with singleton pregnancy was evaluated by detailed ultrasound scanning to document gestational age, amniotic fluid index, cerebroplacental ratio (CPR), exclusion of congenital anomalies and other routine ultrasound scanning items. This cohort was divided into two groups, group one was the group with placental tenting and/or turbid liquor while group two was the group with no evidence of placental tenting or turbid liquor.Results: Documentation of all relevant demographic data was done. The follow up was done every two weeks in all cases unless patients complained of decreased or absent fetal movement, passage of liquor, passage of blood. Spontaneous labour was allowed in primigravidae and elective cesarean section in Cases with previous c-section at completed 38 weeks of gestation was done unless one or more of the following signs had appeared that indicated the need for emergency delivery which were : abnormal low CPR less than 0.76, severe oligohydramnios, biophysical profile equal to or less than 4/8, abnormal cardiotocogram and fetal distress. The duration from the beginning of the study and documentation of the new studied signs in the placenta and turbid liquor till the development of placental insufficiency was calculated in weeks. All complications or adverse events were documented in both groups.Conclusions: Both new signs were associated with increased risk for development of chronic placental insufficiency and can be used as predictors for evaluation of all pregnant women in the second trimester.