An anatomopathological examination of placentas associated with adverse pregnancy outcomes in Moroccan women - A case series

Objective: To characterize placental morphologic features in Moroccan women with adverse outcomes, across different clinical contexts, based on the Amsterdam consensus classification. Methods: A prospective analysis was conducted on placentas with umbilical cords collected fresh between March 1, 2024 and July 15, 2024 from women with adverse pregnancy outcomes. Clinical data (age, parity, gravidity, complications) were retrieved. Macroscopic parameters (weight, dimensions, cord insertion, membranes, lesions) were assessed, followed by systematic sampling. Tissue was processed by standard histology (formalin fixation, paraffin embedding, hematoxylin and eosin staining), and lesions were classified per Amsterdam criteria. Results: 16 placentas from patients with adverse pregnancy outcomes were included. The median maternal age was 30 years. Adverse conditions included placental abruption (50%), intrauterine growth restriction (IUGR, 38%), intrauterine fetal death (IUFD, 31%), pre-eclampsia/eclampsia (19%), premature rupture of membranes (13%), and oligohydramnios (13%). Several placentas were associated with more than one adverse condition. Histopathology revealed maternal vascular malperfusion lesions in 94%, particularly in pre-eclampsia, IUGR, and IUFD. Fetal vascular malperfusion was found in 88%, mainly in IUGR and IUFD. Inflammatory lesions, dominated by acute maternal and fetal responses stage 3 (necrotizing chorioamnionitis and funisitis), were primarily linked to IUFD. Conclusions: Placental examination enhances understanding of the pathophysiology underlying adverse pregnancy outcomes, supports diagnostic confirmation, and guides preventive strategies for recurrence. This study highlights the prevalence of maternal vascular malperfusion in Moroccan women and emphasizes the importance of systematic placental histopathology in obstetric care.