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Register a new userAbnormality of the placental vasculature affects placental thickness
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Our empirical modeling suggests that deformation of placental vascular growth is associated with abnormal placental chorionic surface shape. Altered chorionic surface shape is associated with lowered placental functional efficiency. We hypothesize that placentas with deformed chorionic surface vascular trees and reduced functional efficiency also have irregular vascular arborization that will be reflected in increased variability of placental thickness and a lower mean thickness. We find that non-centrality of the umbilical cord insertion is strongly and significantly correlated with disk thickness (Spearmans rho=0.128, p=0.002). Deformed shape is strongly and significantly associated with lower overall thickness and higher variability of thickness with beta between -0.173 and -0.254 (p<0.001) . Both lower mean thickness and high variability of thickness are strongly correlated with higher beta (reduced placental efficiency) (p<0.001 and p=0.038 respectively). Greater thickness variability is correlated with higher beta independent of the other placental shape variables p=0.004.
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We tested the hypothesis that the fetal-placental relationship scales allometrically and identified modifying factors. Among women delivering after 34 weeks but prior to 43 weeks gestation, 24,601 participants in the Collaborative Perinatal Project (CPP) had complete data for placental gross proportion measures, specifically, disk shape, larger and smaller disk diameters and thickness, and umbilical cord length. The allometric metabolic equation was solved for alpha and beta by rewriting PW= alpha(BW)^beta as Log (PW) = Log(alpha) + beta*Log(BW). Mean beta was 0.78+ 0.02 (range 0.66, 0.89), 104% of that predicted by a supply-limited fractal system (0.75). Gestational age, maternal age, maternal BMI, parity, smoking, socioeconomic status, infant sex, and changes in placental proportions each had independent and significant effects on alpha. Conclusions: In the CPP cohort, the placental - birth weight relationship scales to approximately 3/4 power.
The primary exchange units in the human placenta are terminal villi, in which fetal capillary networks are surrounded by a thin layer of villous tissue, separating fetal from maternal blood. To understand how the complex spatial structure of villi influences their function, we use an image-based theoretical model to study the effect of tissue metabolism on the transport of solutes from maternal blood into the fetal circulation. For solute that is taken up under first-order kinetics, we show that the transition between flow-limited and diffusion-limited transport depends on two new dimensionless parameters defined in terms of key geometric quantities, with strong solute uptake promoting flow-limited transport conditions. We present a simple algebraic approximation for solute uptake rate as a function of flow conditions, metabolic rate and villous geometry. For oxygen, accounting for nonlinear kinetics using physiological parameter values, our model predicts that villous metabolism does not significantly impact oxygen transfer to fetal blood, although the partitioning of fluxes between the villous tissue and the capillary network depends strongly on the flow regime.
Weight at delivery is a standard cumulative measure of placental growth. But weight is a crude summary of other placental characteristics, such as the size and shape of the chorionic plate and the location of the umbilical cord insertion. Distributions of such measures across a cohort reveal information about the developmental history of the chorionic plate that is unavailable from an analysis based solely on the mean and standard deviation. Various measures were determined from digitized images of chorionic plates obtained from the Pregnancy, Infection, and Nutrition Study, a prospective cohort study of preterm birth in central North Carolina between 2002 and 2004. The centroids (the geometric centers) and umbilical cord insertions were taken directly from the images. The chorionic plate outlines were obtained from an interpolation based on a Fourier series, while eccentricity (of the best-fit ellipse), skewness, and kurtosis were determined from a shape analysis using the method of moments. The distribution of each variable was compared against the normal, lognormal, and Levy distributions. We found only a single measure (eccentricity) with a normal distribution. All other placental measures required lognormal or heavy-tailed distributions to account for moderate to extreme deviations from the mean, where relative likelihoods in the cohort far exceeded those of a normal distribution. Normal and lognormal distributions result from the accumulated effects of a large number of independent additive (normal) or multiplicative (lognormal) events. Thus, while most placentas appear to develop by a series of small, regular, and independent steps, the presence of heavy-tailed distributions suggests that many show shape features which are more consistent with a large number of correlated steps or fewer, but substantially larger, independent steps.
During fetoscopic laser photocoagulation, a treatment for twin-to-twin transfusion syndrome (TTTS), the clinician first identifies abnormal placental vascular connections and laser ablates them to regulate blood flow in both fetuses. The procedure is challenging due to the mobility of the environment, poor visibility in amniotic fluid, occasional bleeding, and limitations in the fetoscopic field-of-view and image quality. Ideally, anastomotic placental vessels would be automatically identified, segmented and registered to create expanded vessel maps to guide laser ablation, however, such methods have yet to be clinically adopted. We propose a solution utilising the U-Net architecture for performing placental vessel segmentation in fetoscopic videos. The obtained vessel probability maps provide sufficient cues for mosaicking alignment by registering consecutive vessel maps using the direct intensity-based technique. Experiments on 6 different in vivo fetoscopic videos demonstrate that the vessel intensity-based registration outperformed image intensity-based registration approaches showing better robustness in qualitative and quantitative comparison. We additionally reduce drift accumulation to negligible even for sequences with up to 400 frames and we incorporate a scheme for quantifying drift error in the absence of the ground-truth. Our paper provides a benchmark for fetoscopy placental vessel segmentation and registration by contributing the first in vivo vessel segmentation and fetoscopic videos dataset.
This paper presents a novel deformable registration framework, leveraging an image prior specified through a denoising function, for severely noise-corrupted placental images. Recent work on plug-and-play (PnP) priors has shown the state-of-the-art performance of reconstruction algorithms under such priors in a range of imaging applications. Integration of powerful image denoisers into advanced registration methods provides our model with a flexibility to accommodate datasets that have low signal-to-noise ratios (SNRs). We demonstrate the performance of our method under a wide variety of denoising models in the context of diffeomorphic image registration. Experimental results show that our model substantially improves the accuracy of spatial alignment in applications of 3D in-utero diffusion-weighted MR images (DW-MRI) that suffer from low SNR and large spatial transformations.
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