Evaluation of pregnancy outcome in cases of intrauterine growth restriction in relation to placenta apoptosis and doppler indices of the umbilical and uterine arteries
Keywords:
Apoptosis, Preeclampsia, Intrauterine Growth Restriction, Doppler Indices, PlacentaAbstract
Objective: To assess apoptotic changes in trophoblastic cells in normal term placentae and term placentae complicated by either preeclampsia or intrauterine growth restriction (IUGR). Additionally, we aim to examine the correlation between these apoptotic changes and the Doppler velocity of the umbilical and uterine arteries. Methods: This prospective observational study was conducted on 150 pregnant women, including 100 cases with preeclampsia and 50 controls. Placentas were collected at delivery, and apoptotic changes were examined using light microscopy and immunohistochemical staining. Doppler velocimetries were performed to assess umbilical and uterine artery resistance indices. Pregnancy outcomes and neonatal data were recorded. Results: The incidence of apoptosis in placentae was significantly higher in the preeclampsia group compared to the control group (p<0.001). The umbilical and uterine resistance indices were also significantly higher in the preeclampsia group (p<0.001). There was a positive correlation between the incidence of apoptosis and Doppler resistance indices in the preeclampsia group. Fetal birth weight, Apgar scores at 1 and 5 minutes, and gestational age at delivery were significantly lower in the preeclampsia group (p<0.001). Conclusions: Increased placental apoptosis and abnormal Doppler indices are associated with preeclampsia and adverse pregnancy outcomes.
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Gupte S, Wagh G. Preeclampsia-eclampsia. J Obstet Gynaecol India 2014;64(1):4-13, doi:10.1007/s13224-014-0502-y
Chaiworapongsa T, Chaemsaithong P, Yeo L, et al. Pre-eclampsia part 1: current understanding of its pathophysiology. Nat Rev Nephrol 2014;10(8):466-80, doi:10.1038/nrneph.2014.102
Stoenescu M, Serbanescu MS, Dijmarescu AL, et al. Doppler Uterine Artery Ultrasound in the Second Trimester of Pregnancy to Predict Adverse Pregnancy Outcomes. Curr Health Sci J 2021;47(1):101-106, doi:10.12865/chsj.47.01.16
Harrington K, Fayyad A, Thakur V, et al. The value of uterine artery Doppler in the prediction of uteroplacental complications in multiparous women. Ultrasound Obstet Gynecol 2004;23(1):50-5, doi:10.1002/uog.932
Sezik M, Tuncay G, Yapar EG. Prediction of adverse neonatal outcomes in preeclampsia by absent or reversed end-diastolic flow velocity in the umbilical artery. Gynecol Obstet Invest 2004;57(2):109-13, doi:10.1159/000075675
Savill J, Fadok V. Corpse clearance defines the meaning of cell death. Nature 2000;407(6805):784-8, doi:10.1038/35037722
Sharp AN, Heazell AE, Crocker IP, et al. Placental apoptosis in health and disease. Am J Reprod Immunol 2010;64(3):159-69, doi:10.1111/j.1600-0897.2010.00837.x
Farah O, Nguyen C, Tekkatte C, et al. Trophoblast lineage-specific differentiation and associated alterations in preeclampsia and fetal growth restriction. Placenta 2020;102(4-9, doi:10.1016/j.placenta.2020.02.007
Bakrania BA, Spradley FT, Drummond HA, et al. Preeclampsia: Linking Placental Ischemia with Maternal Endothelial and Vascular Dysfunction. Compr Physiol 2020;11(1):1315-1349, doi:10.1002/cphy.c200008
Singh R, Letai A, Sarosiek K. Regulation of apoptosis in health and disease: the balancing act of BCL-2 family proteins. Nat Rev Mol Cell Biol 2019;20(3):175-193, doi:10.1038/s41580-018-0089-8
Berkowitz GS, Mehalek KE, Chitkara U, et al. Doppler umbilical velocimetry in the prediction of adverse outcome in pregnancies at risk for intrauterine growth retardation. Obstet Gynecol 1988;71(5):742-6
Hanretty KP, Whittle MJ, Rubin PC. Doppler uteroplacental waveforms in pregnancy-induced hypertension: a re-appraisal. Lancet 1988;1(8590):850-2, doi:10.1016/s0140-6736(88)91602-9
Lakhkar BN, Ahamed SA. Doppler velocimetry of uterine and umbilical arteries during pregnancy. Indian Journal of Radiology and Imaging 1999;9(3):119-125
Schiffer V, Evers L, de Haas S, et al. Spiral artery blood flow during pregnancy: a systematic review and meta-analysis. BMC Pregnancy and Childbirth 2020;20(1):680, doi:10.1186/s12884-020-03150-0
Shah DA, Khalil RA. Bioactive factors in uteroplacental and systemic circulation link placental ischemia to generalized vascular dysfunction in hypertensive pregnancy and preeclampsia. Biochem Pharmacol 2015;95(4):211-26, doi:10.1016/j.bcp.2015.04.012
DiFederico E, Genbacev O, Fisher SJ. Preeclampsia is associated with widespread apoptosis of placental cytotrophoblasts within the uterine wall. Am J Pathol 1999;155(1):293-301, doi:10.1016/s0002-9440(10)65123-1
Smith SC, Baker PN, Symonds EM. Increased placental apoptosis in intrauterine growth restriction. Am J Obstet Gynecol 1997;177(6):1395-401, doi:10.1016/s0002-9378(97)70081-4
Crocker IP, Cooper S, Ong SC, et al. Differences in apoptotic susceptibility of cytotrophoblasts and syncytiotrophoblasts in normal pregnancy to those complicated with preeclampsia and intrauterine growth restriction. Am J Pathol 2003;162(2):637-43, doi:10.1016/s0002-9440(10)63857-6
Cotechini T, Komisarenko M, Sperou A, et al. Inflammation in rat pregnancy inhibits spiral artery remodeling leading to fetal growth restriction and features of preeclampsia. J Exp Med 2014;211(1):165-79, doi:10.1084/jem.20130295
Gathiram P, Moodley J. Pre-eclampsia: its pathogenesis and pathophysiolgy. Cardiovasc J Afr 2016;27(2):71-8, doi:10.5830/cvja-2016-009
Selam B, Kayisli UA, Mulayim N, et al. Regulation of Fas ligand expression by estradiol and progesterone in human endometrium. Biol Reprod 2001;65(4):979-85, doi:10.1095/biolreprod65.4.979
Loke YW, King A. Immunology of implantation. Baillieres Best Pract Res Clin Obstet Gynaecol 2000;14(5):827-37, doi:10.1053/beog.2000.0122
Ishihara N, Matsuo H, Murakoshi H, et al. Increased apoptosis in the syncytiotrophoblast in human term placentas complicated by either preeclampsia or intrauterine growth retardation. Am J Obstet Gynecol 2002;186(1):158-66, doi:10.1067/mob.2002.119176
Allaire AD, Ballenger KA, Wells SR, et al. Placental apoptosis in preeclampsia. Obstet Gynecol 2000;96(2):271-6, doi:10.1016/s0029-7844(00)00895-4
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