Placental histopathological correlates of umbilical artery Doppler velocimetry in pregnancies complicated by fetal growth restriction

Spinillo, Arsenio; Gardella, Barbara; Bariselli, Silvia; Alfei, Alessandro; Silini, Enrico Maria; Bello, Barbara Dal

doi:10.1002/pd.3988

Cited by 58 publications

(37 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In our study abnormal Doppler FGR had significantly higher numbers of villous infarction, a marker of MUP. Moreover, the optimal threshold for classification of abnormal placental pathology was detected at ≥3 placental lesions, similar to the aforementioned study by Vedmedovska et al [6] Spinillo et al [10] followed 126 FGR pregnancies for defined placental lesions and correlated findings with UA Doppler velocimetry. They found the PI to be normal in 45 (35.7%) and increased in 44 (34.9%) of the women.…”

Section: Discussionsupporting

confidence: 60%

“…Many other studies have similarly pointed towards a predominant MUP origin for FGR. [6,10,11] Our study derived a much higher sensitivity (80%) and specificity (92.3%) for abnormal Doppler (reduced flow, AEDF or REDF) as a screening tool for detection of abnormal placental pathology.…”

Section: Discussionmentioning

confidence: 99%

“…[8] Abnormal UA DV in pregnancies complicated by FGR has been associated with a heterogeneous, nonspecific group of histological lesions of the placenta irrespective of gestational age or FGR aetiology. [2,6,[10][11][12][13][14] The exact pathophysiological mechanisms correlating these are not well characterised. [15] Various authors have used different placental histopathological classifications, categorisations of placental lesions, Doppler indices and statistical methods making interpretation and inter-study comparison difficult.…”

Section: Discussionmentioning

confidence: 99%

“…[15] Various authors have used different placental histopathological classifications, categorisations of placental lesions, Doppler indices and statistical methods making interpretation and inter-study comparison difficult. [2,6,[10][11][12][13][14] Dicke et al [11] retrospectively investigated the screening efficacy of UA S/D, PI, and AEDF for adverse pregnancy outcomes and placental abnormalities in SGA fetuses. Ninety-four percent of cases with either an S/D or a PI above the 95th percentile, or AEDF, had evidence of placental pathology.…”

Section: Discussionmentioning

confidence: 99%

“…Histological lesions were broadly defined according to the nomenclature and the diagnostic criteria proposed by the placental classification provided by Redline. [9] The discrete histopathological findings were grouped into 15 main findings and four major pathological patterns for the purpose of statistical analysis: [10] (i) maternal vascular underperfusion (MUP) including non-marginal, recent, and organised infarction involving >10% of parenchyma, agglutination, placental syncytial (ST) knots, intervillous fibrin deposition involving more than 20% of the intervillous space, peri-villous fibrin deposition, villous hypoplasia, intervillous haematoma or retroplacental haematoma; (ii) fetal vascular underperfusion (FUP) including fetal vasculopathy and/or avascular villi; (iii) inflammatory with villitis, chorioamnionitis or vasculitis lesions; (iv) others (stromal fibrosis and calcification). The placental lesions were then compared with DV findings (at delivery) and prospectively with neonatal outcome.…”

Section: Methodsmentioning

confidence: 99%

See 4 more Smart Citations

Abnormal umbilical artery Doppler velocimetry and placental histopathological correlation in fetal growth restriction

et al. 2017

View full text Add to dashboard Cite

RESEARCHBackground. Doppler velocimetry (DV) is widely used to assess the vascular formation of the placenta in fetal growth restriction (FGR) and to estimate the haemodynamic condition of the growth-restricted fetus. Umbilical artery (UA) flow is essentially placental, rather than fetal. Hence, DV provides information about the fetal side of the placenta and, alongside placental histopathology, it could possibly help to decipher aetiopathogenesis in FGR cases. Objective. To correlate UA DV findings occurring in FGR with placental findings. Methods. The study was prospective and conducted in a low-income setting. A total of 130 non-anomalous singleton FGR pregnancies (≥24 weeks) were included in the study. All pregnancies were confirmed to be small for gestational age (SGA) after the birth of the neonate. The placental lesions and neonatal outcomes were correlated with DV findings before delivery: 65 cases with normal DV results constituted group 1, and group 2 had 65 cases with abnormal DV results such as reduced flow, absent UA end diastolic flow or reversal of UA end diastolic flow. Results. Group 2 had significantly lower mean (standard deviation) birth weights of 1.59 (0.4) kg v. 1.87 (0.23) kg for group 1 (p<0.001). Considerably higher NICU mortality was seen in group 2 (30.5%) compared with group 1 (6.7%) (p<0.001). The group 2 placentas weighed less, had a higher number of maternal underperfusion (MUP) lesions, higher levels of calcification. Among lesions of MUP, 4 lesions i.e. villous infarction (p<0.001), villous agglutination (p<0.001), syncytial knots (p=0.003) and intervillous fibrin deposition (p=0.001) were present in significantly higher numbers in the abnormal Doppler group compared with the normal Doppler group. Abnormal Doppler had a sensitivity of 80% and specificity of 92.3% for abnormal placental pathology (placental lesions >3).Conclusions. There was a significantly higher number of MUP lesions and neonatal morbidity in SGA patients with abnormal DV findings.

show abstract

Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Abnormal umbilical artery Doppler velocimetry and placental histopathological correlation in fetal growth restriction

et al. 2017

View full text Add to dashboard Cite

show abstract

Doppler Ultrasound of the Fetal Descending Aorta: An Objective Tool to Assess Placental Blood Flow Resistance in Pregnancies With Discordant Umbilical Arteries

Cahill

Mercer

Jagota

et al. 2021

J of Ultrasound Medicine

View full text Add to dashboard Cite

Objectives-To determine the relationship between blood flow in the fetal descending aorta and discordant umbilical arteries (UAs).Methods-Pulsed wave Doppler of both UAs and the descending aorta was performed at 4-weekly intervals between 14 and 40 weeks of gestation in 209 pregnant women. In datasets with discordant UAs, a linear mixed effects model was used to determine the categorical relationship between the UA pulsatility index (PI) (high, low and average) and the descending aorta PI.Results-Of the 209 cases, 81 had a discordance of greater than 25% in UA PI during one of their visits. There were no differences in birth outcomes between the groups with concordant and discordant UA PIs. In the cases with discordant UA PIs, the descending aorta PI was most strongly associated with both the average UA PI (P = .008), and with the UA with the lower PI (P = .008).Conclusions-The relationship between blood flow in the descending aorta and UAs is consistent with the law for combining resistances in parallel. Measurements of the descending aorta PI, particularly in a scenario with discordant UAs, may inform the stability of the feto-placental circulation where discordant UA PIs are found.

show abstract

Changes in fetal Doppler indices as a marker of failure to reach growth potential at term

Morales‐Roselló

Khalil

Morlando

et al. 2014

Ultrasound in Obstet & Gyne

194

196

View full text Add to dashboard Cite

AGA pregnancies may present with fetal cerebral and placental blood flow redistribution indicative of fetal hypoxemia. Fetal Doppler assessment may be of value in detecting AGA pregnancies that are subject to placental insufficiency, fetal hypoxemia and FRGP. Future studies are needed to evaluate the appropriate threshold for the diagnosis of FRGP and the diagnostic performance of this new approach for the management of growth disorders.

show abstract

Placental histopathological correlates of umbilical artery Doppler velocimetry in pregnancies complicated by fetal growth restriction

Abstract: In pregnancies complicated by FGR, abnormalities of UA Doppler velocimetry were associated with placental lesions indicating superficial implantation and maternal vascular underperfusion.

Cited by 58 publications

References 35 publications

Abnormal umbilical artery Doppler velocimetry and placental histopathological correlation in fetal growth restriction

Abnormal umbilical artery Doppler velocimetry and placental histopathological correlation in fetal growth restriction

Doppler Ultrasound of the Fetal Descending Aorta: An Objective Tool to Assess Placental Blood Flow Resistance in Pregnancies With Discordant Umbilical Arteries

Changes in fetal Doppler indices as a marker of failure to reach growth potential at term

Contact Info

Product

Resources

About