Effect of Placental Insufficiency on the Hematological Profile of Neonates

Placental insufficiency is the major cause of intrauterine growth retardation. Umbilical artery (UA) Doppler allows the non-invasive assessment of the severity of impaired placental vascular abnormality. UA end diastolic velocities are positive (PEDV) in mild placental insufficiency but are absent or reversed (AEDV) if 60-70% of the tertiary villous vessels are damaged. The degree of placental dysfunction determines the severity of fetal disease. In addition to disturbances in placental respiratory function, hematologic abnormalities during fetal life and at birth can occur. Aim of the Study: To evaluate the relationship between umbilical artery end diastolic velocity in growth restricted fetuses and hematologic parameters in the neonate. Patients and Methods: All cases of suspected placental insufficiency born over one year period at Al-Galaa Teaching Maternity Hospital were included in the study. They were distributed among three groups: Group (I): 56 cases both term and preterm with mild placental insufficiency PEDV and Group (II): 44 cases both term and preterm with severe placental vascular compromise and absent (AEDV) or reversed (REDV) Group (III): 50 cases both term and preterm acting as controls. Placental insufficiency and growth restricted fetuses were studied with ultrasound and Doppler evaluations of end-diastolic velocity. A complete blood count to assess the hematological parameters was collected from venous cord blood from all neonates born to compromised mothers at birth and a second sample of peripheral venous blood was collected at 48 hrs of life. Results: A total of 103 cases met the inclusion criteria of the study. Our results showed significant anemia, leucopenia, thrombocytopenia, with marked increase in nRBCs in group (II) cases with severe placental insufficiency and absent or reversed end-diastolic volume compared to cases in Group (I) with mild placental insufficiency and positive end-diastolic volume. Again all hematological indices were significantly lower, with a marked increase in the nRBCs in Groups (I) (II) compared to the control group (III). Conclusion: The severity of hematologic alterations at birth and during the first 48 hours of life in growth restricted neonates was proportionate to and predicted by the antenatal umbilical artery end diastolic velocity Doppler status.