Placental histopathology according to amsterdam criteria and correlation with maternal and neonatal outcomes: A case-control study

Abstract

Objective: To assess the placental histopathology (as per the Amsterdam consensus criteria) with fetal placental Doppler and maternal and fetal outcomes in subjects with pre-eclampsia (PE) with severe features versus normotensive controlgroup. Methods: A case control study was conducted over a period of 1 year at Medical college, Baroda which evaluated 40 women who were divided into case group (20 PE with severe features) and control group (20 normotensives) after matching chronological age, gestational age and parity. Parametric tests such as independent t-test and sensitivity, specificity and odds ratio were calculated. Results: Placentae of subjects with PE with severe features were significantly small and having less weight than control group. Mean thickness of umbilical cord (UC) in case group was 0.70±0.23 cm and mean thickness in control group was 0.96±0.10 cm (P value < 0.0001). No significant difference was seen in Feto placental ratio. Infarction was present in 65% of case group and 5% of control group. Decidual vasculopathy was seen in 90% of case group and was not at all seen in control group. Increased syncytial knots were seen in 100% of case group and 65% of control group (P = 0.0040). Vascular sclerosis and stromal fibrosis were seen more in case group than in control group (P = 0.0196 and < 0.0001 respectively). Conclusion: The Amsterdam classification was useful in delineating histopathological findings such as syncytial knots, infraction, decidual vasculopathy and villous stromal vascular karyorrhexis which were found to correlate with abnormal Doppler velocimetry and adverse maternal and neonatal outcomes. However, it was found to be tedious and time consuming.