Placental Hemodynamics in Fetal Growth Restriction

Placental haemodynamics refers to the patterns of blood flow through maternal and fetal circulations that meet in the intervillous space and feto-placental vasculature to support oxygen and nutrient exchange. In fetal growth restriction (FGR), inadequate spiral artery remodelling and aberrant villous branching elevate vascular resistance and impair flow-mediated vasodilatation. These changes produce heterogeneous perfusion, reduced substrate delivery and compensatory endothelial responses such as enhanced nitric oxide synthesis. Imaging and computational studies have identified vortices, elevated pressure and altered shear stress in the intervillous space, while ex vivo analyses demonstrate disrupted vessel length density, branching angles and capillary shear forces. Impaired angiogenesis and deficient villous maturation create a feedback loop of rising shear stress and further vascular maldevelopment. Understanding these haemodynamic mechanisms is crucial for the design of diagnostic imaging methods, predictive models of placental function and targeted interventions aimed at optimising uteroplacental blood flow. Given the global impact of FGR on perinatal morbidity and mortality, advances in placental haemodynamics offer promising avenues to improve prenatal risk stratification and neonatal outcomes.

Research from Nature Portfolio

Ex vivo three-dimensional vascular casting with microCT has demonstrated that FGR placentas exhibit significant alterations in arterial and venous vessel length density, indicating disrupted microvascular architecture and increased fetoplacental resistance. Complementary computational modelling of placental vasculature predicts elevated microvascular shear stress in FGR, showing that heightened shear forces impair endothelial migration and branching angiogenesis, thus perpetuating poor villous development. In silico simulations of uteroplacental flow further reveal that insufficient spiral artery remodelling generates high-velocity jets, vortices and raised wall shear stress in the intervillous space, providing a rheological explanation for the structural and functional abnormalities seen in FGR.

Placental Hemodynamics in Fetal Growth Restriction publication trend

The graph below shows the total number of articles in placental hemodynamics in fetal growth restriction across all publications each year (not limited to Nature Index journals).

Technical terms

Intervillous space (IVS): The maternal blood-filled compartment between chorionic villi where gas and nutrient exchange occur.
Flow-mediated vasodilatation (FMVD): Endothelial-driven dilation of placental vessels in response to increased blood flow, lowering vascular resistance.
Microvascular shear stress: The tangential force per unit area exerted by flowing blood on the endothelial lining of small vessels.
Spiral artery remodelling: The transformation of maternal uterine spiral arteries into high-capacity, low-resistance channels to supply the placenta.
Villous branching angiogenesis: The process of capillary sprouting and network formation within placental villi, essential for feto-placental exchange.
Nitric oxide (NO) generation: Production of NO by endothelial cells, a key mediator of vasodilatation and vascular tone regulation.

References

1. Integrated Placental Modelling of Histology with Gene Expression to Identify Functional Impact on Fetal Growth. Cells (2023).
2. Whole organ vascular casting and microCT examination of the human placental vascular tree reveals novel alterations associated with pregnancy disease. Scientific Reports (2017).
3. Dysregulated flow‐mediated vasodilatation in the human placenta in fetal growth restriction. The Journal of Physiology (2015).
4. Differences in placental capillary shear stress in fetal growth restriction may affect endothelial cell function and vascular network formation. Scientific Reports (2019).
5. Dynamic modeling of uteroplacental blood flow in IUGR indicates vortices and elevated pressure in the intervillous space – a pilot study. Scientific Reports (2017).
6. Micro-CT and histological investigation of the spatial pattern of feto-placental vascular density. Placenta (2019).