Placental thickness and imaging biomarkers as predictors of neonatal outcomes in term singleton pregnancies in a tertiary hospital in Uyo

Abstract

Context: Accurate antenatal prediction of neonatal outcomes remains a global clinical challenge, particularly in low-resource settings. Placental imaging biomarkers are underutilized in routine obstetric practice.

Aim: To assess placental thickness and selected ultrasound-derived placental imaging biomarkers as predictors of adverse neonatal outcomes.

Materials and Methods: This prospective cross-sectional analytical study included 320 term singleton pregnancies to evaluate the association between placental thickness, Doppler indices, and neonatal outcomes. Placental thickness, echotexture, placental lakes, uterine and umbilical artery Doppler indices were measured. Neonatal outcomes assessed included birth weight, 5-minute Apgar score, neonatal intensive care unit (NICU) admission, and early neonatal morbidity. Multivariable logistic regression identified independent associations between placental parameters and outcomes.

Results: Abnormal placental thickness (thin) was observed in 38 (64.4%) and (thick) 21 (35.6%) of abnormal placentas. Abnormal echotexture and placental lakes were seen in 67 (20.9%) and 58 (18.1%), respectively. Elevated umbilical and uterine artery resistance was noted in 51 (15.9%) and 45 (14.1%) of cases. Adverse neonatal outcomes included 20 (33.9%) low birth weight, 16 (27.1%) low Apgar score, and 23 (39.0%) NICU (Neonatal Intensive Care Unit) admissions. Multivariable analysis showed that combined placental biomarkers independently predicted adverse outcomes shown by abnormal placental thickness (AOR-7.85, P-value - <0.001, 95% CI: 4.10-15.02), Elevated umbilical resistive index (AOR-5.62, P-value - <0.001, 95% CI: 2.90-10.88) and abnormal uterine artery Doppler (AOR-4.97, P-value - <0.001, 95% CI: 2.45-10.10)

Conclusion: Placental thickness combined with imaging biomarkers such as echotexture, lakes, and Doppler indices provides a practical, non-invasive approach to predict neonatal outcomes, supporting comprehensive placental evaluation in antenatal care.