Signs of Poor Placental Perfusion In Placental Pathology in Stillbirth Fetuses [19B]

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Abstract

INTRODUCTION:

Over 50% stillbirths have preceding growth restriction. Our objective was to determine whether placental changes commonly seen in fetal growth restriction are associated with placentas of stillbirth infants.

METHODS:

Secondary analysis of a retrospective chart review on singleton placentas January 2011-January 2016. Exclusion criteria were less than 24 weeks’ gestation, multiple gestations, known aneuploidy. Primary outcome was decreased placental weight. Secondary outcomes were infarcts, villitis, fibrin deposition, calcium deposition, villous hypermaturity, meconium staining, intervillous thrombus. Pathology reports, and demographics from the electronic medical records were reviewed. Chi square was used for categorical variables and logistic regression for adjusted analyses.

RESULTS:

3111 placental reports met inclusion/exclusion criteria. There were 78 stillbirths were noted in the study period, 71 (91%) with placenta evaluation. Nineteen (28%) of stillbirths were born SGA at birth. Placentas of stillbirths were more likely to have decreased placental weight (44% vs 20%), more than 2 (54% vs 26%) and 3 placental outcomes (28% vs 7%), p <0.01. Of the 67 with documented fetal weight at delivery, those placentas associated with small for gestational age (SGA) fetus were more likely to have decreased placental weight, infarcts, calcium deposition, and greater than 2 and 3 placental outcomes.

CONCLUSION:

Placentas from pregnancies with stillbirth have increased rates of placental pathology. Those stillbirths born SGA were more likely to have decreased placental weight, infarcts, calcium deposition and greater than 2 and 3 placental outcomes. These placental findings have been associated with poor placental perfusion and may represent cases of placental insufficiency prior to demise.

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