Histopathological evaluation of the placenta: Clues of intra-uterine fetal demise

Intrauterine fetal demise (IUFD) is a distressful event with lasting impact and risk of recurrence. However, in majority of cases, the cause remains unexplained. The aim of the present study is to evaluate the histomorphological features of placenta, the findings associated with commonly known etiologies of IUFD and other clues provided by it in establishing the cause of IUFD. : A prospective, observational study was conducted at a tertiary healthcare center in North India for a period of 3.5 years. A total of 104 placental specimen from IUFD cases were received and evaluated microscopically by 3 histopathologists. Data was tabulated and analyzed. : Majority cases of IUFD were seen in multigravida women (52.8%) in the age group of 25 to 30 years. We found that inflammatory lesions in 46.1% cases, maternal vascular malformation (MVM) in 25% cases, fetal vascular malformation in (FVM) in 16.3%, combined MVM and FVM in 2.9% while 9.7% cases were idiopathic. Presence of fibrotic villi, intervillous fibrin deposition, chorioamnionitis and calcification were the most common findings. Pregnancy induced hypertension was the most common maternal cause of IUFD identified (20.3%), while congenital anomalies were the most common fetal (72.1%) and placenta previa was the most common placental cause (33.3%). A comprehensive placental histopathological evaluation can provide clues regarding the causation and progression of IUFD, allowing clinicians to initiate early management and prevent recurrence. Patient education regarding the same may also motivate the patient to seek early and proper antenatal care in subsequent pregnancies.