Macro and Microsopic Pathology in High Risk Pregnancy

Background: Placental abnormalities are commonly detected in adverse pregnancy outcomes. There is a vast diversity in placental pathology and several factors contribute to this diversity. A detailed placental examination is mandatory to assess any disorder and predict fetal outcomes.

Aims and Objectives: The present study aimed to highlight the placental pathology in various maternal, fetal and placental disorders and also the fetal outcome in these conditions.

Materials and Methods: A one-and-a-half-year prospective study of fifty consecutive placentae was done. A proforma was prepared with relevant clinical details. Maternal, fetal, and placental risk factors were analyzed along with gross and microscopic lesions. Hematoxylin and eosin (H&E) stains were used in routine cases. Appropriate sections were taken from representative sites and Hematoxylin and eosin, Periodic acid Schiff stains were done.

Results: Out of fifty cases of placentae studied, forty-seven cases (94%) showed evidence of pathology associated with maternal, fetal and placental risk factors, either singly or in combination. Maternal risk factors were twenty-five cases (50%) of which the highest percentage being pregnancy-related (84 %). Grossly infarcts and retro placental hematomas were common findings. Histological features of accelerated maturation were lesions commonly seen in these cases. In cases where the fetal outcome was poor like in abortions, intrauterine fetal death and still births all (100%) placentae were abnormal. As far as the other maternal pregnancy-related risk factors were concerned we found majority of abortion cases showed no lesions on gross examination and some authors recorded a single case of Subchorial thrombosis.

Conclusions: In this study, a high percentage of placentae showed evidence of pathology, the majority of which were associated with maternal, fetal or placental risk factors either singly or in combination. Every placenta with poor fetal outcomes was abnormal. Placentae must be carefully examined in order to establish the prognosis of the fetus and to look for signs of various disorders. Determining placental pathology has been aided by the use of both gross and microscopic histopathological examinations.