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Microscopic lesions of placenta and Doppler velocimetry related to fetal growth restriction



The purpose of the study was to find an association between the uterine and umbilical arteries blood flow patterns in growth-restricted (FGR) and normal fetuses and placental microscopic lesions.


Fifty women with prenatally suspected and post-delivery confirmed FGR of singleton fetuses were enrolled in a case–controlled follow-up study from May 2007 to December 2008. Unselected patients with appropriately growing fetuses, matched for gestational age, served as controls. Uterine and umbilical Doppler waveforms were recorded before delivery.


Compared with control group with normal Doppler, FGR women with abnormal Doppler velocimetry of uterine and umbilical arteries had more intervillous thrombi (p = 0.01 and p < 0.0001, respectively) and villous infarctions (p = 0.02 and p = 0.0003, respectively). Thickening of the basal membrane and villitis was clearly linked to the FGR (p = 0.006 and p = 0.01). Vasculitis, on the other hand, is linked to normal growth, without affecting Doppler velocities.


Abnormal Doppler may predict hemorrhagic and ischemic placental lesions in FGR pregnancies and may lead to future improvement of the management of current and subsequent pregnancies.

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  1. 1.

    ACOG. Practice Bulletin No.12. (2001) Intrauterine growth restriction. Int J Gynecol Obstet 72:85–96

    Google Scholar 

  2. 2.

    Alberry M, Soothill P (2007) Managementof fetal growth restriction. Arch Dis Child Fetal Neonatal Ed 92(1):F62–F67

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Royal college of Obstetricians and Gynecologists (2002) The investigation and management of the small-for-gestational-age fetus. Guideline N.31, London, UK

  4. 4.

    Aucott SW, Donohue PK, Northington FJ (2004) Severe early intrauterine growth restriction. J Perinatol 24:435–440

    PubMed  Article  Google Scholar 

  5. 5.

    Dubois L, Girard M (2006) Determinants of birth weight inequalities: population-based study. Pediatr Int 48:470–478

    PubMed  Article  Google Scholar 

  6. 6.

    Kaiser M, Bonamy AK, Akre O, Cnattingius S, Granath F, Norman M (2009) Perinatal risk factor for diabetes in later life. Diabetes 58:523–526

    Article  Google Scholar 

  7. 7.

    Heinonen S, Taipale P, Saarikoski S (2001) Weights of placentas from small for gestational infants revisited. Placenta 22:399–404

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Fox H (2003) General pathology of placenta. In: H. Fox, Well M (eds) Obstetric and gynecological pathology, 5th edn. Churchill Livingstone, New York 2, pp 1273–1326

  9. 9.

    Biswas S, Ghosh SK (2008) Gross morphological changes of placentas associated with intrauterine growth restriction of fetuses: a case control study. Early Hum Dev 84(6):357–362

    PubMed  Article  Google Scholar 

  10. 10.

    Pardi G, Marconi AM, Cetin I (2002) Placental-fetal interrelationship in IUGR fetuses. A review. Placenta 23(Suppl A):136–141

    Article  Google Scholar 

  11. 11.

    Osak R, Webster KM, Bocking AD, Campbell MK, Richardson BS (1997) Nuchal cord evident at birth impacts on fetal size relative to that of the placenta. Early Hum Dev 49(3):193–202

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Sornes T (2000) Umbilical cord knots. Acta Obstet Gynecol Scand 79:157–159

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Salafia CM, Vintzileos A (1992) Placental pathology of idiopathic intrauterine growth retardation at term. Am J Perinatol 9:179–184

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Salafia CM, Ernst LM (1995) The very lowbirthweight infant: maternal complications leading to preterm birth, placental lesions and intrauterine growth. Am J Perinatol 12:106–110

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Salafia CM, Minior VK, Pezzullo JC, Popek EJ, Rozenkrantz TS (2003) Intrauterine growth restriction in infants of less than thirty-two weeks of gestation: associated placental pathologic features. Am J Obstet Gynecol 173:1049–1057

    Google Scholar 

  16. 16.

    Egbor M, Ansari T, Morris N (2006) Morphometric placental villous and vascular abnormalities in early- and late-onset pre-eclampsia with and without fetal growth restriction. BJOG 113(5):580–589

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Kingdom JC, Burrell SJ, Kaufmann P (1997) Pathology and clinical implications of abnormal umbilical artery Doppler waveforms. Ultrasound Obstet Gynecol 9(4):271–286

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Viscardi RM, Sun JCC (2001) Placental lesion multiplicity: risk factor for IUGR and neonatal cranial ultrasound abnormalities. Early Hum Develop 62:1–10

    Article  CAS  Google Scholar 

  19. 19.

    Olofsson P, Laurini RN, Marsal K (1993) A high uterine artery pulsatility index reflects a defective development of placental bed spiral arteries in pregnancies complicated by hypertension and fetal growth retardation. Eur J Obst Gynecol Repr Biol 49:161–168

    Article  CAS  Google Scholar 

  20. 20.

    Ferrazzi E, Bozzo M, Rigano S, Belloti M, Morabito S, Pardi G et al (2002) Temporal sequence of abnormal Doppler changes in the periferal and central circulatory systems of severely growth restricted fetus. Ultrasound Obstet Gynecol 19:140–146

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Aardema MW, Oosterhof H, Timmer A, Van Rooy I, Aarnoudse JG (2001) Uterine artery Doppler flow and uteroplacental vascular pathology in normal pregnancies and pregnancies complicated by pre-eclampsia and small age fetuses. Placenta 22:406–411

    Article  Google Scholar 

  22. 22.

    Kramer MS, Platt RW, Wen SW, Joseph KS, Allen A, Abrahamowicz M, Blondel B, Bréart G (2001) Fetal/Infant Health Study Group of the Canadian Perinatal Surveillance System. A new and improved population-based Canadian reference for birth weight for gestational age. Pediatrics 108(2):E35

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Gomez O, Figueras F, Fernandez S, Bennasar M, Martinez JM, Puerto B, Gratacos E (2008) Reference ranges for uterine artery mean pulsatility index at 11–41 weeks of gestation. Ultrasound Obstet Gynecol 32:128–132

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Acharya G, Wilsgaard T, Berntsen GKR, Maltau JM, Kiserud T (2005) References ranges for serial measurements of umbilical artery Doppler indices in the second half of pregnancy. Am J Obstet Gynecol 192:937–944

    PubMed  Article  Google Scholar 

  25. 25.

    Frusca T, Soregaroli M, Zanelli S, Danti L, Guandalini F, Valcamonico A (1998) Role of uterine artery Doppler investigation in pregnant women with chronic hypertension. Eur J Obstet Gynecol Reprod Biol 79:45–50

    Article  Google Scholar 

  26. 26.

    Benirschke K (1961) Examination of the placenta. Prepared for the collaborative study on cerebral plsy, mental retardation and other neurological and snsory disorders of infancy and childhood; National Institute of Neurological Diseases and Blindness, US Department of Health, Education and Welfare, Public Health Service

  27. 27.

    Kraus FT, Redline RW, Gersell DJ, Nelson DM, Dicke JM (2004) Circulatory problems: thrombi and other vascular lesions. Placental pathology, 1st edn. American Registry of Pathology, Washington, DC, pp 123–127

    Google Scholar 

  28. 28.

    Faye-Petersen OM, Heller DS, Joshi VV (2006) Lesions of placenta as a whole. Vasculitis. Handbook of placental pathology, 2nd edn. Taylor & Francis Group, New York, pp 145–146

    Google Scholar 

  29. 29.

    Redline RW (2007) Villitis of unknown etiology: noninfectious chronic villitis in the placenta. Hum Pathol 38(10):1439–1446

    PubMed  Article  Google Scholar 

  30. 30.

    Benirschke K, Kaufmann P (2000) Pathology of the human placenta, 4th edn. Springer, China, p 196

    Google Scholar 

  31. 31.

    Vedmedovska N, Rezeberga D, Teibe U, Donders GGG (2010) Preventable maternal risk factors and association of genital infection with intrauterine growth restriction in Latvia. Gynecol Obstet Invest 70:219–226

    Article  Google Scholar 

  32. 32.

    Vedmedovska N, Rezeberga D, Teibe U, Donders GGG, Polukarova S (2010) Fetal growth restriction in Latvia. Int J Gynaecol Obstet. doi:10.1016/j.ijgo.2010.06.017

  33. 33.

    Sebire NJ, Goldin RD, Regan L (2001) Histomorphological evidence for chronic vasoconstriction of placental stem vessels in pregnancies with intrauterine growth restriction and abnormal umbilical artery Doppler velocimetry indices (Abstract). J Pathol 195:19A

    Google Scholar 

  34. 34.

    Madazli R, Somunkiran A, Calay Z, Ilvan S, Aksu MF (2003) Histomorphology of the placenta and the placental bed of growth restricted foetuses and correlation with the Doppler velocimetries of the uterine and umbilical arteries. Placenta 24:510–516

    PubMed  Article  CAS  Google Scholar 

  35. 35.

    Dicke JM, Huettner P, Yan S, Odibo A, Kraus FT (2009) Umbilical artery Doppler indices in small for gestational age fetuses: correlation with adverse outcomes and placental abnormalities. J Ultrasound Med 28(12):1603–1610

    PubMed  Google Scholar 

  36. 36.

    Laurini R, Laurini J, Marshal K (1994) Placental hystology and fetal blood flow in intraterine growth retardation. Acta Obstet Gynecol Scand 73:529–534

    PubMed  Article  CAS  Google Scholar 

  37. 37.

    Redline RW (2006) Thrombophilia and placental pathology. Clin Obstet Gynecol 49:885–894

    PubMed  Article  Google Scholar 

  38. 38.

    Bujold E, Morency AM, Roberge S, Lacasse Y, Forest JC, Gigučre Y (2009) Acetylsalicylic acid for the prevention of preeclampsia and intra-uterine growth restriction in women with abnormal uterine artery Doppler: a systematic review and meta-analysis. J Obstet Gynaecol Can 31(9):818–826

    PubMed  Google Scholar 

  39. 39.

    Sander CM, Gilliland D, Akers C, McGrath A, Bismar TA, Swart-Hills LA (2002) Livebirths with placental hemorrhagic endovasculitis: interlesional relationships and perinatal outcomes. Arch Pathol Lab Med 126(2):157–164

    PubMed  Google Scholar 

  40. 40.

    So-Young Park, Kim MY, Kim YJ (2002) Placental pathology in intrauterine growth restriction. Korean J Pathol 36:30–37

    Google Scholar 

  41. 41.

    Leo MV, Skurnick JH, Ganesh VV, Adhate A, Apuzzio JJ (1992) Clinical chorioamnionitis is not predicted by umbilical artery Doppler velocimetry in patients with premature rupture of membranes. Obstet Gynecol 79(6):916–918

    PubMed  CAS  Google Scholar 

  42. 42.

    Santolaya J, Sampson M, Nobles G, Font G, Ramakrishnan V, Warsof SL (1991) Doppler evaluation of the fetoplacental circulation in the latent phase of preterm premature rupture of membranes. J Ultrasound Med 10(6):327–330

    PubMed  CAS  Google Scholar 

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The authors are grateful to women who agreed to participate in the study. Grant for this project was provided by the Latvian Ministry of Education and Science and the European Structural Funds.

Conflict of interest

We declare that we have no conflict of interest.

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Correspondence to Natalija Vedmedovska.

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Vedmedovska, N., Rezeberga, D., Teibe, U. et al. Microscopic lesions of placenta and Doppler velocimetry related to fetal growth restriction. Arch Gynecol Obstet 284, 1087–1093 (2011).

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  • Placenta
  • Histological lesions
  • Growth restriction
  • Doppler