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Reprod Sci. 2015 Mar;22(3):316-21. doi: 10.1177/1933719114542024. Epub 2014 Jul 6.

Pregnancy outcome and placental findings in pregnancies complicated by fetal growth restriction with and without preeclampsia.

Author information

1
Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel michalkovo@gmail.com.
2
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Department of Pathology, Edith Wolfson Medical Center, Holon, Israel.
3
Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
4
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Department of Obstetrics & Gynecology, Rabin Medical Center, Petah-Tikva.

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 the 10 th 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.

KEYWORDS:

fetal growth restriction; histopathology; placenta; preeclampsia

PMID:
25001023
DOI:
10.1177/1933719114542024
[Indexed for MEDLINE]

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