Main Article Content
placenta, amsterdam criteria, istological exam, placental disfunction, placental lesion
Background: To verify the correlation between histological examination of the placenta (HP), classifying the lesions according to the Amsterdam criteria (AC), and the main neonatal pathological patterns. Methods: This prospective study carried out at the University of Bari between May 2015 and May 2017,enrolled 350 pregnant women. Complete obstetric history and HP was collected. 380 newborns were also enrolled. The analysis was also carried out by comparing the incidence of the various placental pathologies in the sample of physiological pregnancies (PP), represented by 142 cases, with the incidence of the group with placental anomalies (PA). The statistical software used was STATA MP11. Results: Respiratory disorders (61 cases) are significantly correlated with generic PA (p=0.006). Neonatal sepsis (15 cases) was significantly correlated with placental inflammation (p=0.035) and villitis of unknown origin (p=0.039).Twin pregnancies (50 cases) were correlated with generic PA (p=0.00001) and late maternal malperfusion (p=0.00001). Congenital cardiopathies (50 cases) were correlated with the villitis of unknown origin and PA (p=0.0000). Preterm birth (145 cases)was correlated with the premature malperfusion (p=0, 0011) and PA (p=0.0000); SGA (low weight in relation to the gestational age - 75 cases) neonates were correlated with the early malperfusion (p=0.00000) and the generic PA (p=0.00000). Conclusions: The present study has therefore verified whether in reality the HP can be of great help to the neonatologist in the nosological and therapeutic setting of the pathological newborn. The pathological examination of the placenta is nevertheless essential to clarify the causes of the stillbirths and that these causes are particularly important for the obstetric and neonatal outcome of subsequent pregnancies.
2. Annemiek M. Roescher, Albert Timmer, Jan Jaap H. M. Erwich, and Arend F. Bos. Placental Pathology, Perinatal Death, Neonatal Outcome, and Neurological Development: A Systematic Review. PLoS One. 2014; 9(2): e89419.
3. Korteweg FJ, Erwich JJ, Holm JP et al Diverse placental pathologies as the main causes of fetal death. Obstet Gynecol . Obstet Gynecol. 2009 ;114(4):809-17
4. Yamada N, Sato Y, Moriguchi-Goto S, Yamashita A, Kodama Y, Sameshima H, Asada Y.Histological severity of fetal inflammation is useful in predicting neonatal outcome. Placenta. 2015 ;36(12):1490-3.
5. Bae GE, Yoon N, Choi M, Hwang S, Hwang H, Kim JS..Acute Placental Villitis as Evidence of Fetal Sepsis: An Autopsy Case Report.. Pediatr Dev Pathol. 2016 ;19(2):165-8.
6. Becroft D.M.O. Thompson J.M.D. Mitchell. E.A. The epidemiology of placental infarction at. Placenta. 2002 ;23(4):343-51
7. Catov JM, Scifres CM, Caritis SN, Bertolet M, Larkin J, Parks WT. Neonatal outcomes following preterm birth classified according to placental features. Am J Obstet Gynecol. 2017;216(4):411.e1-411.e14. doi: 10.1016/j.ajog.2016.12.022.
8. Eberle AM, Levesque D, Vintzileos AM, Egan JF, Tsapanos V, Placental pathology in discordant twins. Salafia CM. Am J Obstet Gynecol. 1993 ;169(4):931-5.
9. Weiner E, Kahn M, Giltvedt K, et al. Nonpresenting Dichorionic Twins and Placental Vascular Malperfusion. Obstet Gynecol. 2017 ;129(6):1109-1117.
10. Matthiesen NB, Henriksen TB, Agergaard P, et al. Congenital Heart Defects and Indices of Placental and Fetal Growth in a Nationwide Study of 924 422 Liveborn Infants. Circulation. 2016 ;134(20):1546-1556.
11. Albalawi A, Brancusi F, Askin F et al. Placental Characteristics of Fetuses With Congenital Heart Disease. J Ultrasound Med 2017; 36:965–972.
12. Annemiek M. Roescher Placental Pathology, Perinatal Death, Neonatal Outcome, and Neurological Development: A Systematic Review. 2014 PLOS ONE.
13. Incerpi MH, Miller DA, Samadi R, Settlage RH, Goodwin TM Stillbirth evaluation: What tests are needed? Am J Obstet Gynecol. 1998 ;178(6):1121-5.
14. Heazell AE, Martindale EA Can post-mortem examination of the placenta help determine the cause of stillbirth? J Obstet Gynaecol 2009;29: 225–228.
15. Kidron D, Bernheim J, Aviram R. Placental findings contributing to fetal death, a study of 120 stillbirths between 23 and 40 weeks gestation. Placenta 2009.30: 700–704.
16. Korteweg FJ, Erwich JJ, Timmer A,et al. Evaluation of 1025 fetal deaths: Proposed diagnostic workup. Am J Obstet Gynecol 2012;206: 53.e1–53.e12.
17. Raymond W. Redline, Classification of placental lesions. Am J Obstet Gynecol. 2015 ;213(4 Suppl):S21-8.