The correlation of prenatal brain damage with placental pathology

Several epidemiological studies have emphasized that prenatal factors are the best predictors for cerebral palsy. Many placental pathologists have anecdotally recognized an association between placental pathology and poor pregnancy outcome, including neurologic injury. This study was undertaken to determine if correlations exist between specific types of placental pathology and prenatal brain injury. Ninety-eight stillbirths and livebirths with < 1 hour survival and complete placental and neuropathologic exams were reviewed. Most brain damage was in three categories: germinal matrix/intraventricular hemorrhage (GMH), white matter gliosis/necrosis (WMG/N), and neuronal necrosis. Statistical analysis of contingency tables showed significant associations of WMN with placental chronic vascular changes (PCV), umbilical cord problems, old infarction/abruptio, and meconium staining of the placenta. Associations were found between neuronal necrosis and PCV, surface vessel thrombosis, and old infarction/abruptio. GMH was associated with funisitis, but no other factors. Fetuses with WMN or neuronal necrosis were older than fetuses with GMH or no neuropathology. It is likely that these types of placental pathology can also be correlated with prenatal brain injury in liveborn infants, and examination of the placenta may indicate which infants are at greater risk for neurologic injury.