Placental lesions in small for gestational age fetuses with and without clinical features of fetal growth restriction: a secondary analysis of the DRIGITAT study
Abstract
OBJECTIVE
The primary pathophysiological mechanism underlying fetal growth restriction (FGR) is placental insufficiency, which can be attributed to various placental lesions. It is unknown if ultrasound markers can antenatally detect and distinguish between different placental lesions and their grading. This study aimed to investigate the association between placental lesions, clinical markers including Doppler velocimetry and birth outcome.
STUDY DESIGN
This study was a secondary analysis of the DRIGITAT study, a multicenter prospective cohort with nested randomized controlled trial of late preterm small for gestational age (SGA) pregnancies. Placental slides were independently revised, scored and classified using a digital synoptic reporting tool, according to the Amsterdam Consensus criteria and the Freedman-Ernst subclassification, by two perinatal pathologists blinded to clinical data, except for gestational age. Pregnancy characteristics and birth outcomes of cases with placental pathology available were compared to those without. Within the group with pathology available, participants were classified as FGR (two consecutive abnormal Doppler measurements: umbilicocerebral ratio (UCR) >0.8 and/or umbilical artery pulsatility index (UmbA PI) >p90), potential FGR (once or intermittent abnormal UCR and/or UmbA PI), or SGA not otherwise specified (NOS) (never abnormal UCR or UmbA PI). Placental lesion prevalence and grading were analyzed in relation to Doppler ultrasound…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 690 participants or records.
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