Abstract:

Background: Stillbirth is a devastating experience for both family and clinicians thus causal identification helps the parents in mourning process and for future pregnancy interventions. Previous Studies have reported that systems with pathological examination of the placenta may identify causes of unknown stillbirths in more than 90% of cases.

Broad objective: To determine the association between placenta pathological patterns and stillbirths among women delivering at BMC from January 2022 to December 2022.

Methods: This study was analytical cross-sectional study, involving 120 women who delivered stillbirths at BMC, after delivery Stillbirths’ placenta and membranes were grossly examined for completeness, then were put in a container with 10% neutral buffered formalin for fixation and then were sent in the histopathology laboratory. In the Lab, grossing was done according to surgical pathology grossing manual by Tidiane, followed by staining of the placentas, cord, and membranes by standard H&E staining. Microscopic examination of the placenta was done, and the pathologies were defined according to Amsterdam Placental Workshop Group Consensus. Data were analyzed by using STATA version 15 computer software and the p-value of <0.05 on multivariate logistic regression model was considered significant.

Results: Our study found a prevalence of stillbirth at 31.9/1,000 deliveries for the year 2022-2023 at BMC. We also observed no association between residing in urban, Low literacy, fewer ANC visits (<4), being employed, PE and stillbirth with OR [95%CI] Pvalue of 2.1[0.8-5.1] p=0.085, 0.8[0.4-1.6] p=0.511, 2[0.9-4.9] p=0.085, 1.1[0.5-2.8] p=0.803, 2.3[1.1-4.9] p=0.031 respectively on bivariate analysis. Only PE had a statistical significance on bivariate analysis however neither of these factors had statistical significance on multivariate analysis. The macerated stillbirths had higher rates of fetal vascular malperfusion, chronic inflammation and coagulation-related pathology with OR [95%CI] P-value of 0.6[0.04- 8.2] p=0.689, 0.8[0.1-11.2] p=0.891, 0.8[0.1-10.2] p=0.829 respectively whereby the fresh stillbirths had higher rates of acute chorioamnionitis 14[1.14-19.2] p=0.039 on bivariate analysis. Only acute chorioamnionitis had statistical significance with fresh stillbirth even on multivariate analysis with 6.6[1.3-33.1] p=0.022. No significant difference for maternal vascular malperfusion between the two groups with 0.2[0.03-1.9] p=0.181 for MSB and 4.39[0.5-38.40] p=0.181 for FSB and both had p>0.05 on multivariate analysis. The overall association of all placenta pathologies and stillbirths (MSB+FSB) was significant with pvalue = 0.038 on Chi 2 and Fisher’s Exact test.

Conclusion: This study has shown placenta pathologies exist and largely associated with stillbirth. To reduce unidentified causes of fetal death in utero, pathological evaluation of the placenta should be performed in addition to the clinical diagnosis in all women who have stillbirths at BMC.