Placental Findings in Singleton Stillbirths

Pinar, Halit MD; Goldenberg, Robert L. MD; Koch, Matthew A. MD, PhD; Heim-Hall, Josefine MD; Hawkins, Hal K. MD; Shehata, Bahig MD; Abramowsky, Carlos MD; Parker, Corette B. PhD; Dudley, Donald J. MD; Silver, Robert M. MD; Stoll, Barbara MD; Carpenter, Marshall MD; Saade, George MD; Moore, Janet PhD; Conway, Deborah MD; Varner, Michael W. MD; Hogue, Carol J. R. PhD; Coustan, Donald R. MD; Sbrana, Elena PhD; Thorsten, Vanessa PhD; Willinger, Marian PhD; Reddy, Uma M. MD, MPH

doi: 10.1097/AOG.0000000000000100
Contents: Original Research

OBJECTIVE: To compare placental lesions for stillbirth cases and live birth controls in a population-based study.

METHODS: Pathologic examinations were performed on placentas from singleton pregnancies using a standard protocol. Data were analyzed overall and within gestational age groups at delivery.

RESULTS: Placentas from 518 stillbirths and 1,200 live births were studied. Single umbilical artery was present in 7.7% of stillbirths and 1.7% of live births, velamentous cord insertion was present in 5% of stillbirths and 1.1% of live births, diffuse terminal villous immaturity was present in 10.3% of stillbirths and 2.3% of live births, inflammation (eg, acute chorioamnionitis of placental membranes) was present in 30.4% of stillbirths and 12% of live births, vascular degenerative changes in chorionic plate were present in 55.7% of stillbirths and 0.5% of live births, retroplacental hematoma was present in 23.8% of stillbirths and 4.2% of live births, intraparenchymal thrombi was present in 19.7% of stillbirths and 13.3% of live births, parenchymal infarction was present in 10.9% of stillbirths and 4.4% of live births, fibrin deposition was present in 9.2% of stillbirths and 1.5% of live births, fetal vascular thrombi was present in 23% of stillbirths and 7% of live births, avascular villi was present in 7.6% of stillbirths and 2.0% of live births, and hydrops was present in 6.4% of stillbirths and 1.0% of live births. Among stillbirths, inflammation and retroplacental hematoma were more common in placentas from early deliveries, whereas thrombotic lesions were more common in later gestation. Inflammatory lesions were especially common in early live births.

CONCLUSIONS: Placental lesions were highly associated with stillbirth compared with live births. All lesions associated with stillbirth were found in live births but often with variations by gestational age at delivery. Knowledge of lesion prevalence within gestational age groups in both stillbirths and live birth controls contributes to an understanding of the association between placental abnormality and stillbirth.

LEVEL OF EVIDENCE: II

Placental lesions are highly associated with stillbirth compared with live births, but all lesions associated with stillbirths are found in live births; prevalence varies by gestational age at delivery.

The Warren Alpert Medical School of Brown University, Providence, Rhode Island; Columbia University School of Medicine, New York, New York; RTI International, Durham, North Carolina; the University of Texas Health Science Center at San Antonio, San Antonio, and the University of Texas Medical Branch, Galveston, Texas; Emory University, Atlanta, Georgia; the University of Utah School of Medicine, Salt Lake City, Utah; Tufts University Medical Center, Boston, Masachusetts; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.

For a list of members in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Stillbirth Collaborative Research Network, see the Appendix online at http://links.lww.com/AOG/A465.

Corresponding author: Halit Pinar, The Warren Alpert Medical School of Brown University, Women and Infants Hospital, Division of Perinatal Pathology, 101 Dudley Street, Providence, RI 02905; e-mail: hpinar@brown.edu.

Supported by grants (HD45925, HD45944, HD45952, HD45953, HD45954, and HD45925) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

The authors thank the following members of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Scientific Advisory and Safety Monitoring Board for their review of the study protocol, materials, and progress: Reverend Phillip Cato, PhD; James W. Collins Jr, MD, MPH; Terry Dwyer, MD, MPH; William P. Fifer, PhD; John Ilekis, PhD; Marc Incerpi, MD; George Macones, MD, MSCE; Richard M. Pauli, MD, PhD; Raymond W. Redline, MD; Elizabeth Thom, PhD (chair), as well as all of the other physicians, study coordinators, research nurses, and patients who participated in the Stillbirth Collaborative Research Network.

The views expressed in this article are those of the authors and do not necessarily reflect the views of the National Institutes of Health or the Eunice Kennedy Shriver National Institute of Child Health and Development.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.