Chronic intrauterine bleeding and fetal growth at less than 32 weeks of gestation

Placental hemosiderin deposition representing intrauterine bleeding at leas t 24-48 h before delivery is detected frequently in prematurity, The object ive of this study was to assess incidence and site of histologic evidence o f intrauterine bleeding in association with fetal growth in prematurity. Pl acentas of consecutive nonanomalous singleton liveborns delivered <32 weeks of gestation were studied for the presence of hemosiderin in decidua of th e placental basal plate or extraplacental membranes (confirmed by Prussian blue stain). Cases of placenta previa, clinical abruption, or coagulopathy and cases in whom obstetric and neonatal gestational age assessment differe d by >2 weeks were excluded. A single reviewer blinded to clinical data exc ept for gestational age at delivery assessed the presence of decidual hemos iderin, Statistical analysis included ANOVA, and Mann-Whitney U test with p < 0.05 considered significant. The study included 352 patients delivered f or principal indication of premature rupture of membranes (PROM) or preterm labor (PTL) and 78 patients delivered for preeclampsia between 1989 and 19 94. Mean birth weight percentiles for neonates delivered following PROM/PTL versus preeclampsia were: no decidual hemosiderin 42 +/- 25 versus 17.4 +/ - 25, extraplacental membrane hemosiderin 42 +/- 25 versus 9.2 +/- 10, plac ental basal plate hemosiderin 42 +/- 25 versus 17 +/- 24, and hemosiderin i n both sites 27 +/- 21 versus 6.4 +/- 10 (p = 0.02), Hemosiderin deposition in both placental basal plate and extraplacental decidua is associated wit h significantly tower mean birth weight percentiles in PROM/PTL at less tha n 32 weeks of gestation. We postulate that in these patients placental disr uption which accompanies decidual bleeding may explain the relatively impai red fetal growth. In preeclampsia, hemosiderin depositions are not associat ed with further impaired fetal growth. Copyright (C) 2000 S. Karger AG, Bas el.