Placental histopathological abnormalities and poor perinatal outcomes 2019 TOG

Question 1

Indications for placental histology

Answer 1

Desirable + maternal coagulopathy, maternal substance misuse

Question 2

Process for sending placenta

Answer 2

Question 3

Main groups of placental histological findings?

Answer 3

Question 4

What is maternal vascular malperfusion? Management future preg?

Answer 4

A result of abnormal spiral artery blood flow associated with maternal conditions such as pre-eclampsia.

Ass placental hypoxia and FGR. High doppler resistance.

Future preg: Aspirin, UAD, early delivery risk 10-25%

Question 5

What is massive perivillous fibrin disposition? Management future preg?

Answer 5

Rare
Excessive fibrin & fibrinoid matrix at least 30% distal villi.

Recurrent miscarriage, FGR, stillbirth, PTN, neonatal neurological morbidity

Macroscopically - yellow in colour, stiff & thick

Future: Autoimmune testying, LMWH & LDA, early delivery, recurrence 40-60%

Question 6

What is fetal thrombotic vasculopathy?

Answer 6

Associated with:
- cord entanglement, hypercoiling or other cord abnormalities
- maternal or fetal thrombophilia
- severe chorioamnionitis
- PET FGR.

Blood vessel atrophy cause by occlusive thrombus, villi avascular.

Future: Autoimmune, surveillence

Question 7

What is Villitis of unknown aetiology? Management future preg?

Answer 7

Chronic inflammation with destructive changes and T cell infiltration into chorition villi. Patch or diffuse

5-15% term placentas.
Associated adverse preg outcomes

Future: Autoimmne, surveillance

Question 8

What is villous dysmaturity? Management future preg?

Answer 8

Associated DM (80%)
Terminal villi elated, increased n capillaries and mascrophased, fluid within villous structure.

Chronic fetal hypoxamia

Future: Reduced weight, screen for DM, monitor DM consider delivery at 40/40

Question 9

Chorioamnionitis

Answer 9

grade 1 (mild to moderate): individual or small clusters of maternal neutrophils, diffusely infiltrating the chorion laeve, chorionic plate, subchorionic fibrin or amnion.

grade 2 (severe): presence of three or more chorionic micro-abscesses, which are defined as a confluence of neutrophils measuring at least 10×20 cells. These are typically located between the chorion and decidua, and/or under the chorionic plate.