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Ptacek I, Smith A, Garrod A, et al. Quantitative assessment of placental morphology may identify specific causes of stillbirth. BMC Clin Pathol. 2016;16:1doi: 10.1186/s12907-016-0023-y.
Ptacek, I., Smith, A., Garrod, A., Bullough, S., Bradley, N., Batra, G., Sibley, C. P., Jones, R. L., Brownbill, P., & Heazell, A. E. (2016). Quantitative assessment of placental morphology may identify specific causes of stillbirth. BMC clinical pathology, 161. https://doi.org/10.1186/s12907-016-0023-y
Ptacek, Imogen, et al. "Quantitative assessment of placental morphology may identify specific causes of stillbirth." BMC clinical pathology vol. 16 (2016): 1. doi: https://doi.org/10.1186/s12907-016-0023-y
Ptacek I, Smith A, Garrod A, Bullough S, Bradley N, Batra G, Sibley CP, Jones RL, Brownbill P, Heazell AE. Quantitative assessment of placental morphology may identify specific causes of stillbirth. BMC Clin Pathol. 2016 Feb 09;16:1. doi: 10.1186/s12907-016-0023-y. eCollection 2016. PMID: 26865834; PMCID: PMC4748636.
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BMC Clin Pathol. 2016 Feb 09;16:1. doi: 10.1186/s12907-016-0023-y. eCollection 2016.

Quantitative assessment of placental morphology may identify specific causes of stillbirth.

BMC clinical pathology

Imogen Ptacek, Anna Smith, Ainslie Garrod, Sian Bullough, Nicola Bradley, Gauri Batra, Colin P Sibley, Rebecca L Jones, Paul Brownbill, Alexander E P Heazell

Affiliations

  1. Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Oxford Rd, Manchester, M13 9PL UK ; Maternal and Fetal Health Research Centre, 5th floor (Research), St Mary's Hospital, Oxford Road, Manchester, M13 9WL UK.
  2. Department of Histopathology, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, M13 9WL UK.

PMID: 26865834 PMCID: PMC4748636 DOI: 10.1186/s12907-016-0023-y

Abstract

BACKGROUND: Stillbirth is frequently the result of pathological processes involving the placenta. Understanding the significance of specific lesions is hindered by qualitative subjective evaluation. We hypothesised that quantitative assessment of placental morphology would identify alterations between different causes of stillbirth and that placental phenotype would be independent of post-mortem effects and differ between live births and stillbirths with the same condition.

METHODS: Placental tissue was obtained from stillbirths with an established cause of death, those of unknown cause and live births. Image analysis was used to quantify different facets of placental structure including: syncytial nuclear aggregates (SNAs), proliferative cells, blood vessels, leukocytes and trophoblast area. These analyses were then applied to placental tissue from live births and stillbirths associated with fetal growth restriction (FGR), and to placental lobules before and after perfusion of the maternal side of the placental circulation to model post-mortem effects.

RESULTS: Different causes of stillbirth, particularly FGR, cord accident and hypertension had altered placental morphology compared to healthy live births. FGR stillbirths had increased SNAs and trophoblast area and reduced proliferation and villous vascularity; 2 out of 10 stillbirths of unknown cause had similar placental morphology to FGR. Stillbirths with FGR had reduced vascularity, proliferation and trophoblast area compared to FGR live births. Ex vivo perfusion did not reproduce the morphological findings of stillbirth.

CONCLUSION: These preliminary data suggest that addition of quantitative assessment of placental morphology may distinguish between different causes of stillbirth; these changes do not appear to be due to post-mortem effects. Applying quantitative assessment in addition to qualitative assessment might reduce the proportion of unexplained stillbirths.

Keywords: Avascular villi; Fetal Growth Restriction; Placental Morphometry; Stillbirth; Unexplained Stillbirth; Villous vascularity

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