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Published on: November 20, 2015
Placental pathology in relation to stillbirth and neonatal outcome in an extremely preterm population: a prospective
Marie-Therese Vinnars1,2, Nikos Papadogiannakis3, Josefine Nasiell1
1Department of Clinical Science, Intervention and Technology, Division of Obstetrics and Gynecology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
Objective:
To study associations between placental histopathology and stillbirth as well as neonatal outcome in a population born extremely preterm.
Design:
Prospective cohort study.
Setting:
Stockholm, Sweden.
Population:
167 infants born <27 gestational weeks during 2004-2007.
Methods:
One senior perinatal pathologist, blinded to outcome data, evaluated all placental slides.
Main Outcome Measures:
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.
Results:
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).
Conclusion:
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.
