Correlation of placental histomorphology with doppler velocimetry in preeclampsia and IUGR and their perinatal outcome
Keywords:IUGR, Preeclampsia, Placental histomorphology, Perinatal outcome
Background: Though numerous placental ischemic changes are described in relation to placental insufficiency, universally accepted criteria are unavailable till date leading to under or over reporting. Present study is an attempt to define standardized grading system for placental dysmorphology and correlate it with Doppler changes. The objective was to study placental histomorphology in preeclampsia and IUGR (Intrauterine Growth Restriction), to correlate the placental histomorphology with multivessel Doppler findings and their perinatal outcome in preeclampsia and IUGR.
Methods: Prospective study was done over 2 years, 64 antenatal women with preeclampsia and/or IUGR were recruited, their multivessel Doppler measurements were recorded and placental histomorphological changes were studied post-delivery which were graded as either low or high grade placentas considering degree and number of ischemic changes observed.
Results: Out of 64 cases, 33 (51.5%) cases had low grade changes and 31 (48.5%) had high grade changes. Out of 33 patients with low grade placentas 24 (73%) had normal Doppler, 20 (65%) out of 31 high grade placenta had abnormal Doppler. Placental histomorphology correlated well with Doppler abnormality (Coefficient of Kappa test). Syncytial knots>50%, presence of hypermature villi, infarcts, fibrin deposits were significantly associated with abnormal Doppler. High grade placenta group had significantly poor perinatal outcome (Chi square test).
Conclusions: We formulated a grading system of placental dysmorphology in preeclampsia and IUGR which correlated well with clinical Doppler abnormality and perinatal outcome. Further studies are warranted to develop preventive strategies aimed at specific high grade placental changes seen in pregnancies with abnormal Doppler and develop strategies to improve perinatal outcome.
Stanek J. Hypoxic patterns of placental injury. Arch Pathol Lab Med. 2013;137:706.
Orabona R, Donzelli CM, Falchetti M, Santoro A, Valcamonico A, Frusca T. Placental histological patterns and uterine artery doppler velocimetry in regnancies complicated by early or late pre-eclampsia. Ultrasound Obstet Gynecol. 2016;47:580-5.
Ciğercioğullari E, Filinte D, Toz E, Avciİ, Erdem B, Eminli İ, et al. The determination of normal percentages of syncytiotrophoblastic knots in various regions of placenta: where to count the syncytial knots. Turk Patoloji Derg. 2015;31(1):1-8.
Vayssiere C, Sentilhes L, Eqo A, Bernard C, Cambourieu D, Flamant et al. Fetal growth restriction and intra-uterine growth res triction: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians. Eur J Obstet Gynecol Reprod Biol. 2015;193:10-8.
Tranquilli AL, Dekker G, Magee L, Roberts J, Sibai BM, Steyn W, et al. The classification, diagnosis and management of the hypertensive disorders of pregnancy a revised statement from the ISSHP; pregnancy hypertension. Int J Women’s Cardiovascular Health. 2014:4(2):97-104.
Goyal G, Singh KN, Agarwal R, Patel L, Khare S. Correlation of prenatal ultrasound findings with placental pathology in high risk pregnancy. J Evolution Med Dental Sci. 2014;3(03):665-72.
Ramadan R, Youssef H. Role of antenatal fetal doppler in correlation with histopathological, electron microscopic and immuno-histochemical findings of placentas in prediction of adverse perinatal outcome in fetal growth restricted pregnancies”. EC Gynaecol. 2018;7(9):353-66.
Yadav S, Gupta R, Ghanghoriya S, Tripathi P. Umbilical artery colour doppler in prediction of IUGR and its correlation with histopathology of placenta. Int J Clin Obst Gynaecol. 2019;3(3):19-22.
Günyeli I, Erdemoğlu E, Ceylaner S, Zergeroğlu S, Mungan T. Histopathological analysis of the placental lesions in pregnancies complicated with IUGR and stillbirths in comparison with uncomplicated pregnancies. J Turkish-German Gynecol Assoc. 2011;12:75-9.
Kotgirwar S, Ambiye M, Athavale S, Gupta V, Trivedi S. Study of gross and histological features of placenta in intrauterine growth retardation. J Anat Soc India. 2011;60(1):37-40.
Gunasena GGA, Jayasundara DMC, Salgado SS, Wijesinghe PS, Biyagama B. The placenta in pre-eclampsia: association of histology with umbilical artery doppler velocimetry. MOJ Womens Health 2017;4(4):00092.
Vedmedovska N, Rezeberga D. Microscopioc lesions of placenta and doppler velocimetry related to fetal growth restriction. Arch Gynecol Obst. 2011:284(5):1087-93.
Salafia CM, Pezzullo JC, Minior VK, Divon MY. Placenta in absent/reversal of end diastolic flow. Reprod Biol. 1997;90:5.
Murat AG, Cihat F, Zerrin C. Correlation between first and second trimester uterine artery doppler velocimetry and placental bed histopathology. Int Scholarly Res Notices. 2014:890534.
Curtin WM, Millington KA, Ibekwe TO, Ural SH. Suspected fetal growth restriction at 37 weeks: a comparison of doppler and placental pathology. Bio Med Res Int. 2017:3723879.
Mifsud W, Neil J. Placental pathology in early-onset and late-onset fetal growth restriction. Fetal Diagn Ther. 2014;36:117-28.
Saavedra MS, Simeone S, Triunfo S, Crovetto F, Botet F. Correlation between histological signs of placental underperfusion and perinatal morbidity in late-onset small-for-gestational-age fetuses. Ultrasound Obstet Gynecol. 2015;45(2):149-55.
Vedmedovska N, Rezeberga D, Teibe U, Melderis I, Donders GG. Microscopioc lesions of placenta and doppler velocimetry related to fetal growth restriction. Arch Gynecol Obstet. 2011;284(5):1087-93.
Taysi S, Tascan AS, Ugur MG, Demir M. Radicals, oxidative/nitrosative stress and preeclampsia. Mini-Rev Med Chem. 2019;19(3):33-9.