The stillborn fetus: placental histologic examination in determining a cause

This investigation was undertaken to determine whether or not histologic examination of the placenta contributed to a better understanding of the cause for an intrauterine fetal death. The placentas of stillborn fetuses delivered after the 20th gestational week were examined during a 4.5-year period (January 1979 to June 1983). Adequate information about the clinical history, autopsy examination, and placental histological examination was available in 89 cases. Delivery was usually within the first week after the fetal death. Significant histologic aberrations in the placenta were found in 87 (98%) cases. The most frequent abnormalities were those of vascular insufficiency, hemorrhagic endovasculitis, retroplacental hematomata, acute chorioamnionitis with fetal involvement, and erythroblastosis/hydrops. Histologic abnormalities were supportive of prior impressions in 67 (77%) cases, contradictory to prior impressions in ten (11%) cases, or the sole contributors in explaining the cause of death in ten (11%) cases. Routine histologic examination of the placenta after a recent fetal death provides helpful information in counseling the parents and in planning any future childbearing.