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Updated: Oct 20, 2025
The Hypoxic Ischemic Encephalopathy Model of Perinatal Ischemia
Published on: November 19, 2008
Choosing placental hypoxic-ischemic measures that have clinical implications in child development and diseases
Yanjun Zhao1, Huijuan Zhang2, Yan Chen3
1Department of Child Health Care, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.
Insights
This study identified four key placental measures—short cord length, calcification, opaque membranes, and Hofbauer cells—that predict adverse child health outcomes following hypoxic-ischemic events.
Area of Science:
- Perinatal pathology
- Neonatal neurology
- Obstetrics and Gynecology
Background:
- Placental hypoxic-ischemic pathology is a significant cause of adverse pregnancy outcomes.
- Currently, no standardized system exists for evaluating specific placental morphological and histopathological markers of hypoxia-ischemia.
- Developing such a system is crucial for accurate prognostication and clinical management.
Purpose of the Study:
- To systematically identify core placental hypoxic-ischemic measures with high prognostic relevance for child health.
- To develop a simplified, clinically applicable evaluation system for placental hypoxic-ischemia.
Main Methods:
- Utilized data from the Collaborative Perinatal Project (over 55,000 participants).
- Selected 57 placental measures related to hypoxia-ischemia and analyzed their association with child outcomes (Apgar score, IQ, etc.).
- Employed the least absolute shrinkage and selection operator (LASSO) and training/testing methods for measure selection.
Main Results:
- LASSO identified 7 candidate measures from the initial 57.
- Further analysis retained four measures with the highest prognostic relevance for child morbidity.
- These key indicators include short cord length (ΣOR = 8.51), calcification of cut surface (ΣOR = 8.31), opaque membranes (ΣOR = 5.26), and Hofbauer cells in terminal villi (ΣOR = 4.69).
Conclusions:
- A novel four-measure system for evaluating placental hypoxic-ischemia has been developed.
- This system is simple, demonstrates strong prognostic relevance to child health, and can serve as a primary tool for future research.
- It offers a potential new criterion for assessing placental pathology related to hypoxic-ischemic events.
Purpose:
Placental hypoxic-ischemic pathology is one of the common causes for adverse outcomes. But there is no commonly accepted evaluation system on specific morphological and histopathological measures of the placenta.
Objective:
This study aims to systematically select several core placental hypoxic-ischemic measures that have a high prognostic relevance to child health.
Methods:
We used data from the Collaborative Perinatal Project, a multicenter prospective cohort study that recruited over 55,000 pregnant women and followed their offspring to 7 years old. Women who had information on placental pathology and child outcomes were included. 57 placental measures considered to be relevant to hypoxia-ischemia were selected. Apgar score, intelligence quotient, preeclampsia, birth weight and subclinical neurology injuries were chosen as outcomes. The least absolute shrinkage and selection operator (LASSO) procedure as well as training and testing methods were used to select a more efficient and simpler placental hypoxic-ischemic measures that may have clinical implications.
Results:
Of the 57 measures, 7 were selected as candidates by LASSO. Based on the training and testing methods, we retained placental measures with a higher odds ratio of child morbidity. We further narrowed down to four measures that had the highest prognostic relevance. They were: short cord length (ΣOR = 8.51), calcification of cut surface (ΣOR = 8.31), opaque membranes (ΣOR = 5.26), Hofbauer cells in terminal villi (ΣOR = 4.69).
Conclusions:
Our four-measure system is relatively simple and closely related to the child health. It may be used as a novel placental hypoxic-ischemic evaluation criterion, and function as the first line tool for future research.
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