CLINICO-PATHOLOGICAL STUDY OF PLACENTAL LESIONS AT THE UNIVERSITY OF CALABAR TEACHING HOSPITAL, CALABAR

Abstract

Background: Research on the placenta is not widely undertaken despite known benefits of
such studies. This study was aimed at relating placental lesions with diverse foeto-maternal
clinical presentations. It was, therefore, done to contribute to knowledge about this organ in
our environment and to stir researchers to take up further studies on this vital organ.
Methodology: This research was a descriptive prospective study on placental lesions from
deliveries at the UCTH Calabar. The selection and examination of placentas were based on a
modification of guidelines set by the College of American pathologists (CAP). Prior to gross
examination, relevant maternal and foetal clinical information were extracted. A total of 335
placenta samples were selected and analysed. On the average, 2-4 tissue samples were taken
from the placenta disc, 2-3 from the umbilical cord, and 2 from membrane rolls; then processed,
sectioned, stained, histologic diagnosis rendered and statistical analysis done.
Results: The mean placenta weight was 498.4g (range 140-1500g) and mean cord length
47.3cm (range 24-61cm). Clinically significant placental lesions were variable in the three (3)
regions of the placenta namely membrane, umbilical cord, and placental disc. Overwhelming
majority of clinically significant lesions occurred in the placenta disc. The significant
pathologic findings were mostly inflammatory in the membrane and the cord while the disc
showed clinically significant inflammatory and non- inflammatory lesions. The top five (5)
pathologies recorded include villous hypoplasia/terminal villus deficiency which occurred
in 96(28.7%) cases, villous immaturity in 30(9.0%) cases, chronic chorioamnionitis in
14(4.2%) cases, maternal floor infarction/massive perivillous deposition in 11(3.3%) cases
and acute chorioamnionitis in 7(2.1%) cases. The clinical diagnoses with most significant
pathologies were HIV, intrauterine foetal death (IUFD) and obstructed labour. Regarding
HIV, chorioamnionitis (1.7%) topped inflammatory while villous hypoplasia/terminal villous
deficiency (20.0%) was the commonest non-inflammatory lesion. Similarly, in intrauterine
foetal death (IUFD), chorioamnionitis (24. 56%) was the commonest inflammatory lesion
whereas villous hypoplasia/terminal villous deficiency (42.1%) was the most frequent
non-inflammatory lesion. In obstructed labour, chorioamnionitis (9.3%) emerged as the
commonest inflammatory lesion while the most prevalent non-inflammatory histological
finding was early villous ischaemia (44.2%).
Conclusion: We conclude that this study being the first of its kind in our country will
provide baseline placental morphometric values and histologic findings for future research
works in this area.