title: Pregnancy outcome and placental findings in pregnancies complicated by fetal growth restriction with and without preeclampsia.
abstract: OBJECTIVE
  To compare pregnancy outcome and placental pathology in pregnancies complicated by fetal growth restriction (FGR) with and without preeclampsia.
  
  
  METHODS
  Labor, fetal/neonatal outcome, and placental pathology parameters from neonates with a birth weight below the 10 th percentile (FGR), born between 24 and 42 weeks of gestation, were reviewed. Results were compared between pregnancies complicated with preeclampsia (hypertensive FGR [H-FGR]) to those without preeclampsia (normotensive FGR [N-FGR]). Composite neonatal outcome, defined as 1 or more of early complication (respiratory distress, necrotizing enterocolitis, sepsis, transfusion, ventilation, seizure, hypoxic-ischemic encephalopathy, phototherapy, or death), Apgar score ≤ 7 at 5 minutes, and days of hospitalization, were compared between the groups. Placental lesions, classified as lesions related to maternal vascular supply, lesions consistent with fetal thrombo-occlusive disease and inflammatory lesions, maternal inflammatory response, and fetal inflammatory response, were also compared.
  
  
  RESULTS
  Women in the H-FGR group (n = 72) were older, with higher body mass index (BMI) and higher rate of preterm labor (<34 weeks) than in the N-FGR group (n = 270), P < .001 for all. Composite neonatal outcome was worse in the H-FGR than in the N-FGR group, 50% versus 15.5%, P < .001. Higher rate of maternal placental vascular lesions was detected in H-FGR compared with N-FGR, 82% versus 57.7%, P < .001. Using a stepwise logistic regression model, maternal BMI (1.13 odds ratio [OR], confidence interval [CI] 1.035-1.227, P = .006) and neonatal birth weight (0.996 OR, CI 0.995-0.998, P < .001) were independently associated with worse neonatal outcome.
  
  
  CONCLUSIONS
  Worse neonatal outcome and more maternal placental vascular lesions in pregnancy complicated by FGR with preeclampsia versus FGR without preeclampsia suggest different pathophysiology in these entities.
authors.affiliation: Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel michalkovo@gmail.com.
authors.forename: Michal
authors.initials: M
authors.lastname: Kovo
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Department of Pathology, Edith Wolfson Medical Center, Holon, Israel.
authors.forename: Letizia
authors.initials: L
authors.lastname: Schreiber
authors.affiliation: Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Osnat
authors.initials: O
authors.lastname: Elyashiv
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Department of Obstetrics & Gynecology, Rabin Medical Center, Petah-Tikva.
authors.forename: Avi
authors.initials: A
authors.lastname: Ben-Haroush
authors.affiliation: Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Golan
authors.initials: G
authors.lastname: Abraham
authors.affiliation: Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Jacob
authors.initials: J
authors.lastname: Bar
mesh_terms: D000328:Adult; D001034:Apgar Score; D001724:Birth Weight; D016009:Chi-Square Distribution; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D005865:Gestational Age; D006801:Humans; D062071:Infant, Extremely Premature; D007230:Infant, Low Birth Weight; D050498:Live Birth; D016015:Logistic Models; D016017:Odds Ratio; D066087:Perinatal Death; D010920:Placenta / Q000098:blood supply* / Q000473:pathology; D011225:Pre-Eclampsia / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors
keywords: fetal growth restriction; histopathology; placenta; preeclampsia