Biologically Inspired Digital Histology for Deep Phenotyping of Placental Composition Changes Across Major Lesion Types

Placenta pathology provides diagnostic insights for understanding pregnancy complications and guides maternal and perinatal care. While placental abnormalities reflect both acute and chronic maternal-fetal health states, the organ's spatial and temporal heterogeneity poses significant challenges for systematic histological analysis. To date, there has been no analysis of cell populations and their relationship to placental lesions due to the scale of annotations required by expert pathologists. The Histology Analysis Pipeline.PY (HAPPY), previously published by our group, is a hierarchical deep learning approach for quantitative single-cell resolution analysis of H&E slides. Here we apply HAPPY to analyse 130 slides from 62 live full-term pregnancies across healthy controls and four common placental lesion types (infarction, perivillous fibrin, avascular villi, and intervillous thrombosis). We computed cell-type and tissue-structure compositions, established the expected range of healthy variation, and quantified slide-level deviation from this reference using compositional data analysis. Our results reveal significant cellular composition differences between histologically normal and lesioned placentas, including increased extra-villous trophoblasts and leukocytes, coupled with decreases in Hofbauer cells. These changes accompanied distinctive tissue microstructural alterations, particularly increased fibrin deposition and changes to the villous structures. The magnitude of compositional deviation increased with infarction size but not with intervillous thrombosis. Importantly, many differences extend beyond visibly affected areas, indicating organ-wide adaptive responses rather than purely discrete focal pathologies. This quantitative characterisation provides insights into relationships between specific pathologies and placental structure, demonstrating the potential of AI-based methods to enhance conventional histopathological assessment for research and clinical practice.