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Placental dysfunction: Pathophysiology and clinical considerations

The clinical combination of intrauterine growth restriction (IUGR), decreased amniotic fluid volume and abnormal Doppler flow studies in the presence of a genetically and anatomically normal fetus and uncomplicated maternal condition, is suggestive of placental compromise. The placental disorder is the end result of various pathologic processes; however, the exact nature of these processes and their etiology are often unknown. Throughout pregnancy the placenta undergoes changes that increase its transfer capacity. At the same time the fetal/ placental weight ratio decreases significantly. Studies of the relationship between placental size and pregnancy outcome revealed that although birth weight increases with increasing placental size, placental size does not equate with function (Pardi et al. 2002). Hence, while growth restricted fetuses tend to have small placentas, a small placenta is not necessarily associated with a growth-restricted fetus. In general, the only clinical method of evaluating the placental function is by assessment of fetal growth, amniotic fluid volume and Doppler flow studies. Recent studies have provided us with a better understanding of normal as well as abnormal placentation and their association with fetal growth and well-being, amniotic fluid volume and Doppler flow. The purpose of this review is to update providers of obstetric care about these important issues.