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Pathological findings in placentas from term and preterm intrauterine fetal death pregnancies
Adviser : Dr. Tigor P. Simanjuntak SpOG Student : Arya Sakti Andhika P.S (06-152)
Abstract
To compare pathological findings of placentas from term and preterm pregnancies complicated by intrauterine fetal death (IUFD).
Objective
Abstract
A retrospective cohort study
Study Design
Comparison
placentas from term and preterm placentas delivered before and after 34 weeks gestation
Abstract
Results
849 placentas of IUFD were examined Gross and microscopic pathological finding were noted
Abstract
Conclusions
A vast majority of IUFD placentas reveal numerous pathological findings that reflect uteroplacental insufficiency and abnormal blood supply
Pregnancy loss after 22 complete gestational weeks or a fetus weighing more than 500 gr
Introduction Incidence
In the United States
12.1/1000 births
Caucasians Population
5.5/1000 births
In Israel (SOROKA Medical Centre)
Definition of IUFD
Sample Number of Samples
pregnancy loss after 22 complete gestation weeks or birth weight > 500 g Deliveries between 1995 and 2004 at the Soroka University Medical Center
Result
Characteristic Study group
Ethnicity
Jewish Arab Bedouins 37.1 % (315) 62.9 % (534)
Nulliparity
Gestational age Placental weight
21.2 % (180)
31.67 (weeks) 5.68 (849) 547.57 (gr) 586.688 (749)
Tabel II. Karakteristik Maternal, Janin dan Plasenta Pada Kehamilan Aterm dan Preterm IUFD
Result
Karakteristik Usia Ibu Gravida Paritas Golongan darah Ibu A B AB O Rhesus Positif Negatif Serum Ibu Kadar Hemoglobin Jenis Kelamin Janin Laki-laki Perempuan Berat Lahir berdasarkan Usia Kehamilan SGA / KMK AGA / SMK LGA / BMK
IUFD Preterm 16.2 12.9 4.4 0.1 3.7 0.1 30.4 % 24.2 % 4.8 % 40.5 % 88.5 % 11.5 % 11.10.07 49.9 % 50.1%
IUFD Aterm 29.9 0.5 4.8 0.2 4.3 0.2 31.6 % 23.6 % 7.1 % 37.8 %
0.29 85.8 % 14.2 % 0.004 11.5 0.1 0.72 51.3 % 48.7 % < 0.001 27.9 % 67.9 % 4.2 % 35.1 % 54.1 % 10.8 %
Tabel III. Temuan Kelainan Patologis Makroskopik dari Plasenta Preterm dan Aterm IUFD
Result
(n)
Kelainan Makroskopik
Preterm IUFD
Aterm IUFD
(n)
4.1% (7) 0.148
1.9% (9)
Kalsifikasi
SUA Mekonium Pembengkakan Perdarahan infark
15.8% (81)
5.5% (27) 40.4% (21) 51.6% (210) 5.4% (28) 15.2% (78)
33.5% (59)
4.1% (7) 36.4% (8) 77.3% (116) 5.7% (10) 13.6% (24)
< 0.001
0.455 0.746 < 0.001 0.906 0.620
Tabel IV. Temuan Kelainan Patologis Mikroskopik dari Plasenta Preterm dan Aterm IUFD
Result
Kelainan Mikroskopis Vaskularisasi Yang Buruk Metaplasia Infark Sumbatan Vaskular Trombosis Intravaskular Knot Penebalan Dinding Perdarahan Kalsifikasi Korioamnionitis
Preterm IUFD (n) Aterm IUFD (n) 86.5% (160) 55.5% (111) 44% (88) 25.5% (51) 4.5% (9) 4.5% (9) 91% (182) 12.5% (25) 12.5% (25) 33% (66) 65.9% (56) 70.8% (63) 53.9% (48) 13.5% (12) 9% (8) 3.4% (3) 91% (81) 16.9% (15) 10.1% (9) 30.3% (27)
p < 0.001 0.014 0.118 0.022 0.134 0.657 0.998 0.322 0.561 0.655
Tabel V. Temuan Kelainan Patologis Makroskopik dari Plasenta yang lahir Sebelum dan Sesudah Usia kehamilan 34 Minggu
Result
Kelainan Makroskopik IUFD Sebelum
34 Minggu (n) Insersi Tali Pusat Abnormal Kalsifikasi SUA Mekonium Pembengkakan 1.1% (4) 14% (57) 5.2% (20) 55% (22) 47.6% (157)
IUFD Setelah
34 Minggu (n) 4.5% (12) 29.2% (83) 5.1% (14) 67.6% (23) 74.4% (169)
Perdarahan
infark
5.7% (23)
14% (57)
5.3% (15)
15.8% (45)
0.828
0.511
Tabel VI. Temuan Kelainan Patologis Mikroskopik dari Plasenta yang lahir Sebelum dan Sesudah Usia kehamilan 34 Minggu
Result
Kelainan Mikroskopis
IUFD Sebelum
IUFD Setelah
34 Minggu (n)
Vaskularisasi Yang Buruk Metaplasia Infark Sumbatan Vaskular Trombosis Intravaskular Knot 86.2% (125) 57.1% (89) 41% (64) 28.8% (45) 3.2% (5) 3.8% (6)
34 Minggu (n)
72.8% (91) 63.9% (85) 54.1% (72) 13.5% (18) 9% (12) 4.5% (6) 0.015 0.235 0.026 0.005 0.036 0.778
Penebalan Dinding
Perdarahan Kalsifikasi Korioamnionitis Funisitis Insufisiensi Uteroplasenta
91% (142)
12.2% (19) 12.8% (20) 33.3% (52) 5.8% (9) 91.7% (143)
91% (121)
15.8% (21) 10.5% (14) 30.8% (41) 6.8% (9) 86.5% (115)
0.989
0.376 0.546 0.649 0.726 0.154
Tabel VI. Temuan Kelainan Patologis Mikroskopik dari Plasenta yang lahir Sebelum dan Sesudah Usia kehamilan 34 Minggu
Result
100 80
60 40 20 0
Vaskularisasi Yang Buruk Sumbatan Vaskular Infark IUFD Sebelum Kehamilan 34 Minggu IUFD sedudah Kehamilan 34 Minggu
Discussion
The main finding of this study is
vast majority of IUFD placentas demonstrate pathological characteristics associated with uteroplacental insufficiency
Over 90% of preterm (537 weeks) and over 83% of term IUFD placentas were associated with uteroplacental insufficiency
Discussion
Discussion
Placental lesions leading to obstruction of the fetal circulation are an important cause of adverse pregnancy outcomes
When sufficiently extensive thrombosis may in some cases, be the consequence of stasis or vascular wall damage
The most common cause of stasis is compromised umbilical blood flow secondary to chronic partial or recurrent intermittent umbilical cord compression
it is possible that the rate and severity of cord compression increases with gestational age