Diagnosing placental membrane hypoxic lesions increases the sensitivity of placental examination.
BACKGROUND
Two relatively unknown and recently described placental membrane hypoxic lesions (laminar necrosis and microscopic chorionic pseudocysts) have never been compared with time-honored, focal (infarction), and diffuse hypoxic lesions of placental parenchyma.


OBJECTIVE
To compare the effect on placental diagnosis of the above placental membrane hypoxic lesions and chorionic disc hypoxic lesions (infarctions and global hypoxic pattern of placental injury).


METHODS
Twenty-three clinical (maternal and fetal) and 32 gross and microscopic placental features were retrospectively compared in 4590 placentas from a placental database built during a 13-year period: 168 placentas with at least one hypoxic disc lesion (infarct or global hypoxia) and at least one membrane lesion (microscopic chorionic pseudocysts or laminar necrosis (group 1), 750 placentas with at least one hypoxic villous lesion but no membrane lesion (group 2), 480 placentas with at least one membrane lesion but no villous lesion (group 3), and 3192 placentas with no hypoxic villous or membrane lesions (group 4).


RESULTS
Several clinical and fetal conditions and placental features known to be associated with in utero hypoxia had a statistically significant correlation with the index hypoxic placental lesions, both villous and membranous. Of placentas from patients associated with clinical conditions at risk for hypoxia, 15% featured only hypoxic membrane lesions without a chorionic disc hypoxic lesion.


CONCLUSIONS
Recognizing placental membrane hypoxic lesions increases the sensitivity of placental examination in diagnosing placental hypoxia by at least 15%. The risk of in utero hypoxia is increased when microscopic chorionic pseudocysts and laminar necrosis occur in conjunction with villous hypoxic lesions.
Stanek
Jerzy
J
Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA. jerzy.stanek@cchmc.org
D002823:Chorion / Q000098:blood supply / Q000473:pathology; D003560:Cysts / Q000473:pathology; D016208:Databases, Factual; D005260:Female; D005315:Fetal Diseases / Q000473:pathology; D005333:Fetus / Q000098:blood supply; D006801:Humans; D000860:Hypoxia / Q000473:pathology*; D007238:Infarction / Q000473:pathology; D009336:Necrosis; D010920:Placenta / Q000098:blood supply / Q000473:pathology*; D010922:Placenta Diseases / Q000473:pathology*; D011247:Pregnancy; D012189:Retrospective Studies; D012680:Sensitivity and Specificity