Fetal Vascular Malperfusion: A Comprehensive 10-Year Retrospective Single-Center Cohort Analysis.

BACKGROUND: Fetal vascular malperfusion (FVM) represents a significant cause of adverse perinatal outcomes, yet population-specific patterns remain understudied in Middle Eastern populations. This study characterizes FVM patterns and clinical correlates in Kuwait over a 10-year period. METHODS: Retrospective analysis of 180 histologically confirmed FVM cases from the Maternity Hospital, Kuwait (2014-2024). Cases were classified by FVM grade, associated pathology, and clinical parameters. RESULTS: High-grade FVM predominated (80.0%, 144/180). Distinct trimester-specific patterns emerged: second trimester showed highest inflammatory pathology (18.6%), while maternal vascular malperfusion (MVM) occurred exclusively in third trimester pregnancies (10.7%). Maternal age analysis revealed unexpected peak risk in 30-34 years group (88.3% high-grade FVM). Twin pregnancies demonstrated significantly higher pathological burden (88.9% vs 79.5% in singletons, p = 0.041). CONCLUSIONS: This study reveals distinct FVM patterns in Middle Eastern populations, including unique age-related risks and trimester-specific pathological profiles. These findings support population-specific approaches to FVM assessment and management.