Association of Placental Histology with the Pulsatility Index of Fetal and Uteroplacental Vessels during Pregnancy and with Birthweight Z-Score

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Published Aug 29, 2023
DOI: https://doi.org/10.18103/mra.v11i8.4238

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Main Article Content

Hein Odendaal, Prof
Department of Obstetrics and Gynaecology, Stellenbosch University, Cape Town, South Africa
Lut Geerts, Prof
Department of Obstetrics and Gynaecology, Stellenbosch University
Colleen A Wright, Prof
Lancet Laboratories, Johannesburg, South Africa; Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of  Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
http://orcid.org/0000-0003-4422-7349 Drucilla J Roberts, Dr
Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
http://orcid.org/0000-0002-9104-6674 Pawel Schubert, Prof
Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
http://orcid.org/0000-0003-4422-7349 Theonia K Boyd, Dr
Department of Pathology, Division of Anatomic Pathology, Texas Children’s Hospital, Houston, Texas, USA
http://orcid.org/0000-0003-0244-7319 Lucy Brink, Dr
Department of Obstetrics and Gynaecology, Stellenbosch University, Cape Town, South Africa
http://orcid.org/0000-0001-6737-8225 Daan Nel, Prof
Department of Statistics and Actuarial Science, Stellenbosch University, Stellenbosch, South Africa
http://orcid.org/0000-0003-0998-3405

Abstract

Aims: To compare macro- and microscopic features of the placenta with the pulsatility index (PI) of the uterine (UtA), umbilical (UA) and middle cerebral arteries at 20-24- and 34-38-weeks’ gestation, and with birthweight z-scores (BWZS).


Methods: Recruitment for the Safe Passage Study, which investigated the association of alcohol and tobacco use with stillbirth and sudden infant death syndrome, occurred from August 2007 to January 2015 at community clinics in Cape Town, South Africa. The population represents a predominantly homogenous population of pregnant women from a low socioeconomic residential area. This study is a further analysis of the data of the Safe Passage Study. It consists of 1205 singleton pregnancies for which placental histology was available, of whom 1035 had a known BWZS and 1022 and 979 had fetoplacental Doppler examinations performed at Tygerberg Academic Hospital at 20-24 and 34-38 weeks respectively. Features of the placenta were assessed according to international norms.


Results: Significantly higher ORs for the presence of individual and combined features of maternal vascular malperfusion (MVM) were found with lower BWZS and higher UtA PI values, more consistently than with higher UA PI values. Strongest associations were for a small placenta for gestational age (UtA OR 4.86 at 20-24 and 5.92 at 34-38 weeks; UA OR 5.33 at 20-24 and 27.01 at 34-38 weeks; low BWZS OR 0.31), for accelerated maturation (UtA OR 11.68 at 20-24 weeks and 18.46 at 34-38 weeks; low BWZS 0.61), for macroscopic infarction (UtA OR 6.08 at 20-24 weeks; UA OR 17.02 at 34-38 weeks; low BWZS OR 0.62) and for microscopic infarction (UtA OR 6.84 at 20-24 and 10.9 at 34-38 weeks; low BWZS OR 0.62).


Conclusion: There is considerable variability in the associations between individual features of MVM and increased UtA or UA PI and low BWZS. Although all MVM features currently carry equal weight in defining the condition of MVM, our data suggest that some should carry more weight than others. Macroscopic examination of the placenta may be helpful in identifying placental insufficiency as a small placenta for gestational age and macroscopic infarction were the features most strongly associated with outcomes.

Keywords: Placental histology, multivessel Doppler assessment, maternal vascular malperfusion, fetal vascular malperfusion, placental abruption, birthweight z-score

Article Details

How to Cite
ODENDAAL, Hein et al. Association of Placental Histology with the Pulsatility Index of Fetal and Uteroplacental Vessels during Pregnancy and with Birthweight Z-Score. Medical Research Archives, [S.l.], v. 11, n. 8, aug. 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/4238>. Date accessed: 13 may 2024. doi: https://doi.org/10.18103/mra.v11i8.4238.
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Issue
Vol 11 No 8 (2023): August Issue, Vol.11, Issue 8
Section
Research Articles

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