Placental histological patterns and uterine artery Doppler velocimetry in pregnancies complicated by early or late pre‐eclampsia

ABSTRACT Objectives To study placental patterns in pregnancies complicated by pre‐eclampsia (PE) and to verify whether the findings are related to gestational age (GA) at PE onset and second‐trimester uterine artery (UtA) Doppler. Methods For all pre‐eclamptic women who delivered between January 2010 and December 2013, we collected retrospectively data related to placental findings and UtA Doppler velocimetry performed at PE onset. The study cohort was divided into groups according to early‐onset (EO) or late‐onset (LO) PE. Regression analysis was performed to test the ability of UtA Doppler velocimetry to predict subsequent development of placental lesions, after correcting for possible confounders. Results Placental abnormalities occurred with a significantly lower incidence in the LO‐PE group (n = 72) than in the EO‐PE group (n = 105) (P = 0.02). Irrespective of GA at PE onset, UtA pulsatility index (PI) was able to predict macroscopic infarctions (P = 0.001), distal villous hypoplasia (P = 0.03), decidual arteriolopathy (P = 0.03), villous infarcts (P < 0.001), syncytiotrophoblast ‘knots’ (P = 0.02), microcalcifications (P = 0.02), perivillous fibrin deposition (P = 0.02) and placental hemorrhage (P = 0.01). Conclusions Similar placental abnormalities were present in both EO‐PE and LO‐PE groups, although with quantitative differences according to GA and UtA Doppler velocimetry at PE onset. Histological patterns were predicted by UtA‐PI, independently of GA, supporting the use of UtA Doppler velocimetry as the key criterion in PE classification. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. Linked Comment: Ultrasound Obstet Gynecol 2016; 47: 546–546