Placental Findings Contributing to Perinatal Death: A 15-Year Retrospective Review from a Teaching Hospital in Thailand

Taweevisit, Mana; Thorner, Paul

doi:10.1080/15513815.2020.1747121

Cited by 3 publications

(6 citation statements)

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“…One third of cases with fetal growth restriction in the late fetal stage died in the antepartum period from "maternal floor infarction/massive perivillous fibrin deposit", an uncommon, but specific placental disorder that has a high risk of fetal demise and recurrence in subsequent pregnancies. [17][18][19] Placental examination also provides important information about umbilical cord abnormalities and cord accidents, which were a significant cause of antepartum death in the late fetal stage. In our study, autopsy examination did not reduce the proportion of unexplained stillbirths, nor change any cause of death determined by placental pathology.…”

Section: Discussionmentioning

confidence: 99%

“…Placental examination also provided a cause of death in the majority of cases of fetal growth restriction. One third of cases with fetal growth restriction in the late fetal stage died in the antepartum period from “maternal floor infarction/massive perivillous fibrin deposit”, an uncommon, but specific placental disorder that has a high risk of fetal demise and recurrence in subsequent pregnancies 17–19 . Placental examination also provides important information about umbilical cord abnormalities and cord accidents, which were a significant cause of antepartum death in the late fetal stage.…”

Section: Discussionmentioning

confidence: 99%

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Classification of stillbirth by the International Classification of Diseases for Perinatal Mortality using a sequential approach: A 20‐year retrospective study from Thailand

Taweevisit

Nimitpanya

Thorner

2022

J of Obstet and Gynaecol

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Aim The International Classification of Diseases for Perinatal Mortality (ICD‐PM) is a system for recording causes of perinatal death. In this system, placental pathology is considered a “maternal condition” and this category does not cover the spectrum of placental pathology that can impact on perinatal death. The aim of the study was to apply a wider spectrum of placental pathology as a separate parameter for classifying death in the ICD‐PM. Methods All autopsy reports at a single institution over a 20‐year period (2001–2020) were reviewed. Causes of stillbirth were analyzed in a sequential manner: step 1, clinical history and laboratory results; step 2, placenta; and step 3, autopsy; and classified at each step according to the ICD‐PM. Results The review identified 330 cases, including 126 antepartum and 204 intrapartum deaths. Step 1 identified a cause in 176 (86%) intrapartum deaths and 64 (51%) antepartum deaths. The addition of placental pathology (step 2) changed the cause of death in 12% of cases, with causes now identified in 190 (93%) intrapartum and 89 (71%) antepartum deaths. Adding step 3 did not identify any additional causes of death. Conclusion The accuracy of the ICD‐PM classification is dependent on the data available. Placental pathology made a significant difference in assigning causes of death in our series, stressing the importance of placental examination. Determination of the cause of death based on clinical history and laboratory data alone may be inaccurate, and less useful for comparative studies and planning prenatal care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Classification of stillbirth by the International Classification of Diseases for Perinatal Mortality using a sequential approach: A 20‐year retrospective study from Thailand

Taweevisit

Nimitpanya

Thorner

2022

J of Obstet and Gynaecol

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According to literature sources, the real frequency of many umbilical cord pathologies differs significantly from the statistical data indicated by researchers in their works (from 15% to 38%) [1][2][3][4]. As demonstrated by the studied literary sources, on the modern scientific discussion panel the question of the relationship between the pathology of the umbilical cord and its insertion, as well as reproductive losses in such pregnancy, are

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mentioning

confidence: 95%

mentioning

confidence: 99%

“…usually presented in foreign studies; unfortunately, domestic scientific search contents are sporadic and unsystematized [1][2][3][4]. The thanatogenic value of umbilical cord abnormalities is often exaggerated, or retains aspects of underestimation and controversy [2,3,5]. However, they can also significantly worsen the perinatal outcome when combined with pathology or against the background of gestational complications, which requires systematization of diagnostic approaches and standardization of treatment and preventive measures when they are detected [5].…”

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confidence: 99%

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Risk Factors of Umbilical Cord Pathology and Factors of Negative Perinatal Consequences and Newborn Incidence

Dubetskyi¹,

Makarchuk²,

Andriiets³

et al. 2023

Neonatol. hìr. perinat. med.

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According to literature sources, the real frequency of many umbilical cord pathologies differs significantly from the statistical data indicated by researchers in their works (from 15% to 38%). The implementation of a system of diagnostic and treatment and preventive measures, based on mandatory antenatal and postnatal assessment of the features and characteristics of the umbilical cord, allows to improve perinatal outcomes and reduce perinatal morbidity. The aim of the work was to identify the main risk factors of umbilical cord pathology and negative perinatal consequences; to develop elements of standardization of antenatal and postnatal diagnosis of umbilical cord pathology. Research materials and methods. A retrospective assessment of medical documentation data (3,280 individual medical records of pregnant women) made it possible to establish the frequency of umbilical cord pathology in the population. In the future, a more detailed extended antenatal and postnatal examination of the umbilical cord and placenta after delivery was carried out in 637 patients of reproductive age with pregnancy complicated by pathology of the umbilical cord (main group). The control group was formed by 40 patients with an uncomplicated course of pregnancy and live birth of full-term healthy children. The study was conducted taking into account the main principles of the Helsinki Declaration on Biometric Research and the powers of the GCH ICH, in accordance with biometric norms with compliance with the principles of confidentiality and ethics (excerpt from protocol No. 128/22 of the meeting of the Bioethics Commission dated September 29, 2022, Ivano-Frankivsk National Medical University, Ministry of Health of Ukraine).Data analysis was performed using the Statistica 7.0 package of statistical programs (StatSoftInc., USA). The association of independent variables with the condition being studied is presented as odds ratio (OR) and 95% confidence interval (CI).The materials of the article are the result of the research of the complex research work fragment of the Department of Obstetrics and Gynecology named after I.D. Lanovyi of the Ivano-Frankivsk National Medical University: “Development of diagnostic tactics and pathogenetic substantiation of effective methods of preserving and restoring reproductive potential and improving parameters of a woman’s quality of life in obstetric and gynecological pathology” (state registration number 0121U109269, implementation dates 2021-2026 ), the author is a co-executor of the topic.Research results and their discussion. The following data were noted: an excess of the population norm of the length of the umbilical cord, a high proportion of eccentric and marginal insertion of the umbilical cord (22.14%) and umbilical cord coiling (33.28%), a decrease in the proportion of the reference limits of the umbilical cord tortuosity index (15.86%), in 56.7% of observations, the specific gravity of the umbilical cord was lower. Probable risk factors for umbilical cord pathology with a predominance of age over 35 years, nicotine addiction in pregnant women, multiple fertility, use of IVF programs, change in the amniotic fluid index, overweight and obesity, other clinical conditions associated with metabolic disorders (gestational diabetes, insulin resistance) were identified. Conclusion. The share of the umbilical cord pathology both in the isolated type and in the combination of characteristic features of the umbilical cord is 40.98%. The increase in the risk of negative perinatal consequences has a close relationship with the umbilical cord pathology and the combination of different types of pathology, as well as the addition of gestational complications, which allows for the formation of screening programs and optimization of the diagnostic algorithm.

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Criteria for placental examination for obstetrical and neonatal providers

Roberts¹,

Baergen²,

Boyd³

et al. 2023

American Journal of Obstetrics and Gynecology

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Placental Findings Contributing to Perinatal Death: A 15-Year Retrospective Review from a Teaching Hospital in Thailand

Cited by 3 publications

References 33 publications

Classification of stillbirth by the International Classification of Diseases for Perinatal Mortality using a sequential approach: A 20‐year retrospective study from Thailand

Classification of stillbirth by the International Classification of Diseases for Perinatal Mortality using a sequential approach: A 20‐year retrospective study from Thailand

Risk Factors of Umbilical Cord Pathology and Factors of Negative Perinatal Consequences and Newborn Incidence

Criteria for placental examination for obstetrical and neonatal providers

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