Stillbirth: Correlations Between Brain Injury and Placental Pathology.
Chronic placental pathologic processes such as fetal thrombotic vasculopathy have been linked to brain injury in neonates. We hypothesize that using stillbirth as a model, placental pathology can predict risk for hypoxic-ischemic brain injury. From a single institutional database of stillbirths ≥23 weeks' gestational age, we included cases with full autopsy and neuropathology examination. Bivariable analyses were performed to identify whether there was an association between placental pathologic findings and neuropathologic findings. Logistic regression was used to control for potential confounders. Among 97 potential cases, adequate tissue was analyzable from 79 cases (mean gestational age  =  33 weeks). Acute central nervous system hemorrhage and acute neuronal necrosis were the most common neuropathologic processes seen in this cohort (57% for each). Maternal vascular underperfusion was the most common placental pathology but was not significantly associated with a specific neuropathologic finding. High-grade chronic villitis (HGCV) and fetal thrombotic vasculopathy (FTV) were significantly associated with increased risk for pontosubicular necrosis (odds ratios, 15.73 and 3.79, respectively). These associations persisted after controlling for potential confounders. Chronic placental pathologies, specifically HGCV and FTV, were associated with pontosubicular necrosis, suggesting that placental pathology involving the fetal vasculature and altered fetoplacental blood flow carry the greatest likelihood of hypoxic/ischemic brain injury.
1 Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Linda M
LM
Ernst
1 Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Esther N
EN
Bit-Ivan
2 Department of Obstetrics, Division of Maternal Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Emily S
ES
Miller
1 Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Lucy
L
Minturn
1 Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Eileen H
EH
Bigio
3 Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|4 Center for Autonomic Medicine in Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, and the Stanley Manne Children's Research Institute, Chicago, IL, USA.
Debra E
DE
Weese-Mayer
D001930:Brain Injuries / Q000150:complications / Q000453:epidemiology*; D005260:Female; D006801:Humans; D010922:Placenta Diseases / Q000453:epidemiology* / Q000473:pathology; D011247:Pregnancy; D050497:Stillbirth
cerebral edema; fetal thrombotic vasculopathy; fetoplacental vascular pathology; neuropathology; pontosubicular necrosis