STUDY QUESTION Can three-dimensional (3D) Power Doppler (PD) ultrasound and a skeletonization algorithm be used to assess first-trimester development of the utero-placental vascular morphology? SUMMARY ANSWER The application of 3D PD ultrasonography and a skeletonization algorithm facilitates morphologic assessment of utero-placental vascular development in the first trimester and reveals less advanced vascular morphologic development in pregnancies with placenta-related complications than in pregnancies without placenta-related complications. WHAT IS KNOWN ALREADY Suboptimal development of the utero-placental vasculature is one of the main contributors to the periconceptional origin of placenta-related complications. The nature and attribution of aberrant vascular structure and branching patterns remain unclear, as validated markers monitoring first-trimester utero-placental vascular morphologic development are lacking. STUDY DESIGN, SIZE, DURATION In this prospective observational cohort, 214 ongoing pregnancies were included before 10 weeks gestational age (GA) at a tertiary hospital between January 2017 and July 2018, as a subcohort of the ongoing Rotterdam Periconception Cohort study. PARTICIPANTS/MATERIALS, SETTING, METHODS By combining 3D PD ultrasonography and virtual reality, utero-placental vascular volume (uPVV) measurements were obtained at 7, 9 and 11 weeks GA. A skeletonization algorithm was applied to the uPVV measurements to generate the utero-placental vascular skeleton (uPVS), a network-like structure containing morphologic characteristics of the vasculature. Quantification of vascular morphology was performed by assigning a morphologic characteristic to each voxel in the uPVS (end-, vessel-, bifurcation- or crossing-point) and calculating total vascular network length. A Mann-Whitney U test was performed to investigate differences in morphologic development of the first-trimester utero-placental vasculature between pregnancies with and without placenta-related complications. Linear mixed models were used to estimate trajectories of the morphologic characteristics in the first trimester. MAIN RESULTS AND THE ROLE OF CHANCE All morphologic characteristics of the utero-placental vasculature increased significantly in the first trimester (P < 0.005). In pregnancies with placenta-related complications (n = 54), utero-placental vascular branching was significantly less advanced at 9 weeks GA (vessel points P = 0.040, bifurcation points P = 0.050, crossing points P = 0.020, total network length P = 0.023). Morphologic growth trajectories remained similar after adjustment for parity, conception mode, foetal sex and occurrence of placenta-related complications. LIMITATIONS, REASONS FOR CAUTION The tertiary setting of this prospective observational study provides high internal, but possibly limited external, validity. Extrapolation of the study's findings should therefore be addressed with caution. WIDER IMPLICATIONS OF THE FINDINGS The uPVS enables assessment of morphologic development of the first-trimester utero-placental vasculature. Further investigation of this innovative methodology needs to determine its added value for the assessment of (patho-) physiological utero-placental vascular development. STUDY FUNDING/COMPETING INTEREST(S) This research was funded by the Department of Obstetrics and Gynecology of the Erasmus MC, University Medical Centre, Rotterdam, The Netherlands. There are no conflicts of interest. TRIAL REGISTRATION NUMBER Registered at the Dutch Trial Register (NTR6854).

中文翻译：

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使用骨架化算法通过 3D 能量多普勒超声图像分析评估早孕期子宫胎盘血管形态​​：鹿特丹围孕期队列。

研究问题 能否使用三维 (3D) 能量多普勒 (PD) 超声和骨骼化算法来评估子宫-胎盘血管形态​​的早孕发育？答案总结 应用 3D PD 超声检查和骨架化算法有助于在妊娠早期对子宫胎盘血管发育进行形态学评估，并揭示与没有胎盘相关并发症的妊娠相比，有胎盘相关并发症的妊娠的血管形态学发育程度较低。已知信息 子宫-胎盘血管系统发育不佳是胎盘相关并发症围孕期起源的主要原因之一。异常血管结构和分支模式的性质和归因仍不清楚，由于缺乏监测早孕期子宫胎盘血管形态​​发育的有效标记物。研究设计、规模、持续时间 在这个前瞻性观察队列中，2017 年 1 月至 2018 年 7 月期间，在一家三级医院纳入了 214 名孕龄 (GA) 未满 10 周的持续妊娠患者，作为正在进行的鹿特丹围孕期队列研究的一个子队列。参与者/材料、设置、方法 通过结合 3D PD 超声检查和虚拟现实，在 GA 7、9 和 11 周获得子宫胎盘血管体积 (uPVV) 测量值。将骨架化算法应用于 uPVV 测量以生成子宫胎盘血管骨架 (uPVS)，这是一种包含脉管系统形态特征的网络状结构。通过为 uPVS 中的每个体素（末端、血管、分叉点或交叉点）分配形态学特征并计算总血管网络长度来进行血管形态学的量化。进行了 Mann-Whitney U 检验以研究有和没有胎盘相关并发症的妊娠在早孕期子宫-胎盘血管形态​​发育方面的差异。线性混合模型用于估计妊娠早期形态特征的轨迹。主要结果和机会的作用 子宫胎盘脉管系统的所有形态学特征在妊娠早期显着增加 (P < 0.005)。在有胎盘相关并发症的妊娠中 (n = 54)，子宫胎盘血管分支在 GA 9 周时明显较不先进（血管点 P = 0.040，分叉点 P = 0.050，交叉点 P = 0.020，总网络长度 P = 0.023）。在对胎次、受孕方式、胎儿性别和胎盘相关并发症的发生进行调整后，形态学生长轨迹保持相似。局限性、谨慎的理由 本前瞻性观察研究的三级设置提供了较高的内部有效性，但外部有效性可能有限。因此，应谨慎处理研究结果的外推。研究结果的更广泛意义 uPVS 能够评估早孕期子宫-胎盘脉管系统的形态发育。对这种创新方法的进一步研究需要确定其对评估（病态）生理性子宫胎盘血管发育的附加值。研究资金/竞争利益 本研究由荷兰鹿特丹大学医学中心伊拉斯谟医学中心妇产科资助。没有利益上的冲突。试用注册号 在荷兰试用注册处注册 (NTR6854)。