Histomorphological Study of Placenta in Intrauterine Growth Restriction

Abstract

Foetal growth is primarily determined by its genetically programmed growth potential and is influenced by maternal, foetal, and placental health. In intrauterine growth restriction (IUGR), the foetus fails to achieve its genetically predetermined growth potential, with the estimated foetal weight falling below the 10th percentile for its gestational age. IUGR refers to impaired foetal growth as a result of foetal, maternal, or placental causes, whereas small-for-gestational-age (SGA), means a measure of foetal size and not a direct measure of the quality of antenatal growth. SGA infants are usually described as constitutionally small foetuses.  Growth-restricted foetuses are at an increased risk not only for adverse perinatal outcomes but also for long-term health complications in adulthood. Placental insufficiency has been identified in several studies as a major contributing factor to IUGR. Studies have shown that the distinctive placental Histopathological features in IUGR can serve as predictors of future IUGR recurrence. In this present study too, the histomorphological examination of placenta in 75 pregnant women with IUGR showed marked placental infarctions and intervillous fibrinoid deposition indicating that the placental insufficiency is key contributory factor. Objective: To assess the morphological and histopathological changes in the placenta of pregnant women diagnosed with IUGR. Materials and Methods: This cross-sectional study was conducted on 75 singleton pregnancies between 32–42 weeks of gestation, with IUGR diagnosed on ultrasonography. Cases with multiple gestations, polyhydramnios, uncertain gestational dates, or irregular menstrual cycles were excluded. Results: Colour Doppler analysis showed high-resistance flow in the umbilical artery in 25.3% of cases and low-resistance flow in the middle cerebral artery in 6.7%. Histopathological examination revealed perivillous fibrin deposition in 97.3%, calcifications in 53.3%, and hemorrhages/infarctions in 20% of cases. Conclusion: The placental disease is a significant factor among IUGR underlying processes. This study highlights the significance of histopathological evaluation of the placenta to understand better underlying pathological mechanisms and guide clinical management. The distinctive placental Histopathological features in IUGR may serve as predictors of future IUGR recurrence and help in early recognition of pregnancies that require "high-risk" antenatal care.