title: Placental findings in late-onset SGA births without Doppler signs of placental insufficiency.
abstract: OBJECTIVE
  To describe placental pathological findings in late-onset small-for-gestational age (SGA) births for which Doppler signs of placental insufficiency are lacking.
  
  
  METHODS
  A series of placentas were evaluated from singleton pregnancies of SGA births (birth weight below the 10th percentile) delivered after 34 weeks with normal umbilical artery Doppler (pulsatility index below the 95th percentile), that were matched by gestational age with adequate-for-gestational age (AGA) controls. Using a hierarchical and standardized system, placental lesions were classified histologically as consequence of maternal underperfusion, fetal underperfusion or inflammation.
  
  
  RESULTS
  A total of 284 placentas were evaluated (142 SGA and 142 AGA). In the SGA group, 54.2% (77/142) of the placentas had weights below the 3rd percentile for GA while it was a 9.9% (14/142) in the AGA group (p < 0.001). Only 21.8% (31/142) of SGA placentas were free of histological abnormalities, while it was 74.6% (106/142) in the AGA group (p < 0.001). In the abnormal SGA placentas (111/142) there were a total of 161 lesions, attributable to MUP in 64% (103/161), FUP in 15.5% (25/161), and inflammation in 20.5% (33/161).
  
  
  CONCLUSIONS
  In most placentas of term SGA neonates with normal UA Doppler histological abnormalities secondary to maternal underperfusion prevail, reflecting latent insufficiency in uteroplacental blood supply. This is consistent with the higher risk of adverse perinatal outcome reported in this population and underscores a need for new markers of placental disease.
  
  
  CONCLUSIONS
  A significant proportion of late-onset SGA births with normal umbilical artery Doppler may still be explained by placental insufficiency.
authors.affiliation: Department of Maternal-Fetal Medicine, Institute Clínic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic-IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain; Maternal-Fetal Unit, CEDIFETAL, Centro de Diagnóstico de Ultrasonido e Imágenes, CEDIUL, Barranquilla, Colombia.
authors.forename: M
authors.initials: M
authors.lastname: Parra-Saavedra
authors.forename: F
authors.initials: F
authors.lastname: Crovetto
authors.forename: S
authors.initials: S
authors.lastname: Triunfo
authors.forename: S
authors.initials: S
authors.lastname: Savchev
authors.forename: A
authors.initials: A
authors.lastname: Peguero
authors.forename: A
authors.initials: A
authors.lastname: Nadal
authors.forename: G
authors.initials: G
authors.lastname: Parra
authors.forename: E
authors.initials: E
authors.lastname: Gratacos
authors.forename: F
authors.initials: F
authors.lastname: Figueras
mesh_terms: D000328:Adult; D057210:Delayed Diagnosis; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000276:immunology / Q000473:pathology* / Q000503:physiopathology; D005317:Fetal Growth Retardation / Q000209:etiology / Q000276:immunology / Q000473:pathology*; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D008297:Male; D016555:Matched-Pair Analysis; D010920:Placenta / Q000276:immunology / Q000473:pathology*; D010922:Placenta Diseases / Q000000981:diagnostic imaging / Q000276:immunology / Q000473:pathology / Q000503:physiopathology; D021041:Placental Circulation; D010927:Placental Insufficiency / Q000000981:diagnostic imaging / Q000276:immunology / Q000473:pathology* / Q000503:physiopathology; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D047928:Premature Birth; D011446:Prospective Studies; D047929:Term Birth; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging
keywords: BW; Doppler; EFW; FUP; GA; Growth restriction; IUGR; MUP; Perinatal outcome; Placental lesions; SGA; UA; Weight centile; birth weight; estimated fetal weight; fetal underperfusion; gestational age; intrauterine growth restriction; maternal underperfusion; small for gestational age; umbilical artery