Usefulness of a placental profile in high-risk pregnancies.
OBJECTIVE
Test the hypothesis that a placental function profile can reassure most high-risk women with normal test results yet accurately can identify a subset of women who are destined for major complications that will be attributable to placental disease.


METHODS
This was a prospective study of 212 high-risk pregnancies that used the placental profile (16- to 18-week maternal serum screening, 18- to 23-week uterine artery Doppler imaging, and placental morphologic condition). Odds ratios (95% CI) were derived for intrauterine fetal death (IUFD), preterm delivery at < 34 weeks of gestation, preeclampsia/hemolysis, elevated liver enzymes, and low platelet count syndrome (HELLP) syndrome, small for gestational age delivery, and early-onset intrauterine growth restriction (IUGR); all normal test results (n =125) were compared with > or = 1 abnormal test results.


RESULTS
The odds of the development of adverse outcomes were significantly less in women with all normal test results (preeclampsia/HELLP [odds ratio, 0.2; 95% CI, 0.1-0.4]), preterm delivery (odds ratio, 0.1; 95% CI, 0.06-0.3), small for gestational age delivery (odds ratio, 0.2; 95% CI, 0.09-0.3), early-onset IUGR (0), and IUFD (odds ratio, 0.05 [0.01-0.2]). Combining those women with two (n = 21) of 3 (n = 15) abnormal test results together predicted 14 of 19 severe IUGR and 15 of 22 IUFD cases.


CONCLUSIONS
This placental function profile at 16-23 weeks of gestation can reassure women with normal test results by identifying a smaller subset of women who are at reduced risk of perinatal morbidity or death from severe IUGR.
Toal
Meghana
M
Department of Obstetrics and Gynecology, Placenta Clinic, Maternal-Fetal Medicine Division, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
Chan
Cynthia
C
Fallah
Shafagh
S
Alkazaleh
Fawaz
F
Chaddha
Vandana
V
Windrim
Rory C
RC
Kingdom
John C P
JC
D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D005313:Fetal Death / Q000517:prevention & control*; D005317:Fetal Growth Retardation / Q000517:prevention & control; D005500:Follow-Up Studies; D005865:Gestational Age; D017359:HELLP Syndrome / Q000517:prevention & control; D006801:Humans; D016017:Odds Ratio; D010298:Parity; D010920:Placenta / Q000000981:diagnostic imaging* / Q000473:pathology*; D011225:Pre-Eclampsia / Q000517:prevention & control; D011247:Pregnancy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D011296:Prenatal Diagnosis / Q000379:methods; D011446:Prospective Studies; D012016:Reference Values; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D014599:Uterus / Q000098:blood supply