Uterine doppler velocimetry and placental hypoxic-ischemic lesion in pregnancies with fetal intrauterine growth restriction

We tested the hypothesis that Doppler velocimetry of the ascending uterine arteries (Ut.DV) in cases of fetal intrauterine growth restriction (IUGR) can reflect the presence of hypoxic-ischaemic lesions of the placenta, and whether this prediction is affected by the maternal blood pressure status. Ut.DV was obtained within 7 days of delivery in 90 consecutive pregnancies with IUGR and in 37 uneventful control pregnancies. Abnormal Ut.DV was defined as an average of a (left and right systolic)/diastolic ratio > 2.6 and diastolic notching. After delivery, pathological studies were performed with attention paid to macroscopic and microscopic evidence of hypoxic or ischaemic placental lesions related to uteroplacental vascular pathological features. In patients with IUGR, the total rate of placental lesions was significantly higher in the presence of abnormal Ut.DV compared to the presence of normal Ut.DV (relative risk, 6.35; 95 per cent confidence interval = 5.2-7.3). The rate and the severity of these lesions was not significantly different between normotensive and hypertensive pregnancies (87 versus 93 per cent; P = 0.2). When Ut.DV was normal, the rate of placental lesions was similar between IUGR cases and control pregnancies (14 versus 8 per cent; P = 0.69). The perinatal outcome was not significantly different in any of the normotensive and the hypertensive pregnancies with growth-restricted fetuses and abnormal Ut.DV. The presence of abnormal Doppler velocimetry of the uterine arteries in pregnancies with fetal intrauterine growth restriction is may be in fact an important indicator of hypoxic or ischaemic placental lesions. This abnormal Doppler velocimetry is independent of the maternal blood pressure status.