Placental histological patterns and uterine artery Doppler velocimetry in pregnancies complicated by early or late pre-eclampsia

Orabona, Rossana; Donzelli, Carla; Falchetti, Marcella; Santoro, Amerigo; Valcamonico, Adriana; Frusca, T.

doi:10.1002/uog.15799

Cited by 46 publications

(42 citation statements)

References 27 publications

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“…The authors concluded that prevalence was four‐ to seven‐fold higher in PE compared with normal pregnancies. These findings are consistent with our own, in which we identified qualitatively similar placental lesions in the total cohort of women affected by PE, although their incidence was quantitatively different according to gestational age (GA) at PE onset, with pathological placental changes being significantly more frequent in cases complicated by early‐onset PE (< 34 weeks' gestation (EO‐PE) as compared with those with late‐onset PE (> 34 weeks' gestation (LO‐PE)). We also tested the relationship between histopathological placental features and second‐trimester uterine artery (UtA) Doppler velocimetry.…”

supporting

confidence: 91%

Re: Placental histopathology associated with pre‐eclampsia: a systematic review and meta‐analysis

Orabona

Donzelli

Falchetti

et al. 2018

Ultrasound in Obstet & Gyne

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supporting

confidence: 91%

Re: Placental histopathology associated with pre‐eclampsia: a systematic review and meta‐analysis

Orabona

Donzelli

Falchetti

et al. 2018

Ultrasound in Obstet & Gyne

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“…On the other hand, SGA cases with normal fetoplacental Doppler exhibited a higher prevalence of placental findings than did uncomplicated pregnancies. Additionally, UtA‐PI showed the ability to predict villous infarcts in PE. Overall, fetoplacental Doppler parameters seem to reflect placental vascular findings related to malperfusion.…”

Section: Discussionmentioning

confidence: 95%

Distinctive patterns of placental lesions in pre‐eclampsia vs small‐for‐gestational age and their association with fetoplacental Doppler

Paulés

Youssef

Rovira

et al. 2019

Ultrasound in Obstet & Gyne

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Objectives To describe placental histopathological findings in a large cohort of pregnancies complicated by pre‐eclampsia (PE) and/or small‐for‐gestational age (SGA), and to investigate their association with fetoplacental Doppler parameters. Methods This was a prospective observational study of normotensive pregnancies with SGA (defined as birth weight < 10th centile) (n = 184), PE pregnancies with a normally grown fetus (n = 102), pregnancies with both PE and SGA (n = 120) and uncomplicated pregnancies (n = 202). Uterine (UtA), umbilical (UA) and fetal middle cerebral (MCA) artery pulsatility indices (PI) were assessed. The cerebroplacental ratio (CPR) was calculated by dividing MCA‐PI by UA‐PI. Doppler parameters were considered abnormal when UtA‐PI or UA‐PI was > 95th centile or MCA‐PI or CPR was < 5th centile. Placental lesions were categorized as vascular (maternal or fetal side), immunoinflammatory or other, according to the 2014 Amsterdam Placental Workshop Group Consensus Statement. Comparison between the study groups was performed using univariate and multiple regression analysis, and logistic regression was used to determine the relationship between abnormal Doppler parameters and placental lesions. Results Maternal‐side vascular lesions were significantly more common in PE pregnancies with SGA than in the other groups (PE + SGA, 73% vs PE, 46% vs SGA, 38% vs controls, 31%; P = 0.01) and included mainly two types of lesion: developmental (PE + SGA, 13% vs PE, 5% vs SGA, 3% vs controls, 1.5%; P < 0.001) and malperfusion (PE + SGA, 70% vs PE, 39% vs SGA, 32% vs controls, 25%; P = 0.001). In contrast, the incidence of fetal‐side developmental lesions was significantly higher in normotensive SGA pregnancies than in controls and PE pregnancies (PE + SGA, 0% vs PE, 3% vs SGA, 8% vs controls, 2%; P = 0.001). All cases displayed a lower prevalence of infectious lesions than did controls, with the highest prevalence of immune lesions observed in pregnancies with both PE and SGA (PE + SGA, 18% vs PE, 8% vs SGA, 10% vs controls, 9%; P = 0.001). All fetoplacental Doppler parameters evaluated were associated with maternal‐side vascular lesions, mainly malperfusion (mean UtA‐PI: odds ratio (OR), 2.45 (95% CI, 1.51–3.97); UA‐PI: OR, 2.05 (95% CI, 1.02–4.47); MCA‐PI: OR, 2.75 (95% CI, 1.40–5.42); CPR: OR, 1.75 (95% CI, 1.04–2.95)). This association was evident mainly in the normotensive SGA group, being non‐significant in controls or PE pregnancies without SGA. No significant associations were observed between fetoplacental Doppler parameters and other placental lesions in any of the study groups. Conclusions PE and SGA are associated with different patterns of placental histopathological lesions in accordance with the clinical manifestation of the placental disorder (maternal vs fetal). Fetoplacental Doppler findings show an association with placental malperfusion lesions on the maternal side, supporting the use of abnormal Doppler as a surrogate for placental insufficiency. Copyright © 2019 ISUOG. Publishe...

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“…The use of ultrasound as a tool for screening/prediction of PE is based on the fact that defective placentation results in incomplete transformation of the spiral arteries. Placental villous and vascular histopathological lesions are four‐to‐seven times more common in PE than in non‐PE pregnancies and are associated with increased resistance to uterine artery blood flow. Measurement of impedance (or resistance) to flow in the uterine arteries by Doppler assessment thus renders quantifiable the incomplete transformation of the spiral arteries.…”

Section: Screening For Pre‐eclampsia Using Ultrasoundmentioning

confidence: 99%

ISUOG Practice Guidelines: role of ultrasound in screening for and follow‐up of pre‐eclampsia

Sotiriadis

Hernández‐Andrade

Costa

et al. 2018

Ultrasound in Obstet & Gyne

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115

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RESUMEN Pautas de práctica de ISUOG: la función del ultrasonido en la detección y seguimiento de la preeclampsia Introducción La hipertensión en el embarazo afecta hasta el 10% de las mujeres embarazadas y la incidencia global combinada de la preeclampsia (PE) es de aproximadamente el 3%. Las diferencias significativas entre los países desarrollados y en desarrollo pueden atribuirse a diferencias reales o a diferencias derivadas de la adquisición de datos. La PE y sus complicaciones contribuyen en gran medida a la morbilidad y mortalidad materna y perinatal en todo el mundo. Dado que la atención oportuna y efectiva puede mejorar los resultados de la PE, el desarrollo de estrategias eficaces de predicción y prevención ha sido uno de los principales objetivos de la atención prenatal y de la investigación. La PE es una enfermedad multisistémica de origen multifactorial: está relacionada con placentación defectuosa, estrés oxidativo, autoinmunidad, activación de plaquetas y trombina, inflamación intravascular, disfunción endotelial, desequilibrio en la angiogénesis y mala adaptación cardíaca materna. La invasión defectuosa de la placenta está fuertemente asociada con la mayoría de los casos de PE temprana y grave. En contraste, la placentación defectuosa parece ser menos importante para el desarrollo de la PE que se manifiesta más tarde en el embarazo, por ejemplo después de las 34 semanas. En comparación con los embarazos afectados por la enfermedad de aparición temprana, en aquellos complicados con PE a término o cerca de este, la frecuencia de anomalías histológicas de las placentas es significativamente menor, y los factores maternos (p. ej. el síndrome metabólico o la hipertensión crónica) tienen una importancia relativamente mayor. También se observan diferencias entre la PE de aparición temprana y la de aparición tardía en los factores de riesgo, la capacidad de respuesta vascular materna, el rendimiento del cribado y la eficacia de la prevención. El conocimiento cada vez mayor sobre la fisiopatología de la PE se refleja en las estrategias de cribado actuales, que se basan en el historial, la demografía, los biomarcadores (como la presión arterial) y el Doppler de la arteria uterina. Actualmente hay más de 10 000 artículos de PubMed relacionados con la detección de la PE, lo que indica el gran interés en este tema. Menos de una quinta parte de estos se refieren a la detección temprana, lo que constituye un avance de la última década. El objetivo de estas Pautas es revisar la evidencia más reciente y, en lo posible, proporcionar recomendaciones basadas en la evidencia con respecto a la función del ultrasonido en el cribado y seguimiento de la PE. Las Pautas se centran en los aspectos técnicos y clínicos del cribado, sin incluir los aspectos económicos y políticos de la salud, como la conveniencia y la rentabilidad del cribado. Además, estas Pautas se elaboraron partiendo del supuesto de que se dispone de los recursos necesarios para la realización del cribado y el seguimiento (equipo, examinadores y conocimient...

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Placental histological patterns and uterine artery Doppler velocimetry in pregnancies complicated by early or late pre-eclampsia

Abstract: Objectives To study placental patterns in pregnancies complicated by pre-eclampsia (PE)

Cited by 46 publications

References 27 publications

Re: Placental histopathology associated with pre‐eclampsia: a systematic review and meta‐analysis

Re: Placental histopathology associated with pre‐eclampsia: a systematic review and meta‐analysis

Distinctive patterns of placental lesions in pre‐eclampsia vs small‐for‐gestational age and their association with fetoplacental Doppler

ISUOG Practice Guidelines: role of ultrasound in screening for and follow‐up of pre‐eclampsia

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