Placental Findings in Singleton Stillbirths

• Type of Material: Article
• Authors: Halit Pinar, Brown University; Robert L. Goldenberg, Columbia University; Matthew A. Koch, RTI International; Josefine Heim-Hall, University of Texas Health Science Center; Hal K. Hawkins, University of Texas Medical Branch; Bahig Shehata, Emory University; Carlos Abramowsky, Emory University; Corette B. Parker, RTI International; Donald J. Dudley, University of Texas Health Science Center; Robert M. Silver, University of Utah; Barbara Stoll, Emory University; Marshall Carpenter, Tuft University Medical Center; George Saade, University of Texas Medical Branch; Janet Moore, RTI International; Deborah Conway, University of Texas Health Science Center; Michael W. Varner, University of Utah; Carol J Hogue, Emory University; Donald R. Coustan, Brown University; Elena Sbrana, University of Texas Medical Branch; Vanessa Thorsten, RTI International; Marian Willinger, Eunice Kennedy Shriver National Institute of Child Health and Human Development; Uma M. Reddy, Eunice Kennedy Shriver National Institute of Child Health and Human Development
• Language: English
• Date: 2014-02-01
• Publisher: Lippincott, Williams & Wilkins: No Hybrid Open Access
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2014 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins.
• Final Published Version (URL): http://dx.doi.org/10.1097/AOG.0000000000000100
• Title of Journal or Parent Work: Obstetrics and Gynecology
• ISSN: 0029-7844
• Volume: 123
• Issue: 2
• Start Page: 325
• End Page: 336
• Grant/Funding Information: Supported by grants (HD45925; HD45944; HD45952;HD45953; HD45954; and HD45925) from the NICHD.
• Keywords: FETAL; POSTMORTEM EXAMINATION; CLASSIFICATION; OUTCOMES; DEATH; Obstetrics & Gynecology; BIRTH; PERINATAL AUTOPSY; Life Sciences & Biomedicine; RISK-FACTORS; RATES; INFECTION; Science & Technology
• Research Categories: Health Sciences, Pathology; Health Sciences, Epidemiology; Health Sciences, Obstetrics and Gynecology

Abstract

Objective:To compare placental lesions for stillbirth cases and live birth controls in a population-based study. Methods:Pathological examinations were performed on placentas from singleton pregnancies using a standard protocol. Data were analyzed overall and within gestational age groups at delivery. Results:Placentas from 518 stillbirths and 1,200 live births were studied. Single umbilical artery was present in 7.7% of stillbirths and 1.7% of live births, velamentous cord insertion was present in 5% of stillbirths and 1.1% of live births, diffuse terminal villous immaturity was present in 10.3% of stillbirths and 2.3% of live births, inflammation (eg, acute chorioamnionitis of placental membranes) was present in 30.4% of stillbirths and 12% of live births, vascular degenerative changes in chorionic plate was present in 55.7% of stillbirths and 0.5% of live births, retroplacental hematoma was present in 23.8% of stillbirths and 4.2% of live births, intraparenchymal thrombi was present in 19.7% of stillbirths and 13.3% of live births, parenchymal infarction was present in 10.9% of stillbirths and 4.4% of live births, fibrin deposition was present in 9.2% of stillbirths and 1.5% of live births, fetal vascular thrombi was present in 23% of stillbirths and 7% of live births, avascular villi was present in 7.6% of stillbirths and 2.0% of live births, and hydrops was present in 6.4% of stillbirths and 1.0% of live births. Among stillbirths, inflammation and retroplacental hematoma were more common in placentas from early deliveries, while thrombotic lesions were more common in later gestation. Inflammatory lesions were especially common in early live births. Conclusion: Placental lesions were highly associated with stillbirth compared to live births. All lesions associated with stillbirth were found in live births but often with variations by gestational age at delivery. Knowledge of lesion prevalence within gestational age groups in both stillbirths and live birth controls contributes to an understanding of the association between placental abnormality and stillbirth.