Antenatal fetal death in premature pregnancy. Clinical and morphological aspects

Objective: assessment of the morphological features of the placenta during antenatal fetal death in comparison with the clinical features of the course of pregnancy at various gestation periods. Materials and methods: a retrospective analysis of 270 fetal autopsy protocols was conducted. Exclusion criteria included multiple pregnancies and congenital anomalies. Morphological assessment involved macroscopic examination (placental mass and size) and histology (sections stained with hematoxylin and eosin, examined under 10x and 40x magnification). Statistical analysis was performed using MedCalc, GraphPad Prism 8, and Excel, with ROC analysis, Student’s t-test, and Pearson’s correlation (p < 0.05). Results: the incidence of AFD was 41.85% at 22–27/6 weeks, 27.41% at 28–33/6 weeks, 18.15% at 34–36/6 weeks, and 12.59% at ≥37 weeks. Placental hyperplasia was more frequent at early gestations (54%), while hypoplasia predominated at later terms (56%). PFC showed no prognostic value for CPI (AUC = 0.52, p = 0.648) or inflammation (AUC = 0.559, p = 0.169). An inverse correlation was observed between PFC and gestational age (rxy = -0.66, p < 0.001). CPI peaked at 34–36/6 weeks (66.7%), while inflammatory changes were most prevalent at 22–27/6 weeks (47.2%). Conclusion: the retrospective study identified key patterns in placental morphological changes depending on gestational age. The findings underscore the need for individualized prenatal monitoring, infection prevention, and correction of fetoplacental blood flow disturbances to reduce stillbirth rates, particularly in high-risk groups. Future research should focus on differentiating the causes of CPI to optimize clinical strategies.

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