Donald School Journal of Ultrasound in Obstetrics and Gynecology

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VOLUME 8 , ISSUE 4 ( October-December, 2014 ) > List of Articles


Difference between Vascularization Indexes of the Placenta in Severe Pre-eclampsia and Normal Pregnancy by Three-dimensional Power Doppler Ultrasound

Wiku Andonotopo, Herman Kristanto, Besari Adi Pramono

Keywords : Pre-eclampsia,3D power Doppler,Placental vascular biopsy,Vascular index

Citation Information : Andonotopo W, Kristanto H, Pramono BA. Difference between Vascularization Indexes of the Placenta in Severe Pre-eclampsia and Normal Pregnancy by Three-dimensional Power Doppler Ultrasound. Donald School J Ultrasound Obstet Gynecol 2014; 8 (4):329-335.

DOI: 10.5005/jp-journals-10009-1372

License: CC BY-NC 4.0

Published Online: 01-09-2015

Copyright Statement:  Copyright © 2014; The Author(s).



The object of this study was to analyze the vascularization index of three-dimensional (3D) power Doppler ultrasound (PDUS) of the placenta in severe pre-eclampsia compared with normal pregnancy conditions by vascular biopsy sampling sphere.

Subjects and methods

This study is a prospective longitudinal observational study on 80 pregnant women which divided into 2 groups: Group I (study group) were 40 pregnant women with severe pre-eclampsia, group II (control group) were 40 pregnant women without disorder. Variables examined in this study were vascular index (VI), flow index (FI) and vascular flow index (VFI) of the 3D-PD placental perfusion. Its correlation to gestational age in normal pregnancy compared with the condition of preeclampsia were obtained by taking multiple biopsy sampling vascular sphere. All pregnant women underwent 3D PD-US examination (single examination only), data volume recorded of the placenta allows for off-line analysis without the presence of the patient, thus allowing the data analysis done anywhere and anytime by observers for the comparative analysis of interobserver reliability.


The placenta can be visualized perfectly in both of the study group and also the control group. Average Kappa value for the acquisition of placental vascularization index measurements with 3D PD-US was 0.72 (0.61-0.82), 0.73 (0.65-0.82) and 0.71 (0.61-0.81) for VI, FI and VFI in the range of 20 to 38 weeks showed good interobserver reliability. All 3D power Doppler indices had a significant association with gestational age, with VI showed a less significant relationship (r = 0.207, p = 0.0139) and FI has the most significant relationship (r = 0.582, p < 0.001). FI index increased progressively with gestational age, while the VI index values indicate dispersion pattern and reached a plateau from week 30 onwards. Entering week 37th, there was a decrease in the value of the index VI until the end of pregnancy. Meanwhile, VFI index appears to resemble the pattern of a combination of both VI and FI index (r = 0.692, p <0.001).


All parameters of 3D power Doppler index was lower in the severe pre-eclampsia compared with normal pregnancy. 3D PD-US can be used to assess the vascularization of the placenta and the intensity of intra-placental blood flow. Placental vascular biopsy method is fairly efficient way to perform routine evaluations evolution of placental vascular branch during pregnancy.

How to cite this article

Andonotopo W, Kristanto H, Dewantiningrum J, Pramono BA. Difference between Vascularization Indexes of the Placenta in Severe Pre-eclampsia and Normal Pregnancy by Three-dimensional Power Doppler Ultrasound. Donald School J Ultrasound Obstet Gynecol 2014;8(4):329-335.

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  1. Pregnancy hypertension. In William Obstetrics: 23rd ed. USA: McGraw-Hill 2010:706-749.
  2. Placenta: angiogenesis and vascular assessment through three-dimensional power Doppler ultrasonography. Arch Gynecol Obstet 2008; 277:195-200.
  3. Placental vasculature as visualized by 3D power Doppler angiography and 3D color Doppler imaging. Ultrasound Obstet Gynecol 2007;30:917-920.
  4. Three-dimensional power Doppler: validity and reliability. Ultrasound Obstet Gynecol 2010;36:530-533.
  5. Correlation between uteroplacental three-dimensional power Doppler indices and true uterine blood flow: evaluation in a pregnant sheep model. Ultrasound Obstet Gynecol 2010;36:635-640.
  6. Determining the relationship between three-dimensional power Doppler data and true blood flow characteristics: an in vitro flow phantom experiment. Ultrasound Obstet Gynecol 2008;32:540-550.
  7. In vitro dual perfusion of human placental lobules as a flow phantom to investigate the relationship between fetoplacental flow and quantitative 3D power Doppler angiography. Placenta 2009;30:130-135.
  8. Placental vascular sonobiopsy using three-dimensional power Doppler ultrasound in normal and growth restricted fetuses. Placenta 2009;30:391-397.
  9. Assessment of placental fractional moving blood volume using quantitative three-dimensional power doppler ultrasound. Ultrasound Med Biol 2003;29:19-23.
  10. Assessment of placental vascularization by three-dimensional power Doppler ‘vascular biopsy’ in normal pregnancies. Croat Med J 2005;46: 765-771.
  11. Intervillous and uteroplacental circulation in normal early pregnancy and early pregnancy loss assessed by 3-dimensional power Doppler angiography. Am J Obstet Gynecol 2009;200:315.e1-8.
  12. Effects of maternal cigarette smoking on placental volume and vascularization measured by 3-dimensional power Doppler ultrasonography at 11+0 to 13+6 weeks of gestation. Am J Obstet Gynecol 2009;200:415.e1-5.
  13. An assessment of vascularity and flow intensity of the placenta in normal pregnancy and pre-eclampsia using three-dimensional ultrasound. J Matern Fetal Neonatal Med 2010;23:894-899.
  14. First-trimester 3-dimensional power Doppler of the uteroplacental circulation space: a potential screening method for pre-eclampsia. Am J Obstet Gynecol 2010;203:238.e1-7.
  15. Is three-dimensional power Doppler ultrasound useful in the assessment of placental perfusion in normal and growth restricted pregnancies? Ultrasound Obstet Gynecol 2008;31:171-176.
  16. Placental volume and three-dimensional power Doppler analysis in prediction of pre-eclampsia and small for gestational age between Week 11 and 13 weeks and 6 days of gestation. Prenat Diagn 2011; 31:367-371.
  17. Quantitative three-dimensional power Doppler angiography: a flow free phantom experiment to evaluate the relationship between color gain, depth and signal artifact. Ultrasound Obstet Gynecol 2010;35:361-368.
  18. Evaluation of the effect of machine settings on quantitative three-dimensional power Doppler angiography: an in vitro flow phantom experiment. Ultrasound Obstet Gynecol 2008;32:551-559.
  19. Evaluation of volume vascularization index and flow index: a phantom study. Ultrasound Obstet Gynecol 2008;32:560-564.
  20. Does sphere volume affect the performance of three-dimensional power Doppler virtual vascular sampling for predicting malignancy in vascularized solid or cystic-solid adnexal masses? Ultrasound Obstet Gynecol 2010;35:602-608.
  21. Quantitative analysis of placental vasculature by three-dimensional power Doppler ultrasonography in normal pregnancies from 12 to 40 weeks of gestation. Placenta 2009;30:142-148.
  22. First-trimester 3-dimensional power Doppler for the screening of preeclampsia: the analysis of a greater proportion of the uteroplacental unit might improve the accuracy of the method. Am J Obstet Gynecol 2011;204:e4-5; author reply e5-6.
  23. The ‘volumetric’ pulsatility index as evaluated by spatiotemporal imaging correlation (STIC): a preliminary description of a novel technique, its application to the endometrium and an evaluation of its reproducibility. Ultrasound Med Biol 2011;37:2160-2168.
  24. Reproducibility of first trimester three-dimensional placental measurements in the evaluation of early placental insufficiency. J Obstet Gynaecol Can 2009;31:1144-1148.
  25. Reproducibility of three-dimensional power Doppler placental vascular indices in pregnancies between 26 and 35 weeks. Arch Gynecol Obstet 2011;283:213-217.
  26. Reproducibility of placental volume and vasculature indices obtained by 3-dimensional power Doppler sonography. J Ultrasound Med 2010;29:911-916.
  27. Evaluation of the intraobserver and interobserver reliability of data acquisition for three-dimensional power Doppler angiography of the whole placenta at 12 weeks gestation. Ultrasound Med Biol 2010;36:1405-1411.
  28. Evaluating the intra- and interobserver reliability of threedimensional ultrasound and power Doppler angiography (3D-PDA) for assessment of placental volume and vascularity in the second trimester of pregnancy. Ultrasound Med Biol 2011;37:376-385.
  29. Reproducibility of regional placental vascularity/perfusion measurement using 3D power Doppler. Ultrasound Obstet Gynecol 2010;36:202-209.
  30. Reproducibility of the study of placental vascularization by three-dimensional power Doppler. J Perinat Med 2004;32:228-233.
  31. Evaluation of a clinical test. I: assessment of reliability. BJOG 2001;108:562-567.
  32. Reproducibility of 3D power Doppler placental vascular indices. Arch Gynecol Obstet 2011;283:403-404.
  33. Computer analysis of threedimensional power angiography images of foetal cerebral, lung and placental circulation in normal and high-risk pregnancy. Ultrasound Med Biol 2005;31:321-327.
  34. Imaging of placental vasculature using three-dimensional ultrasound and color power Doppler: a preliminary study. Ultrasound Obstet Gynecol 1998;12:45-49.
  35. Assessment of placental fractional moving blood volume using quantitative three-dimensional power Doppler ultrasound. Ultrasound Med Biol 2003;29:19-23.
  36. 3D power Doppler in the study of fetal and maternal angiogenesis and vasculogenesis. The Ultrasound Review of Obstetrics and Gynecology 2006;6:1-19.
  37. Placental blood flow measured by simultaneous multigate spectral Doppler imaging in pregnancies complicate by placental vascular abnormalities. Ultrasound Obstet Gynecol 1999;14:262-266.
  38. Investigation of intraplacental villous arteries by Doppler flow imaging in growth-restricted fetuses. Am J Obstet Gynecol 2002;186:297-302.
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