Placental Pathology Findings Associated With Adverse Outcomes Among Women With Sickle Cell Hemoglobinopathies [8N

Abstract

INTRODUCTION: The objective of this study is to investigate the relationship between placental pathology findings among women with sickle cell hemoglobinopathies (SCH) and adverse perinatal outcomes (APO). METHODS: This is a retrospective cohort study of non-anomalous, singleton infants born to mothers with laboratory confirmed SCH and placental pathology results. Medical charts were reviewed for maternal and neonatal outcomes as we sought to identify histologic findings associated with APOs. APOs included fetal death, small for gestational age neonates, umbilical cord pH < 7.2, 5 minute Apgar < 7, and neonatal death. RESULTS: One hundred thirty-five patients met inclusion criteria. Eighty-six percent had sickle cell trait, 12% had sickle cell disease, and 2% had hemoglobin SC disease. Twenty-seven pregnancies (20%) were complicated by APOs. There was no difference in presence of the following placental findings among the APO group as compared to the group without APOs: delayed villous maturation (p=0.59), perivillous fibrin deposition (p=0.58), placental infarction (p=0.62), chorioamnionitis (p=0.63), funisitis (p=0.24), villous congestion (p=0.39), and increased syncytial knots (p=0.10). When placental pathology findings among patients with sickle cell anemia were compared to patients with other types of SCH, there was a difference among groups with respect to increased syncytial knots (p < 0.01). CONCLUSION: There was no difference in placental pathology findings among patients with SCH with and without APOs. Severity of maternal disease was associated with a higher rate of increased syncytial knots; which are associated with reduced uteroplacental perfusion and may be induced by exposure of the placenta to hypoxia or oxidative stress as seen in SCH.