Intrauterine growth restriction with absent end-diastolic flow velocity in the umbilical artery is associated with maldevelopment of the placental terminal villous tree

OBJECTIVE: Our purpose was to evaluate the structure of placental terminal villi and their capillaries in pregnancies complicated by intrauterine growth restriction with absent end-diastolic flow velocity in the umbilical artery. STUDY DESIGN: Glutaraldehyde-perfusion-fixed villous tissue and a plas...

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Published in:American journal of obstetrics and gynecology 1996-12, Vol.175 (6), p.1534-1542
Main Authors: Krebs, Christiane, Macara, Lena M., Leiser, Rudolf, Bowman, Adrian W., Greer, Ian A., Kingdom, John C.P.
Format: Article
Language:English
Subjects:
Biological and medical sciences
Blood Flow Velocity
Chorionic Villi - pathology
Chorionic Villi - ultrastructure
Corrosion Casting
Diastole
Diseases of mother, fetus and pregnancy
Female
Fetal Growth Retardation - physiopathology
Gynecology. Andrology. Obstetrics
Humans
intrauterine growth restriction
Medical sciences
Microscopy, Electron, Scanning
placental terminal villi
Pregnancy
Pregnancy. Fetus. Placenta
scanning electron microscopy
Umbilical Arteries - physiopathology
Umbilical artery Doppler imaging
vascular cast
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Summary:OBJECTIVE: Our purpose was to evaluate the structure of placental terminal villi and their capillaries in pregnancies complicated by intrauterine growth restriction with absent end-diastolic flow velocity in the umbilical artery. STUDY DESIGN: Glutaraldehyde-perfusion-fixed villous tissue and a plastic cast of the vessels in at least two cotyledons were prepared from 10 cases with intrauterine growth restriction and 9 gestational age-matched control placentas. The structure and dimensions of 20 terminal capillary loops per cast were determined by scanning electron microscopic examination, and their appearances were correlated with the peripheral villi of the perfusion-fixed villous tissue. RESULTS: Capillary loops in the growth-restricted cases were sparse in number and significantly longer than in the control cases (218 μm [72] vs 137 μm [30], mean and SD, p < 0.05). They exhibited fewer branches (4.0 [1.9] per loop vs 6.1 [2.2], p < 0.05) and a majority of loops were uncoiled (79% vs 18%, p < 0.05). The villous tissues from the growth-restricted cases demonstrated elongated villi, consistent with the cast findings. The trophoblast surface was wrinkled and in some areas covered by fibrin plaques. CONCLUSIONS: The terminal villous compartment of the placenta appears to be maldeveloped in preterm intrauterine growth restriction pregnancies where absent end-diastolic flow velocity is demonstrated in the umbilical artery before delivery. These findings are consistent with an increase in fetoplacental vascular impedance at the capillary level and may account for the impaired gas and nutrient transfer in this disorder. (Am J Obstet Gynecol 1996;175:1534-42.)
ISSN:0002-9378
1097-6868
DOI:10.1016/S0002-9378(96)70103-5