The long term objective of this project is to develop four MR methodologies to assess placental structure, microstructure and function across gestation, to integrate these into one comprehensive MR examination that is acceptable to pregnant women and to combine this with continuous fetal ECG recordings to provide a step change in antenatal assessment of the normal and abnormally developing placenta when compared to current methods such as those based on ultrasound, velocimetry and serum markers.
Specific aims are: To implement and optimize the following techniques: discriminant microstructure assessment based on diffusion imaging, MR elastography and MR susceptibility and hyperoxia for placental imaging so that each is capable of providing sensitive and reliable information. To accelerate these individual methods within a motion correction framework to produce a single robust integrated MR examination that takes no longer than 60 minutes' scanning time. To use this approach to identify differences in placental structure and function across gestation; between normal pregnancies and those at high risk of obstetric syndromes, considered to be secondary to inadequate placental implantation, fetal growth restriction and preeclampsia; and in women with a high BMI >30kg/mm2. To combine highly detailed MRI examination of the placenta with an indirect measure of placental function provided by assessment of fetal heart rate variability. The latter can be determined using overnight continuous fetal ECG, which can be obtained more frequently during progression of an at-risk pregnancy and so provide a comprehensive assessment capability. To validate our approach against placental histology and pregnancy outcomes. The project will deliver a new capability to assess and monitor the placenta in at-risk pregnancies. As obesity rates continue to rise, there will be an increasing burden of such pregnancies and an increasing benefit to society from managing these pregnancies more effectively based on more robust, detailed and comprehensive information.
An increasing number of women are at risk of poor pregnancy outcomes because of placental dysfunction. Current approaches for screening and monitoring high-risk women are not adequate, leading to needless maternal and fetal mortality and morbidity. A comprehensive assessment of placental structure and function, using combined MR methodologies and fetal ECG will improve detection of poor placental implantation and dysfunction, identify women for appropriate interventions and improve monitoring prior to delivery in order to improve outcomes for both mother and child.
|Hutter, Jana; Slator, Paddy J; Christiaens, Daan et al. (2018) Integrated and efficient diffusion-relaxometry using ZEBRA. Sci Rep 8:15138|