Stillbirth, Hypertensive Disorders of Pregnancy, and Placental Pathology

• Type of Material: Article
• Authors: Karen Gibbins, University of Utah; Robert Silver, University of Utah; Halit Pinar, Brown University; Uma Reddy, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Corette B. Parker, RTI International; Vanessa Thorsten, RTI International; Marian Willinger, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Donald J. Dudley, University of Virginia; Radek Bukowski, Yale New Haven Medical Center; George R Saade, University of Texas Medical Branch; Matthew A Koch, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Deborah Conway, University of Texas at San Antonio; Carol J Hogue, Emory University; Barbara Stoll, Emory University; Robert L. Goldenberg, Columbia University
• Language: English
• Date: 2016-07-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 Elsevier Ltd.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.placenta.2016.04.020
• Title of Journal or Parent Work: Placenta
• ISSN: 0143-4004
• Volume: 43
• Start Page: 61
• End Page: 68
• Keywords: FETAL-GROWTH RESTRICTION; RISK-FACTORS; Reproductive Biology; UNITED-STATES; TRENDS; GESTATIONAL-AGE; LESIONS; Developmental Biology; SEVERITY; Placental pathology; Obstetrics & Gynecology; MATERNAL UNDERPERFUSION; Stillbirth; Preeclampsia; LATE-ONSET PREECLAMPSIA; Science & Technology; DEATH; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Public Health; Health Sciences, Medicine and Surgery

Abstract

Introduction Stillbirth, preeclampsia, and gestational hypertension (PE/GH) have similar clinical risk factors and redundant placental pathology. We aim to discern if stillbirth with PE/GH has a particular phenotype by comparing stillbirths with and without PE/GH. Methods Secondary analysis of the Stillbirth Collaborative Research Network, a population-based cohort study of all stillbirths and a sample of live births from 2006 to 2008 in five catchment areas. We compared placental pathology between stillbirths and with and without PE/GH, stratified by term or preterm. We also compared placental pathology between stillbirths and live births with PE/GH. Results 79/518 stillbirths and 140/1200 live births had PE/GH. Amongst preterm stillbirths, there was higher feto-placental ratio in PE/GH pregnancies (OR 1.24 [1.11, 1.37] per unit increase), and there were more parenchymal infarctions (OR 5.77 [3.18, 10.47] ). Among PE/GH pregnancies, stillbirths had increased maternal and fetal vascular lesions, including retroplacental hematoma, parenchymal infarction, fibrin deposition, fetal vascular thrombi, and avascular villi. Discussion Stillbirth pregnancies are overwhelmingly associated with placental lesions. Parenchymal infarctions are more common in PE/GH preterm stillbirths, but there is significant overlap in lesions found in stillbirths and PE/GH.