Histopathology of Placenta in Stillbirth

Abstract Purpose: For the development and survival of the fetus, the placenta plays an important role before birth. Examination of the placenta can aid/tell us the sequence of events prebirth, which will aid in identifying the etiology of unfavorable outcomes such as stillbirth, preterm delivery, intrauterine growth retardation, and neurodevelopmental impairment. We attempt to study the histopathological features of the placenta in stillbirths and categorize the various factors of placental pathology contributing to the same. Materials and Methods: From 60 stillbirths, placentae with umbilical cord and membranes were studied for 18 months at Kempegowda Institute of Medical Sciences. Detailed histomorphology with clinical details was recorded. TULIP classification of stillbirth was used to categorize the placental pathology. Results: Women from 19 to 38 years (38 multigravida, 22 primigravidae) with the majority in the gestational age of 20–28 weeks formed the study group. Maternal comorbidities were associated in 80% of cases, the most common being hypertensive disorders of pregnancy. The major cause of stillbirth in our cohort was placental bed pathology (maternal vascular underperfusion – 41%) followed by parenchymal pathology (fetal thrombotic vasculopathy – 17%, massive perivillous fibrin deposition – 12%). Placental pathology was seen in 86% of mothers with recurrent fetal loss. Conclusion: Histomorphology of the placenta is an essential step in determining the cause of stillbirth, especially in recurrent conditions. This will aid in planning future pregnancies and tailoring appropriate treatment plans.