Histopathological Changes in the Placenta in Late Intrauterine Fetal Deaths at a Tertiary Hospital in Bangladesh

Introduction: Meticulous gross andmicroscopic studiesof the singleton placenta alone may provide valuable information regarding the cause of unexplained intrauterine fetal deaths(IUFDs) and can offer potential treatment options for its prevention in future pregnancies. Objective: To determine the histopathological changes in the placenta associated with late intrauterine fetal death. Method: A cross-sectional study was carried out in the Department of Pathology, Sir Salimullah Medical College Mitford Hospital, Dhaka, fromMarch 2021 to January 2023. A total of 80 patients aged between 19 and 44 years with late IUFDs were included in this study. Theplacentas of the dead newbornswere histopathologically analyzed. Results: All of the patients presentedsignificant gross andhistopathological changes in the placental specimens. A total of 71.3% of them were <30 years of age. Fifty percent of the patients were multipara, and 45% were primi. The gestational ages of 61.3% of the patients were within 37–40 weeks, 20% were within 28–32 weeks, and 18.8% were within 33–36 weeks. The mean placental weight was 407 gm, and 46.3% of the patients had placental weights within 410–450 gm. A total of 33.8% of the patients had placental diameters within 9–12 cm, and 48.8% had placental diameters within 13–16 cm. Cord insertion was eccentric in 41.3%, central in 45.0% and marginal in 12.5% of the patients. A total of 18.8% of patients had hypocoil, and 10% had hypercoiled cords. Twenty percent ofpatients had retroplacental hemorrhage. The membrane was greenish yellow in 3.8% of the samples and pale bluish in 2.4% of the samples. The significantmicroscopic findings were vascular ectasia with congestion in 26.3% of the patients, disorders of villous maturation in 35%, perivillous fibrin deposition in 15.0%, intervillous hemorrhage in 23.8%, subamniotic hemorrhagein 2.5%, microcalcification in 18.8%, infarct with avascular ghost villi in 17.5%, villous edema in 15%, deciduitis in 6.25%, thrombus in 5%, perivillous fibrin deposition in 15%, chorangiosis in 2.5%, villitis of unknown origin in 25% and chronic intervillositis in 17.5% of the patients. Maternal and fetal inflammatory responses were present in 26 patients, of whom46.2% had stage 1 and 38.5% had stage 2 maternal inflammatory responses. A total of 7.7% had stage 1 inflammatory response, and 23.1% had stage 2 fetalinflammatory response. Discussion: This study revealed that late IUFD is associated withsignificant placental histopathological abnormalities. Identification of these abnormalities can provide information about the etiopathogenesis of late intrauterine fetal deaths, can play a very important role in medicolegal situations and can guide physicians in the management of patients to prevent further pregnancy losses.