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2. Cross‐modality and in‐vivo validation of <scp>4D</scp> flow <scp>MRI</scp> evaluation of uterine artery blood flow in human pregnancy

Author

M. D. Tisdall, Walter R Witschey, Eileen Hwuang, Brianna F. Moon, Kirpal Kochar, Ana E. Rodríguez-Soto, N. Koelper, Pei-Hsin Wu, Nadav Schwartz, Felix W. Wehrli, John A. Detre, Shobhana Parameshwaran, Marta Vidorreta, and Michael C. Langham

Subjects
Adult, medicine.medical_specialty, Pregnancy Trimester, Third, Hemodynamics, Multimodal Imaging, Article, Preeclampsia, Pre-Eclampsia, Predictive Value of Tests, Pregnancy, Interquartile range, Prenatal Diagnosis, Internal medicine, medicine.artery, medicine, Humans, Placental Circulation, Radiology, Nuclear Medicine and imaging, Prospective Studies, Uterine artery, Fetal Growth Retardation, Radiological and Ultrasound Technology, medicine.diagnostic_test, business.industry, Infant, Newborn, Pregnancy Outcome, Reproducibility of Results, Obstetrics and Gynecology, Magnetic resonance imaging, General Medicine, Blood flow, medicine.disease, Magnetic Resonance Imaging, Uterine Artery, Cross-Sectional Studies, Reproductive Medicine, Area Under Curve, Pulsatile Flow, Infant, Small for Gestational Age, Cardiology, Gestation, Female, business, Blood Flow Velocity
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

Published
2021

3. Fully Automated Placental Volume Quantification From <scp>3D</scp> Ultrasound for Prediction of Small‐for‐Gestational‐Age Infants

Author

James C. Gee, Natalie Yushkevich, Jiancong Wang, Ipek Oguz, Paul A. Yushkevich, Shobhana Parameshwaran, Baris U. Oguz, Alison M. Pouch, and Nadav Schwartz

Subjects
Placenta, Pipeline (computing), Gestational Age, Ultrasonography, Prenatal, Article, Pregnancy, Placental volume, medicine, Humans, Radiology, Nuclear Medicine and imaging, 3D ultrasound, Segmentation, Radiological and Ultrasound Technology, medicine.diagnostic_test, business.industry, Infant, Newborn, Obstetrics and Gynecology, General Medicine, Patient counseling, medicine.disease, Pregnancy Trimester, First, Fully automated, Infant, Small for Gestational Age, Small for gestational age, Female, Test performance, Nuclear medicine, business
Abstract

OBJECTIVES: Early placental volume (PV) has been associated with small-for-gestational-age infants born under the 10(th)/5(th) centiles (SGA10/SGA5). Manual or semi-automated PV quantification from 3DUS is time-intensive, limiting its incorporation into clinical care. We devised a novel convolutional neural network (CNN) pipeline for fully-automated placenta segmentation from 3DUS images, exploring the association between the calculated PV and SGA. METHODS: 3DUS volumes obtained from singleton pregnancies at 11–14 weeks’ gestation were automatically segmented by our CNN pipeline trained and tested on 99/25 images, combining two 2D and one 3D models with downsampling/upsampling architecture. The PVs derived from the automated segmentations (PV(CNN)) were used to train multi-variable logistic-regression classifiers for SGA10/SGA5. The test performance for predicting SGA was compared to PVs obtained via the semi-automated VOCAL (GE-Healthcare) method (PV(VOCAL)). RESULTS: We included 442 subjects with 37 (8.4%) and 18 (4.1%) SGA10/SGA5 infants, respectively. Our segmentation pipeline achieved a mean Dice score of 0.88 on an independent test-set. Adjusted models including PV(CNN) or PV(VOCAL) were similarly predictive of SGA10 (AUCs: PV(CNN)=0.780, PV(VOCAL)=0.768). The addition of PV(CNN) to a clinical model without any PV included (AUC=0.725) yielded statistically significant improvement in AUC (P

Published
2021

4. Minimally interactive placenta segmentation from three-dimensional ultrasound images

Author

Jiancong Wang, James C. Gee, Alison M. Pouch, Ipek Oguz, Baris U. Oguz, Paul A. Yushkevich, Natalie Yushkevich, Nadav Schwartz, and Shobhana Parameshwaran

Subjects
Image fusion, Correlation coefficient, Intraclass correlation, business.industry, Image Processing, Ultrasound, Image registration, Pattern recognition, Image processing, Image segmentation, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, Medicine, Radiology, Nuclear Medicine and imaging, Segmentation, Artificial intelligence, business
Abstract

Purpose: Placental size in early pregnancy has been associated with important clinical outcomes, including fetal growth. However, extraction of placental size from three-dimensional ultrasound (3DUS) requires time-consuming interactive segmentation methods and is prone to user variability. We propose a semiautomated segmentation technique that requires minimal user input to robustly measure placental volume from 3DUS images. Approach: For semiautomated segmentation, a single, central 2D slice was manually annotated to initialize an automated multi-atlas label fusion (MALF) algorithm. The dataset consisted of 47 3DUS volumes obtained at 11 to 14 weeks in singleton pregnancies (28 anterior and 19 posterior). Twenty-six of these subjects were imaged twice within the same session. Dice overlap and surface distance were used to quantify the automated segmentation accuracy compared to expert manual segmentations. The mean placental volume measurements obtained by our method and VOCAL (virtual organ computer-aided analysis), a leading commercial semiautomated method, were compared to the manual reference set. The test-retest reliability was also assessed. Results: The overlap between our automated segmentation and manual (mean Dice: 0.824 ± 0.061 , median: 0.831) was within the range reported by other methods requiring extensive manual input. The average surface distance was 1.66 ± 0.96 mm . The correlation coefficient between test-retest volumes was r = 0.88 , and the intraclass correlation was ICC ( 1 ) = 0.86 . Conclusions: MALF is a promising method that can allow accurate and reliable segmentation of the placenta with minimal user interaction. Further refinement of this technique may allow for placental biometry to be incorporated into clinical pregnancy surveillance.

Published
2019

5. Influence of Gestational Age at Initiation of Antihypertensive Therapy: Secondary Analysis of CHIPS Trial Data (Control of Hypertension in Pregnancy Study)

Author

Anouk Pels, Ben Willem J. Mol, Joel Singer, Terry Lee, Peter von Dadelszen, Wessel Ganzevoort, Elizabeth Asztalos, Laura A. Magee, Amiram Gafni, Andrée Gruslin, Michael Helewa, Eileen Hutton, Shoo Lee, Alexander Logan, Jennifer Menzies, Jean-Marie Moutquin, Kellie Murphy, Evelyne Rey, Sue Ross, Johanna Sanchez, Jim G. Thornton, Ross Welch, Trinh Hoac, Joanne Kirton, Katherine Trigiani, Ainy Zahid, Michael B. Bracken, Patricia Crowley, Lelia Duley, Richard Ehrenkranz, Kevin Thorpe, Sunny Chan, Michael Shi, Shelley Yu, Raquel de Lourdes Martin, Maria Florencia Bassi, Mirta Clara Caruso, Valeria Lagunas, Fernando Vera, Maria Mohedano de Duhalde, Alicia Beatriz Roque, Patricia Roldan, Esteban Marcos Duhalde, Viviana Dip, Jesus Daniel Aguirre, Elba Mirta Alicia Morales, Griselda Itati Abreo, Teresa De Sagastizabal, Carolina Gomez, Nadia Rizzi, Carlos Arias, Ricardo Antonio Bruno, Kassam Mahomed, Alison Drew, Ann Green, Jane Hoare, Bill Hague, Suzette Coat, Caroline Crowther, Peter Muller, Sophie Trenowden, Barry Walters, Claire Parker, Dorothy Graham, Craig Pennell, Eileen Sung, Angela Makris, Gaksoo Lee, Charlene Thornton, Annemarie Hennessy, Louise Farrell, Nelson Sass, Henri Korkes, Dayana Couto Ferreira, Renato Augusto Moreira de Sa, Monique Schmidt Marques Abreu, Rita Guerios Bornia, Nancy Ribeiro da Silva, Fernanda Freitas Oliveira Cardoso, Caio Coelho Marques, Jorge Hornos, Ricardo Leal Davdt, Letícia Germany Paula, Pedro Luis Zanella, Gabrielle Inglis, Ruth Dillon, Ashley Docherty, Anna Hutfield, Keith Still, Sayrin Lalji, Tamara Van Tent, Chris Hotz, Tracy Messmer, Joel G. Ray, Howard Berger, Leanne De Souza, Andrea Lausman, Tatiana Freire-Lizama, Kate Besel, Paul Gibson, Greta Ellsworth, Leslie Miller, T. Lee-Ann Hawkins, Michelle Hladunewich, Anna Rogowsky, Dini Hui, Virginia Collins, Isabelle Delisle, Cora Fanning, Nestor Demianczuk, Rshmi Khurana, Winnie Sia, Catherine Marnoch, Carmen Young, Cheryl Lux, Sophie Perreault, Valerie Tremblay, Sophie Desindes, Anne-Marie Côté, Veronique Dagenais, Heather Clark, Elaine O’Shea, Ruth Rennicks White, Shital Gandhi, Mary-Jean Martin, Cheryl Brush, Gareth Seaward, Jill Newstead-Angel, Judy Brandt, Jocelyne Martel, Kristine Mytopher, Elise Buschau, Erin Keely, Patti Waddell, Svetlana Shachkina, Alan Karovitch, Robert Anderson, Nicole Koenig, Theresa Yong, Marie Vasiliou, Peri Johnson, Beth Allan, Renato Natale, Laura Kennedy, Lucie Opatrny, Lorraine Lavigne, George Carson, Sheila Kelly, Joan Crane, Donna Hutchens, Juan Pedro Kusanovic, Christian Figueroa, Karla Silva Neculman, Juan Andres Ortiz, Paula Vargas, Pedro Ferrand, Jorge Carrillo, Rodrigo Cifuentes Borrero, Dahiana Marcela Gallo, Luisa Fernanda Moreno, Fred Kirss, Kristiina Rull, Anne Kirss, Tamas Major, Andrea Fodor, Tunde Bartha, Mordechai Hallak, Nardin Aslih, Saja Anabousi-Murra, Ester Pri-Or, Linda Harel, Sima Siev, Marwan Hakim, Christina Simona Khoury, Najla Hamati, Mazen El-Zibdeh, Lama Yousef, Ruth Hughes, Di Leishman, Barbra Pullar, Matthew Farrant, Malgorzata Swiatkowska-Freund, Krzysztof Preis, Anette Aleksandra Traczyk-Los, Anna Partyka, Joanna Preis-Orlikowska, Mariusz Lukaszuk, Grzegorz Krasomski, Michael Krekora, Anna Kedzierska-Markowicz, Katarzyna Zych-Krekora, Grzegorz H. Breborowicz, Anna Dera-Szymanowska, Jannet Bakker, Joost Akkermans, Eline van den Akker, Sabine Logtenberg, Steven Koenen, Maartje de Reus, David Borman, Martijn A. Oudijk, Annemiek Bolte, Viki Verfaille, Bart Graaf, Martina Porath, Corine Verhoeven, Maureen T.M. Franssen, Lida Ulkeman, Ineke Hamming, Jose H.M. Keurentjes, Ina van der Wal, S.W.A. Nij Bijvank, A.A. Lutjes, Henricus Visser, Hubertina Catharina Johanna Scheepers, Erik van Beek, Coby van Dam, Kathy van den Berg-Swart, Paula Pernet, Birgit van der Goes, Nico Schuitemaker, Gunilla Kleiverda, Marcel van Alphen, Ageeth Rosman, Ingrid Gaugler-Senden, Marieke Linders, Catherine Nelson-Piercy, Annette Briley, May Ching Soh, Kate Harding, Hayley Tarft, David Churchill, Katherine Cheshire, Julia Icke, Mausumi Ghosh, James Thornton, Yvonne Toomassi, Karen Barker, Joanne Fisher, Nicky Grace, Amanda Green, Joanne Gower, Anna Molnar, Shobhana Parameshwaran, Andrew Simm, George Bugg, Yvette Davis, Ruta Desphande, Yvette Gunn, Mohammed Houda, Nia Jones, Jason Waugh, Carly Allan, Gareth Waring, Steve A. Walkinshaw, Angela Pascall, Mark Clement-Jones, Michelle Dower, Gillian Houghton, Heather Longworth, Tej Purewal, Derek Tuffnell, Diane Farrar, Jennifer Syson, Gillian Butterfield, Vicky Jones, Rebecca Palethorpe, Tracey Germaine, Marwan Habiba, Debbie Lee, Olufemi Eniola, Lynne Blake, Jane Khan, Helen M. Cameron, Kim Hinshaw, Amanda Bargh, Eileen Walton, Olanrewaju Sorinola, Anna Guy, Zoe D’Souza, Rhiannon Gabriel, Jo Williams, Heidi Hollands, Olujimi Jibodu, Sara Collier, Pauline Tottie, Claire Oxby, James Dwyer, Franz Majoko, Helen Goldring, Sharon Jones, Janet Cresswell, Louise Underwood, Mary Kelly-Baxter, Rebecca Robinson, Dilly Anumba, Anne Chamberlain, Clare Pye, Clare Tower, Sue Woods, Lisa Horrocks, Fiona Prichard, Lynsey Moorhead, Sarah Lee, Louise Stephens, Cara Taylor, Suzanne Thomas, Melissa Whitworth, Jenny Myers, Ellen Knox, Katie Freitas, Mark Kilby, Amanda Cotterill, Khalil Abdo, Katrina Rigby, Julie Butler, Fiona Crosfill, Sean Hughes, Sanjeev Prashar, Fatimah Soydemir, Janet Ashworth, Lorraine Mycock, Jill Smith, Amaju Ikomi, Kerry Goodsell, Jean Byrne, Maxwell Masuku, Alice Pilcher, Meena Khandelwal, Gunda Simpkins, Michelle Iavicoli, Yon Sook Kim, Richard Fischer, Robin Perry, Eugene Y. Chang, Tamara D. Saunders, Betty W. Oswald, Kristin D. Zaks, Sarosh Rana, Dawn McCullough, Anna Sfakianaki, Cheryl Danton, Erin Kustan, Luisa Coraluzzi, Helen How, Christina Waldon, Jeffrey Livingston, Sherry Jackson, Lisa Greene, Dinesh Shah, Jorge E. Tolosa, Monica Rincon, Leonardo Pereira, Amy E. Lawrence, Janice E. Snyder, D. Michael Armstrong, Teresa Blue, Austin Hester, Kathryn Salisbury, Obstetrics and gynaecology, APH - Quality of Care, Amsterdam Reproduction & Development (AR&D), Midwifery Science, Graduate School, Obstetrics and Gynaecology, and APH - Digital Health

Subjects
Gestational hypertension, medicine.medical_specialty, Randomization, Hypertension in Pregnancy, Birth weight, artikel tijdschrift, Preeclampsia, fetal growth restriction, preeclampsia, 03 medical and health sciences, 0302 clinical medicine, Internal Medicine, medicine, hypertension pregnancy-induced, 030212 general & internal medicine, humans, Pregnancy, 030219 obstetrics & reproductive medicine, pregnancy outcome, Obstetrics, business.industry, Gestational age, blood pressure, medicine.disease, 3. Good health, Blood pressure, business
Abstract

For hypertensive women in CHIPS (Control of Hypertension in Pregnancy Study), we assessed whether the maternal benefits of tight control could be achieved, while minimizing any potentially negative effect on fetal growth, by delaying initiation of antihypertensive therapy until later in pregnancy. For the 981 women with nonsevere, chronic or gestational hypertension randomized to less-tight (target diastolic blood pressure, 100 mm Hg), or tight (target, 85 mm Hg) control, we used mixed-effects logistic regression to examine whether the effect of less-tight (versus tight) control on major outcomes was dependent on gestational age at randomization, adjusting for baseline factors as in the primary analysis and including an interaction term between gestational age at randomization and treatment allocation. Gestational age was considered categorically (quartiles) and continuously (linear or quadratic form), and the optimal functional form selected to provide the best fit to the data based on the Akaike information criterion. Randomization before (but not after) 24 weeks to less-tight (versus tight) control was associated with fewer babies with birth weight P interaction =0.005), but more preterm birth ( P interaction =0.043), and no effect on perinatal death or high-level neonatal care >48 hours ( P interaction =0.354). For the mother, less-tight (versus tight) control was associated with more severe hypertension at all gestational ages but particularly so before 28 weeks ( P interaction =0.076). In women with nonsevere, chronic, or gestational hypertension, there seems to be no gestational age at which less-tight (versus tight) control is the preferred management strategy to optimize maternal or perinatal outcomes. Clinical Trial Registration— URL: https://www.isrctn.com . Unique identifier: ISRCTN71416914.

Published
2018

7. 1050: Cross-modality, in-vivo validation of 4D-Flow MRI evaluation of uterine artery blood flow in human pregnancy

Author

Brianna F. Moon, Ana E. Rodríguez-Soto, Nadav Schwartz, Marta Vidorreta, Kirpal Kochar, Mary D. Sammel, John A. Detre, Nathanel C. Koelper, Matthew Dylan Tisdall, Shobhana Parameshwaran, Felix W. Wehrli, Eileen Hwuang, and Walter R Witschey

Subjects
medicine.medical_specialty, Pregnancy, Cross modality, business.industry, In vivo, medicine.artery, medicine, Obstetrics and Gynecology, Radiology, Blood flow, Uterine artery, business, medicine.disease
Published
2019

8. Routine antenatal management later in pregnancy

Author

Lucy Kean and Shobhana Parameshwaran

Subjects
Pregnancy, medicine.medical_specialty, Reproductive Medicine, business.industry, Obstetrics, Obstetrics and Gynecology, Medicine, business, medicine.disease, Routine antenatal care
Abstract

Routine antenatal care in later pregnancy is geared towards the detection of problems requiring specialist input and the reassurance that pregnancy is progressing well when no problems are identified. This review follows on from ‘routine antenatal management at the booking clinic', and assesses the specific tasks and investigations that are routine for all women in later pregnancy.

Published
2013

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