Study of Placental Pathology in Cases of Intrauterine Fetal Deaths
Keywords:
Intrauterine deaths, Placental changes in diabetes, Placental changes in hypertension. Perivilloius fibrin, Intervillous haemorrhage.
Abstract
Background: Intrauterine fetal death is agonizing, often unpredictable event. The mother, the fetus, and the placenta all are involved in the complex process of fetal death and therefore, should be addressed together. Unfortunately, the cause of death is unexplained sometimes up to two third of intrauterine deaths. For the proper determination of the cause, and further prevention, Placenta is the most accessible and readily evaluable specimen which is mirror image of pregnancy. Methods: This cross-sectional study was carried out in the Department of Pathology in a tertiary care hospital from June 2015 to May 2017. Material for the present study comprised of 99 placentas obtained from the cases of IUFD, delivered in the Department of Obstetrics and Gynecology of a tertiary care hospital. These 99 placentas were received in the Department of Pathology along with clinical details for histomorphological study. Result: Histopathological examination of placenta revealed following findings - Perivillous fibrin 62/99 (62.62%) cases, calcification 51/99 (51.51%) cases, intervillous hemorrhage 46/99 (46.46%) cases, prominent syncytial knots 45/99 (45.45%) cases, cytotrophoblastic proliferation 41/99 (41.41%) cases, increased vascularity 31/99 (31.31%) cases, fibrinoid necrosis 19/99 (19.19%) cases, hydropic villi 09/99 (09.09%) cases and villitis in 07/99 (07.07%) cases. Conclusion: The placenta can be considered as the diary of pregnancy. After fetal death, it remains viable for several days. The value of examining the placenta determining cause of death in intrauterine fetal death is evident and varies from 28-85%.The value depends largely on the quality of the placental reports.References
1. Fretts RC. Etiology and prevention of stillbirth. Am J Obstet Gynecol 2005; 193:1923-35.
2. Goldenberg RL, Kirby R, Culhane JF. Stillbirth:a review. J Matern fetal Neonatal Med 2004; 16:79-94
3. Burnley H, Moore I. An Audit to assess the quality of necropsies performed on stillborn infants. J clin pathol 2005; 58:93-4
4. Gordijin SJ, Erwich JJ, Khong TY. Value of the perinatal autopsy: critique. Pediatric Dev Pathol 2002; 5:480-8
5. Fleurisca J. Korteweg, Jan Jaap H.M. Erwich, Jozien P.Holm, Joke M.Ravise, Jan Van der Meer,Nic J.G.M.veeger,Albertus Timmer.American College of Obstetrician and Gynaecology.Diverse Placental Pathologies as the main cause of fetal death.2009;114:809
6. Estimate of mortality indicators-census of India website-vital statistics 2010;4:81.
7. Trevor macpherson: fact and fancy – what can we really tell from the placenta? Arch .pathol. Lab. Med. 115: 672-681.
8. Benirschke K: The Placenta in the context of History and Modern Medical Practice. Arch. Pathol. Lab. Med. 1991; 115: 663-667.
9. Patel S, Thaker R, Shah P, Majumder S. Study of causes and complications of intrauterine fetal death (IUFD). Int J Reprod Contracept Obstet Gynecol 2014; 3:931-5.
10. Dave A, Patidar R, Goyal S, Dave A. Intrauterine fetal demise-a tragic event: a study of its epidemiology, causes and methods of induction. Int J Reprod Contracept Obstet Gynecol 2016; 5:1316-21.
11. Nohr EA, Bech BH, Davies MJ, Morten, Frytenberg, Tine Brink Henriksen Jorn Olsen. Prepregnancy obesity and Fetal Death. American college of Obstetricians and Gynecologists. 2005; 106(2): 250-259.
12. Singh N, Pandey K, Gupta N, Arya AK, Pratap C, Naik R. A retrospective study of 296 cases of intrauterine fetal deaths at a tertiary care centre. Int J Reprod Contracept Obstet Gynecol 2013; 2:141-6.
13. Ujwala CH, shyamala Guruvare, Sudha S Bhat, lavanya Rai, Sugandhi Rao, Evaluation of placenta in Fetal Demise and Fetal growth Restriction. Journal of Clinical and Diagnostic Research. 2013;11:2530-2533
14. Sharma I, Bansal A. Eclampsia: maternal and perinatal outcome among tribal population of Bastar, Chhattisgarh, India in a tertiary care centre. Int J Reprod Contracept Obstet Gynecol 2016; 5:1887-91.
15. Prasanna N, Mahadevappa K, Antaratani RC, Lokare L. Cause of death and associated conditions of stillbirths. Int J Reprod Contracept Obstet Gynecol 2015; 4:1970-4.
16. Tamrakar SR, Chawla CD. Intrauterine Foetal Death and its Probable Causes: Two year Experience in Dhulikhel Hospital – Kathmandu University Hospital. Kathmandu Univ med J 2012; 10(4):44-48.
17. Shaheen S, Akhtar S. Causes of intrauterine foetal death. JPMI 2006; 209(3) :239-242.
18. Choudhary A, Gupta V. Epidemiology of Intrauterine Fetal Deaths: A Study In Tertiary Referral Centre In Uttarakhand. Journal of Dental and Medical Sciences (IOSR-JDMS) Mar. 2001;13 (3): 03-06.
19. Patel S, Sirpurkar M, Patel MS. A retrospective study to evaluate etiological factors associated with intrauterine fetal death at tertiary referral centre. Int J Reprod Contracept Obstet Gynecol 2016;5:970-5
20. Balu D, Nayak A, Swarup A. A study of intrauterine fetal death in a tertiary care hospital. Int J Reprod Contracept Obstet Gynecol 2015; 4:2028-31.
21. Patil SS, Siddheshware R, Sambarey PW. Clinical correlation with pathology of placenta in medical disorders of pregnancy and its comparison in normal pregnancy. Int J Reprod Contracept Obstet Gynecol 2017; 6:127-32.
22. Ranga SS. Adaline Thangam MK. Mallika V, Indira MV. Morphological and Histological Variations of Human Placenta in Hypertensive Disorders of Pregnancy. Int J Anat Res 2017; 5(1):3591-3598.
23. Vijayalakshmi B, Sunitha Kitteli. “A Study of Histopathological Changes of Placenta in Pre Eclampsia and Perinatal Outcome”. Journal of Evolution of Medical and Dental Sciences 2015; 4(67);11667-11673.
24. Baske A. Histological Changes of Placenta in Maternal Anemia. Indian Journal of Basic and Applied Medical Research. Sept 2017;06(4);78-87.
25. Salge AK, Rocha KM, Xavier RM, Ramalho WS, Rocha E´ L, Guimara˜ es JV, et al. Macroscopic placental changes associated with fetal and maternal events in diabetes mellitus. Clinics. 2012; 67(10):1203-1208
26. Denise A. Elsasser, Cande V. Ananth, Vinay Prasad, Anthony M. Vintzileos. Diagnosis of Placental Abruption: Relationship between Clinical and Histopathological Findings. Eur J Obstet Gynecol Reprod Biol. 2010 February; 148(2):125.
2. Goldenberg RL, Kirby R, Culhane JF. Stillbirth:a review. J Matern fetal Neonatal Med 2004; 16:79-94
3. Burnley H, Moore I. An Audit to assess the quality of necropsies performed on stillborn infants. J clin pathol 2005; 58:93-4
4. Gordijin SJ, Erwich JJ, Khong TY. Value of the perinatal autopsy: critique. Pediatric Dev Pathol 2002; 5:480-8
5. Fleurisca J. Korteweg, Jan Jaap H.M. Erwich, Jozien P.Holm, Joke M.Ravise, Jan Van der Meer,Nic J.G.M.veeger,Albertus Timmer.American College of Obstetrician and Gynaecology.Diverse Placental Pathologies as the main cause of fetal death.2009;114:809
6. Estimate of mortality indicators-census of India website-vital statistics 2010;4:81.
7. Trevor macpherson: fact and fancy – what can we really tell from the placenta? Arch .pathol. Lab. Med. 115: 672-681.
8. Benirschke K: The Placenta in the context of History and Modern Medical Practice. Arch. Pathol. Lab. Med. 1991; 115: 663-667.
9. Patel S, Thaker R, Shah P, Majumder S. Study of causes and complications of intrauterine fetal death (IUFD). Int J Reprod Contracept Obstet Gynecol 2014; 3:931-5.
10. Dave A, Patidar R, Goyal S, Dave A. Intrauterine fetal demise-a tragic event: a study of its epidemiology, causes and methods of induction. Int J Reprod Contracept Obstet Gynecol 2016; 5:1316-21.
11. Nohr EA, Bech BH, Davies MJ, Morten, Frytenberg, Tine Brink Henriksen Jorn Olsen. Prepregnancy obesity and Fetal Death. American college of Obstetricians and Gynecologists. 2005; 106(2): 250-259.
12. Singh N, Pandey K, Gupta N, Arya AK, Pratap C, Naik R. A retrospective study of 296 cases of intrauterine fetal deaths at a tertiary care centre. Int J Reprod Contracept Obstet Gynecol 2013; 2:141-6.
13. Ujwala CH, shyamala Guruvare, Sudha S Bhat, lavanya Rai, Sugandhi Rao, Evaluation of placenta in Fetal Demise and Fetal growth Restriction. Journal of Clinical and Diagnostic Research. 2013;11:2530-2533
14. Sharma I, Bansal A. Eclampsia: maternal and perinatal outcome among tribal population of Bastar, Chhattisgarh, India in a tertiary care centre. Int J Reprod Contracept Obstet Gynecol 2016; 5:1887-91.
15. Prasanna N, Mahadevappa K, Antaratani RC, Lokare L. Cause of death and associated conditions of stillbirths. Int J Reprod Contracept Obstet Gynecol 2015; 4:1970-4.
16. Tamrakar SR, Chawla CD. Intrauterine Foetal Death and its Probable Causes: Two year Experience in Dhulikhel Hospital – Kathmandu University Hospital. Kathmandu Univ med J 2012; 10(4):44-48.
17. Shaheen S, Akhtar S. Causes of intrauterine foetal death. JPMI 2006; 209(3) :239-242.
18. Choudhary A, Gupta V. Epidemiology of Intrauterine Fetal Deaths: A Study In Tertiary Referral Centre In Uttarakhand. Journal of Dental and Medical Sciences (IOSR-JDMS) Mar. 2001;13 (3): 03-06.
19. Patel S, Sirpurkar M, Patel MS. A retrospective study to evaluate etiological factors associated with intrauterine fetal death at tertiary referral centre. Int J Reprod Contracept Obstet Gynecol 2016;5:970-5
20. Balu D, Nayak A, Swarup A. A study of intrauterine fetal death in a tertiary care hospital. Int J Reprod Contracept Obstet Gynecol 2015; 4:2028-31.
21. Patil SS, Siddheshware R, Sambarey PW. Clinical correlation with pathology of placenta in medical disorders of pregnancy and its comparison in normal pregnancy. Int J Reprod Contracept Obstet Gynecol 2017; 6:127-32.
22. Ranga SS. Adaline Thangam MK. Mallika V, Indira MV. Morphological and Histological Variations of Human Placenta in Hypertensive Disorders of Pregnancy. Int J Anat Res 2017; 5(1):3591-3598.
23. Vijayalakshmi B, Sunitha Kitteli. “A Study of Histopathological Changes of Placenta in Pre Eclampsia and Perinatal Outcome”. Journal of Evolution of Medical and Dental Sciences 2015; 4(67);11667-11673.
24. Baske A. Histological Changes of Placenta in Maternal Anemia. Indian Journal of Basic and Applied Medical Research. Sept 2017;06(4);78-87.
25. Salge AK, Rocha KM, Xavier RM, Ramalho WS, Rocha E´ L, Guimara˜ es JV, et al. Macroscopic placental changes associated with fetal and maternal events in diabetes mellitus. Clinics. 2012; 67(10):1203-1208
26. Denise A. Elsasser, Cande V. Ananth, Vinay Prasad, Anthony M. Vintzileos. Diagnosis of Placental Abruption: Relationship between Clinical and Histopathological Findings. Eur J Obstet Gynecol Reprod Biol. 2010 February; 148(2):125.
Published
2018-10-26
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