Role of Placenta in Intrauterine Fetal Demise in a Tertiary Care Hospital of Peshawar, Pakistan

Abstract

Background: Intrauterine Fetal Demise (IUFD) is the loss of a fetus at or after 20 weeks of gestation. It can be caused by many factors; placental pathologies play a vital role in these cases, but evidence in the literature is limited.

Objective: This study aimed to investigate the specific role of histopathological findings of the placenta associated with IUFDs.

Methods: In this retrospective study, IUFD cases (>20 weeks' gestation) from January 2021 to August 2023 were retrieved from the hospital database. Clinical features such as maternal age, gestational age, and fetal gender were noted. Lesions were categorized as maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM), inflammatory lesions, and idiopathic lesions. The contributor to fetal death was classified as primary, secondary, associated minor, incidental, or unknown. Other histopathological findings were also recorded.

Results Placentas of 100 cases of IUFD were observed in total. The mean maternal age was 25 years. Fetal sex distribution included 42 females and 34 males. Relevant obstetric complications included bad obstetric history (n=39), preeclampsia (n=15), intrauterine growth restriction (n=7), oligohydramnios (n=5), pregestational diabetes (n=4), others/ not provided (n=30). Inflammatory lesions and MVM had the highest incidence, at 31% and 30%, respectively, and were identified as the primary contributors to IUFD. In 39 cases, extensive neutrophilic infiltrate was recorded.

Conclusion: Inflammatory lesions and MVM were among the most frequently observed placental histopathological findings in IUFD cases, demonstrating the significant role of placental pathologies in fetal demise.