Placental Pathology and Stillbirth: A Review of the Literature and Guidelines for the Less Experienced

Abstract

The aim of this review is to examine the role of placental pathology in the understanding of singleton stillbirth. The placenta may be regarded as the “black box” of pregnancy and detailed examination may afford insight into the fetal and maternal events leading to this tragic outcome. In the UK, 1 in 200 to 1 in 240 pregnancies end in stillbirth whilst India accounts for the majority of global stillbirths. Between 2010 and 2013, India showed a decline in the stillbirth rate and it continues to fall–a recent report felt that the majority of deaths in the third trimester were preventable. However, in order to prevent such deaths we need to understand their cause. Postmortem studies may cast light on the many factors which lead to stillbirth or early neonatal death but there is anecdotal evidence that certain groups are reluctant to authorise postmortem examination and in a religiously diverse and observant country such as India, postmortem may not be acceptable to families. However, if the purpose of the postmortem study is properly explained, many families would agree to such an examination. In this paper the authors aim to look at how examination of the singleton placenta alone may provide valuable information regarding the causation of stillbirth and indicate potential treatment options for its prevention in future pregnanices. The authors will consider the more commonly encountered lesions, clinically and pathologically and provide guidelines for those less experienced in this field.

Keywords

India - Stillbirth - Placental pathology - Maternal vascular malperfusion - Thrombophilia - Fetal vascular malperfusion - Diabetes - BMI

Publication History

Received: 29 March 2017

Accepted: 12 July 2017

Article published online:
08 May 2023