Placental pathology in relation to stillbirth and neonatal outcome in an extremely preterm population: a prospective cohort study

• Published in: Acta obstetricia et gynecologica Scandinavica Vol. 94; no. 6; p. 584
• Main Authors: Vinnars, Marie-Therese, Papadogiannakis, Nikos, Nasiell, Josefine, Holmström, Gerd, Westgren, Magnus
• Format: Journal Article
• Language: English
• Published: United States 01-06-2015
• Subjects: Adult; Apgar Score; Female; Humans; Infant, Extremely Premature; Infant, Newborn; Infant, Newborn, Diseases - epidemiology; Infant, Small for Gestational Age; Placenta - pathology; Pregnancy; Pregnancy Complications - epidemiology; Pregnancy Outcome - epidemiology; Prospective Studies; Risk Factors; Stillbirth - epidemiology; Sweden - epidemiology; Sweden; villous maturation; Histopathology; prematurity; thrombosis; placental weight
• ISSN: 1600-0412
• DOI: 10.1111/aogs.12610

To study associations between placental histopathology and stillbirth as well as neonatal outcome in a population born extremely preterm.
Prospective cohort study.
Stockholm, Sweden.
167 infants born <27 gestational weeks during 2004-2007.
One senior perinatal pathologist, blinded to outcome data, evaluated all placental slides.
Intrauterine fetal death, small-for-gestational age, major neonatal morbidity (intraventricular hemorrhage ≥grade 3, retinopathy of prematurity ≥grade 3, necrotizing enterocolitis, cystic periventricular leukomalacia or severe bronchopulmonary dysplasia) and neonatal mortality. Additional outcome variables were Apgar score at 5 min, sepsis, and treated patent ductus arteriosus.
Accelerated villous maturation was associated with a decreased risk for Apgar score <7 at 5 min (p = 0.041). Fetal thrombosis and low placental weight were associated with an increased risk for both intrauterine fetal death (p < 0.001 and p = 0.011, respectively) and small-for-gestational age (p < 0.001 and p < 0.001, respectively).
Placental histology may have prognostic value as it appears to be associated with intrauterine fetal death, as well as with being small-for-gestational age and assignment of a low Apgar score at birth.