More Maternal Vascular Malperfusion and Chorioamnionitis in Placentas After Expectant Management vs. Immediate Delivery in Fetal Growth Restriction at (Near) Term: A Further Analysis of the DIGITAT Trial

Conclusion: Expectant management of late FGR is associated with increased maternal vascular malperfusion and chorioamnionitis. This may have implications for fetal and neonatal outcome, such as programming in the developing child influencing health outcomes later in life. Introduction Fetal growth restriction (FGR) is a condition in pregnancy in which the fetus fails to reach its growth potential. FGR affects up to 15% of all pregnancies (1, 2) and is not only associated with mortality, but also with long term morbidity (3–5). Appropriate placental nutrient and oxygen supply is essential for normal fetal growth. The origin of placental insufficiency is multifactorial (6, 7). Several types of lesions can be found in placentas of pregnancies complicated by FGR (7–9). The main placental lesions found in FGR placentas are maternal vascular malperfusion, fetal vascular malperfusion, and villitis of unknown etiology (9). Elevated nucleated red blood cells are considered as an indication of fetal hypoxia (10, 11). Other rare findings in placentas of FGR complicated pregnancies include chronic histiocytic intervillositis and massive perivillous fibrinoid deposition (12, 13). Until now, adequate fetal monitoring and optimal timing of delivery are the only possible interventions for FGR as other therapeutic options are lacking (14). Timing of delivery in case of FGR is balanced between (relative) prematurity on the one side and prolonged undernutrition/hypoxia ...
Source: Frontiers in Endocrinology - Category: Endocrinology Source Type: research