Perinatal arterial ischemic stroke: how informative is the placenta?

Area of Science:

• Neuroplacentology
• Perinatal Neurology
• Pathology

Background:

• Neuroplacentology investigates placental effects on fetal and neonatal brain development.
• Perinatal arterial ischemic stroke (PAIS) is a significant concern in neonates.
• Previous research on placental pathology and PAIS lacks conclusive evidence due to diverse methodologies.

Purpose of the Study:

• To elucidate the association between placental pathology and perinatal arterial ischemic stroke (PAIS).
• To analyze histological findings in placentas from neonates diagnosed with PAIS.

Main Methods:

• Histological examination of placentas from 16 neonates with confirmed PAIS.
• Classification of placental lesions into inflammation, hypoxic damage, and abnormal birthweight/placenta weight ratio.
• Comparison with matched control placentas (singleton and twin pregnancies) and a controlled amniotic membrane donation program cohort.

Main Results:

• Over half of PAIS placentas (56%) exhibited multiple lesion categories, similar to controls (65%).
• Pathological placentas showed more severe and extensive lesions compared to controls.
• One case linked PAIS to SARS-CoV-2 placentitis, expanding the scope of COVID-19's perinatal impact.

Conclusions:

• PAIS can arise from complex interactions of maternal and fetal factors, highlighting the placenta's role.
• Placental examination is valuable for understanding PAIS etiology.
• Caution is advised when interpreting placental findings due to their presence in control groups.