Placental aetiologies of foetal growth restriction: clinical and pathological differences.
BACKGROUND
Placental morphology and pregnancy outcome differ between normal pregnancies and those with foetal growth restriction (FGR). Most reports do not differentiate among different placental injury patterns related to foetal growth restriction.


OBJECTIVE
To evaluate placental and perinatal findings in growth restricted pregnancies based on three placental injury patterns: maternal and foetal blood supply abnormalities, and villitis of unknown aetiology, compared to those of preeclampsia (PE) and normal pregnancies.


METHODS
Retrospective review.


METHODS
65 growth restricted newborns and their placentas.


METHODS
Comparison of the clinical perinatal characteristics and outcomes, placental pathology and the number of syncytiocapillary membranes in the terminal villi, of the 65 FGR cases with 13 pregnancies complicated with preeclampsia (PE), and 25 uncomplicated pregnancies as controls, at 34-40weeks gestation.


RESULTS
The most common injury patterns of FGR placentas were maternal underperfusion (66%) (group 1), foetal blood supply abnormality (17%) (group 2), and villitis of unknown aetiology (17%) (group 3). The rate of induced labours was the highest in group 1 but the rate of operative deliveries due to suspected foetal asphyxia was the highest in group 2 (p<0.05). In the FGR cases, inverse relationship was found between birth weight and the number of syncytiocapillary membranes (r=-0.31, p<.05) in the maternal underperfusion FGR cases (group 1) only.


CONCLUSIONS
The different injury patterns in placentas of FGR patients may be correlated to different clinical outcomes. Placental examination in FGR pregnancies can provide a specific pathophysiologic explanation that may recur in subsequent pregnancies and lead to changes in follow-up and management.
Aviram
Rami
R
Department of Obstetrics and Gynecology, Meir Medical Centre, 59 Tchernihovski St., Kfar Saba 44281, Israel. rami.aviram@clalit.org.il <rami.aviram@clalit.org.il>
T
Biron Shental
BS
Kidron
Debora
D
D001724:Birth Weight; D005260:Female; D005317:Fetal Growth Retardation / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010920:Placenta / Q000098:blood supply* / Q000473:pathology* / Q000503:physiopathology; D010922:Placenta Diseases / Q000473:pathology / Q000503:physiopathology; D011247:Pregnancy; D012189:Retrospective Studies