Review of placental histological changes in stillbirths at Chris Hani Baragwanath academic hospital
Introduction Placental histology plays a vital role in determining the cause of stillbirths. A universal classification system has helped to standardise the interpretation of placental histological findings. The purpose of this study was to determine the placental lesions identified in stillbirths and their significance. The study describes histopathological changes in placentas of stillbirths, the association between placental findings and cause of fetal death and impact of maternal HIV infection on placental findings. Methods A retrospective cross-sectional study was performed at Chris Hani Baragwanath Academic Hospital in Soweto to identify placental lesions found in placentas of stillbirths. Data were abstracted from placental histology reports and case records from January to December 2017.The Amsterdam classification was used to classify placental findings Results A total of 625 stillbirths occurred at Chris Hani Baragwanath Academic Hospital between January and December 2017. In all the placentas from stillbirths sent for histology, 204 of the placentas met the inclusion criteria for the study. Maternal vascular malperfusion (MVM) was the most common finding on placental histology affecting 36.3% of cases, and the majority of placentas with MVM were from hypertensive mothers. Histological changes in keeping with chorioamnionitis were the second most common lesions, found in 24.5% of cases. There were 62% of the total number of placentas with chorioamnionitis that had acute chorioamnionitis suggesting a recent infection. Hypertension in pregnancy and its complications was associated with 31.3% of placental abruption. Placental infarction was found in 40.6% of placentas and the majority of the mothers with infarction had hypertension in pregnancy and its complications. There was no association between stillbirths and extremes of maternal age. HIV positive pregnant women who were not virally suppressed had the same number of stillbirths compared to virally suppressed mothers. Women with maternal comorbidities had an increased risk of having a stillbirth. Hypertensive disorders complicated 29% of pregnancies in this study. Conclusion Maternal vascular malperfusion (MVM) was the most common finding on placental histology of stillbirths followed by chorioamnionitis. Hypertension was the commonest finding in mothers with stillbirths and maternal vascular malperfusion.
A dissertation submitted in fulfillment of the requirements for the degree of Master of Medicine in Obstetrics and Gynaecology to the Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, 2022