Retroplacental Hemorrhage Research Articles

Painless Placental Abruption with 80% Retroplacental Bleeding: Case Report

Painless Placental Abruption with 80% Retroplacental Bleeding: Case Report

Outcome-Based Risk Stratification Model for the Diagnosis of Placental Maternal Vascular Malperfusion

The Amsterdam Consensus Statement introduced the term maternal vascular malperfusion (MVM) to group a constellation of findings associated with impaired maternal–placental circulation. In isolation, these findings are relatively common in placentas from normal gestations, and there is uncertainty on how many, and which, are required. We aimed to determine the criteria essential for MVM diagnosis in correlation with obstetrical outcomes. A total of 200 placentas (100 with a reported diagnosis of MVM and 100 controls matched by maternal age and gravida-para-abortus status) were reviewed to document MVM features. Obstetrical outcomes in the current pregnancy were recorded including hypertension, pre-eclampsia with or without severe features, gestational diabetes, prematurity, fetal growth restriction, and intrauterine fetal demise. On univariate logistic regression analysis, adverse outcome was associated with low placental weight (LPW, <10% percentile for gestational age), accelerated villous maturation (AVM), decidual arteriopathy (DA), infarcts (presence and volume), distal villous hypoplasia, and excess multinucleated trophoblast in basal plate ≥2 mm (all P < .01) but not with retroplacental hemorrhage. In a multivariable model DA, infarcts and AVM were significantly associated with adverse outcomes, whereas LPW showed a trend toward significance. A receiver–operating characteristic curve including these 4 parameters showed good predictive ability (area under the curve [AUC], 0.8256). Based on the probability of an adverse outcome, we recommend consistent reporting of DA, AVM, infarcts, and LPW, summarizing them as “diagnostic of MVM” (DA or AVM plus any other feature, yielding a probability of 65%–97% for adverse obstetrical outcomes) or “suggestive of MVM” (if only 1 feature is present, or only 2 features are infarcts plus LPW, yielding a probability of up to 52%). Other features such as distal villous hypoplasia, excess (≥2 mm) multinucleated trophoblast, and retroplacental hemorrhage can also be reported, and their role in MVM diagnosis should be further studied.

Skeletal Growth Arrest Lines in Fetal Remains: Histopathology and Correlative Placental Pathology.

Skeletal growth arrest lines (GAL) are transverse lines of metaphyseal radiodensity accompanying episodic severe physiological stress. They are poorly described in fetal remains. We searched our autopsy practice for instances of fetal GAL in post mortem radiology, and correlated them with long bone histology and placental pathology. We describe the appearance, distribution, and pathology of GAL in a cohort of fetal autopsies, and compare the placental pathology accompanying GAL to the placental pathology of asymmetrical growth restriction (AGR) in the same time period. In 2108 consecutive fetal post mortems, we found 20 cases with GAL. About 16 were in singletons with AGR. In these 16, the distribution of placental pathologies was similar to a contemporaneous cohort of 113 cases with AGR. Of the remaining 4, two twins out of 9 sets of monochorionic twins with AGR demonstrated GAL. One case of GAL had symmetrical growth restriction with cytomegalovirus infection, and one case had no AGR and an old, unexplained retroplacental hemorrhage. On histology, GAL are characterized by a region of mineralized chondroid, which is variably incorporated into irregular trabecular bone. GALs accompany a variety of placental pathologies and twin-twin transfusion, suggesting episodic disease progression.

Placental pathology in early-onset fetal growth restriction: insights into fetal growth restriction mechanisms.

Early-onset fetal growth restriction (FGR), an identifiable variant of FGR, exhibits divergences in its severity, management, and placental pathologies when juxtaposed with late-onset FGR. The objective of this cross-sectional investigation was to scrutinize placental pathologies in pregnancies afflicted by early-onset FGR, emphasizing a comparative analysis between cohorts with and without preeclampsia (PE). The study encompassed a cohort of 85 expectant mothers who received a diagnosis of early-onset FGR. Rigorous histopathological (HP) and immunohistochemical (IHC) assessments were conducted on the placentas. Comparative analyses were performed, distinguishing between individuals diagnosed with both PE and early-onset FGR, and those presenting normotensive early-onset FGR. HP analysis unveiled a multitude of shared placental lesions, encompassing retroplacental hemorrhage, expedited villous maturation, infarctions, and calcification-associated fibrin deposits. IHC investigations displayed affirmative immunoreactivity for anti-hypoxia-inducible factor (HIF) and anti-vascular endothelial growth factor (VEGF) antibodies within the placental infarcted villitis. Moreover, noteworthy variances in placental measurements and distinctive lesions were discerned when comparing the PE and early-onset FGR cohort with the normotensive group. Maternal malperfusion emerged as a pivotal determinant linked to placental lesions in pregnancies affected by early-onset FGR. Remarkably, the occurrence of infarctions, specifically delayed infarctions, exhibited a noteworthy correlation with PE. These findings accentuate the significance of pursuing additional research endeavors aimed at unraveling the intricate mechanisms governing maternal malperfusion and its consequential influence on placental health in the context of early-onset FGR, with particular attention to the interplay with PE.

A multidisciplinary approach to rescue a full-term pregnant and her fetus after blunt abdominal trauma: A case report and literature review

Blunt abdominal trauma due to motor vehicle crash is one of the leading causes of mortality during pregnancy. Though the trauma team plays a critical role in the initial management, a multidisciplinary contribution is essential to ensure the safety of the mother and her fetus. This case report followed the multidisciplinary approach for the management of a 32-year-old female during the last week of pregnancy. She sustained blunt trauma causing maternal and fetal distress due to abruption of the placenta with a large intrauterine and retroplacental hemorrhage, retro-hepatic and retroperitoneal hemorrhage, pseudoaneurysm of uterine arteries leading to postpartum hemorrhage. Immediate intervention and management at a Level 1 trauma center led to survival of both the mother and infant.

Association of placental chorangiosis with pregnancy complication and prenatal outcome: a case-control study

BackgroundChorangiosis is a vascular change involving the terminal chorionic villi in the placenta. It results from longstanding, low-grade hypoxia in the placental tissue, and is associated with such conditions as intrauterine growth restriction (IUGR), diabetes, and gestational hypertension in pregnancy. Chorangiosis rarely occurs in normal pregnancies. However, its prevalence is 5–7% of all placentas from infants admitted to newborn intensive care units. The present study was aimed at determining the association of chorangiosis with pregnancy complications and perinatal outcomes.MethodsIn this case-control study, 308 chorangiosis cases were compared with 308 controls (with other diagnoses in pathology) in terms of maternal, placental, prenatal, and neonatal characteristics derived from the medical records of participants retrospectively. R and SPSS version 22 software tools were used, and the statistical significance level was considered 0.05 for all the tests.ResultsPreeclampsia, diabetes mellitus, maternal hemoglobin, maternal hematocrit, C/S, oligohydramnios, fetal anomaly, dead neonates, NICU admissions were significantly higher in the chorangiosis group OR = 1.6, 3.98, 1.68, 1.92, 2.1, 4.47, 4.22, 2.9, 2.46, respectively (p-value< 0.05 for all). Amniotic fluid index, birth weight, cord PH amount, 1st, and 5th Apgar score was lower in the chorangiosis group OR = 0.31, 1, 0.097, 0.83, 0.85, respectively (p-value< 0.05 for all). Moreover, fundal placenta, retro placental hemorrhage, perivillous fibrin deposition, calcification, and acute chorioamnionitis were higher in the chorangiosis group OR = 2.1, 11.8, 19.96, 4.05, and 6.38 respectively, (p-value< 0.05). There was a high agreement between the two pathologists, and the power of the study was estimated at 99%.ConclusionAlthough chorangiosis is an uncommon condition, it is associated with a higher incidence of perinatal and neonatal morbidity and mortality. Therefore, it should be considered an important clinical sign of adverse pregnancy outcomes and should be reported in the pathology evaluation.

The spectrum of placental pathology in a public v. private laboratory practice in Gauteng Province, South Africa

Background. Laboratory information systems have a wealth of patient and health data that can be made available for research. These data can serve to better inform healthcare delivery and formulation of policies. The placenta is just one histopathology laboratory specimen that can provide such insight, particularly with regard to maternal and neonatal healthcare. Objectives. To describe the spectrum of placental pathology in a private and public laboratory and to ascertain implications for improved maternal and neonatal healthcare and policies. Methods. We conducted a retrospective descriptive study of placental histopathology reports from Lancet Laboratories and the National Health Laboratory Service (NHLS) in Johannesburg over a 1-year period (August 2017 - July 2018). The reports were categorised according to the 2014 Amsterdam Placental Workshop Group Consensus Statement and the percentages of each diagnostic entity compared between the two laboratories. These diagnostic categories included ascending infection, maternal vascular malperfusion (MVM), fetal vascular malperfusion, haematogenous infection, chronic villitis of unknown aetiology, retroplacental haemorrhage, no specific pathological changes and ‘other’. Differences in maternal age and gestational age were also compared. Results. There were 1 172 and 946 placentas that were entered into the study at Lancet and NHLS, respectively. MVM was the most prevalent pathology seen in both laboratories (40.6% and 47.7%; p =0.3193). Mean maternal and gestational age were both higher in the private system (both p &lt;0.0000). Conclusion. Differences in placental pathology were multifactorial and reasons may include differences in socioeconomic status and resources, clinical and laboratory policies and practices, as well as pathologist training and expertise. Clear clinical guidelines for the submission and histopathological examination of the placenta are required to better inform neonatal and maternal healthcare and policies. In our divided healthcare system, collaborative medical research is not only possible between the public and private sectors but also necessary to achieve better healthcare and equity for patients in South Africa.

Risk Factors for Intrauterine Growth Restriction: 9 Years Analysis in Tertiary Care Hospital

Background: Intrauterine growth restricted (IUGR) fetuses are at higher risk of developing neonatal complications and also known to develop metabolic syndrome in adult life. So, an early antenatal detection, choosing the optimal time and method of delivery and intervention when required could minimize the risk significantly.&#x0D; Objective: To find out the prenatal outcome and the maternal and placental risk factors.&#x0D; Methods: A prospective study was conducted from January 2010 to January 2019, at a Teaching Hospital. A singleton pregnancy, above 28 weeks of gestation with clinical diagnosis of IUGR and confirmed by ultrasonography were included in the study. The statistical analysis was performed by Statistical Package of Social Sciences (SPSS) 23.0 software.&#x0D; Results: Maternal risk factors like low pregnancy body mass index, preeclampsia, anaemia, hypothyroidism and placental factors like retro placental hemorrhage were mainly responsible for intrauterine growth restriction.&#x0D; Conclusions: The early identification of risk factors and management of the same antenatal is an important issue to prevent adverse prenatal outcomes associated with IUGR.

Placental Thickness in First Trimester (11-14) Weeks and Correlation with Preeclampsia and Intrauterine Growth Retardation

Background: First trimester trophoblastic invasion has far-reaching consequences for the fetus; failure at this stage may result in fetal growth restriction with morbidity both in the immediate perinatal period, as well as throughout development into adulthood. Objective: The aim of this study was to estimate the placental thickness in first trimester (11-14) weeks and investigating the correlation with preeclampsia and intrauterine growth retardation. Patients and methods: This prospective cross-sectional study was conducted at Al-Azhar University Hospital. The study included 50 patients. Results: There was a significant increase in the maximal placental thickness (PT) to placental volume ratio in growth restricted fetuses in our study. This may be a reflection of reduction in placental surface area. Further work is required to confirm this finding using more accurate stereological analysis of the placenta in utero. In this study, the MRI appearance of suspected retroplacental haemorrhage, placental infarct, and subchorionic haemorrhage was confirmed by placental histology in 100%, 100%, and 33% of cases respectively. Conclusion: From our study, it can be concluded that PT can be used as a predictor of the GA, in the women in whom the LMP is unreliable or is not known

Role of Ultrasound in Detection of Abruptio Placentae and its Clinical Correlation

Introduction: Abruptio placentae is one of the major complications in second half of pregnancy. It accounts for 0.4-1 % of all deliveries. With the advent of ultrasonography, though abruptio placentae has been diagnosed however the sensitivity is less. Those patients clinically suspicious of abruption placenta with negative ultrasound findings can have positive intrapartum findings suggestive of abruptio. Fetal outcome is associated with the gestational age. Preterm deliveries with abruption have higher incidence of perinatal morbidity and mortality as compared to term pregnancies.Methods: It is a prospective study conducted in Manipal Teaching Hospital, Pokhara from July 2017 to July 2018. All the cases of more than twenty eight weeks gestation, singleton pregnancies without preexisting maternal medical diseases suspicious of abruption placentae were included in the study. Ultrasonological and intrapartum findings were recorded. Data was analyzed using SPSS (VERSION16).Results: Out of forty patients presented with per vaginal bleeding, sixteen were diagnosed as placental abruption either clinically or ultrasonographically. Only ten patients had positive ultrasound findings of retroplacental clot or subchorionic hemorrhage. Out of six patients with negative ultrasound findings, only four had positive Intrapartum findings suggestive of abruption placenta. The specificity (100%) of ultrasound in diagnosing abruption was more than the sensitivity (71.43%) and the accuracy was 75%.Conclusion: Ultrasound is less sensitive in diagnosing abruption placenta and the lesser the gestational age, the more in the increase in perinatal morbidity and mortality.

Analysis of frequency and risk factors for intrauterine growth restriction

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Intrauterine growth restricted (IUGR) fetuses are at greater risk of developing fetal hypoxia, neonatal complications, impaired neurodevelopment, and also neonatal intensive care unit stay and neonatal mortality. They are also known to develop metabolic syndrome in adult life. So, the main objective of this study was to find out the frequency of intrauterine growth restriction, to identify the maternal and placental risk factors associated with intrauterine growth restriction and its perinatal outcome amongst pregnant women attending the Obstetric Outpatient Department in Dhulikhel Hospital, Kathmandu University Hospital&lt;/span&gt;.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;A prospective study was conducted from June 2011 to June 2017, at Dhulikhel Hospital, Kathmandu University Hospital, Kavre, Nepal. A singleton pregnancy, above 28 weeks of gestation with clinical diagnosis of IUGR and confirmed by ultrasonography were included in the study. The statistical analysis was performed by Statistical Package of Social Sciences (SPSS) 20.0 software. &lt;/span&gt;&lt;span lang="EN-IN"&gt; &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Maternal risk factors like preeclampsia, anaemia, low pregnancy body mass index and placental factors like retroplacental hemorrhage were mainly responsible for intrauterine growth restriction&lt;/span&gt;.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Antenatal risk factors responsible for IUGR are important for the management of IUGR pregnancies and to prevent adverse perinatal outcome. &lt;/span&gt;&lt;/p&gt;

Association of Retroplacental Blood With Basal Plate Myofibers.

Objectives Diagnosed clinical abruption showing blood clot should be signed out in the pathology report as retroplacental hemorrhage with or without parenchymal indentation, and submitted clot separate from the placenta should be weighed. In our experience, some cases sent as clinical abruptions have been cases of morbid adherence. This study was undertaken to evaluate the association of retroplacental blood with basal plate myofibers (BPMF). Methods One hundred fifty-six placentas reviewed by a board-certified pediatric pathologist at a community hospital were evaluated for significant retroplacental blood. Basal plates were reviewed for deviations from normal. Results Of the 156 placentas, 33 (21%) had significant retroplacental blood; 21/156 (13%) had a separate clot, of which 11/21 (52%) had BPMF. Eleven BPMF-associated separate clots ranged from 10.5 to 60 g (average 23), while the clots of 10 cases with no demonstrated BPMF ranged from 19 to 440 g (average 82), tending to be larger ( p < .03). Basal plate damage prior to delivery was noted in both sets of placentas. BPMF placentas could have myometrial damage prior to delivery. Conclusions Since BPMF may confer a risk for accreta in a subsequent pregnancy, submission of a separate clot with the placenta should lead the pathologist to evaluate for basal plate myofibers on H&E and consider if there is an evidence-based indication to do an actin stain, before presuming a diagnosis of abruption.

Manifestations of Hypoxia in the Second and Third Trimester Placenta.

The placental pathologies that develop in the context of hypoxic insults to the fetus and placenta are termed maternal vascular malperfusion (MVM). On molecular analysis, these lesions primarily show evidence of oxidative damage, suggesting that they arise in the context of hypoxia-reperfusion injury. The earliest abnormalities are likely incomplete or absent remodeling of maternal spiral arteries (decidual arteriopathy). These vascular remodeling defects then lead to subsequent damage patterns, including accelerated villous maturation, distal villous hypoplasia, increased syncytial knots, villous infarction, retroplacental hemorrhage, and placental hypoplasia. MVM may occur in a surprisingly wide array of clinical disorders, but the relation between these clinical disorders and placental MVM is complex. It seems likely that these clinical disorders represent final common pathways for multiple etiologies, only some of which result in MVM. Birth Defects Research 109:1345-1357, 2017.© 2017 Wiley Periodicals, Inc.

Association of retroplacental blood with basal plate myofibers

ObjectivesDiagnosed clinical abruption showing blood clot should be signed out in the pathology report as retroplacental hemorrhage with or without parenchymal indentation, and submitted clot separ...

The placental factor in spontaneous preterm birth in twin vs. singleton pregnancies

ObjectiveThe association between infection and inflammatory response in singleton preterm birth (PTB) is well established, yet, less is known about PTB in twins. We aimed to compare the placental component and pregnancy outcome in pregnancies complicated with PTB of singletons vs. twin deliveries. We hypothesized that due to different underlying mechanisms, placental inflammatory lesions will be more prevalent in placentas derived from singleton pregnancies than twins. Study designLabor characteristics, neonatal outcome and placental histopathology reports of spontaneous PTB at 24–336/7 weeks, from 1/2008–12/2015, were reviewed. Resultswere compared between dichorionic-diamniotic twin deliveries (twins group) and singleton deliveries (singleton group) matched for gestational age. Excluded from the study medically indicated deliveries, due to preeclampsia or fetal growth restriction, and monochorionic twins. Placental lesions were classified to maternal vascular supply lesions, fetal vascular supply lesions, and maternal (MIR) and fetal (FIR) inflammatory responses. Composite neonatal outcome was defined as one or more of early complications: respiratory distress, necrotizing enterocolitis, sepsis, blood transfusion, ventilation, seizures, intra-ventricular hemorrhage, hypoglycemia, phototherapy, or death. ResultsThe twins group (n=72) was characterized by higher maternal BMI (p=0.009), and higher rates of assisted reproductive techniques (56.2% vs. 17.8%, p<0.001) and cesarean deliveries (75.3% vs. 32.8%, p<0.001) as compared to the singleton group (n=72). Placentas from the singleton group were characterized by higher rate of MIR, 58.9% vs. 19.2%, (p<0.001), FIR, 31.5% vs. 3.4%, (p<0.001), retro-placental hemorrhage, 26% vs. 8.9% (p<0.001), and vascular lesions related to maternal malperfusion, 28.8% vs. 9.6%, (p<0.001), as compared to placentas from the twins group. Higher rate of neonatal sepsis was observed in the singleton group as compared to the twins group, 24.7% vs. 4.1%, p<0.001, respectively. By logistic regression analyses retro-placental hemorrhage, placental maternal vascular malperfusion lesions, MIR, FIR and neonatal sepsis were found to be independently associated with singleton PTB: aOR 3.4, 95% CI 2.1–6.9, p<0.001, aOR=3.1, 95% CI 1.8–7.2, p<0.001, aOR=2.9, 95% CI 1.4–7.8, p<0.001, aOR=4.9, 95% CI 2.3–6.9, p<0.001, and aOR=4.8, 95% CI 2.3–6.7, p<0.001 respectively. ConclusionPlacentas from singleton PTBs are characterized by higher rate of inflammatory and malperfusion lesions. The lack of these findings in twins PTBs suggests different factors that participate in the development of preterm birth in twins, such as over-distension of the uterus and up regulation of oxytocin receptors.

Incidence and outcome of severe ante-partum hemorrhage at the Teaching Hospital Yalgado Ouédraogo in Burkina Faso.

BackgroundHemorrhage is the main cause of maternal death during pregnancy. This study aims to evaluate incidence and outcomes of Severe Ante Partum Hemorrhage (SAPH) during the third trimester of pregnancy prior to delivery.MethodsAnalytical cross-sectional study with prospective data collection during 12 months in Yalgado Ouedraogo Hospital, Ouagadougou, Burkina Faso. In this context SAPH is specifically referring to Ante Partum Hemorrhage (APH) and Intra Partum Hemorrhage (IPH) in the 3rd trimester. Postpartum Hemorrhage (PPH) was not included.ResultsDuring our study 7,469 women were admitted in obstetrics and 122 cases of SAPH were recorded. SAPH represented 1.6% (n = 122) of hospitalizations causes and 14.5% (n = 1083) of hemorrhages during pregnancy. Mean age was 27.8 ± 6.9 years, mean parity 2.8 ± 1.3 and mean duration of pregnancy was 37 Weeks Amenorrhea (WA). Evacuation from other facilities was the main mode of admission (91.8%, n = 112) and blood transfusion was the essence of resuscitation. Complications were observed in 80.3% (n = 98). During the study, 118 maternal deaths were reported of which 15.6% (n = 19) related to SAPH. Among SAPH cases who died (n = 19) majority (n = 16) had severe anemia (n = 16; 82.6%, p = 0.004). Ten women (8.19%) were admitted in Intensive Care Unit (ICU). Fifteen premature births (12.3%) and 22 perinatal deaths (18.1%) were recorded. Evacuation (p = 0.04), critical clinical condition during admission (p = 0.004), and Uterine Rupture (UR) (p = 0.002) were associated with poor outcome. The Retroplacental Hemorrhage (RPH) (40.9%) was the most common cause of fetal death (p = 0.005) and was associated with High Blood Pressure (HBP) and pre-eclampsia.ConclusionAPH is a complication associated with significant maternal and fetal morbidity and mortality.

Placental histopathology lesions and pregnancy outcome in pregnancies complicated with symptomatic vs. non-symptomatic placenta previa

BackgroundThe mechanisms involved in bleeding in cases of placenta previa (PP) and the effect on pregnancy outcome is unclear. ObjectivesWe aimed to compare pregnancy outcome and placental histopathology in pregnancies complicated with symptomatic (bleeding) vs. non-symptomatic PP, and to study the effects of the co-existence of histopathological retro-placental hemorrhage (RPH) in cases of symptomatic PP on neonatal and maternal outcomes. Study designLabor and maternal characteristics, neonatal outcome and placental histopathology lesions of pregnancies with PP, delivered between 24 and 42weeks, during 2009–2015, were reviewed. Results were compared between PP who had elective cesarean delivery (CD) (previa group) and PP with bleeding necessitating emergent CD (symptomatic previa group). Placental lesions were classified to lesions consistent with maternal malperfusion or fetal thrombo-occlusive disease (vascular and villous changes), and inflammatory lesions. ResultsCompared to the previa group (n=63), the symptomatic previa group (n=74) was characterized by older patients (p<0.001), higher rate of smokers (p=0.005), thrombophilia (p=0.038), and preterm deliveries (p<0.001). Placentas within the symptomatic previa group were smaller, with higher rates of weight<10th% (p=0.02), RPH (p<0.001) and villous changes related to maternal malperfusion (p=0.023). As compared to symptomatic PP without RPH, co-existence of RPH was associated with higher rate of adverse neonatal outcome (p<0.001) and maternal blood transfusion (p=0.02). On multivariate regression analysis, composite adverse neonatal outcome was found to be dependent on coexisting RPH (OR=2.8, 95%CI 1.2–11.7, p=0.03), and low gestational age (OR=3.1, 95%CI 1.6–4.9, p=0.02). ConclusionsSymptomatic placenta previa is associated with increased placental malperfusion lesions suggesting an association of maternal malperfusion with abnormal placental separation. The coexisting finding of RPH with symptomatic placenta previa can be seen as a marker for more extensive/severe placental separation, hence the association with maternal transfusion requirements and poorer fetal outcome.

Maternal and Placental Risk Factors associated with Intrauterine Growth Restriction and the Perinatal Outcomes

ABSTRACT Objectives Identifying the factors responsible for the intrauterine growth restriction (IUGR) is very important, so that early interventions could be suggested to improve the perinatal outcome. The major objectives of this study are to analyze the impact of risk factors, specifically the maternal and placental risk factors, on IUGR and the perinatal outcomes. Materials and methods A prospective study was done on 60 women with IUGR pregnancies from January 2013 to January 2014, at Pushpagiri Medical College Hospital, Thiruvalla. Inclusion criteria were: singleton pregnancies, above the gestational age of 28 weeks, clinically diagnosed IUGR and confirmed subsequently on ultrasound. The statistical analysis was performed utilizing Statistical Package of the Social Sciences (SPSS) software and the significance level of p-value &lt; 0.05 was accepted as statistically significant. Results Statistical analysis shows that maternal risk factors like chronic hypertension, pre-eclampsia, low socioeconomic status of mother, overt diabetes, anemia, gestational diabetes mellitus, low prepregnancy body mass index and hypothyroidism were significantly associated with IUGR. In this study, placental factors like chorangiomatosis, increased syncytial knotting, villous infarction, increased perivillous fibrinoid deposition, accelerated villous maturation, retroplacental hemorrhage and acute chorioamnionitis were significantly associated with IUGR. Conclusion Alertness toward antenatal risk factors for poor pregnancy outcome is important for the optimal management of IUGR pregnancies. Despite antenatal recognition of IUGR and associated risk factors, not all perinatal deaths can be prevented. How to cite this article Thekkedathu VCA. Maternal and Placental Risk Factors associated with Intrauterine Growth Restriction and the Perinatal Outcomes. J South Asian Feder Obst Gynae 2015;7(3):176-181.

Study of Placental Insufficiencies in IUGR Babies in Term Pregnancies

&lt;p&gt;&lt;strong&gt;Introduction:&lt;/strong&gt; In intrauterine growth restricted babies, at term, the placenta might hold the key to the etiology. This present study is aimed at comparison of data of gross and pathological study of placentae from normal weight (control) and IUGR groups and attempted to establish a relationship between placenta pathology and intrauterine growth retardation in term pregnancy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt; Aims and Objectives:&lt;/strong&gt; 1. To study placental factors associated with IUGR. 2. To study prevalence of placental factors in details. Material and Methods: A study of 100 patients, with more 37 and less 42 weeks of gestation wasconducted for 2yrs in a tertiary care hospital. A thorough general examination&amp;amp;amp;Systemic examination which included per abdominal examination including uterine height, abdominal girth, symphysio fundal height, estimated fetal weight, abdominal grips, fetal heart auscultation, and per vaginal examination. Routine and specific investigations will be sent for clinical correlation. Placenta obtained after delivery was send for macroscopic and microscopic examination to pathologist. The reports obtained will be used to study placental causes in IUGR and placenta in detail.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Result:&lt;/strong&gt; Average placental weight of term pregnancy is 400 gms and placental coefficient is 0.18. decidual surface area is 254 cm2 and its thickness is 2.72cm. Retroplacental haemorrhage is closely associated with PIH. Microscopic infarction is found with high frequency (p&amp;lt;0.005). Placenta of IUGR fetus, gross pathological changes like severe infarction with or without retroplacental haematoma can obviously be noted but they are not found to be statistically significant. Placental coefficient is increased in cases of anemia. Syncytial knot formation in excess and thickening of basement membrane is well correlated.&lt;/p&gt;

Study of Placental Insufficiencies in IUGR Babies in Term Pregnancies

Introduction: In intrauterine growth restricted babies, at term, the placenta might hold the key to the etiology. This present study is aimed at comparison of data of gross and pathological study of placentae from normal weight (control) and IUGR groups and attempted to establish a relationship between placenta pathology and intrauterine growth retardation in term pregnancy. Aims and Objectives: 1. To study placental factors associated with IUGR. 2. To study prevalence of placental factors in details. Material and Methods: A study of 100 patients, with more 37 and less 42 weeks of gestation wasconducted for 2yrs in a tertiary care hospital. A thorough general examinationaSystemic examination which included per abdominal examination including uterine height, abdominal girth, symphysio fundal height, estimated fetal weight, abdominal grips, fetal heart auscultation, and per vaginal examination. Routine and specific investigations will be sent for clinical correlation. Placenta obtained after delivery was send for macroscopic and microscopic examination to pathologist. The reports obtained will be used to study placental causes in IUGR and placenta in detail. Result: Average placental weight of term pregnancy is 400 gms and placental coefficient is 0.18. decidual surface area is 254 cm2 and its thickness is 2.72cm. Retroplacental haemorrhage is closely associated with PIH. Microscopic infarction is found with high frequency (p<0.005). Placenta of IUGR fetus, gross pathological changes like severe infarction with or without retroplacental haematoma can obviously be noted but they are not found to be statistically significant. Placental coefficient is increased in cases of anemia. Syncytial knot formation in excess and thickening of basement membrane is well correlated.