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Pregnancy Outcome and Placental Findings in Pregnancies Complicated by Fetal Growth Restriction With and Without Preeclampsia

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Abstract

Objective

To compare pregnancy outcome and placental pathology in pregnancies complicated by fetal growth restriction (FGR) with and without preeclampsia.

Methods

Labor, fetal/neonatal outcome, and placental pathology parameters from neonates with a birth weight below the10th percentile (FGR), born between 24 and 42 weeks of gestation, were reviewed. Results were compared between pregnancies complicated with preeclampsia (hypertensive FGR [H-FGR]) to those without preeclampsia (normotensive FGR [N-FGR]). Composite neonatal outcome, defined as 1 or more of early complication (respiratory distress, necrotizing enterocolitis, sepsis, transfusion, ventilation, seizure, hypoxic–ischemic encephalopathy, phototherapy, or death), Apgar score ≤7 at 5 minutes, and days of hospitalization, were compared between the groups. Placental lesions, classified as lesions related to maternal vascular supply, lesions consistent with fetal thrombo-occlusive disease and inflammatory lesions, maternal inflammatory response, and fetal inflammatory response, were also compared.

Results

Women in the H-FGR group (n = 72) were older, with higher body mass index (BMI) and higher rate of preterm labor (<34 weeks) than in the N-FGR group (n = 270), P < .001 for all. Composite neonatal outcome was worse in the H-FGR than in the N-FGR group, 50% versus 15.5%, P < .001. Higher rate of maternal placental vascular lesions was detected in H-FGR compared with N-FGR, 82% versus 57.7%, P < .001. Using a stepwise logistic regression model, maternal BMI (1.13 odds ratio [OR], confidence interval [CI] 1.035-1.227, P = .006) and neonatal birth weight (0.996 OR, CI 0.995-0.998, P < .001) were independently associated with worse neonatal outcome.

Conclusion

Worse neonatal outcome and more maternal placental vascular lesions in pregnancy complicated by FGR with preeclampsia versus FGR without preeclampsia suggest different pathophysiology in these entities.

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Author information

Authors and Affiliations

  1. Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, PO Box 5, 58100, Holon, Israel

    Michal Kovo MD, PhD, Osnat Elyashiv MD, Golan Abraham MD & Jacob Bar MD, MSc

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Michal Kovo MD, PhD, Letizia Schreiber MD, Osnat Elyashiv MD, Avi Ben-Haroush MD, Golan Abraham MD & Jacob Bar MD, MSc

  3. Department of Pathology, Edith Wolfson Medical Center, Holon, Israel

    Letizia Schreiber MD

  4. Department of Obstetrics & Gynecology, Rabin Medical Center, Petah-Tikva, Israel

    Avi Ben-Haroush MD

Authors
  1. Michal Kovo MD, PhD
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  2. Letizia Schreiber MD
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  4. Avi Ben-Haroush MD
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  6. Jacob Bar MD, MSc
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Correspondence to Michal Kovo MD, PhD.

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Kovo, M., Schreiber, L., Elyashiv, O. et al. Pregnancy Outcome and Placental Findings in Pregnancies Complicated by Fetal Growth Restriction With and Without Preeclampsia. Reprod. Sci. 22, 316–321 (2015). https://doi.org/10.1177/1933719114542024

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