Adverse Pregnancy Outcome, the Uteroplacental Interface, and Preventive Strategies

Adverse pregnancy outcome (APO), includes fetal loss ≥20 weeks’ gestation (fetal death), severe preeclampsia <36 weeks, or severe intrauterine growth restriction (severe IUGR) defined as birth weight ≤5th percentile or ≤10th percentile for gestational age. APO affects 8% of pregnant women (320,000 annually) and collectively contributes to the largest proportion of maternal/fetal mortality and morbidity. Women with prior APO in antecedent pregnancy are at high risk of an adverse maternal or fetal outcome in the subsequent pregnancy. Maternal serum markers and Doppler ultrasound can be used to predict adverse pregnancy outcome. There are no adequate, completed randomized trials for prophylactic measures; the roles of aspirin, calcium, and low molecular weight heparin need to be evaluated.