Stillbirth, hypertensive disorders of pregnancy, and placental pathology.
Stillbirth, preeclampsia, and gestational hypertension (PE/GH) have similar clinical risk factors and redundant placental pathology. We aim to discern if stillbirth with PE/GH has a particular phenotype by comparing stillbirths with and without PE/GH.



Secondary analysis of the Stillbirth Collaborative Research Network, a population-based cohort study of all stillbirths and a sample of live births from 2006 to 2008 in five catchment areas. We compared placental pathology between stillbirths and with and without PE/GH, stratified by term or preterm. We also compared placental pathology between stillbirths and live births with PE/GH.



79/518 stillbirths and 140/1200 live births had PE/GH. Amongst preterm stillbirths, there was higher feto-placental ratio in PE/GH pregnancies (OR 1.24 [1.11, 1.37] per unit increase), and there were more parenchymal infarctions (OR 5.77 [3.18, 10.47]). Among PE/GH pregnancies, stillbirths had increased maternal and fetal vascular lesions, including retroplacental hematoma, parenchymal infarction, fibrin deposition, fetal vascular thrombi, and avascular villi.



Stillbirth pregnancies are overwhelmingly associated with placental lesions. Parenchymal infarctions are more common in PE/GH preterm stillbirths, but there is significant overlap in lesions found in stillbirths and PE/GH.
The University of Utah School of Medicine, Salt Lake City, UT, United States. Electronic address: Karen.gibbins@hsc.utah.edu.
Karen J
KJ
Gibbins
The University of Utah School of Medicine, Salt Lake City, UT, United States.
Robert M
RM
Silver
The Warren Alpert Medical School of Brown University, Providence, RI, United States.
Halit
H
Pinar
Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States.
Uma M
UM
Reddy
RTI International, Durham, NC, United States.
Corette B
CB
Parker
RTI International, Durham, NC, United States.
Vanessa
V
Thorsten
Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States.
Marian
M
Willinger
University of Virginia, United States.
Donald J
DJ
Dudley
Yale-New Haven Hospital, United States.
Radek
R
Bukowski
University of Texas Medical Branch, Galveston, TX, United States.
George R
GR
Saade
Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States.
Matthew A
MA
Koch
University of Texas San Antonio, United States.
Deborah
D
Conway
Emory University, United States.
Carol J
CJ
Hogue
Emory University, United States.
Barbara J
BJ
Stoll
Columbia University School of Medicine, New York, NY, United States.
Robert L
RL
Goldenberg
D000293:Adolescent; D000367:Age Factors; D015331:Cohort Studies; D005260:Female; D005313:Fetal Death / Q000209:etiology*; D005865:Gestational Age; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000473:pathology*; D010920:Placenta / Q000473:pathology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000473:pathology; D050497:Stillbirth; D055815:Young Adult
Placental pathology; Preeclampsia; Stillbirth