Maternal and fetal vascular lesions of malperfusion in the placentas associated with fetal and neonatal death: results of a prospective observational study

Fetal Growth Restriction: Mechanisms, Epidemiology, and Management

“…52 In a larger Pakistani study, FVM had a relative risk of 4.09 in fetal deaths vs. live term births and a relative risk of 1.77 in preterm neonatal deaths vs. live term births. 53 Obstruction of the umbilical cord is most often the result of mechanical problems such as a marginal or velamentous insertion or a true knot. The obstruction can also be caused by thrombi, for example in cases of fetal thrombosis/coagulopathy or an abnormal coiling index.…”

The causes of stillbirths in south Asia: results from a prospective study in India and Pakistan (PURPOSe)

“…The major findings of PURPOSe, which emphasise the confluence of maternal hypertensive conditions and placental malperfusion leading to growth restriction and asphyxia, have major implications for research and programmes that aim to reduce stillbirth. 25 In almost all countries where stillbirth rates have been substantially reduced, the effective strategy has usually involved identifying fetuses at risk of stillbirth and delivering them before a fetal death. 26 , 27 …”

Placental vascular malperfusion lesions are associated with hypertension, growth restriction, and antepartum hemorrhage and ultimately with fetal and preterm neonatal death

“…Sentilhes et al have cleverly used propensity score weighting to account for indication and/or selection bias and have concluded that leaving the placenta in-situ in PAS cases is associated with a significantly decreased risk of massive hemorrhage (adjusted risk ratio, 0.29). 1 It is reassuring that 68% of the study population and 81% of patients with an antenatal diagnosis were managed at designated PAS centers of excellence. This patient flow illustrates a collegial culture in France, with the referral of most of the potentially complex patients to institutions that in turn evolve into high-volume centers offering multidisciplinary care.…”

“…We appreciate Carbillon et al for their comments on our recent study. 1,2 The PURPOSE study found a clear, significant relationship between placental vascular malperfusion and fetal death in 2 low-resource settings. We also found that the major clinical conditions associated with fetal death included maternal hypertension, antepartum hemorrhage, and fetal growth restriction (small for gestational age [SGA]) as defined by the INTERGROWTH criteria.…”

“…In the current study, we notice that 37/62 (60%) patients had attempted manual removal of the placenta before hysterectomy. 1 More recently, our group has reported on quality improvement initiatives that translated to improved patient outcomes. 3 These initiatives include standardization of antenatal care, patient blood management with the use of prophylactic tranexamic acid, elective use of cell salvage, and internal iliac artery ligation.…”