Livebirths With Placental Hemorrhagic Endovasculitis

Abstract

Background and Objective.—Hemorrhagic endovasculitis (HEV) is a vasodisruptive alteration of fetal-placental blood vessels that has been associated with perinatal morbidity and mortality and abnormalities of growth and development. Clinicopathologic conditions that are often identified in pregnancies with HEV-affected placentas include villitis of unknown etiology, chorionic vessel thrombi, villous erythroblastosis, meconium staining, and maternal hypertension. The clinical implications of HEV are often disputed. This case-control study assesses the clinical relevance of HEV in placentas of viable infants and examines the interplay of coexistent intraplacental lesions. Methods.—We reviewed clinical records and slides from 104 livebirths with placentas affected by HEV above a specified severity level (cases) and 104 matched livebirths with placentas that were not affected by HEV (controls). We evaluated incidences of perinatal complications with increasing HEV severity indices in placentas with and without coexistent lesions. Interlesional relationships were established by matching HEV severity indices with severity indices of coexistent lesions. Hemorrhagic endovasculitis was subcategorized into active, bland, and healed forms and clustered capillary lesions (hemorrhagic villitis). Results.—Lesions that were frequently coexistent in HEV-affected placentas included villitis of unknown etiology, chorionic thrombi, villous fibrosis, erythroblastosis, and primary infarcts. Compared with the control group, the case group had higher incidences of abnormal fetal heart rate tracings (P < .003), fetal distress (P < .001), and growth restriction (P < .001). Increasing severities of HEV and coexistent lesions were associated with higher rates of perinatal complications. Complication rates were higher in HEV cases, with or without coexistent lesions. The complication rate was higher in cases affected by HEV and hemorrhagic villitis than in cases affected by HEV alone (P < .03). Significant interlesional relationships were evident between HEV and villitis of unknown etiology, chorionic thrombi, villous fibrosis, and erythroblastosis. Conclusions.—Severe forms of HEV can occur in placentas of livebirths. The severity of HEV and associated lesions and the presence of hemorrhagic villitis have important clinical implications. Interlesional relationships between HEV and thrombotic, chronic inflammatory, and chronic vaso-occlusive lesions exist. Pregnancies with HEV-affected placentas with or without coexistent lesions are at risk for perinatal complications.

To study the correlation between severe oligohydramnios with perinatal outcome along with histopathology of placenta

“…The result of the present study is comparable to Melamed N et al's [20] study, which shows perinatal outcome was more severe in cases of oligohydramnios complicated by PIH than in isolated oligohydramnios. So, a woman who is at term with isolated oligohydramnios with reassuring fetal surveillance and absence of maternal morbidity and evidence of IUGR is not associated with adverse perinatal outcomes.…”

Maternal Factors and Placental Pathologies Associated with a Diagnosis of Chronic Villitis

“…Previous studies have shown associations between VUE and placental pathologies such as fetal vascular malperfusion and chronic deciduitis. [16][17][18] Other authors have reported associations between VUE and umbilical cord abnormalities such as marginal cord insertion and cord hypercoiling. 19,20 Despite the associations, studies of clinical risk factors associated with VUE are still needed, especially those with larger sample sizes to increase generalizability.…”