Abstract
We aimed to clarify and contribute to a better comprehension of associations and correlations between placental histological findings, pregnancy evolution, and neonatal outcomes. This is a longitudinal and prospective observational study, performed between May 2015 and May 2019, on 506 pregnant women. Clinical data related to pregnancy outcome, neonatal health status, and placental histology were primarily collected. Twin pregnancies or malformed newborns were excluded and therefore the study was conducted on 439 cases. These cases have been then subdivided into the following study groups: (a) 282 placentas from pathological pregnancies; and, (b) a control group of 157 pregnancies over 33 weeks of gestational age, defined as physiological or normal pregnancies due to the absence of maternal, fetal, and early neonatal pathologies, most of which had undergone elective cesarean section for maternal or fetal indication. A normal placenta was present in 57.5% of normal pregnancies and in 42.5% of pathological pregnancies. In contrast, placental pathology was present in 26.2% of normal pregnancies and 73.8% of pathological pregnancies. Comparison of the neonatal health status with the pregnancy outcome showed that, among the 191 newborns classified as normal, 98 (51.3%) were born from a normal pregnancy, while 93 (48.7%) were born from mothers with a pathological pregnancy. Among the 248 pathological infants, 59 (23.8%) were born from a mother with a normal pregnancy, while 189 (76.2%) were born from pregnancies defined as pathological. Placental histology must be better understood in the context of natural history of disease. Retrospective awareness of placental damage is useful in prevention in successive pregnancy, but their early identification in the evolving pregnancy could help in association with biological markers or more sophisticated instruments for early diagnosis.
Highlights
IntroductionSince it is still difficult to explore the human placenta working principles with the current methods of investigation, histological examination, albeit a posteriori, is the only way to understand the complex functions that nature has entrusted to this organ, which functions as lung, kidney, and liver of the fetus, as well as a regulator and stabilizer of fetal biohumoral and endocrine exchange
The aim of this study is to investigate the associations between histological examination of the placenta, classified according to the Amsterdam criteria, and the main clinical aspects, both maternal and neonatal, in order to understand to what extent this histological examination reflects placental function and to what extent it can be used for the prognosis and prevention of subsequent pregnancies
The most frequent pregnancy pathology was the premature rupture of membranes before 37 weeks (72 cases, 25.5%), followed by 55 cases (19.5%) of intrauterine growth retardation (IUGR) and 44 cases of hypertension (15.6%), 27 cases (9.6%) of oligohydramnios (AFI
Summary
Since it is still difficult to explore the human placenta working principles with the current methods of investigation, histological examination, albeit a posteriori, is the only way to understand the complex functions that nature has entrusted to this organ, which functions as lung, kidney, and liver of the fetus, as well as a regulator and stabilizer of fetal biohumoral and endocrine exchange. Up to the present day, the study of placental histology is the sole instrument enlightening many aspects of placental physiopathology. It still presents unresolved problems, such as the widespread feedback of classified pathological aspects in normal pregnancies. Despite the development and large acceptance of a standardized, reproducible classification system based on previously defined features [1], many details of placental structure and function remain to be elucidated, especially with regard to the influence of maternal conditions and modulation of fetal-neonatal health
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