Gross presentation and histomorphological changes of placentae in patients presenting with intrauterine foetal death at Kenyatta national hospital

Abstract

Background: There are 3.2 million annual stillbirths, at least 98% occur in low-/middle income countries, and on average, as many as two-thirds of these stillbirths are thought to occur antenatally, prior to labour. The most useful test towards a diagnosis after stillbirth is pathological examination of the placenta and the foetus. However, this pathological examination is done in less than half of the placentae after cases of stillbirth. Objective: To determine gross presentation and histomorphological changes of placentae in patients presenting with intrauterine foetal death as compared to live births. Design: A case control study. Setting: The Kenyatta National Hospital’s labour ward and the Department of Human Pathology, University of Nairobi. Subjects: The cases were mothers who presented with IUFD at a gestation of 28 weeks and above. The controls were a comparative group of mothers who delivered live babies at the hospital and were matched for age. Results: Reduction of the mass of functioning villi was present in 11.8% of placenta in the stillbirth group compared to 2% in the live birth group (p-value 0.002). There was significant presence of other placental abnormalities in the stillbirth group (22.5%) compared to the live birth group (9.8%) (p-value-0.002). Conclusion: This study revealed that histological examination of placenta is useful in identifying some causes of stillbirths. This knowledge may lead to preventive measures which would lower perinatal mortality.