Decidual vasculopathy and adverse perinatal outcome in preeclamptic pregnancy

Objective: Decidual vasculopathy (DV) describes pathological findings seen in the spiral arteries in preeclampsia (PE). Morphologically, DV is characterized by fibrinoid necrosis and foamy macrophages within the vessel walls. The impact of the lesions on clinical outcome and placental pathology is unclear. We compared cases with DV to cases without these lesions on clinical outcome and placental histology in PE. Study design: Placental sections from 107 patients admitted with PE at the Radboud University Nijmegen Medical Centre, during the years 1995-2000, were analyzed. 25 cases were excluded due to incomplete records or multiple pregnancy. Cases with DV (n = 41) and without DV (n = 41) were compared for various clinical and placental histological parameters, using Mann Whitney test. P-value <0.05 was considered significant. Results: Clinically, DV related to higher diastolic blood pressure, shorter gestational age, lower birth weight and lower umbilical artery pH. Histologically, DV related to more accelerated villous maturity and perivascular inflammatory cell infiltration. No differences were found in maternal biochemical variables (protein-to-creatinine ratio, constituents of HELLP syndrome), fetal maternal interface parameters (placenta weight, infarctions, hematoma, calcifications), or neonatal outcome measures (birth weight centile, APGAR scores, and perinatal death). Conclusions: In PE, the presence of DV related to placental accelerated villous maturity, perivascular inflammatory cell infiltration, and adverse maternal and fetal outcome without affecting neonatal survival. Whether or not DV results from or raises the risk on severe preeclampsia remains to be elucidated.