Quantitative ultrasound characterization of the human placenta for detection of placenta-mediated pregnancy complications

Quantitative Ultrasound in Placenta (QUS-P) measures the acoustic properties of the underlying tissue and therefore can be used to detect structural changes associated with placenta-mediated diseases in utero. To develop a real-time, non-invasive clinical tool using QUS-P, we first conducted an ex-vivo study on post-delivery human placentas (n = 47), of which 25 were from pregnancies affected by pre-eclampsia (PE) and/or small-for-gestational age (SGA). Ultrasound radio-frequency data were analyzed to estimate QUS-P parameters: attenuation coefficient, backscatter coefficient and effective scatterer diameter. A logistic regression model developed using these QUS-P parameters achieved high discrimination (AUROC: 0.89 (95% CI: 0.78–0.98)) and calibration (slope: 0.93 and intercept 0.003) for PE/SGA detection. Building on these findings, we conducted STIMULUS, an in utero study involving pregnant participants (34–36 weeks gestation). Preliminary analysis (n = 184) identified 29 (15.8%) neonates with perinatal hypoxia, 5 of which showed maternal/fetal vascular malperfusion. Logistic regression using QUS-P parameters predicted hypoxia with an AUROC of 0.70 (95% CI: 0.58–0.81) and the sub-category of placenta-mediated hypoxia with an AUROC of 0.98 (95% CI: 0.88–1.0). The findings demonstrate that QUS-P holds potential for integration into prenatal care as an early, non-invasive tool for predicting placenta-mediated diseases before clinical onset.