Abstract
BackgroundMaternal perception of reduced fetal movement (RFM) is associated with increased risk of stillbirth and fetal growth restriction (FGR). DFM is thought to represent fetal compensation to conserve energy due to insufficient oxygen and nutrient transfer resulting from placental insufficiency. To date there have been no studies of placental structure in cases of DFM.ObjectiveTo determine whether maternal perception of reduced fetal movements (RFM) is associated with abnormalities in placental structure and function.DesignPlacentas were collected from women with RFM after 28 weeks gestation if delivery occurred within 1 week. Women with normal movements served as a control group. Placentas were weighed and photographs taken. Microscopic structure was evaluated by immunohistochemical staining and image analysis. System A amino acid transporter activity was measured as a marker of placental function.Placentas from all pregnancies with RFM (irrespective of outcome) had greater area with signs of infarction (3.5% vs. 0.6%; p<0.01), a higher density of syncytial knots (p<0.001) and greater proliferation index (p<0.01). Villous vascularity (p<0.001), trophoblast area (p<0.01) and system A activity (p<0.01) were decreased in placentas from RFM compared to controls irrespective of outcome of pregnancy.ConclusionsThis study provides evidence of abnormal placental morphology and function in women with RFM and supports the proposition of a causal association between placental insufficiency and RFM. This suggests that women presenting with RFM require further investigation to identify those with placental insufficiency.
Highlights
There has been little reduction in stillbirth rates in high-income countries over the past 20 years, with the incidence of stillbirth in the UK and the USA approximately,5–6 per 1,000 live births [1,2]
This study provides evidence of abnormal placental morphology and function in women with reduced fetal movements (RFM) and supports the proposition of a causal association between placental insufficiency and RFM
This suggests that women presenting with RFM require further investigation to identify those with placental insufficiency
Summary
There has been little reduction in stillbirth rates in high-income countries over the past 20 years, with the incidence of stillbirth in the UK and the USA approximately ,5–6 per 1,000 live births [1,2] This results in part from a lack of sufficiently sensitive and specific methods of identifying women at highest-risk of stillbirth [3]. The use of RFM as a screening tool to identify women at increased risk of stillbirth is contentious; this is in part related to the lack of pathophysiological evidence linking RFM to stillbirth Both pathological and non-pathological conditions are associated with RFM [8]; the most common pathological association with RFM is small for gestational age (SGA) or fetal growth restriction (FGR), which affects approximately 20% of pregnancies with RFM [9,10,11]. To date there have been no studies of placental structure in cases of DFM
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