Sabato 27 ottobre 2012 - Pacini Editore

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vascular insufficiency pattern was more frequent in the PE group,
although highly represented also among normotensive FGR. Finally,
chronic villitis was more common in normotensive FGR.
Few studies have performed a systematic pathological assessment
of FGR placentas or have correlated histology findings with
clinical outcome and FGR etiology 8 9 . Previous studies were also
limited by small sample size, different inclusion criterion, variability
in clinical and pathologic measures, and lack of multivariate
statistical analysis. Recently, Kovo et al (10) reported a higher
CONGRESSO aNNualE di aNatOmia patOlOGiCa SiapEC – iap • fiRENzE, 25-27 OttOBRE 2012
Tab. I. placental pathologic findings in 126 pregnancies complicated by fGR according to the presence of pE.
Variables
Variables detected at gross examination
Category
With PE
n 54 (%)
W/o PE
n 72 (%)
p
placental weight (g) mean±ds 266±74 266±96 0.203
Placental maximum diameter (cm) mean±ds 14.0±2.3 14.1±2.4 0.816
Placental minimum diameter (cm) mean±ds 11.1±2.1 11.6±2.2 0.223
placental maximum width (cm) mean±ds 2.6±0.6 2.7±0.8 0.445
placental minimum width (cm) mean±ds 1.5±0.6 1.7±0.6 0.031
Cord length (cm) mean±ds 23.9±10.0 24.5±10.9 0.767
cord diameter (cm) mean±ds 1.0±0.3 1.0±0.3 0.627
Retroplacental hematoma Present 4 (7.4) 5 (6.9) 0.920
intervillous thrombus Present 5 (9.2) 12 (16.7) 0.228
Recent infarction Present 11 (20.4) 8 (11.1) 0.151
organized infarction Present 34 (63) 23 (31.9) 0.001
Chronic abruption Present 2 (3.7) 0 0.100
fibrin deposition
Microscopic variables
Mild
Massive
3 (5.5)
1 (1.8)
6 (8.3)
2 (2.8)
0.782
Chorionamnionatis grade
Mild
Moderate-severe
3 (5.5)
0
5 (6.9)
1 (1.4)
0.647
Chorionamnionitis stage
1
2
3 (5.5)
0
3 (4.2)
3 (4.2)
0.301
inflammatory fetal reaction Present 0 1 (1.4) 0.385
acute villitis Present 1 (1.8) 1 (1.4) 0.837
Chronic villitis Present 4 (7.4) 17 (23.6) 0.016
fetal thrombotic vasculopathy Present 2 (3.7) 4 (5.5) 0.629
fVt+ avascular villi Present 15 (27.8) 16 (22.2) 0.474
fVt grade
Mild
Moderate-severe
6 (11.1)
9 (16.7)
9 (12.5)
7 (9.7)
0.510
Meconium staining of membranes Present 38 (70.4) 53 (73.6) 0.688
Syncitial knots
< 30%
> 30%
12 (22.2)
38 (70.4)
29 (40.3)
30 (41.7)
0.006
Villous agglutination < 20
> 20
10 (18.5)
7 (13)
13 (18.1)
6 (8.3)
0.685
intervillous fibrin deposition mild-moderate
Marked
30 (55.5)
14 (25.9)
42 (58.3)
22 (30.5)
0.482
Villous hypoplasia Present 13 (24.1) 15 (20.8) 0.665
atherosis of spiral arteries Present 20/51 (39.2) 11/71 (15.5) 0.003
mural arterial hypertrophy Present 31 (57.4) 29 (40.3) 0.065
Muscular arteries in basal plate Present 24/46 (52.2) 23/69 (33.3) 0.044
trophoblastic giant cells Present 38 (70.4) 31/70 (44.3) 0.004
immature intermediate trophoblast
Class of pathological lesions
Present 42 (77.8) 36/70 (51.4) 0.003
Superficial implantation Present 42 (77.8) 37/71 (52.1) 0.003
infection/inflammation Present 3 (5.5) 7 (9.7) 0.392
fetal vascular damage Present 15 (27.8) 16 (22.2) 0.474
Maternal vascular damage Present 33 (61.1) 35 (48.6) 0.164
prevalence of maternal vascular lesions in PE-associated FGR
than in normotensive FGR and in PE without FGR; conversely,
fetal vascular anomalies and chronic villitis were more frequent
in normotensive FGR.
The strength points of our study are: a) standardized pathologic
evaluation, including systematic macroscopic examination and
sampling of the placentas, use of validated diagnostic criteria,
semiquantitive scoring of elementary histological features,
analysis of patterns of lesions; b) reproducibility of pathologic