Placental pathology in case of fetal growth restriction - sonographic and morphological indicators of the critical condition

Aim. To study the peculiarities of placental structure and the state of utero-placental and fetal-placental blood flow in fetal growth restriction.

Methods. A prospective study of 50 pregnant women admitted to the department of pathology of pregnancy with fetal growth restriction followed by a retrospective analysis of the obtained data considering risk factors and clinical course of the pregnancy and the results of morphological examination of afterbirth. For the diagnosis of fetal growth restriction ultrasound and Doppler ultrasound of blood flow in the uterine arteries and umbilical artery, and cardiotocography were performed.

Results. The most informative sonographic markers of the critical state of the fetus in case of fetal growth restriction are abnormal blood flow indicators of «mother-placenta-fetus» system (critical blood flow disorder in uterine arteries and umbilical artery grade III, blood flow disorder in the medial cerebral artery of the fetus), and also significant hypamnion and changes in placenta combined with poor results of cardiotocography. Obtained data correlated with the results of morphological examination of aftherbirth. Impaired blood flow and significant hypamnion on ultrasound indicate acute placental insufficiency, suggest poor fetal condition, including antenatal death. Petrifaction, infarction and calcification on ultrasound point to chronic placental insufficiency and compensated fetal condition, and they correlate with more favorable perinatal outcomes.

Conclusion. The findings of the study demonstrated that ultrasound, Doppler, clinical laboratory and subsequent morphological examination provide very detailed information about the state of placental structure and need for urgent care.