Clinical Diagnostic Value Of Multi-parametric Ultrasound In Assessing Placental Insufficiency During The Second Trimester

Background Placental insufficiency is closely related to the incidence of adverse pregnancy outcomes between mothers and infants.Generally,clinical symptoms do not appear until the third trimester,which misses the best opportunity for intervention by obstetricians and increases the difficulty of treatment.Therefore,early and accurate assessment of placental insufficiency has important clinical significance.Objective To investigate the diagnostic clinical value of multi-parametric ultrasound in accessing placental insufficiency during the second trimester and the diagnostic efficacy of the prediction model,so as to provide an important basis for accurate diagnosis of placental insufficiency in the early clinical stage.Methods A total of 209 pregnant women who underwent ultrasonography and regular prenatal examination until delivery in our hospital during the second trimester(20–24 weeks)were selected as the study subjects.According to clinical follow-up,they were divided into118 cases in the normal group and 91 cases in the placental insufficiency group.All study subjects underwent conventional two-dimensional ultrasonography,three-dimensional power Doppler ultrasonography(3D-PDU)and shear wave elastography(SWE).Conventional two-dimensional ultrasonography was performed to measure the blood flow parameters of uterine artery(Ut A),fetal umbilical artery(UA)and middle cerebral artery(MCA)in pregnant women,including pulsation index(PI),resistance index(RI),peak systolic flow rate/end-diastolic flow rate(S/D),fetal venous catheter flow rate and cerebral placental rate(CPR).4D view software was used to calculate the placental 3D-PDU blood flow parameters in the region of interest,including blood flow index(FI),vascular index(VI)and vascular blood flow index(VFI).SWE technique was used to obtain the mean Young’s modulus(Emean)in the central and marginal regions of the placenta respectively.The differences in general and ultrasound data between the two groups were compared,and the diagnostic efficacy of each ultrasound imaging technique in accessing placental insufficiency independently and jointly were analyzed.The prediction model was constructed by binary Logistic regression to analyze the clinical diagnostic value and predictive efficacy of multi-parametric ultrasound in accessing placental insufficiency during the second trimester.Results In the placental insufficiency group,pre-pregnancy BMI of pregnant women,Ut A blood flow parameters,and Emean in the central and marginal regions of the placenta were higher than those in the normal group,while CPR,VI,and VFI were lower than those in the control group,and the differences were statistically significant(P < 0.001).The Emean in the marginal regions of the placenta was higher than that in the central regions in the normal and placental insufficiency groups,and the differences were statistically significant(P < 0.001).Yet there was no statistically significant difference in Emean in the corresponding regions of the placenta between different gestational weeks at 20–24 weeks(P > 0.05).Compared with the separate application of two-dimensional conventional ultrasound,3D-PDU and SWE,the combined application of the three techniques had the highest AUC(0.960)and the highest specificity(96.61%)in accessing placental insufficiency during the second trimester.Ut A-RI,CPR,and Emean were independent factors for predicting placental insufficiency during the second trimester,with cutoff values of 0.65,1.53,and 4.14 KPa,and area under the curve(AUC)of 0.901,0.579,and 0.904,respectively,and the predictive model was constructed based on the above factors with the greatest diagnostic efficacy(AUC = 0.945,sensitivity87.91%,and specificity 94.92%).Conclusion The prediction model of multi-parametric ultrasound based on Ut A-RI(≥0.65),CPR(≤ 0.65)and Emean(≥ 4.14KPa)during the second trimester has certain clinical diagnostic value in accessing placental insufficiency.It is a new imaging strategy with transformation potential,which can accurately access placental insufficiency and guide early clinical intervention to improve perinatal outcomes.