Placental Pathology in Relation to Uterine Artery Doppler Findings in Pregnancies with Severe Intrauterine Growth Restriction and Abnormal Umbilical Artery Doppler Changes

Abstract

<b>Objectives</b> Current guidelines for diagnosis and management of early-onset intrauterine growth restriction (IUGR) rely on umbilical artery Doppler (UAD), without including uterine artery Doppler (UtAD). We hypothesized that IUGR cases with abnormal UAD but normal UtAD has a different spectrum of placental pathology compared with those with abnormal UtAD. <b>Study Design</b> Retrospective review of pregnancies with sonographic evidence of IUGR and abnormal UAD prior to delivery. Cases with ≥ 1 UtAD record(s) after 18⁺⁰ weeks' gestation and placental pathology were included. Cases were stratified according to initial UtAD pulsatility index (PI) values (<i>n</i> = 196): normal (<i>n</i> = 19; PI < 95th centile for gestational age/no notching), intermediate (<i>n</i> = 69; PI ≥ 95th centile/no/unilateral notching) and abnormal (<i>n</i> = 108; PI ≥ 95th centile/bilateral notching). Pregnancy outcomes and placental pathology were compared between groups. <b>Results</b> Women in the normal group delivered later than those in the abnormal group (30.1 ± 3.5 vs. 28.0 ± 3.5 weeks; mean ± standard deviation; <i>p</i> = 0.03). Their placentas exhibited higher rates of chronic intervillositis (15.8 vs. 0.9%; <i>p</i> = 0.01), chorangiosis (15.8 vs. 0.9%; <i>p</i> < 0.0001), and massive perivillous fibrin deposition (21.1 vs. 7.4%; <i>p</i> = 0.05), but had lower rates of uteroplacental vascular insufficiency (26.3 vs. 79.6%; <i>p</i> < 0.0001). <b>Conclusion</b> Approximately 10% of pregnancies with early-onset IUGR and abnormal UAD exhibited normal UtAD waveforms. They delivered later, and their placentas exhibited unusual placental pathologies.