Safety of contrast-enhanced ultrasound using microbubbles in human pregnancy: A scoping review

Abstract

Introduction Successful placentation is crucial for fetal development and maintaining a healthy pregnancy. Placental insufficiency can cause a variety of obstetric complications. Despite the many efforts to enhance diagnosing placental insufficiency, no imaging technique has proven satisfactory. A promising imaging technique is contrast-enhanced ultrasound (CEUS) using microbubbles which has proven capable of (micro)vascular imaging. Its use for placental vascularization assessment in human pregnancies remains constrained by limited evidence and safety concerns. This scoping review aims to demonstrate the safety of CEUS used in human pregnancy in the published literature to date.

Material and Methods A systematic search using PubMed, Medline, Embase, and Cochrane databases was performed. All studies where contrast-enhanced ultrasound was used in pregnant humans were included. Studies, where there was a planned termination of pregnancy, were excluded. To assess the safety of CEUS during pregnancy, relevant outcomes were divided into the following 3 categories; fetal outcome, maternal outcome, and pregnancy and neonatal outcomes.

Results A total of 13 articles were included, in which 256 women underwent CEUS during pregnancy. No clinically significant maternal or fetal adverse events or negative pregnancy or neonatal outcomes associated with CEUS were described.

Conclusion Based on our findings, we consider expanding the knowledge of this promising diagnostic technique in future larger clinical studies to be safe and relevant.

Zusammenfassung

Einleitung Eine erfolgreiche Plazentation ist entscheidend für die fetale Entwicklung und die Aufrechterhaltung einer gesunden Schwangerschaft. Eine Plazenta-Insuffizienz kann eine Reihe von geburtshilflichen Komplikationen verursachen. Trotz zahlreicher Bemühungen, die Diagnose der Plazenta-Insuffizienz zu verbessern, hat sich keine Bildgebungstechnik als zufriedenstellend erwiesen. Ein vielversprechendes bildgebendes Verfahren ist der kontrastverstärkte Ultraschall (CEUS) mit Microbubbles, der sich für die (mikro-)vaskuläre Bildgebung bewährt hat. In der Schwangerschaft ist sein Einsatz zur Beurteilung der Plazenta-Vaskularisation durch eine geringe Evidenz und Sicherheitsbedenken erschwert. Diese Übersichtsarbeit zielt darauf ab, die Sicherheit von CEUS in der Schwangerschaft in der bisher publizierten Literatur zu untersuchen.

Material und Methoden Es wurde eine systematische Suche in den Datenbanken PubMed, Medline, Embase und Cochrane durchgeführt. Eingeschlossen wurden alle Studien, in denen kontrastverstärkter Ultraschall bei schwangeren Frauen eingesetzt wurde. Ausgeschlossen wurden Studien mit geplantem Schwangerschaftsabbruch. Um die Sicherheit von CEUS in der Schwangerschaft zu bewerten, wurden relevante Ergebnisse in die folgenden 3 Kategorien eingeteilt: Fetales Outcome, maternales Outcome, Outcome der Schwangerschaft und des Neugeborenen.

Ergebnisse Es wurden insgesamt 13 Artikel eingeschlossen, in denen sich 256 schwangere Frauen einer CEUS-Untersuchung unterzogen. Im Zusammenhang mit CEUS wurden keine klinisch bedeutsamen maternalen oder fetalen unerwünschten Ereignisse und kein negativer Outcome der Schwangerschaft oder des Neugeborenen beschrieben.

Schlussfolgerung Aufgrund dieser Ergebnisse halten wir es für sicher und wichtig, das Wissen in Bezug auf diese vielversprechende Diagnosetechnik durch zukünftige größere klinische Studien zu erweitern.

Keywords

ultrasonography - contrast-enhanced ultrasound - microbubbles - safety - pregnancy

Publication History

Received: 20 February 2024

Accepted after revision: 10 May 2024

Accepted Manuscript online:
24 June 2024

Article published online:
06 September 2024

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