Placental pathology in relation to stillbirth and neonatal outcome in an extremely preterm population: a prospective cohort study

Acta Obstet Gynecol Scand. 2015 Jun;94(6):584-90. doi: 10.1111/aogs.12610. Epub 2015 Mar 9.


Objective: To study associations between placental histopathology and stillbirth as well as neonatal outcome in a population born extremely preterm.

Design: Prospective cohort study.

Setting: Stockholm, Sweden.

Population: 167 infants born <27 gestational weeks during 2004-2007.

Methods: One senior perinatal pathologist, blinded to outcome data, evaluated all placental slides.

Main outcome measures: Intrauterine fetal death, small-for-gestational age, major neonatal morbidity (intraventricular hemorrhage ≥grade 3, retinopathy of prematurity ≥grade 3, necrotizing enterocolitis, cystic periventricular leukomalacia or severe bronchopulmonary dysplasia) and neonatal mortality. Additional outcome variables were Apgar score at 5 min, sepsis, and treated patent ductus arteriosus.

Results: Accelerated villous maturation was associated with a decreased risk for Apgar score <7 at 5 min (p = 0.041). Fetal thrombosis and low placental weight were associated with an increased risk for both intrauterine fetal death (p < 0.001 and p = 0.011, respectively) and small-for-gestational age (p < 0.001 and p < 0.001, respectively).

Conclusion: Placental histology may have prognostic value as it appears to be associated with intrauterine fetal death, as well as with being small-for-gestational age and assignment of a low Apgar score at birth.

Keywords: Histopathology; placental weight; prematurity; thrombosis; villous maturation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Apgar Score
  • Female
  • Humans
  • Infant, Extremely Premature*
  • Infant, Newborn
  • Infant, Newborn, Diseases / epidemiology
  • Infant, Small for Gestational Age
  • Placenta / pathology*
  • Pregnancy
  • Pregnancy Complications / epidemiology
  • Pregnancy Outcome / epidemiology*
  • Prospective Studies
  • Risk Factors
  • Stillbirth / epidemiology
  • Sweden / epidemiology