Comparison of Placental Histopathological Findings with Good and Adverse Neonatal Outcomes- A Prospective Observational Study

Abstract

Introduction: The placenta plays a crucial role in the growth and survival of foetus by performing most of the vital functions for the foetus before delivery. Histopathological examination of placenta can help in investigating the mechanism of placental dysfunction, which can further help in devising more precise intervention strategies and can contribute to more effective therapies in the future. Aim: To compare the placental histopathological findings of patients with adverse neonatal outcomes and good neonatal outcomes. Materials and Methods: This was a prospective observational study conducted on 200 antenatal cases with gestational age >34 weeks were enrolled in the study from IPD of Department of Obstetrics and Gynaecology, Swaroop Rani Hospital, Prayagraj, Uttar Pradesh, India, over a period of 1 year. They were followed- up till delivery and assessed for neonatal outcomes. On the basis of neonatal outcome, patients were divided into two groups- group A with normal neonatal outcomes and group B with adverse neonatal outcomes. A gross and histopathological examination of placenta was performed for each case. The results were compiled and statistically analysed to compare the findings between the groups. The p-value was calculated using Chi-square score and value of <0.05 was considered significant. Results: Out of 200 cases, 143 belonged to group A (with normal neonatal outcomes), in which majority 121 (84%) had normal placental histopathology, 8 (5.5%) had villous infarcts, 9 (6.2%) had syncytial knots and 5 (3.4%) had calcifications. Mean placental weight in group A was 425.88 grams while that in group B was 363.70 grams (p-value <0.0001). Group B (with adverse neonatal outcomes) had 57 cases, 8.8% cases were delivered via vaginal delivery, with low Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score in 53 (26.5%), need for Neonatal Intensive Care Unit (NICU) admission in 57 (28.5%), need for mechanical ventilation in 12 (6%) and death in 6 (3%) cases. Villous infarcts was the placental histopathological feature in all cases with neonatal complications low APGAR score, NICU admission, those requiring mechanical ventilation or neonatal death. Out of these 57 cases, 8 (14%) had normal placental histopathology while 15 (26.3%) had infarcts, 12 (21%) syncytial knots, 9 (15.8%) had calcifications, and 13 (22.8%) had necrosis. Statistically significant difference (p-value <0.05) was found between the two groups in terms of abnormal histopathological findings and mean placental weight. Conclusion: Neonates with adverse outcomes had abnormal placental histopathological findings like villous infarcts, syncytial knots, calcifications, and necrosis.