Abstract
The aim of this review is to examine the role of placental pathology in the understanding
of singleton stillbirth. The placenta may be regarded as the “black box” of pregnancy
and detailed examination may afford insight into the fetal and maternal events leading
to this tragic outcome. In the UK, 1 in 200 to 1 in 240 pregnancies end in stillbirth
whilst India accounts for the majority of global stillbirths. Between 2010 and 2013,
India showed a decline in the stillbirth rate and it continues to fall–a recent report
felt that the majority of deaths in the third trimester were preventable. However,
in order to prevent such deaths we need to understand their cause. Postmortem studies
may cast light on the many factors which lead to stillbirth or early neonatal death
but there is anecdotal evidence that certain groups are reluctant to authorise postmortem
examination and in a religiously diverse and observant country such as India, postmortem
may not be acceptable to families. However, if the purpose of the postmortem study
is properly explained, many families would agree to such an examination. In this paper
the authors aim to look at how examination of the singleton placenta alone may provide
valuable information regarding the causation of stillbirth and indicate potential
treatment options for its prevention in future pregnanices. The authors will consider
the more commonly encountered lesions, clinically and pathologically and provide guidelines
for those less experienced in this field.
Keywords
India - Stillbirth - Placental pathology - Maternal vascular malperfusion - Thrombophilia
- Fetal vascular malperfusion - Diabetes - BMI
