Abstract

Aim: To characterize the distribution of histopathological lesion patterns in placentas referred for pathological examination on obstetric indication, to define the obstetric indications for referral, and to evaluate the associations between lesion patterns and clinical indications at a single tertiary center.

Methods: In this single-center, retrospective, descriptive and analytical archival study, records of placentas obtained from deliveries and submitted for pathological examination on clinical indication between January 2018 and February 2026 were reviewed. Obstetric indications and histopathological findings were extracted from the clinical and pathology reports and classified according to the Amsterdam Placental Workshop Group consensus into maternal vascular, fetal vascular, acute inflammatory, and chronic inflammatory patterns. Associations were assessed with the chi-square or Fisher exact test, and continuous variables were compared using the Mann-Whitney U test.

Results: A total of 399 placentas were analyzed. The mean maternal age was 30.3 years, and 73.9% of placentas were obtained by cesarean section. The most frequent indications were hypertensive disorders of pregnancy (14.3%), preterm birth (13.5%), congenital anomaly (12.8%), and fetal growth restriction (12.5%). Most placentas were reported as normal or non-specific (86.7%), and a defined lesion pattern was identified in 13.3%, among which acute inflammatory (5.3%) and maternal vascular (4.8%) patterns predominated. Acute inflammatory lesions were significantly more common among placentas referred for suspected infection (42.9%; p = 0.005), whereas the associations of maternal vascular malperfusion with hypertensive disorders, growth restriction, and diabetes did not reach significance.

Conclusion: In this large single-center series, most referred placentas were histologically unremarkable in routine reporting, with acute inflammatory and maternal vascular lesions predominating among abnormal cases, and acute inflammatory lesions were associated with suspected infection. Standardized sampling and synoptic reporting are needed to realize the diagnostic value of placental examination.

Keywords: placenta, placenta diseases, chorioamnionitis, pregnancy complications, pathology, retrospective studies

License

Copyright (c) 2026 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to Cite

1.
Yaprak Bayrak B, Kavas G, Doğan Y. Retrospective evaluation of histopathological lesion patterns and obstetric indications in placentas referred for pathological examination. J Trends Med Invest. 2026;2(2):53-6. https://doi.org/10.64512/JTMI.2026.27

References

  1. Govender N, Lazarus L, Abel T, Naicker T. Placental morphology and morphometry: is it a prerequisite for future pathological investigations? Adv Exp Med Biol. 2023;1392:85-105. https://doi.org/10.1007/978-3-031-13021-2_5
  2. Al Fahdi M, Riyami NA, Ahmed B. Placental histopathological abnormalities in adverse obstetric outcomes: a retrospective cross-sectional study at Sultan Qaboos University Hospital. BMC Womens Health. 2024;24(1):613. https://doi.org/10.1186/s12905-024-03447-8
  3. Byrne J, Ranaei-Zamani N, Hutchinson JC, Hillman S. A retrospective analysis of placental histopathological findings in gestational diabetes mellitus (GDM). Placenta. 2025;162:20-26. https://doi.org/10.1016/j.placenta.2025.02.008
  4. Khong TY, Kim CJ, Rogers BB. Amsterdam Placental Workshop Group Consensus Statement definitions revisited: basal chronic villitis. Virchows Arch. 2025;487(3):501-509. https://doi.org/10.1007/s00428-025-04152-z
  5. Dankó I, Kelemen E, Tankó A, Cserni G. Correlations of placental histopathology, neonatal outcome, and cardiotocogram baseline variability and acceleration patterns in the growth restricted preterm population. Pediatr Dev Pathol. 2023;26(5):447-457. https://doi.org/10.1177/10935266231178615
  6. Orsaria M, Liviero S, Rossetti E, et al. Placental acute inflammation infiltrates and pregnancy outcomes: a retrospective cohort study. Sci Rep. 2021;11(1):24165. https://doi.org/10.1038/s41598-021-03655-4
  7. Mizrachi Y, Barber E, Torem M, et al. Is there a role for placental histopathology in predicting the recurrence of preterm birth? Arch Gynecol Obstet. 2019;300(4):917-923. https://doi.org/10.1007/s00404-019-05266-x
  8. Gonen N, Levy M, Kovo M, et al. Placental histopathology and pregnancy outcomes in “early” vs. “late” placental abruption. Reprod Sci. 2021;28(2):351-360. https://doi.org/10.1007/s43032-020-00287-3
  9. Ditisheim A, Sibai B, Tatevian N. Placental findings in postpartum preeclampsia: a comparative retrospective study. Am J Perinatol. 2020;37(12):1217-1222. https://doi.org/10.1055/s-0039-1692716
  10. Matthews KC, Fox NS, Rebarber A. The association between placental histopathology, fetal growth restriction, and preeclampsia in twin pregnancies. Am J Perinatol. 2021;38(8):784-790. https://doi.org/10.1055/s-0039-3402716
  11. Stevens R, Odell N, Wadee R. The clinical significance of placental histopathological evaluation in the management of high-risk obstetric patients: a cross-sectional retrospective study. South African Journal of Obstetrics and Gynaecology. 2023;29(1):e2109.
  12. Strahler L, Horky A, Spahn S, Bahlmann F, Gradhand E. Unveiling clinical relevance: investigating placentas submitted for histological examination and their correlation with clinical indications and histological findings. Life (Basel). 2024;14(8):927. https://doi.org/10.3390/life14080927
  13. Romero R, Kim YM, Pacora P, et al. The frequency and type of placental histologic lesions in term pregnancies with normal outcome. J Perinat Med. 2018;46(6):613-630. https://doi.org/10.1515/jpm-2018-0055
  14. Redline RW, Ravishankar S, Bagby CM, Saab ST, Zarei S. Four major patterns of placental injury: a stepwise guide for understanding and implementing the 2016 Amsterdam consensus. Mod Pathol. 2021;34(6):1074-1092. https://doi.org/10.1038/s41379-021-00747-4
  15. Boujenah J, Cohen J, Allouche M, et al. Prevalence and association of placental lesions with obstetrical features and outcome: data from French prospective study. AJOG Glob Rep. 2024;4(3):100374. https://doi.org/10.1016/j.xagr.2024.100374
  16. Cetinkaya Demir B, Ozerkan K, Kosan B, Aslan MK, Uncu G. Management and outcomes of 308 placenta accreta spectrum cases at a multidisciplinary tertiary center in Turkey: a 16-year experience. BMC Pregnancy Childbirth. 2026;26(1):307. https://doi.org/10.1186/s12884-026-08820-z
  17. Kükrer S, Arlıer S, Dilek O, Gülümser Ç. A novel approach for the early prediction and prevention of placenta accreta spectrum and severe peripartum hemorrhage in patients with complete placenta previa: leveraging three-dimensional placental topography, cervical length, and dilatation parameters on magnetic resonance imaging. BMC Pregnancy Childbirth. 2024;24(1):784. https://doi.org/10.1186/s12884-024-06996-w
  18. Turowski G, Tony Parks W, Arbuckle S, Jacobsen AF, Heazell A. The structure and utility of the placental pathology report. APMIS. 2018;126(7):638-646. https://doi.org/10.1111/apm.12842