Microscopic Placental Lesions in Unexplained Intrauterine Fetal Death: A Comparison with Live-Birth Placentas

Open Access

Abstract

Introduction: Unexplained intrauterine fetal death (IUFD) remains a significant obstetric challenge, and microscopic placental lesions may provide important evidence of underlying pathological processes that are not apparent clinically or macroscopically. Histopathological examination can identify inflammatory, vascular, and maternal or fetal malperfusion lesions associated with fetal demise. Therefore, this study aimed to assess the pattern of microscopic placental lesions in unexplained IUFD and compare them with those observed in live-birth placentas. Methods & Materials: This case-control study was conducted in the Department of Obstetrics & Gynaecology, Sir Salimullah Medical College Mitford Hospital, Dhaka, from July 2021 to June 2022. A total of 100 pregnant women were included in the study using purposive sampling. Data were analyzed using SPSS version 22. Results: The study included 100 subjects, with the mean age significantly higher in the IUFD case group than in controls (27.12±5.11 vs. 23.94±4.70 years, p=0.001), while irregular ANC was also significantly more common among cases (84.0% vs. 56.0%, p=0.002). Histopathological examination showed significantly higher frequencies of acute/chronic inflammation (60.0% vs. 18.0%, p=0.001), perivillous fibrin deposition (18.0% vs. 2.0%, p=0.007), infarction/necrosis (20.0% vs. 6.0%, p=0.037), hemorrhage (24.0% vs. 4.0%, p=0.004), and cord thrombosis (14.0% vs. 0%, p=0.006) in IUFD placentas. Microscopic calcification was more frequent in cases but did not differ significantly (p=0.182). Conclusion: The study demonstrated that microscopic placental abnormalities were significantly more frequent in unexplained IUFD than in live-birth placentas. Acute inflammation was the most common finding (56.0% vs 18.0%), followed by hemorrhage (24.0% vs 4.0%), infarction/necrosis (20.0% vs 6.0%), perivillous fibrin deposition (18.0% vs 2.0%), and cord thrombosis (14.0% vs 0%), with these differences reaching statistical significance (p<0.05). Microscopic calcification was also more prevalent in the IUFD group, although the difference was not statistically significant.