Doppler velocimetry and small for gestational age pregnancies in sickle cell disease associated with abnormal placental pathology

Summary

Placentas from singleton deliveries of 108 prospectively followed pregnant women, 18 with sickle cell disease (16 SS, 2 SC) 36 with AS and 54 with AA haemoglobin were examined and findings correlated with antepartum Doppler results and neonatal outcome. Systolic/diastolic ratios ⩾3 were designated as abnormal. Gross and microscopical examinations of placentas were done by a pathologist blinded to the Doppler results and pregnancy outcome.

Results of our study show moderate to severe villous sclerosis as well as intervillous fibrin deposits in 31 per cent (5/16) of SS placentas examined but these were absent in the placentas of SC, AS and AA patients. The same patients with sickle cell (SS) disease demonstrated both abnormal uterine and umbilical systolic/diastolic ratios. Four of these five pregnancies resulted in the births of small for dates babies. In contrast, the nine SS women with normal Doppler studies and the two patients with only an abnormal uterine Doppler had normal or minimal placental findings and normal weight babies.

Our data suggest that placental villous sclerosis and intervillous fibrin deposits are associated with abnormal umbilical and abnormal uterine velocimetry in SS and SC individuals.