Perinatal Outcomes in Premature Placental Calcification and the Association of a Color Doppler Study: Report from a Tertiary Care Hospital in Eastern India

Abstract

Introduction: Placental calcification, identified before the 36th week of gestational age, is known as premature placental calcification (PPC). PPC could be a clue for the poor fetal outcome. However, its association with adverse perinatal outcomes is yet to be confirmed. Objective: The primary objective was to determine and compare the perinatal outcomes in pregnancies with and without documented premature placental calcification. Methodology: The present study was a prospective cohort study performed from October 2017 to September 2019. We consecutively enrolled 494 antenatal women who presented to our antenatal OPD after taking consent to participate in our study. Transabdominal sonographies were conducted between 28–36 weeks of gestation to document placental maturity. We compared maternal and fetal outcomes between those who were identified with grade III placental calcification (n = 140) and those without grade III placental calcification (n = 354). Results: The incidence of preeclampsia, at least one abnormal Doppler index, obstetrics cholestasis, placental abruption, and FGR (fetal growth restriction) pregnancies were significantly higher in the group premature placental calcification. We also found a significantly increased incidence of Low APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) scores, NICU (Neonatal Intensive Care Unit) Admission, Abnormal CTG (cardiotocography), meconium-stained liquor, and low birth weight babies in those with grade III placental calcification. Conclusion: Clinicians should be aware of documenting placental grading while performing ultrasonography during 28 to 36 weeks. Ultrasonographically, the absence of PPC can define a subcategory of low-risk pregnant populations which probably need no referral to specialized centers and can be managed in these settings.

Predictors of adverse perinatal outcomes in women at 40 weeks or more of pregnancy

“…13 Studies have found that preterm placental calcification is associated with maternal and perinatal adverse outcomes (e.g., preeclampsia, at least one abnormal Doppler index, obstetric cholestasis, placental abruption, intrauterine growth retardation, maternal intensive care unit admission, low-birth-weight infants, and low perinatal APGAR scores) oligohydramnios, perinatal mortality, hypoxia due to placental insufficiency, asphyxia, and cesarean section are also seen at increased rates in post-term pregnancies compared to term pregnancies. 1,[14][15][16] Although the etiology of post-term pregnancies is not yet fully known, it has been reported in the literature that there are many risk factors for the development of a post-term pregnancy, such as obesity, primiparity, advanced maternal age, and low education level. 17,18 In our study, the presence of grade 3 placental calcification seemed to negatively affect perinatal outcomes in women at ≥40 weeks of pregnancy.…”