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Disorders of placental villous maturation in fetal death

Authors
  • Jaiman, Sunil1, 2
  • Romero, Roberto1, 3, 4, 5, 6, 7, 8
  • Pacora, Percy1, 8, 2
  • Jung, Eunjung1, 2
  • Bhatti, Gaurav1, 2
  • Yeo, Lami1, 2
  • Kim, Yeon Mee1, 9
  • Kim, Bomi1, 9
  • Kim, Chong Jai1, 10
  • Kim, Jung-Sun1, 11
  • Qureshi, Faisal1, 2
  • Jacques, Suzanne M.1, 2
  • Erez, Offer1, 2, 12
  • Gomez-Lopez, Nardhy1, 2, 2
  • Hsu, Chaur-Dong1, 2, 2
  • 1 Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, USA , (United States)
  • 2 Wayne State University School of Medicine, USA , (United States)
  • 3 University of MI, USA , (United States)
  • 4 MI State University, USA , (United States)
  • 5 Wayne State University, USA , (United States)
  • 6 Detroit Medical Center, USA , (United States)
  • 7 Florida International University, USA , (United States)
  • 8 Wayne State University/Hutzel Women’s Hospital, 3990 John R, Box 4 , (United States)
  • 9 Inje University College of Medicine, Republic of Korea , (South Korea)
  • 10 University of Ulsan College of Medicine, Asan Medical Center, Republic of Korea , (South Korea)
  • 11 Sungkyunkwan University School of Medicine, Samsung Medical Center, Republic of Korea , (South Korea)
  • 12 Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel , (Israel)
Type
Published Article
Journal
Journal of Perinatal Medicine
Publisher
Walter de Gruyter GmbH
Publication Date
Apr 01, 2020
Volume
48
Issue
4
Pages
345–368
Identifiers
DOI: 10.1515/jpm-2020-0030
Source
De Gruyter
Keywords
License
Yellow

Abstract

Objective The aims of this study were to ascertain the frequency of disorders of villous maturation in fetal death and to also delineate other placental histopathologic lesions in fetal death. Methods This was a retrospective observational cohort study of fetal deaths occurring among women between January 2004 and January 2016 at Hutzel Women’s Hospital, Detroit, MI, USA. Cases comprised fetuses with death beyond 20 weeks’ gestation. Fetal deaths with congenital anomalies and multiple gestations were excluded. Controls included pregnant women without medical/obstetrical complications and delivered singleton, term (37–42 weeks) neonate with 5-min Apgar score ≥7 and birthweight between the 10th and 90th percentiles. Results Ninety-two percent (132/143) of placentas with fetal death showed placental histologic lesions. Fetal deaths were associated with (1) higher frequency of disorders of villous maturation [44.0% (64/143) vs. 1.0% (4/405), P < 0.0001, prevalence ratio, 44.6; delayed villous maturation, 22% (31/143); accelerated villous maturation, 20% (28/143); and maturation arrest, 4% (5/143)]; (2) higher frequency of maternal vascular malperfusion lesions [75.5% (108/143) vs. 35.7% (337/944), P < 0.0001, prevalence ratio, 2.1] and fetal vascular malperfusion lesions [88.1% (126/143) vs. 19.7% (186/944), P < 0.0001, prevalence ratio, 4.5]; (3) higher frequency of placental histologic patterns suggestive of hypoxia [59.0% (85/143) vs. 9.3% (82/942), P < 0.0001, prevalence ratio, 6.8]; and (4) higher frequency of chronic inflammatory lesions [53.1% (76/143) vs. 29.9% (282/944), P < 0.001, prevalence ratio 1.8]. Conclusion This study demonstrates that placentas of women with fetal death were 44 times more likely to present disorders of villous maturation compared to placentas of those with normal pregnancy. This suggests that the burden of placental disorders of villous maturation lesions is substantial.

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