Clinical Associations with a Placental Diagnosis of Delayed Villous Maturation: A Retrospective Study

Abstract

Delayed villous maturation (DVM) is a spectrum of placental disease characterized by decreased tertiary villus formation, reduced vasculosyncytial membrane formation, and, in its more severe forms, increased large bullous villi. In some series it has been associated with an increased risk of stillbirth in the late third trimester, but overall there are few data on its significance. The aim of this study was to assess perinatal factors associated with, and the clinical significance of, the finding of DVM on placental histology. This was a retrospective study investigating all pregnancies with DVM diagnosed on placental histology in a tertiary level unit between December 2001 and August 2006. Over a 6-year period, 2915 placentas were triaged for histopathological assessment, representing 6.1% of all 48 054 deliveries in this time period. One hundred ninety (6.3%) of these selected cases showed DVM. Fifteen placentas from infants with less than 34 completed weeks of gestation were excluded, leaving 175 for further analysis. When compared with controls matched for gestation and delivering within the same time period (n = 175), DVM was significantly associated with pregestational diabetes (8% vs 2.8%, P < .05; relative risk 2.8 [95% confidence interval 1.03-7.6]), gestational diabetes (8.6% vs 3.4%, P < 0.05; relative risk 2.5 [95% confidence interval 0.99-6.3]), and prenatal or intrapartum intrauterine death (8.6% vs 0%, P < 0.05). Delayed villous maturation is associated with both gestational and pregestational diabetes mellitus and with perinatal death.

Placental Pathology in Full-Term Infants with Hypoxic-Ischemic Neonatal Encephalopathy and Association with Magnetic Resonance Imaging Pattern of Brain Injury

“…19 Decreased placental maturation has been associated with gestational diabetes and perinatal death. 19,20 The association with the white matter/watershed and white matter/watershed injury with BGT involvement injury patterns suggests a role for antenatal, chronic hypoxia in these types of injury. In contrast, none of the placentas from infants with predominant BGT injury showed evidence of decreased maturation, supporting the hypothesis that severe chronic hypoxia is not a factor in this group.…”

A systematic review of placental pathology in maternal diabetes mellitus

“…Additionally, increased incidence of placental villous immaturity was commonly seen in placentas affected by pregestational (8, 32, 37) and GDM (10, 43). This placental abnormality, which has been independently associated with an increased risk of perinatal mortality (60), may serve as a connection between maternal diabetes and an increased risk of fetal intrauterine death (61). Further study in these areas is warranted to elucidate etiologic mechanisms.…”

Delayed Villous Maturation of the Placenta: Quantitative Assessment in Different Cohorts

“…In a retrospective study, we have previously shown an association between DVM as defined qualitatively, and an adverse perinatal outcome 8 . We have also shown that DVM is not associated with antenatal ultrasound parameters 6 .…”