Global Hypoxic Patterns of Placental Injury: Clinicopathologic Associations
J Stanek. Cincinnati Children's Hospital Medical Center, Cincinnati, OH
Background: There is no universally accepted system of histological classification of global hypoxic patterns of placental injury. This retrospective analysis has been designed to validate the Kingdom-Kaufmann classification system of patterns of placental hypoxia as preuterine (PR), uterine (UH) and postuterine (PU), based on selected histological features of chorionic villi: maturation, extracellular matrix, cytotrophoblasts, vascularity, macrophages, and syncytial knotting.
Design: Of ≥20weeks 5097 placentas consecutively signed by the author, 4413 did not feature histological patterns of global hypoxia while 684 did, of which 289 placentas showed PR, 237 placentas showed UH, and 158 placentas showed PU. Several maternal, fetal and neonatal, and gross and microscopic placental features were statistically compared among PR, UH, and PU using analysis of variance or Yates chi-square.
Results: . There were statistically significant differences (P≤0.001) between PR, UH and PU, respectively: average gestational age 35, 33 and 34 weeks, preeclampsia 12, 45, and 33%, cesarean sections 32, 50, and 58%, intrauterine growth restriction 10, 23, and 28%, umbilical cord compromise 6, 0, and 9%, complications of 3rd stage of labor 5, 2, and 12%, placental weight 437, 328, and 318g, meconium staining 39, 22, and 25%, infarction 12, 37, and 29%, hypertrophic decidual arteriolopathy 18, 44, and 28%, atherosis of spiral arterioles 4, 23, and 12%, membrane laminar necrosis 11, 24, and 21%, membrane microscopic chorionic pseudocysts 5, 14, and 13%, increased extravillous trophoblasts 3, 20, and 13%, multinucleated trophoblastic giant cells in maternal floor 7, 24, and 20%, and chorangiosis 35, 13, and 2%.
Conclusions: Despite a significant overlap of associated clinical conditions and placental histological features, the Kingdom-Kaufmann classification of hypoxic patterns of placental injury helps to clarify the etiopathogenesis of a significant proportion of complications of pregnancy and abnormal fetal or neonatal outcomes. PR seems to portend the best prognosis to the fetus, and tends to occur later in 3rd trimester, typically featuring chorangiosis and meconium staining. UH is strongly associated with preeclampsia, infarctions, decidual arteriolopathy, laminar necrosis and microscopic chorionic pseudocysts of membranes, multinucleated trophoblastic giant cells of the maternal floor, and increased amount of extravillous trophoblasts. PU features the smallest placentas and most strongly correlates with the umbilical cord compromise and complications of 3rd stage of labor.
Category: Gynecologic & Obstetrics
Tuesday, March 23, 2010 1:00 PM
Poster Session IV # 126, Tuesday Afternoon