MRI Assessment of Placental Health
| Status: | Recruiting |
|---|---|
| Conditions: | Women's Studies |
| Therapuetic Areas: | Reproductive |
| Healthy: | No |
| Age Range: | 18 - 45 |
| Updated: | 6/23/2017 |
| Start Date: | April 2014 |
| End Date: | September 2020 |
The ultimate goal of this project is to develop methods that allow informed decision-making
on the delivery time of fetuses that are at increased risk of stillbirth due to IUGR. In
placenta related IUGR pregnancies, there can be multiple concurrent placental pathologies.
Although there is no specific correspondence between a single type of pathology and IUGR,
the common result of these pathologies is placental insufficiency, which limits the
maternal-fetal exchange. Oxygen and nutrition transport is known to be hindered in IUGR
placentas due to obstructed or abrupt vasculature, massive fibrin deposition, and
inflammation in the villous and intervillous space (villitis). Thus one potential approach
to distinguish IUGR pregnancies from normal ones is to assess the efficiency of placental
transport. Based on the hypothesis that efficiency of oxygen transport is representative for
overall oxygen and nutrition transport in placenta, the investigators propose to
characterize the blood oxygenation and blood perfusion in placenta in vivo via MRI, and use
it as an index for better stratification in the IUGR risk group. The investigators will also
consider alternative MRI approaches such as structural, diffusion and spectroscopy
measurements inside the placenta, which might reflect the state of placental transport and
reveal the status of placental health.
Specific aims: 1) To correlate the MRI metrics that differentiate placental insufficiency
from normal placenta transport with histopathology data of the placenta. 2) To correlate the
MRI metrics that reflects placental insufficiency with fetal outcome
on the delivery time of fetuses that are at increased risk of stillbirth due to IUGR. In
placenta related IUGR pregnancies, there can be multiple concurrent placental pathologies.
Although there is no specific correspondence between a single type of pathology and IUGR,
the common result of these pathologies is placental insufficiency, which limits the
maternal-fetal exchange. Oxygen and nutrition transport is known to be hindered in IUGR
placentas due to obstructed or abrupt vasculature, massive fibrin deposition, and
inflammation in the villous and intervillous space (villitis). Thus one potential approach
to distinguish IUGR pregnancies from normal ones is to assess the efficiency of placental
transport. Based on the hypothesis that efficiency of oxygen transport is representative for
overall oxygen and nutrition transport in placenta, the investigators propose to
characterize the blood oxygenation and blood perfusion in placenta in vivo via MRI, and use
it as an index for better stratification in the IUGR risk group. The investigators will also
consider alternative MRI approaches such as structural, diffusion and spectroscopy
measurements inside the placenta, which might reflect the state of placental transport and
reveal the status of placental health.
Specific aims: 1) To correlate the MRI metrics that differentiate placental insufficiency
from normal placenta transport with histopathology data of the placenta. 2) To correlate the
MRI metrics that reflects placental insufficiency with fetal outcome
Inclusion Criteria:
1. The pregnant mother with twin gestation with diagnosis of selective IUGR based upon
obstetrical US findings as following:
- Proven monochorionicity / dichotionicity
- Discordance in estimated fetal weight (EFW). Growth restriction (<10 percentile
of norm) in one or both fetus(es) AND/OR growth discordance (> or = 20%) between
twin fetuses.
2. The pregnant mother with singleton gestation with diagnosis of IUGR based upon
obstetrical US findings as following:
- Proven singleton gestation
- Growth restriction of fetus (<10 percentile of norm)
- Doppler measurements that indicates placental insufficiency: umbilical artery,
middle cerebral artery, uterine artery; or oligohydramnios.
3. Gestational age: Bigger than 18 weeks.
4. Pregnant mother is between age 18 to 45, clinically stable and can safely tolerate
fetal MRI study.
Exclusion Criteria:
Fetuses/infants with the following features will be excluded.
1. Fetus/infant with chromosomal anomalies or known genetic disorders.
2. Fetus/infant with other major congenital malformation.
3. Presence of any condition or abnormality that in the opinion of the Investigator
would compromise the safety of the patient, quality or completeness of the data.
Pregnant mothers with the following features will be excluded.
1. Mothers with contraindication to MRI (with pacemaker, metal in body, oversize).
2. Mothers with claustrophobia
3. Mothers medically unstable for the MRI study
We found this trial at
2
sites
300 Longwood Ave
Boston, Massachusetts 02115
Boston, Massachusetts 02115
(617) 355-6000
Phone: 857-218-5111
Boston Children's Hospital Boston Children's Hospital is a 395-bed comprehensive center for pediatric health care....
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