Analysis of placental pathology and fetal outcome

Amrutha Ramachandran


Background: A careful examination of placenta along with microscopic study may frequently point to the cause of perinatal death. The American College of Pathologists has provided guidelines for the examination of placenta. Aim of this study was to illustrate the gross and histopathological changes in placenta in certain normal and abnormal pregnancies and to analyse the relationship of placental pathology with fetal outcome.

Methods: A prospective study of 120 deliveries at a tertiary teaching centre in India. Each placenta was studied macroscopically and sent to the pathology department for histological examination.  The study included placentas of normal pregnancies and those with maternal high-risk features. The placenta was fixed in formalin and 6 sections were taken. The paraffin sections were studied for vessel wall thickening, infarction, villitis, chorioangiosis, calcification and intervillous hemorrhage. The primary outcome variables were fetal and neonatal morbidity. Abnormal fetal /neonatal events in each histological group were compared with the normal group using Ψ2 test for homogeneity. For cell frequencies less than 5, Fischer exact test was used.

Results: Vessel wall thickening was demonstrated in 54/120 patients (45%). 7 out of 54 (12.96%) fetuses were still born in this group compared to 2/30 (6.67%) with normal histology (p value <0.05). Infarcts were demonstrated in 15/120 (12.5%). The occurrence of abnormal neonatal events in this group was significant p <0.01.

Conclusions: Placental histological features of vessel wall thickening, and infarction is associated with abnormal fetal and neonatal outcome. Larger studies are required to establish the inference.


Fetal outcome, Histological features, Neonatal outcome, Placental pathology

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Altshuler G, Deppisch LM. College of American pathologist’s conference XIX on the examination of the placenta. Report of the working group on indications of placental examination. CAP placenta consensus conference. Arch Pathol Lab Med. 1991;115;701-3.

Benirschke K, Kaufmann P, Baergen R. Pathology of the Human Placenta. 5th ed. New York, Springer Verlag; 2012.

Fox GE, Van Wesep R, Resau JH, Sun CC. The effect of immersion formaldehyde fixation on human placental weight. Arch Pathol Lab Med. 1991 Jul;115(7):726-8.

Novak RF. A brief review of the anatomy, histology, and ultrastructure of the full-term placenta. Arch Pathol Lab Med. 1991 Jul;115(7):654-9.

Langston C, Kaplan C, Macpherson T, Manci E. Practice guideline for examination of the placenta. Arch Pathol Lab Med. 1997 May;121(5):449.

Naeye R, Travers H. College of American Pathologists conference on the examination of placenta: Report of the working group on the role of the pathologist in malpractice litigation involving placenta. Arch Pathol Lab Med. 1995;115:717-9.

Roberts DJ, Post MD. The placenta in pre-eclampsia and intrauterine growth restriction. J Clin Pathol. 2008 Dec;61(12):1254-60.

Corton M,‎ Leveno K,‎ Bloom S,‎ Dashe J,‎ Spong C. Williams Obstetrics, 24th Edi. McGraw Hill. 13:978-0071798398.

Geipel A, Germer U, Welp T, Schwinger E, Gembruch U. Prenatal diagnosis of single umbilical artery: determination of the absent side, associated anomalies, Doppler findings and perinatal outcome. Ultrasound Obstet Gynecol. 2000 Feb 1;15(2):114-7.

Tachibana M, Nakayama M, Miyoshi Y. Placental examination: prognosis after delivery of the growth-restricted fetus. Curr Opin Obstet Gynecol. 2016 Apr 1;28(2):95-100.

Katz N, Schreiber L, Oron A, Halachmi S, Kohelet D. Inflammatory response in preterm newborns born after prolonged premature rupture of membranes: is there a correlation with placental histological findings?. IMAJ. 2017 Oct;19(10):610-3.

Sato Y, Benirschke K, Marutsuka K, Yano Y, Hatakeyama K, Iwakiri T et al. Associations of intrauterine growth restriction with placental pathological factors, maternal factors and fetal factors; clinicopathological findings of 257 Japanese cases. Histol Histopathol. 2013 Jan;28(1):127-32.

Marcorelles P. Placental features in intrauterine growth retardation. J Gynecol Obstet Reprod Biol. 2013 Dec;42(8):996-1007.

Zhong N, Zhong M. China Human Placenta Project: A global effort to promote placenta medicine. Placenta. 2016 Aug;44:112-3.

Guttmacher AE, Maddox YT, Spong CY. The Human Placenta Project: placental structure, development, and function in real time. Placenta. 2014 May;35(5):303-4.

Armstrong DL, McGowen MR, Weckle A, Pantham P, Caravas J, Agnew D et al. The core transcriptome of mammalian placentas and the divergence of expression with placental shape. Placenta. 2017 Sep;57:71-8.