Severe fetal placental vascular lesions in term infants with neurologic impairment

Objective

This study tests the hypothesis that placental disease can identify antepartum processes that either progress into the intrapartum period or predispose to intrapartum brain injury.

Study design

Lesions that affect large fetal vessels were compared in the placentas of 125 neurologically impaired term infants who were the focus of clinical negligence litigation and 250 consecutive singleton deliveries of ≥36 weeks of gestation.

Results

One or more of 4 severe placental fetal vascular lesions (fetal thrombotic vasculopathy, chronic villitis with obliterative fetal vasculopathy, chorioamnionitis with severe fetal vasculitis, and meconium-associated fetal vascular necrosis) were found in 51% of index cases versus 10% of the comparison group (P <.0001). Prevalence of these lesions in the 64 infants with cerebral palsy was 52% (P <.0001).

Conclusion

Severe fetal placental vascular lesions are correlated highly with neurologic impairment and cerebral palsy. Their nature, duration, and anatomic location make them strong candidates for the antepartum processes that place fetuses at risk for brain injury during the intrapartum period.

Key words: Brain damage, Cerebral palsy, Neonatal encephalopathy, Placenta