Uteroplacental insufficiency is a condition marked by insufficient blood flow to the placenta during pregnancy. It is imperative to understand the underlying placental pathologies and their clinical implications.

To study the prevalence, distribution, and types of placental pathology among women with clinically recognizable subgroups of FGR and abnormal uterine or umbilical artery Doppler findings.

Abnormal uterine or umbilical artery Doppler of FGR pregnancies was studied with a comprehensive examination of the macroscopic and microscopic abnormalities of 50 placentae. Specific features such as infarction, villitis of unknown etiology, intervillous inflammation, and massive perivillous fibrin deposition were assessed by microscopy.

Among the subjects with uteroplacental insufficiency, 98% displayed placental infarcts. Key histopathological characteristics observed in placentas included villous thrombosis (94%), intervillous hemorrhage (98%), and perivillous fibrin deposition (98%). Inflammatory changes such as villitis, intervillositis, and deciduitis were significantly associated with high resistance in the umbilical artery. The ultrasound demonstrated a positive predictive value of 97.8% for detecting placental infarct.

In pregnancies complicated by uteroplacental insufficiency, macroscopic and microscopic placental abnormalities were prevalent. Conditions such as villitis, intervillositis, deciduitis and abruption showed noteworthy differences between the HIGH flow and AEDF/REDF groups can be used as indicators for postpartum histopathological examination whether delivery occurred timely or not as per findings on color Doppler. Inflammatory changes might be more related to labor events than being indicative of FGR.