Small and large placentas as indicators of adverse pregnancy outcomes: the role of placental morphometrics in clinical practice

BACKGROUND: Placental morphometry reflects intrauterine conditions and may serve as an early marker of chronic uteroplacental insufficiency and adverse perinatal outcomes. Although antenatal ultrasound can provide indirect information on placental size and morphology, the present study was based on postnatal morphometric and histopathological placental assessment. OBJECTIVE: To evaluate the association between postnatal placental morphometric and histopathological features and perinatal outcomes. MATERIALS AND METHODS: Retrospective observational study of placentas from 443 singleton pregnancies was analyzed. Placentas were classified as appropriate for gestational age (AGA-P) or small for gestational age (SGA-P) according to placental weight percentiles. Morphometric parameters and histopathological lesions were compared with gestational age at delivery, birth weight, Apgar scores, and adverse perinatal outcomes. RESULTS: < 0.05). Placental weight, disk weight, and surface area were markedly reduced in the SGA-P group across both comorbid and healthy pregnancies. Histopathological examination demonstrated a higher prevalence of basal plate inflammation, fibrinoid deposition, impaired basal plate perfusion, and vascular lesions in SGA-P placentas. Adverse outcomes were more frequent in SGA-P placentas, and placental surface area independently predicted adverse outcome among women with comorbidities. CONCLUSIONS: Combined postnatal morphometric and histopathological assessment of the placenta may provide valuable prognostic information and facilitate recognition of placental phenotypes associated with adverse perinatal outcomes. Reduced placental weight and surface area identify a distinct placental phenotype associated with chronic uteroplacental insufficiency and unfavorable neonatal outcomes. Future prospective studies should evaluate whether antenatal ultrasound markers of placental size and morphology correlate with postnatal placental findings and improve prenatal risk stratification.