Grading placental fetal vascular malperfusion and short-term perinatal outcome

Abstract

This retrospective analysis was performed to seek possible associations of the global fetal vascular malperfusion (GFVM) and grade of segmental fetal vascular malperfusion (SFVM) with early perinatal outcome. Clinical associations of 538 consecutive cases of placental fetal vascular malperfusion (FVM), including 374 cases of SFVM (group 1: 308 low-grade, group 2: 66 high-grade), and 65 cases of GFVM without segmental villous changes (group 3), were statistically compared. Histological SFVM was graded on HE (Subgroups 1A and 2A) and on CD34 or histochemistry stains (segmental endothelial fragmentation, segmental hypovascularity and/or mineralization) (subgroups 1B and 2B). The short term neonatal outcome as evaluated by NICU stay and neurological complications was statistically significantly more frequently complicated in association with high-grade SFVM than in low-grade SFVM and GFVM in general, and equally frequently in high-grade SFVM diagnosed on HE slides only and on CD34 immunostain and/or mineralization histochemistry only (about 61% of cases each). High-grade SFVM portends a more complicated short-term perinatal outcome than low-grade SFVM or GFVM. CD34 immunohistochemistry and/or mineralization histochemistry diagnosed/upgraded high-grade SFVM has the same short-term prognostic significance as high-grade SFVM diagnosed on HE only, thus increasing the sensitivity of placental examination for FVM by these methods.

Keywords

• fetal vascular malperfusion
• grade
• placenta
• umbilical cord compromise
• histology
• cd34 immunostain.