Clinical correlates of histopathological entities of the placenta

Health practitioners caring for pregnant women and neonates frequently encounter placental histopathological reports with esoteric diagnostic entities of contentious clinical significance like chronic villitis, massive perivillous fibrin deposition, chronic histiocytic intervillositis, materno-fetal vascular malperfusion and delayed villous maturation. These lesions may recur in succeeding pregnancies. 

Recurrent placental conditions such as villitis of unknown aetiology (VUE), chronic histiocytic intervillositis, vascular malperfusion, Massive perivillous fibrin deposition (MPFVD) and Delayed villous maturation (DVM; ‘villous dysmaturity’) possess an increased risk of perinatal morbidity and mortality. 

A recent article reviewed the status quo of placental pathology and research, focusing on clinical management implications for some of these most often reported but less understood recurrent clinicopathological entities of the placenta. This review also provided an update on the current nomenclature and classification of placental conditions. 

Adequate reporting and correct interpreting of placental histopathology can provide useful information to understand the adverse pregnancy outcomes and guide further management of the mother, newborn or future pregnancy. Empirical treatments with prednisolone, aspirin, heparin and intravenous immunoglobulins can be given for immune-mediated placental conditions. However, evidence-based guidelines for the management of these conditions are lacking.

A lack of universally accepted diagnostic criteria, terminology and grading systems impedes the full potential of placental histopathology in fetomaternal care. The universal adoption of the Amsterdam criteria by reporting pathologists and obstetricians has come as a positive and welcome step in generating uniformity of nomenclature. 

More research is needed to elucidate definitive pathogenetic mechanisms, local epidemiology, the exact impact on perinatal morbidity and mortality, evidence-based management guidelines and therapy for aforementioned recurrent idiopathic placental conditions. 

Matsika A. Clinical correlates of histopathological entities of the placenta. AJGP. 2021;50(1–2).

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