The value of histopathology of the placenta in a tertiary referral hospital in South Africa

Abstract

Background. Unexplained intrauterine death (IUD) remains the most common cause of perinatal death in babies of <1 000 g in South Africa (SA). Information from examination of the placenta subsequent to an adverse perinatal outcome is often underutilised and placental histology can contribute to determining the cause of perinatal death and other adverse outcomes in many instances. 

Objectives. To correlate placental histopathology with the clinical indication for submission and to demonstrate the value of placental histopathology in understanding adverse perinatal outcomes. 

Methods. We reviewed 2 years’ singleton placental histology reports at a tertiary academic hospital in the Western Cape, SA. All samples were from placentas of >24 weeks’ gestation. 

Results. The total sample (N=822) comprised 60.9% live-birth placentas and 39.1% IUD placentas. In the IUD group, the cause of death was clinically unexplained in 55.9% of cases. Histopathology identified in this group included chorioamnionitis (CA) (34.5%), maternal vascular malperfusion (32.1%), abruptio placentae (31.5%), delayed villous maturation (17.8%) and toxoplasmosis, other agents, rubella, cytomegalovirus and herpes simplex (TORCH) infections (6.1%), most commonly syphilis. No pathology was found in only 2% of IUD cases. Among live births, preterm labour accounted for 41.9% of placental submissions, of which the cause was unknown in 46.2% of cases. Clinically indicated and histologically defined CA was poorly correlated. 

Conclusion. This study demonstrates the value of placental histopathology in cases of adverse perinatal outcome.