Publication: Distal villous lesions are clinically more relevant than proximal large muscular vessel lesions of placental fetal vascular malperfusion
Authors
Stanek, Jerzy
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Publisher
Universidad de Murcia, Departamento de Biologia Celular e Histiologia
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DOI
https://doi.org/10.14670/HH-18-414
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info:eu-repo/semantics/article
Description
Abstract
Background. Fetal vascular malperfusion
(FVM) can be diagnosed on placental examination based
on histology of distal placental villi and large muscular
placental vessels. While histology of both those
placental compartments can be low grade or high grade,
it is not known if these are clinically equivalent. This
retrospective study aimed to compare the impact of
placental distal villous and large vessel FVM lesions on
clinical and placental phenotypes.
Methods. Clinical and placental phenotypes of 479
consecutive ≥20 weeks of gestation at delivery cases of
placental FVM were analyzed among 3 groups: Group 1:
86 cases with distal FVM (clusters of sclerotic distal villi
and/or those with stromal vascular karyorrhexis and/or
mineralization, and/or endothelial fragmentation by
CD34 immunostain) without large vessel lesions; Group
2: 186 cases with large vessel lesions (fetal vascular
ectasia, vascular thrombi, stem vessel obliteration,
intramural fibrin deposition) without distal villous
lesions; and Group 3: 207 cases showing both distal
villous lesions and large fetal vessel lesions.
Results. Statistically significant differences
(Bonferroni correction) were observed in: average
gestational age at delivery 31, 35, 34 weeks, fetal growth
restriction 24, 9, 25%, average placental weight 318,
413, 366 g, postuterine pattern of chronic hypoxic
placental injury 12, 2, 6%, luminal vascular
abnormalities in stem vessels 16, 3, 11%, and high grade
FVM 33, 16, 39%, among Groups 1-3, respectively.
Conclusion. Because of longer time needed for its
development, distal FVM portends poorer prognosis for
the fetus than large vessel FVM
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