title: Placental pathology in early intrauterine growth restriction associated with maternal hypertension.
abstract: BACKGROUND
  To identify key pathological characteristics of placentas from pregnancies complicated by early intrauterine growth restriction, and to examine their relations with maternal hypertensive disease and umbilical artery Doppler waveform abnormalities.
  
  
  METHODS
  Single-center retrospective cohort study of singleton pregnancies with abnormal umbilical artery Doppler flow patterns resulting in a live birth <34 weeks of a baby with a weight <10th percentile for gestational age. Umbilical artery end diastolic flow was classified as being either present or absent/reversed (AREDF). Data were stratified into intrauterine growth restriction with or without hypertensive disease and pathological characteristics were compared between these various conditions according to predefined scoring criteria.
  
  
  RESULTS
  Among 164 placentas studied, we found high rates of characteristic histopathological features that were associated with intrauterine growth restriction, including infarction (>5% in 42%), chronic villitis (21%), chronic chorioamnionitis (36%), membrane necrosis (20%), elevated nucleated red blood cells (89%), increased syncytial knotting (93%), increased villous maturation (98%), fetal thrombosis (32%) and distal villous hypoplasia (35%). Chronic inflammation of fetal membranes and syncytial knotting were more common in women with concomitant hypertensive disease as compared to women with normotensive IUGR (p < 0.05). Placentas from women with umbilical artery AREDF were more likely to show increased numbers of nucleated red blood cells and distal villous hypoplasia (p < 0.05).
  
  
  CONCLUSIONS
  Placentas of women with early IUGR show high rates of several histological aberrations. Further, concomitant maternal hypertension is associated with characteristic inflammatory changes and umbilical artery AREDF with signs of chronic hypoxia.
authors: University Medical Center Utrecht, Division of Perinatology, Department of Obstetrics, The Netherlands. Electronic address: J.H.W.Veerbeek@umcutrecht.nl.
authors: J H W
authors: JH
authors: Veerbeek
authors: University Medical Center Utrecht, Division of Perinatology, Department of Obstetrics, The Netherlands; University Medical Center Utrecht, Department of Pathology, The Netherlands.
authors: P G J
authors: PG
authors: Nikkels
authors: University Medical Center Utrecht, Division of Perinatology, Department of Obstetrics, The Netherlands.
authors: H L
authors: HL
authors: Torrance
authors: University Medical Center Utrecht, Division of Perinatology, Department of Obstetrics, The Netherlands.
authors: J
authors: J
authors: Gravesteijn
authors: University Medical Center Utrecht, Division of Perinatology, Department of Obstetrics, The Netherlands.
authors: E D
authors: ED
authors: Post Uiterweer
authors: University Medical Center Utrecht, Division of Perinatology, Department of Obstetrics, The Netherlands.
authors: J B
authors: JB
authors: Derks
authors: University Medical Center Utrecht, Division of Perinatology, Department of Obstetrics, The Netherlands.
authors: S V
authors: SV
authors: Koenen
authors: University Medical Center Utrecht, Division of Perinatology, Department of Obstetrics, The Netherlands.
authors: G H A
authors: GH
authors: Visser
authors: University of Southampton, Academic Unit of Human Development and Health, Southampton, United Kingdom.
authors: B B
authors: BB
authors: Van Rijn
authors: University Medical Center Utrecht, Division of Perinatology, Department of Obstetrics, The Netherlands.
authors: A
authors: A
authors: Franx
mesh_terms: D000328:Adult; D005260:Female; D005317:Fetal Growth Retardation / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000473:pathology*; D010920:Placenta / Q000473:pathology*; D011247:Pregnancy; D012189:Retrospective Studies; D018608:Ultrasonography, Doppler; D014469:Umbilical Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology; D055815:Young Adult
keywords: Chronic chorioamnionitis; Intra uterine growth restriction; Placental pathology; Preeclampsia