Trans-abdominal in vivo placental vessel occlusion using High Intensity Focused Ultrasound.
View / Open Files
Authors
Shaw, Caroline J
Rivens, Ian
Civale, John
Botting, Kimberley J
Ter Haar, Gail
Publication Date
2018-09-11Journal Title
Sci Rep
ISSN
2045-2322
Publisher
Springer Science and Business Media LLC
Volume
8
Issue
1
Pages
13631
Language
eng
Type
Article
Physical Medium
Electronic
Metadata
Show full item recordCitation
Shaw, C. J., Rivens, I., Civale, J., Botting, K. J., Ter Haar, G., Giussani, D. A., & Lees, C. C. (2018). Trans-abdominal in vivo placental vessel occlusion using High Intensity Focused Ultrasound.. Sci Rep, 8 (1), 13631. https://doi.org/10.1038/s41598-018-31914-4
Abstract
Pre-clinically, High Intensity Focused Ultrasound (HIFU) has been shown to safely and effectively occlude placental blood vessels in the acute setting, when applied through the uterus. However, further development of the technique to overcome the technical challenges of targeting and occluding blood vessels through intact skin remains essential to translation into human studies. So too does the assessment of fetal wellbeing following this procedure, and demonstration of the persistence of vascular occlusion. At 115 ± 10 d gestational age (term~147 days) 12 pregnant sheep were exposed to HIFU (n = 6), or to a sham (n = 6) therapy through intact abdominal skin (1.66 MHz, 5 s duration, in situ ISPTA 1.3-4.4 kW.cm-2). Treatment success was defined as undetectable colour Doppler signal in the target placental vessel following HIFU exposures. Pregnancies were monitored for 21 days using diagnostic ultrasound from one day before HIFU exposure until term, when post-mortem examination was performed. Placental vessels were examined histologically for evidence of persistent vascular occlusion. HIFU occluded 31/34 (91%) of placental vessels targeted, with persistent vascular occlusion evident on histological examination 20 days after treatment. The mean diameter of occluded vessels was 1.4 mm (range 0.3-3.3 mm). All pregnancies survived until post mortem without evidence of significant maternal or fetal iatrogenic harm, preterm labour, maternal or fetal haemorrhage or infection. Three of six ewes exposed to HIFU experienced abdominal skin burns, which healed without intervention within 21 days. Mean fetal weight, fetal growth velocity and other measures of fetal biometry were not affected by exposure to HIFU. Fetal Doppler studies indicated a transient increase in the umbilical artery pulsatility index (PI) and a decrease in middle cerebral artery PI as a result of general anaesthesia, which was not different between sham and treatment groups. We report the first successful application of fully non-invasive HIFU for occlusion of placental blood flow in a pregnant sheep model, with a low risk of significant complications. This proof of concept study demonstrates the potential of this technique for clinical translation.
Keywords
Uterus, Blood Vessels, Middle Cerebral Artery, Umbilical Arteries, Fetus, Placenta, Animals, Sheep, Humans, Disease Models, Animal, Hemorrhage, Ultrasonography, Prenatal, Blood Flow Velocity, Pregnancy, Female, High-Intensity Focused Ultrasound Ablation
Identifiers
External DOI: https://doi.org/10.1038/s41598-018-31914-4
This record's URL: https://www.repository.cam.ac.uk/handle/1810/285818
Statistics
Total file downloads (since January 2020). For more information on metrics see the
IRUS guide.
Recommended or similar items
The current recommendation prototype on the Apollo Repository will be turned off on 03 February 2023. Although the pilot has been fruitful for both parties, the service provider IKVA is focusing on horizon scanning products and so the recommender service can no longer be supported. We recognise the importance of recommender services in supporting research discovery and are evaluating offerings from other service providers. If you would like to offer feedback on this decision please contact us on: support@repository.cam.ac.uk