Fetal vascular malperfusion and short-term outcomes: Does low grade matter?

IntroductionThis study aimed to evaluate the possible associations between specific fetal vascular malperfusion (FVM) findings-beyond standard high- and low-grade criteria-and fetal and neonatal clinical complications in a tertiary high-complexity hospital.MethodsWe conducted a retrospective, observational, descriptive cohort study of 706 placentas, correlating routine histological findings with maternal conditions and fetal and neonatal outcomes. Bivariate and multivariate logistic regression analyses were performed to explore potential associations between detailed microscopic features and clinical variables.ResultsA high frequency of FVM was observed in this high-risk population. Several histologic features were found to be associated with adverse perinatal outcomes, including cases classified as low-grade FVM. Similar patterns of association were observed between FVM and maternal pre-pregnancy conditions as well as gestational complications.DiscussionBecause FVM is typically diagnosed only after delivery, its clinical impact may be underrecognized. Our findings suggest a potential increased risk of neonatal and fetal complications in both low- and high-grade FVM. We highlight the importance of considering the temporal progression of fetal circulatory obstruction, from leukocyte stasis to calcified thrombi.