45. Placental pathology in indigenous and non-indigenous women in the northern territory

Abstract

Background The Northern Territory has the highest rate of preterm delivery, low birth weight and perinatal mortality in Australia. Despite this, placental histopathology has not been described. The aim of the study was to undertake a small pilot study to determine the rate of vascular pathology and inflammation of the placenta in women delivering at the Royal Darwin Hospital. Methodology Women were randomly recruited between May and June 2009 after delivery at the Royal Darwin Hospital with written consent obtained. Placentas were examined macroscopically and sectioned according to the College of American Pathologists International Guidelines. Histopathology examination was undertaken from the 24 term placentas. Results Results of 24 term placentas examined revealed pathological changes in 83% of them. The mean placental weight was 570 g (SD 113). 50% of placentas showed inflammation of the chorion, amnion or the cord. Thirteen placentas showed a degree of infarction, with over 54% classified as clinically significant. 50% of placentas showed a degree of haemorrhage. There were no significant differences in rates of infarction or inflammation comparing Indigenous and non-Indigenous placentas. The rate of chorioamnionitis in this study was 10 times the reported rate of 5% in a large study conducted at Royal Prince Alfred Hospital, Sydney in 1979. Conclusion The pilot analysis suggests that over 80% of placentas from women delivering at Royal Darwin Hospital demonstrated significant abnormalities, potentially affecting feto-maternal outcomes. A prospective cohort study examining 193 placentas has been subsequently conducted to correlate placental pathology to maternal, obstetric and neonatal outcomes.