title: Placental Pathology in Relation to Uterine Artery Doppler Findings in Pregnancies with Severe Intrauterine Growth Restriction and Abnormal Umbilical Artery Doppler Changes.
abstract: ObjectivesCurrent guidelines for diagnosis and management of early-onset intrauterine growth restriction (IUGR) rely on umbilical artery Doppler (UAD), without including uterine artery Doppler (UtAD). We hypothesized that IUGR cases with abnormal UAD but normal UtAD has a different spectrum of placental pathology compared with those with abnormal UtAD.Study DesignRetrospective review of pregnancies with sonographic evidence of IUGR and abnormal UAD prior to delivery. Cases with ≥ 1 UtAD record(s) after 18+0weeks' gestation and placental pathology were included. Cases were stratified according to initial UtAD pulsatility index (PI) values (n= 196): normal (n= 19; PI < 95th centile for gestational age/no notching), intermediate (n= 69; PI ≥ 95th centile/no/unilateral notching) and abnormal (n= 108; PI ≥ 95th centile/bilateral notching). Pregnancy outcomes and placental pathology were compared between groups.ResultsWomen in the normal group delivered later than those in the abnormal group (30.1 ± 3.5 vs. 28.0 ± 3.5 weeks; mean ± standard deviation;p= 0.03). Their placentas exhibited higher rates of chronic intervillositis (15.8 vs. 0.9%;p= 0.01), chorangiosis (15.8 vs. 0.9%;p< 0.0001), and massive perivillous fibrin deposition (21.1 vs. 7.4%;p= 0.05), but had lower rates of uteroplacental vascular insufficiency (26.3 vs. 79.6%;p< 0.0001).ConclusionApproximately 10% of pregnancies with early-onset IUGR and abnormal UAD exhibited normal UtAD waveforms. They delivered later, and their placentas exhibited unusual placental pathologies.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Khrystyna
authors.initials: K
authors.lastname: Levytska
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Mary
authors.initials: M
authors.lastname: Higgins
authors.affiliation: Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Keating
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Nir
authors.initials: N
authors.lastname: Melamed
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Melissa
authors.initials: M
authors.lastname: Walker
authors.affiliation: Department of Histopathology, Institute of Child Health, Great Ormond Street Hospital, University College London, London, United Kingdom.
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Sebire
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: John C P
authors.initials: JC
authors.lastname: Kingdom
mesh_terms: D000328:Adult; D001724:Birth Weight; D005260:Female; D005313:Fetal Death / Q000209:etiology; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging*; D005865:Gestational Age; D006801:Humans; D008297:Male; D010920:Placenta / Q000098:blood supply / Q000473:pathology; D010922:Placenta Diseases / Q000473:pathology*; D021041:Placental Circulation; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal; D014469:Umbilical Arteries / Q000000981:diagnostic imaging*; D055988:Uterine Artery / Q000000981:diagnostic imaging*