title: IFPA Gábor Than Award Lecture: Recognition of placental failure is key to saving babies' lives.
abstract: In high-income countries, placental failure is implicated in up to 65% of cases of stillbirth. Placental failure describes the situation where the placenta cannot meet the fetus' needs and may be the end-result of a variety of underlying pathological processes evident in the placental disc, membranes and umbilical cord. These include lesions with genetic, environmental, infectious, inflammatory, mechanical, metabolic, traumatic or vascular origin. Investigation of placental tissue from stillbirths and from pregnancies at an increased risk of stillbirth has demonstrated changes in macroscopic and microscopic structure which are themselves related to abnormal placental function. A better understanding and identification of placental failure may improve the management of pregnancy complications and of pregnancies after stillbirth (which have a 5-fold increased risk of stillbirth). The majority of current antenatal tests focus on the fetus and its response to the intrauterine environment; few of these investigations reduce stillbirths in low-risk pregnancies. However, some currently used investigations reflect placental development, structure and vascular function, while other investigations employed in clinical research settings such as the evaluation of placental structure and shape have a good predictive value for adverse fetal outcome. In addition, recent studies suggest that biomarkers of placental inflammation and deteriorating placental function can be detected in maternal blood suggesting that holistic evaluation of placental structure and function is possible. We anticipate that development of reliable tests of placental structure and function, coupled to assessment of fetal wellbeing offer a new opportunity to identify pregnancies at risk of stillbirth and to direct novel therapeutic strategies to prevent it.
authors.affiliation: Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, UK; St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK. Electronic address: alexander.heazell@manchester.ac.uk.
authors.forename: A E P
authors.initials: AE
authors.lastname: Heazell
authors.affiliation: Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, UK; St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK.
authors.forename: S A
authors.initials: SA
authors.lastname: Worton
authors.affiliation: Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, UK; St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK.
authors.forename: L E
authors.initials: LE
authors.lastname: Higgins
authors.affiliation: Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, UK; St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK.
authors.forename: E
authors.initials: E
authors.lastname: Ingram
authors.affiliation: Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, UK; St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK.
authors.forename: E D
authors.initials: ED
authors.lastname: Johnstone
authors.affiliation: Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, UK; St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK.
authors.forename: R L
authors.initials: RL
authors.lastname: Jones
authors.affiliation: Maternal and Fetal Health Research Centre, Institute of Human Development, University of Manchester, UK; St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK.
authors.forename: C P
authors.initials: CP
authors.lastname: Sibley
mesh_terms: D000818:Animals; D005260:Female; D005313:Fetal Death / Q000517:prevention & control*; D006801:Humans; D007231:Infant, Newborn; D050498:Live Birth; D010922:Placenta Diseases / Q000175:diagnosis* / Q000628:therapy; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods / Q000639:trends; D050497:Stillbirth / Q000453:epidemiology
keywords: Fetal growth restriction; Perinatal death; Placental dysfunction; Placental insufficiency; Stillbirth