Assessing Placental Shear Wave Elastography as a Tool for Evaluating Preeclampsia

Abstract

Background Hypertensive disorders of pregnancy, especially its dreaded complication preeclampsia, remain a major cause of morbidity and mortality for both the mother and the fetus. Existing tools for the prediction of preeclampsia remain inadequate in their sensitivity and specificity. Hence, there is an urgent need for a reliable, economically feasible, and objective marker for its diagnosis/early prediction. In this regard, shear wave elastography has shown great promise. Shear wave elastography is a novel method to quantify tissue stiffness, which is objective and has significantly lower inter-observer variability. Objectives We aim to quantify the tissue elasticity using point shear wave elastography (pSWE) in the placentas of diagnosed cases of preeclampsia and to compare them with the placentas of healthy controls in order to evaluate if there is a significant statistical difference between the two. Materials and methods This comparative study was conducted at the Department of Radiodiagnosis, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, India, from August 2022 to July 2024. The study included 60 participants, divided into two groups: 30 patients with preeclampsia and 30 healthy pregnancies. Placental stiffness was measured using a Samsung HS70A ultrasound machine (Samsung Electronics Pvt. Ltd., Seoul, South Korea), and pSWE was performed with a curvilinear probe. Data was analyzed using IBM SPSS Statistics for Windows, Version 21 (Released 2012; IBM Corp., Armonk, New York, United States), and the significance of differences between the two groups was assessed using an independent t-test with a p-value of <0.05, considered statistically significant. Results The mean placental stiffness, measured in kilopascals (kPa), was significantly higher in the preeclampsia group (11.71 ± 1.52 kPa) in comparison to the healthy group (3.36 ± 0.66 kPa) (p = 0.001). Patients suffering from preeclampsia were found to have significantly higher levels of placental stiffness. Conclusion Early diagnosis remains key to managing preeclampsia so that adequate monitoring and treatment could be provided to the patients. Our study showed that there is a significant statistical difference in the placental stiffness in patients with preeclampsia in comparison to a healthy placenta. Hence, shear wave elastography can be used as a supplementary tool to aid in the diagnosis/prediction of preeclampsia.

Keywords: fetal growth restriction; hypertensive disorders of pregnancy; prediction of preeclampsia; preeclampsia; shear wave elastography.

Figure 1. pSWE image showing placental tissue stiffness in the region of interest (ROI) in two patients.

A: showing placental stiffness measurement in a 24-year-old G2P1L1 (29 weeks’ gestation); B: showing placental stiffness in a 24-year-old primigravida (28 weeks’ gestation), diagnosed case of preeclampsia pSWE: point shear wave elastography

Figure 2. Bar graph showing comparison of the mean placental stiffness (kPa) between the groups.

Group A: controls; Group B: cases