Fetal growth restriction and preeclampsia as endpoints of a spectrum from the viewpoint of placental histopathology.

Abstract

Background: We evaluated the common histopathological characteristics of preeclampsia (PE) and fetal growth restriction (FGR), and demonstrated the major differences of the three groups of 1/PE with FGR, 2/PE without FGR and 3/FGR without PE.

Methods: Placental slides were studied retrospectively. Predominantly FGR- and PE-associated lesions were identified. Gestational age at the time of delivery (GATD) and diagnosis-to-delivery time (DTDT) were also examined.

Results: Decidual arteriopathies, maternal hypertension and obesity were more common in PE, and villous capillarization was significantly lower in FGR. We found that only villous infarction and chorangiosis had a connection with GATD. Villous infarction and chorangiosis were associated with DTDT >80 days, while placental changes leading to decreased villous capillarization was associated with DTDT <30 days.

Conclusions: Despite several common histopathological characteristics, placental histopathological profile of PE with FGR, PE without FGR and FGR without PE have remarkable differences, indicating histological background of their distinguished prognosis. Inadequate vascular development and decidual vasculopathies are characteristic in PE, while the undercapillarization of placental villous tree and villitis of unknown etiology leading to placental damage are characteristic of FGR. The dynamic equilibrium of different entities determines global placental function, and manifestation of FGR and/or PE.