Document Type : Original Research


1 Department of Pathology, PSG IMSR, Coimbatore, India

2 Department of Professor, Pathology, Annapoorana medical college, Salem, India

3 Professor, Pathology, PSG IMSR, Coimbatore, India


Background & Objective: Fetal growth restriction (FGR) is one of the leading causes of perinatal morbidity and mortality. Our study aimed to analyze the gross and histopathological changes in the placentas of growth-restricted fetuses.
Methods: Placentas of fifty growth-restricted fetuses received in the Department of Pathology for 3 years were studied. Clinical data including ultra-sonographic findings were obtained. The received placentas were photographed and the details were documented in a prepared template. The relevant tissues were processed, analyzed, and correlated with the clinical findings.
Results: The study demonstrates distinctive gross and histological abnormalities in the placentas of growth-restricted fetuses. More than two-thirds of the placentas had shorter gestational age (preterm), seen as commonly associated with maternal co-morbidities such as oligohydramnios and pregnancy induced hypertension (PIH). The predominant gross lesions observed were the umbilical cord abnormalities, infarcts, and intervillous thrombus. Maternal vascular malperfusion (MVM) and fetal vascular malperfusion (FVM) were the two common histologic findings. Characteristic placental lesions with a significant risk of recurrence identified were distal villous immaturity (DVI), villitis of unknown etiology (VUE), and massive perivillous fibrin deposition (MPVFD). The unusual placental causes included  villous capillary lesions and histological chorioamnionitis.
Conclusion: Although a diverse etiology can cause FGR, the severity depends on the cumulative effects of multiple placental lesions. Hence, a meticulous placental examination is crucial for the effective management of growth-restricted fetuses in the current and subsequent pregnancies.


Main Subjects

  1. Sankaran S, Kyle PM. Aetiology and pathogenesis of IUGR. Best Pract Res ClinObstetGynaecol. 2009;23(6):765-77. [DOI:10.1016/j.bpobgyn.2009.05.003] [PMID]
  2. Vedmedovska N, Rezeberga D, Teibe U, Melderis I, Donders GG. Placental pathology in fetal growth restriction. Eur J Obstet Gynecol Reprod Biol. 2011;155(1):36-40. [DOI:10.1016/j.ejogrb.2010.11.017] [PMID]
  3. Halliday HL. Neonatal management and long-term sequelae. Best Pract Res Clin Obste tGynaecol. 2009;23(6):871-80. [DOI:10.1016/j.bpobgyn.2009.06.005] [PMID]
  4. Biswas S, Ghosh SK. Gross morphological changes of placentas associated with intrauterine growth restriction of fetuses: a case control study. Early Hum Dev. 2008;84(6):357-62. [DOI:10.1016/j.earlhumdev.2007.09.017] [PMID]
  5. Barut, F., Barut, A., Gun, B.D. Intrauterine growth restriction and placental angiogenesis. DiagnPathol. 2010;5(1):1-7. [DOI:10.1186/1746-1596-5-24] [PMID] [PMCID]
  6. Ahmed A, Perkins J. Angiogenesis and intrauterine growth restriction. Baillieres Best Pract Res ClinObstetGynaecol. 2000;14(6):981-98. [DOI:10.1053/beog.2000.0139] [PMID]
  7. Rosenberg A. The IUGR newborn. SeminPerinatol. 2008;32(3):219-24. [DOI:10.1053/j.semperi.2007.11.003] [PMID]
  8. Ross MG, Beall MH. Adult sequelae of intrauterine growth restriction. SeminPerinatol. 2008;32(3):213-8. [DOI:10.1053/j.semperi.2007.11.005] [PMID] [PMCID]
  9. Lausman A, McCarthy FP, Walker M, Kingdom J. Screening, diagnosis, and management of intrauterine growth restriction. J ObstetGynaecol Can. 2012;34(1):17-28. [DOI:10.1016/S1701-2163(16)35129-5] [PMID]
  10. Khong TY, Mooney EE, Ariel I, Balmus N, Boyd T, Anne Brundler M, et al. Sampling and Definitions of Placental Lesions: Amsterdam Placental Workshop Group Consensus Statement. Arch Pathol Lab Med. 2016;140(7):698-713. [DOI:10.5858/arpa.2015-0225-CC] [PMID]
  11. American College of Obstetricians and Gynecologists' Committee on Practice Bulletins-Obstetrics and the Society for Maternal-FetalMedicin. ACOG Practice Bulletin No. 204: Fetal Growth Restriction. Obstet Gynecol. 2019;133(2):e97-e109. [PMID] [DOI:10.1097/AOG.0000000000003070]
  12. Khong TY, Mooney EE, Ariel I, Nathalie C M, Balmus, Theonia K Boyd, Marie-Anne Brundler, et al. Sampling and Definitions of Placental Lesions: Amsterdam Placental Workshop Group Consensus Statement. Arch Pathol Lab Med. 2016;140(7):698-713. [DOI:10.5858/arpa.2015-0225-CC] [PMID]
  13. Mardi K, Sharma J. Histopathological evaluation of placentas in IUGR pregnancies. Indian J PatholMicrobiol. 2003;46(4):551-4.
  14. So-Young Park, Moon Young Kim, Yee Jeong Kim, Yi Kyeong Chun, Hye Sun Kim, et al. Placental Pathology in Intrauterine Growth Retardation. Korean J Pathol. 2002;36:30-7.
  15. Ch U, Guruvare S, Bhat SS, Rai L, Rao S. Evaluation of placenta in Fetal demise and Fetal growth restriction. J ClinDiagn Res. 2013;7(11):2530-3. [PMID] [PMCID] [DOI:10.7860/JCDR/2013/6204.3601]
  16. Little WA. The significance of placental/fetal weight ratios. Am J Obstet Gynecol. 1960;79(1):134-7. [DOI:10.1016/0002-9378(60)90372-0] [PMID]
  17. Fox H. Pathology of the placenta. Major ProblPathol. 1978;7:343-8.
  18. Rana J, Ebert GA, Kappy KA. Adverse perinatal outcome in patients with an abnormal umbilical coiling index. Obstet Gynecol. 1995;85(4):573-7. [DOI:10.1016/0029-7844(94)00435-G] [PMID]
  19. Redline RW, Boyd T, Campbell V, Scott Hyde, Cynthia Kaplan, T Yee Khong, et al. Maternal vascular underperfusion: nosology and reproducibility of placental reaction patterns. Pediatr Dev Pathol. 2004;7(3):237-49. [DOI:10.1007/s10024-003-8083-2] [PMID]
  20. Saleemuddin A, Tantbirojn P, Sirois K, Christopher P Crum, Theonia K Boyd, Shelley Tworoger, et al. Obstetric and perinatal complications in placentas with fetal thrombotic vasculopathy. Pediatr Dev Pathol. 2010;13(6):459-64. [DOI:10.2350/10-01-0774-OA.1] [PMID]
  21. Kraus FT, Acheen VI. Fetal thrombotic vasculopathy in the placenta: cerebral thrombi and infarcts, coagulopathies, and cerebral palsy. Hum Pathol. 1999;30(7):759-69. [DOI:10.1016/S0046-8177(99)90136-3] [PMID]
  22. Redline RW. Severe fetal placental vascular lesions in term infants with neurologic impairment. Am J Obstet Gynecol. 2005;192(2): 452-7. [DOI:10.1016/j.ajog.2004.07.030] [PMID]
  23. Kraus FT. Fetal Thrombotic Vasculopathy: Perinatal Stroke, Growth Restriction, and Other Sequelae. SurgPatholClin. 2013;6(1):87-100. [DOI:10.1016/j.path.2012.10.001] [PMID] [PMCID]
  24. Bagby C, Redline RW. Multifocal chorangiomatosis. Pediatr Dev Pathol. 2011;14 (1):38-44. [DOI:10.2350/10-05-0832-OA.1] [PMID]
  25. Knox WF, Fox H. Villitis of unknown aetiology: its incidence and significance in placentae from a British population. Placenta. 1984;5(5):395-402. [DOI:10.1016/S0143-4004(84)80019-3] [PMID]
  26. Redline RW, Abramowsky CR. Clinical and pathologic aspects of recurrent placental villitis. Hum Pathol. 1985;16(7):727-31. [DOI:10.1016/S0046-8177(85)80159-3] [PMID]
  27. Russell P, Atkinson K, Krishnan L. Recurrent reproductive failure due to severe placental villitis of unknown etiology. J Reprod Med. 1980;24(2):93-8.
  28. Romero R, Whitten A, Korzeniewski SJ, Nandor Gabor Than, PiyaChaemsaithong, Jezid Miranda, et al. Maternal floor infarction/massive perivillous fibrin deposition: a manifestation of maternal antifetal rejection?. Am J Reprod Immunol. 2013;70(4):285-98. [DOI:10.1111/aji.12143] [PMID] [PMCID]