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Correlation of Doppler Velocimetry of Uterine and Umbilical Arteries with Placental Pathology in Pregnancy Associated with Intrauterine Growth Restriction

  • Ahmed M. MagedEmail author
  • Mohamed Waly
  • Ahmed AbdelHak
  • Tamer S. Eissa
  • Nada K. Osman
Original Article
  • 7 Downloads

Abstract

To correlate histomorphology of the placenta with Doppler studies of uterine and umbilical arteries. A comparative observational study conducted on 75 pregnant women divided into 2 groups: Group 1 included 25 women with appropriate for gestational age fetuses. Group 2 included 50 women with FGR. Uterine and umbilical artery Doppler, study of placental pathology and immunohistochemistry of placental villous tissues were evaluated. There was a significant difference between the two study groups regarding both abnormal uterine (0 vs. 58%) and umbilical artery (0 vs. 58%) Doppler (p < 0.001). Syncytial knots > 30% (44 vs. 60%), fibrinoid necrosis > 5% (8 vs. 46.7%), placental infarction > 5% (0 vs. 15%), perivillous fibrinoid deposition > 5% (1.8 vs. 16.7%) (p < 0.001) but not calcifications (56 vs. 60%, p = 0.121) were significantly higher in FGR placentas. A statistically significant (p < 0.001) increase in the expression of VEGF in FGR placentas when compared with normal placentas. Abnormal uterine artery but not umbilical artery Doppler was significantly associated with abnormal placental pathology. Women with both abnormal uterine and umbilical artery Doppler velocimetries were delivered earlier and their babies had lower mean birth and placental weight (p < 0.001). Incidence of abnormal placental pathology was significantly higher in this specific group of FGR pregnancies (p < 0.001). There is high association between abnormal uterine and umbilical artery Doppler and placental pathology in FGR associated pregnancies.

Trial Registration NCT03081754.

Keywords

Uterine artery Doppler Umbilical artery Doppler FGR Placental pathology 

Notes

Compliance with Ethical Standards

Conflict of interest

No conflict of interest.

References

  1. 1.
    Battaglia FC, Lubchenco LO. A practical classification of newborn infants by weight and gestational age. J Pediatr. 1967;71(2):159–63.CrossRefPubMedGoogle Scholar
  2. 2.
    Gardosi J, Chang A, Kalyan B, Sahota D, Symonds EM. Customized antenatal growth charts. Lancet. 1992;339(8788):283–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Milovanovic I, Njuieyon F, Deghmoun S, Chevenne D, Levy-Marchal C, Beltrand J. Innate small babies are metabolically healthy children. J Clin Endocrinol Metab. 2012;97(12):4407–13.  https://doi.org/10.1210/jc.2012-1993.CrossRefPubMedGoogle Scholar
  4. 4.
    Bukowski R, Uchida T, Smith GC, Malone FD, Ball RH, Nyberg DA, Comstock CH, Hankins GD, Berkowitz RL, Gross SJ, Dugoff L, Craigo SD, Timor IE, Carr SR, Wolfe HM, D’Alton ME, First and Second Trimester Evaluation of Risk (FASTER) Research Consortium. Individualized norms of optimal fetal growth. Obstet Gynecol. 2008;111(5):1065–76.  https://doi.org/10.1097/AOG.0b013e3181704e48.CrossRefPubMedGoogle Scholar
  5. 5.
    Brosens I, Pijnenborg R, Vercruysse L, Romero R. The, “Great Obstetrical Syndromes” are associated with disorders of deep placentation. Am J Obstet Gynecol. 2011;204(3):193–201.  https://doi.org/10.1016/j.ajog.2010.08.009.CrossRefPubMedGoogle Scholar
  6. 6.
    Rudzinski E, Gilroy M, Newbill C, Morgan T. Positive C4d immunostaining of placental villous syncytiotrophoblasts supports host-versus-graft rejection in villitis of unknown etiology. Pediatr Dev Pathol. 2013;16(1):7–13.  https://doi.org/10.2350/12-05-1195-OA.1.CrossRefPubMedGoogle Scholar
  7. 7.
    Greer LG, Ziadie MS, Casey BM, Rogers BB, McIntire DD, Leveno KJ. An immunologic basis for placental insufficiency in fetal growth restriction. Am J Perinatol. 2012;29(7):533–8.  https://doi.org/10.1055/s-0032-1310525.PubMedGoogle Scholar
  8. 8.
    Kovo M, Schreiber L, Ben-Haroush A, Wand S, Golan A, Bar J. Placental vascular lesion differences in pregnancy-induced hypertension and normotensive fetal growth restriction. Am J Obstet Gynecol. 2010;202(6):561.e1–5.  https://doi.org/10.1016/j.ajog.2010.01.012.CrossRefGoogle Scholar
  9. 9.
    Redline RW. Villitis of unknown etiology: noninfectious chronic villitis in the placenta. Hum Pathol. 2007;38(10):1439–46.CrossRefPubMedGoogle Scholar
  10. 10.
    Mari G, Piconi J. Doppler vascular changes in IUGR. Semin Perinatol. 2008;32(3):182–9.  https://doi.org/10.1053/j.semperi.2008.02.011.CrossRefPubMedGoogle Scholar
  11. 11.
    Biswas S. Placental changes in idiopathic intra uterine growth restriction. OA Anat. 2013;1(2):11.Google Scholar
  12. 12.
    Maulik D, Evans JF, Ragolia L. Fetal growth restriction: pathogenic mechanisms. Clin Obstet Gynecol. 2006;49:219–27.CrossRefPubMedGoogle Scholar
  13. 13.
    Ahmed A, Perkins J. Angiogenesis and intrauterine growth restriction. Baillieres Best Pract Res Clin Obstet Gynaecol. 2000;14:981–98.CrossRefPubMedGoogle Scholar
  14. 14.
    Frater JL, Kay NE, Goolsby CL, Crawford SE, Dewald GW, Peterson LC. Dysregulated angiogenesis in B-chronic lymphocytic leukemia: morphologic, immunohistochemical, and flow cytometric evidence. Diagn Pathol. 2008;3:16.  https://doi.org/10.1186/1746-1596-3-16.CrossRefPubMedGoogle Scholar
  15. 15.
    Arroyo JA, Winn VD. Vasculogenesis and angiogenesis in the IUGR placenta. Semin Perinatol. 2008;32(3):172–7.  https://doi.org/10.1053/j.semperi.2008.02.006.CrossRefPubMedGoogle Scholar
  16. 16.
    Barut F, Barut A, Gun B, Kandemir N, Harma M, Aktunc E, Ozdamar S. Intrauterine growth restriction and placental angiogenesis. Diagn Pathol. 2010;5:24.  https://doi.org/10.1186/1746-1596-5-24.CrossRefPubMedGoogle Scholar
  17. 17.
    Albu AR, Anca AF, Horhoianu VV, Horhoianu IA. Predictive factors for intrauterine growth restriction. J Med Life. 2014;7(2):165–71.PubMedGoogle Scholar
  18. 18.
    Chitty LS, Altman D. Appendix: charts of fetal measurements. In: Rodeck CH, Whittle MJ, editors. Fetal medicine, basic science and clinical practice. London: Churchill Livingstone; 1999. p. 1095–140.Google Scholar
  19. 19.
    Madazli R, Somunkiran A, Calay Z, Livan S, Aksu F. Histomorphology of the placenta and the placental bed of growth restricted fetuses and correlation with the Doppler velocimetries of the uterine and umbilical arteries. Placenta. 2003;24(5):510–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Arduini D, Rizzo G, Mancuso S, Romanini C. Longitudinal assessment of blood flow velocity waveforms in the healthy human fetus. Prenat Diagn. 1987;7(9):613–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Kotigwar S, Ambiye M, Athavale S, Gupta V, Trivedi S. Study of gross and histological of placenta in intrauterine growth retardation. J Anat Soc India. 2011;60(1):37–40.CrossRefGoogle Scholar
  22. 22.
    Hasan J, Byers R, Jayson GC. Intra-tumoural microvessel density in human solid tumours. Br J Cancer. 2002;86:1566–77.CrossRefPubMedGoogle Scholar
  23. 23.
    Shieh YS, Lee HS, Shiah SG, Chu YW, Wu CW, Chang LC. Role of angiogenic and non-angiogenic mechanisms in oral squamous cell carcinoma: correlation with histologic differentiation and tumor progression. J Oral Pathol Med. 2004;33:601–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Kingdom J, Walker M, Drewlo S, Keating S. Intrauterine growth restriction: placental basis and implications for clinical practice. In: Kilby MD, Johnson A, Oepkes D, editors. Fetal therapy. Cambridge: Cambridge University Press; 2012.Google Scholar
  25. 25.
    Gómez O, Figueras F, Martínez JM, del Río M, Palacio M, Eixarch E, Puerto B, Coll O, Cararach V, Vanrell JA. Sequential changes in uterine artery blood flow pattern between the first and second trimesters of gestation in relation to pregnancy outcome. Ultrasound Obstet Gynecol. 2006;28(6):802–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Stampalija T, Gyte GM, Alfirevic Z. Utero-placental Doppler ultrasound for improving pregnancy outcome. Cochrane Database Syst Rev. 2010;9:CD008363.  https://doi.org/10.1002/14651858.cd008363.pub2.Google Scholar
  27. 27.
    Figueras F, Gratacós E. Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol. Fetal Diagn Ther. 2014;36:86–98.CrossRefPubMedGoogle Scholar
  28. 28.
    Oros D, Figueras F, Cruz-Martinez R, Meler E, Munmany M, Gratacos E. Longitudinal changes in uterine, umbilical and fetal cerebral Doppler indices in late-onset small-for-gestational age fetuses. Ultrasound Obstet Gynecol. 2011;37:191–5.CrossRefPubMedGoogle Scholar
  29. 29.
    Spinillo A, Gardella B, Bariselli S, Alfei A, Silini E, Dal Bello B. Placental histopathological correlates of umbilical artery Doppler velocimetry in pregnancies complicated by fetal growth restriction. Prenat Diagn. 2012;32(13):1263–72.CrossRefPubMedGoogle Scholar
  30. 30.
    Berkley E, Chauhan SP, Abuhamad A. Doppler assessment of the fetus with intrauterine growth restriction. Am J Obstet Gynecol. 2012;206(4):300–8.  https://doi.org/10.1016/j.ajog.2012.01.022.CrossRefPubMedGoogle Scholar
  31. 31.
    Afodun AM, Quadri KK, Masud MA, Ogunsola OA, Muhammad RO, Ajiboye RA, Caxton-Martins EA. Histological and histochemical studies of normal and growth retarded human placental tissue. Eur J Anat. 2014;18(3):153–8.Google Scholar
  32. 32.
    Kinzler WL, Vintzileos AM. Fetal growth restriction. Curr Opin Obstet Gynecol. 2008;2:125–31.CrossRefGoogle Scholar
  33. 33.
    Helske S, Vuorela P, Carpén O, Hornig C, Weich H, Halmesmäki E. Expression of vascular endothelial growth factor receptors 1, 2 and 3 in placentas from normal and complicated pregnancies. Mol Hum Reprod. 2001;7(2):205–10.CrossRefPubMedGoogle Scholar
  34. 34.
    Kaufmann P, Mayhew TM, Charnock-Jones DS. Aspects of human fetoplacental vasculogenesis and angiogenesis. II. Changes during normal pregnancy. Placenta. 2004;25(2–3):114–26.CrossRefPubMedGoogle Scholar
  35. 35.
    Bernstein I, Gabbe SG. Intrauterine growth restriction. In: Gabbe SG, Niebyl JR, Simpson JL, Annas GJ, editors. Obstetrics: normal and problem pregnancies. 3rd ed. New York: Churchill Livingstone; 1996. p. 863–86.Google Scholar

Copyright information

© Society of Fetal Medicine 2019

Authors and Affiliations

  1. 1.Obstetrics and Gynecology DepartmentCairo UniversityGizaEgypt

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