title: Correlation between histological signs of placental underperfusion and perinatal morbidity in late-onset small-for-gestational-age fetuses.
abstract: OBJECTIVE
  To investigate whether signs of placental underperfusion (PUP), defined as any maternal and/or fetal vascular pathology, confer an increased risk of neonatal morbidity in late-onset small-for-gestational-age (SGA) fetuses with normal umbilical artery (UA) Doppler indices.
  
  
  METHODS
  A cohort of 126 SGA singleton fetuses with normal UA Doppler indices that were delivered after 34 weeks' gestation was studied. For each case, the placenta was evaluated histologically for signs of PUP using a hierarchical and standardized classification system. Neonatal morbidity was assessed according to the score calculated from the morbidity assessment index for newborns (MAIN), a validated outcome scale. The independent association between PUP and neonatal morbidity was evaluated using multivariable median regression analysis.
  
  
  RESULTS
  In 84 (66.7%) placentae, 97 placental histological findings that qualified as signs of PUP were observed. These PUP cases had a significantly higher incidence of emergency Cesarean section for non-reassuring fetal status (44.1% vs 21.4%, respectively; P = 0.013) and neonatal metabolic acidosis at birth (33.3% vs 14.3%, respectively; P = 0.023), than did those without PUP. The median MAIN score differed significantly between those with PUP and those without (89 vs 0, respectively; P = 0.025). This difference remained significant after adjustment for potential confounders. The proportion of cases with scores indicative of mild to severe morbidity was also significantly higher in the PUP group (31% vs 14.3%, respectively; P = 0.043).
  
  
  CONCLUSIONS
  In late-onset SGA fetuses with normal UA Doppler indices, signs of PUP imply a higher neonatal morbidity. These findings allow the phenotypic profiling of fetal growth restriction among the general population of late-onset SGA.
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: S
authors.initials: S
authors.lastname: Simeone
authors.forename: S
authors.initials: S
authors.lastname: Triunfo
authors.forename: F
authors.initials: F
authors.lastname: Crovetto
authors.forename: F
authors.initials: F
authors.lastname: Botet
authors.forename: A
authors.initials: A
authors.lastname: Nadal
authors.forename: E
authors.initials: E
authors.lastname: Gratacos
authors.forename: F
authors.initials: F
authors.lastname: Figueras
mesh_terms: D000328:Adult; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D010927:Placental Insufficiency / Q000473:pathology*; D011247:Pregnancy; D012307:Risk Factors; D018608:Ultrasonography, Doppler / Q000379:methods; D016216:Ultrasonography, Prenatal / Q000379:methods; D014469:Umbilical Arteries / Q000000981:diagnostic imaging
keywords: Doppler; fetal development; fetal growth restriction; neonatal complications; placenta; ultrasonography