The online version of this article (doi:10.1186/1475-2875-11-5) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
MJR designed the study, carried out the ultrasound scanning, performed the statistical analysis and drafted the manuscript. WEM performed the volume measurements, helped with the statistical analysis and drafted the manuscript. SK carried out the ultrasound scanning and organized the study on site. GS helped with the volume measurements and organized the database. EO performed the statistical analysis and helped to draft the manuscript. JAN participated in the design and coordination of the study. SHK participated in its design and coordination of the study. RMG participated in the design and coordination of the study, helped in the statistical analysis and helped to draft the manuscript. ATP participated in the design and coordination of the study, helped in the statistical analysis and helped to draft the manuscript. FN conceived of the study and participated in the design and coordination of the study, and helped to draft the manuscript. All authors read and approved the final manuscript.
The presence of malaria parasites and histopathological changes in the placenta are associated with a reduction in birth weight, principally due to intrauterine growth restriction. The aim of this study was to examine the feasibility of studying early pregnancy placental volumes using three-dimensional (3D) ultrasound in a malaria endemic area, as a small volume in the second trimester may be an indicator of intra-uterine growth restriction and placental insufficiency.
Placenta volumes were acquired using a portable ultrasound machine and a 3D ultrasound transducer and estimated using the Virtual Organ Computer-aided AnaLysis (VOCAL) image analysis software package. Intra-observer reliability and limits of agreement of the placenta volume measurements were calculated. Polynomial regression models for the mean and standard deviation as a function of gestational age for the placental volumes of uninfected women were created and tested. Based on these equations each measurement was converted into a z -score. The z-scores of the placental volumes of malaria infected and uninfected women were then compared.
Eighty-four women (uninfected = 65; infected = 19) with a posterior placenta delivered congenitally normal, live born, single babies. The mean placental volumes in the uninfected women were modeled to fit 5th, 10th, 50th, 90th and 95th centiles for 14-24 weeks' gestation. Most placenta volumes in the infected women were below the 50th centile for gestational age; most of those with Plasmodium falciparum were below the 10th centile. The 95% intra-observer limits of agreement for first and second measurements were ± 37.0 mL and ± 25.4 mL at 30 degrees and 15 degrees rotation respectively.
The new technique of 3D ultrasound volumetry of the placenta may be useful to improve our understanding of the pathophysiological constraints on foetal growth caused by malaria infection in early pregnancy.
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- Effect of malaria on placental volume measured using three-dimensional ultrasound: a pilot study
Marcus J Rijken
William E Moroski
Eric O Ohuma
J Alison Noble
Stephen H Kennedy
Aris T Papageorghiou
François H Nosten
- BioMed Central
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