B‐flow/spatiotemporal image correlation M‐mode ultrasound provides novel method to quantify spiral artery remodeling during normal human pregnancy

• Published in: Ultrasound in obstetrics & gynecology 2024-09, Vol.64 (3), p.322-329
• Main Authors: Turan, O. M., Liang, Y., Kelley, B., Turan, S., Pepe, G. J., Albrecht, E. D.
• Format: Article
• Language: English
• Subjects: Adult; Arteries; Blood vessels; B‐flow; Diastole; Female; Growth factors; Gynecology; Heart; human; Humans; Kinases; Longitudinal Studies; Modulus of elasticity; M‐mode ultrasound; Observational studies; Obstetrics; Physiology; Placenta; Placenta - blood supply; Placenta - diagnostic imaging; Placenta growth factor; Placenta Growth Factor - blood; PlGF; Pregnancy; Pregnancy Proteins - blood; Pregnancy Trimester, Third; Pregnancy Trimesters - blood; Pregnancy Trimesters - physiology; Prospective Studies; Serum levels; sFlt‐1; Smooth muscle; spiral artery distensibility; Systole; Trophoblasts; Tyrosine; Ultrasonic imaging; Ultrasonic testing; Ultrasonography, Prenatal - methods; Ultrasound; Uterine Artery - diagnostic imaging; Uterine Artery - physiology; Vascular Endothelial Growth Factor Receptor-1 - blood; Vascular Remodeling - physiology; Veins & arteries
• ISSN: 0960-7692; 1469-0705; 1469-0705
• DOI: 10.1002/uog.27636

ABSTRACT Objectives During human pregnancy, placental extravillous trophoblasts replace vascular smooth muscle and elastic tissue within the walls of the uterine spiral arteries, thereby remodeling them into distensible low‐resistance vessels to promote placental perfusion. The present study determined whether B‐flow/spatiotemporal image correlation (STIC) M‐mode ultrasonography provides an in‐vivo imaging method able to digitally quantify spiral artery luminal distensibility as a physiological index of spiral artery remodeling during the advancing stages of normal human pregnancy. Methods A prospective, longitudinal, observational study was conducted to quantify spiral artery distensibility (i.e. vessel luminal diameter at systole minus diameter at diastole) by B‐flow/STIC M‐mode ultrasonography during the first, second and third trimesters in 290 women exhibiting a normal pregnancy. Maternal serum levels of placental growth factor (PlGF) and soluble fms‐like tyrosine kinase‐1 (sFlt‐1), growth factors that modulate important events in spiral artery remodeling, were quantified in a subset of the women in the first, second and third trimesters of pregnancy. Results Median (interquartile range (IQR)) spiral artery distensibility increased progressively between the first (0.17 (0.14–0.21) cm), second (0.23 (0.18–0.28) cm) and third (0.26 (0.21–0.35) cm) trimesters of pregnancy (P