Pathological Insights: Placental and Umbilical Cord Changes in Stillbirth

Stillbirth evaluation plays a crucial role in the management of future pregnancies, as it can help identify risk factors that may recur. Additionally, it may provide a definitive cause of death, helping bring closure to the family and guiding both emotional healing and clinical care.

To study various pathological findings of the placenta and umbilical cord in cases of stillbirths.

Fifty women suffering stillbirths occurring at ≥ 24 weeks of gestation were included in the study. Demographic details, past obstetric history, and antenatal history of the present pregnancy were recorded for all women. Detailed general physical, obstetric, and systemic examinations were done. All antenatal investigations were noted. After delivery, the stillborn was weighed, and any gross congenital malformations (CMF) were documented. Histopathological evaluation was done as per the Amsterdam placental group workshop consensus statement.

The majority of women were between 19 and 30 years old. A history of stillbirth in previous pregnancies was present in four women. Most of the stillbirths were antepartum. Prominent clinical causes of stillbirths included fetal malformations, fetal growth restriction, and hypertensive disorders in pregnancy. However, a notable number remained unclassified (18%). Gross and microscopic findings of the placenta, cord, and membranes are presented. The most common histopathological placental finding was fibrin deposition, seen in 38 cases, with other notable features being placental infarction, calcification, and chorioamnionitis. Placental findings were correlated with clinical causes of stillbirth. Findings in clinically unclassified stillbirths are also enumerated.

Our study underscores the importance of conducting autopsies and examining placental histopathology to determine the causes of stillbirth. Such insights are essential for planning personalized care, helping to improve outcomes in future pregnancies, particularly those following a loss.