Investigating Placental Abnormalities and Blood Flow in Uteroplacental Insufficiency

Uteroplacental insufficiency – characterized by inadequate blood flow to the placenta during pregnancy, necessitates an understanding of its underlying placental pathologies and their clinical implications.

A recent study investigated the prevalence, distribution, and types of placental pathology in women clinically categorized with fetal growth restriction (FGR) and abnormal uterine or umbilical artery Doppler readings.

This study examined 50 placentae from pregnancies – focusing on macroscopic and microscopic abnormalities. Features such as infarction, villitis of unknown etiology, intervillous inflammation, and massive perivillous fibrin deposition were analyzed microscopically.

The results showed that 98% of the participants with uteroplacental insufficiency had placental infarcts. Notable histopathological findings were – villous thrombosis in 94%; intervillous hemorrhage in 98%; and perivillous fibrin deposition among 98% of the women. Inflammatory changes such as villitis, intervillositis, and deciduitis were significantly linked to high resistance in the umbilical artery. Ultrasound demonstrated a 97.8% positive predictive value for detecting placental infarcts.

It was concluded that in pregnancies with uteroplacental insufficiency, macroscopic and microscopic placental abnormalities were common. Conditions such as villitis, intervillositis, deciduitis, and abruption showed significant differences between high flow and absent end‐diastolic flow (AEDF) or reversed end‐diastolic flow (REDF) groups. Thus, postpartum histopathological examination should be employed regardless of the delivery timing based on color Doppler findings. On the other hand, inflammatory changes are more likely to be related to labor events than indicative of FGR.

Source: Chavan R, Narkhede HR, Satoskar PR, et al. Obst and Gynec India. 2024 Mar 25:1-7.