Placental pathology in early intrauterine growth restriction associated with maternal hypertension.
INTRODUCTION
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).


DISCUSSION
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.
['Veerbeek|J H W|JH|', 'Nikkels|P G J|PG|', 'Torrance|H L|HL|', 'Gravesteijn|J|J|', 'Post Uiterweer|E D|ED|', 'Derks|J B|JB|', 'Koenen|S V|SV|', 'Visser|G H A|GH|', 'Van Rijn|B B|BB|', 'Franx|A|A|']
D000328:Adult D005260:Female D005317:Fetal Growth Retardation D006801:Humans D046110:Hypertension, Pregnancy-Induced D010920:Placenta D011247:Pregnancy D012189:Retrospective Studies D018608:Ultrasonography, Doppler D014469:Umbilical Arteries D055815:Young Adult
Placental pathology Chronic chorioamnionitis Intra uterine growth restriction Preeclampsia