Correlation of Placental Histopathology with Maternal Biochemical and Physiological Parameters in Medico-Legal Cases of Stillbirth

Abstract

Background: Placental pathology is a major component of stillbirth investigation and can identify vascular, inflammatory, infectious, and degenerative lesions that may explain fetal death. This study evaluated the relationship between placental histopathological findings and maternal biochemical and physiological parameters in medico-legal stillbirth cases.

Methods: A comparative cross-sectional study was designed around 100 medico-legal stillbirth cases. Maternal demographic, clinical, physiological, and biochemical data were recorded, and placental specimens were examined using standardized gross and microscopic histopathological assessment. Placental lesions were categorized into maternal vascular malperfusion, fetal vascular malperfusion, inflammatory/infective lesions, retroplacental hemorrhage, villous maturation abnormalities, and other degenerative changes. Associations between placental lesions and maternal parameters were assessed using appropriate statistical tests.

Results: The mean maternal age was 29.7±6.1 years and mean gestational age was 33.8±4.1 weeks. Placental pathology was identified in 82 (82.0%) cases. Maternal vascular malperfusion was present in 35 (35.0%), fetal vascular malperfusion in 22 (22.0%), acute inflammatory lesions in 19 (19.0%), chronic inflammatory lesions in 14 (14.0%), retroplacental hemorrhage in 17 (17.0%), and abnormal villous maturation in 21 (21.0%) cases. Hypertension/preeclampsia was significantly associated with maternal vascular malperfusion (p<0.001), while elevated fasting glucose was associated with increased placental inflammatory and vascular lesions (p=0.018). Maternal hemoglobin was lower in cases with chronic inflammatory lesions (10.4±1.3 vs 11.3±1.2 g/dL, p=0.004). Systolic and diastolic blood pressures were significantly higher among women with maternal vascular malperfusion. Maternal vascular malperfusion correlated positively with systolic blood pressure (r=0.41, p<0.001) and HOMA-IR (r=0.29, p=0.004).

Conclusion: Placental histopathology provides clinically meaningful information in medico-legal stillbirth investigations and demonstrates important associations with maternal vascular, metabolic, and inflammatory abnormalities. Integration of placental examination with maternal biochemical and physiological data may improve classification of stillbirth and provide useful information for future pregnancy counselling.