Cited by 328Pregnancy and preeclampsia studiesBirth, Development, and HealthNeurological Complications and Syndromes

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Placental Pathology in Early-Onset and Late-Onset Fetal Growth Restriction

Mifsud, William, Sebire, Neil J.·2014·Fetal Diagnosis and Therapy

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Abstract

Several histopathological features are found more frequently in placentas from pregnancies complicated by fetal growth restriction (FGR), including villous infarction, maternal vascular changes and villous morphological alterations, although around one quarter of placentas associated with FGR lack any morphological abnormality on routine examination. Since similar changes may also affect clinically uncomplicated pregnancies, the positive predictive value of such findings for pathological FGR in an unselected case remains low. However, the pattern of placental pathologies varies with clinical subgroup. The combination of placental bed and parenchymal lesions in FGR with abnormal uterine artery Doppler velocimetry is essentially identical to preterm pre-eclampsia (PET), and there is an association between FGR with abnormal umbilical artery Doppler findings and lesions of fetal stem arteries and terminal villous hypovascularity. Conversely, placentas from pregnancies complicated by PET or FGR presenting at or near term have a significantly lower frequency of histological abnormalities compared to early-onset disease and absence of a distinctive biochemical profile. The histological placental findings in FGR are therefore varied, from morphologically unremarkable through to severe uteroplacental vasculopathy, with no single pathological feature associated with high sensitivity or specificity. Severe early-onset FGR, overlapping with severe early-onset PET, is mainly associated with features of impaired maternal uteroplacental perfusion secondary to defective extravillous trophoblast invasion, and its consequences. Late-onset FGR probably represents a more heterogeneous group with less characteristic histological changes. Future research using histopathological assessment of aggregated data from multiple studies into larger datasets with centralised pathology review will allow delineation of distinctive clinicopathological associations and further understanding of pathophysiology.

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Authors: Mifsud, W., & Sebire, N. J.
Affiliations: Great Ormond Street Hospital (GB)
Corresponding author: Sebire, Neil J.
ORCID: Mifsud, William
Sebire, Neil J.
Venue: Fetal Diagnosis and Therapy
Publisher: S. Karger AG
Published: 2014
Volume: 36
Issue: 2
Pages: 117-128
ISSN: 1015-3837 (ISSN-L)
1421-9964
DOI: 10.1159/000359969
OpenAlex: W2084099835
Cited by: 328
References: 108
Citations by year: 2026: 17 · 2025: 20 · 2024: 29 · 2023: 40 · 2022: 31 · 2021: 41 · 2020: 33 · 2019: 26 · 2018: 40 · 2017: 16 · 2016: 18 · 2015: 13 · 2014: 3
FWCI: 2.66
Type: journal article
Language: en
Open access: closed
Licence: www.karger.com/Services/SiteLicenses (vor)
www.karger.com/Services/SiteLicenses (tdm)
Locations: Fetal Diagnosis and Therapy (publishedVersion)
PubMed (publishedVersion)
UCL Discovery (University College London) (submittedVersion)
Topics: Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
Health Sciences › Medicine › Clinical Neurology › Neurological Complications and Syndromes
Keywords: placental pathology, fetal growth restriction, early-onset fetal growth restriction, late-onset fetal growth restriction, preterm preeclampsia, uterine artery Doppler, umbilical artery Doppler, extravillous trophoblast invasion
MeSH terms: Female, Fetal Growth Retardation, Fetus, Humans, Placenta, Pregnancy, Fetal Development

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Placental Pathology in Early-Onset and Late-Onset Fetal Growth Restriction

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