Archives of Gynecology and Obstetrics

, Volume 300, Issue 6, pp 1583–1589 | Cite as

Recurrent intrauterine growth restriction: characteristic placental histopathological features and association with prenatal vascular Doppler

  • Keren Rotshenker-Olshinka
  • Jennia MichaeliEmail author
  • Naama Srebnik
  • Sveta Terlezky
  • Letizia Schreiber
  • Rivka Farkash
  • Sorina Grisaru Granovsky
Maternal-Fetal Medicine



Intrauterine growth restriction (IUGR) is a leading cause of perinatal morbidity and mortality, carrying a 20% recurrence rate. The placental disease is a cardinal factor among IUGR underlying processes. This study describes placental histopathological features (HPf) characteristic of recurrent IUGR (rIUGR) and assesses association with antenatal Doppler studies.


We conducted a retrospective case–control study, between the years 2005–2016, evaluating 34 placentae of 17 women with rIUGR, and 59 placentae of a gestational age-matched control. Doppler studies within a week prior to delivery were analyzed for the rIUGR group.


Placental HPf characteristic of rIUGR is maternal and fetal vascular malperfusion lesions; maternal accelerated villous maturation and villous infarcts, repetitive feature rate 88.8% (95% CI 37.2–97), and fetal chorionic plate/stem villous thrombi, repetitive feature rate 66.6% (95% CI 30–90.3). Among women with abnormal Doppler, 83.3% had a placenta HPf of maternal vascular malperfusion lesions and 66.7% presented with a hypertensive disorder.


Women with rIUGR are a unique group of patients characterized by repetitive placental HPf of both maternal and fetal vascular malperfusion lesions. Specifically, maternal vascular malperfusion lesions are associated with abnormal Doppler findings. In conclusion, characteristic placental HPf may serve as predictors of future IUGR recurrence, thus offering early recognition of pregnancies that require “high-risk” antenatal care.


Placenta Recurrent IUGR Histopathological features Vascular malperfusion 


Author contributions

KR-O helped in research performance and authored the manuscript. JM authored the manuscript, was involved in the critical review, and was corresponding author. NS assisted in research performance and critically reviewed the manuscript. ST and LS assisted in research performance. RF helped in statistical analysis. SGG contributed to research concept, statistical analysis, manuscript review, and critical appraisal.


No funding or other financial support was received for this work.

Compliance with ethical standards

Conflict of interest

All authors declare they have no conflict of interest.

Ethics approval

The study was approved by the Institutional Review Board for clinical studies of Shaare Zedek Medical Center, Affiliated with the Hebrew University Hadassah School of Medicine, Jerusalem, Israel. Approval ID: 0173-16-SZMC.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, Shaare Zedek Medical CenterAffiliated with the Hebrew University Hadassah School of MedicineJerusalemIsrael
  2. 2.Department of Pathology, Edith Wolfson Medical CenterAffiliated with the Tel Aviv University Sackler Faculty of MedicineHolonIsrael

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