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Original articles
Placental histology related to fetal brain sonography
  1. F M F Rosier-van Dunné1,
  2. G van Wezel-Meijler2,
  3. R O C Kaschula3,4,
  4. P A B Wranz4,
  5. H J Odendaal5,
  6. J I P de Vries1
  1. 1Department of Obstetrics and Gynaecology, Research Institute MOVE, VU University Medical Centre, Amsterdam, The Netherlands
  2. 2Department of Neonatology, Leiden University Medical Centre, Leiden, The Netherlands
  3. 3Formerly Department of Pathology, Red Cross Hospital, University of Cape Town, Cape Town, South Africa
  4. 4Department of Pathology, Faculty of Health Sciences, University of Stellenbosch and NHLS, Cape Town, South Africa
  5. 5Department of Obstetrics and Gynaecology, Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa
  1. Correspondence to Dr F M F Rosier-van Dunné, Department of Obstetrics and Gynaecology, VU University Medical Centre, Post Box 7057, 1007MB Amsterdam, The Netherlands; fleur.rosier{at}inter.nl.net

Abstract

Background Chronic hypoxia and inflammatory processes can induce placental disturbances that may indirectly lead to perinatal brain injury.

Objective To study histological features of the placenta in relation to echogenicity changes in the periventricular white matter, ventricular system and basal ganglia/thalami of the fetal brain.

Design Prospective study of 77 fetuses between 26 and 34 weeks gestational age with their placentas. The pregnancies were complicated by hypertensive disorders (n=42) or preterm labour (n=35).

Results Of the placentas 79% showed uteroplacental hypoperfusion, inflammation or a combination. Transvaginal ultrasound examination of the brain revealed echogenicity changes in 73% of the fetuses (44 mild, 29 moderate). Moderate brain echogenicity changes (periventricular echodensity (PVE) grade IB: increased echogenicity brighter than choroid plexus, intraventricular echodensity (IVE) grade II and III: echodensity filling ventricle respectively <50% and ≥50%; basal ganglia/thalamic echodensity (BGTE): locally increased echogenicity within basal ganglia/thalami) were equally distributed over cases with uteroplacental hypoperfusion and inflammatory features in the placenta. PVE grade IB was always associated with placental pathology. The sensitivity and negative predictive value of placental pathology for moderate echogenicity changes were high (0.91 and 0.88, respectively), while the specificity and positive predictive value were low (0.27 and 0.34, respectively).

Conclusions Normal placental histology predicted no or mild echogenicity changes, supporting the view that the latter are physiological. Placental pathology was always present in cases with grade IB PVE, presumed to represent mild or early forms of white matter injury. Both uteroplacental hypoperfusion and inflammatory features were seen in placentas from pregnancies with hypertensive disorders.

https://doi.org/10.1136/adc.2009.181198

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    Footnotes

    • Funding Medical Research Council Unit for Perinatal Mortality, University of Stellenbosch.

    • Competing interests None.

    • Ethics approval This study was conducted with the approval of the MRC, Medical Ethical Committee of Tygerberg Hospital, University of Stellenbosch. Project number 98/152.

    • Provenance and peer review Not commissioned; externally peer reviewed.