Pattern of placenta histopathology in low birth weight babies seen in a tertiary health centre in South-Western Nigeria

Abstract

Background: Pre-term delivery is usually associated with low birth weight and is a known obstectrics problem in our setting. Few Histopathologists are interested in placental pathology, and this is particularly so because consent is often difficult to get from the relatives making few specimens available for study in our environment.

Objective: Our objective was to evaluate the placental histopathology in low birth weight infants (LBW, birth weight < 2500 g) and to determine if placental histopathological findings are associated with low birth weight and preterm deliveries.

Methods: The placenta of thirty-eight consecutive cases of LBW deliveries at the Obafemi Awolowo University Teaching Hospital, Wesley Guild Hospital, (lesa were histologically examined.

Results: A total of thirty-eight LBW placentas were examined. The Male: Female ratio was 1.8:1. The maternal age range 19 - 38 years (mean age = 28.7 yrs +/- 5.37SD). The parity ranged from 0 to 5. The birth weight ranged 0.75 - 2.4kg (mean 1.84kg +/- 0.39SD). The gestational age at delivery range was 25 - 38 weeks (mean 32.85 weeks +/- 3.7SD). Histological examination of the placentae showed that 17 cases (44.7%) had evidence of placenta malaria (PM), 17 cases (44.7%) had chorioamnionitis (CA), 9 cases (23.7%) had villitis, 2 cases (5.3%) had vasculitis and 4 cases (10.5%) had no abnormality. Four sets of twins (8 cases) were among the 38 cases seen. A case of abruptio placenta was delivered by caesarean section, with histological diagnosis of active- chronic malaria. Out of the cases with CA11 (64.7%) had mild CA, 4 (23.6%) moderate while 2 (11.8) had severe infection. Placenta malaria co-infection was also found in 7 (41%) of the CA. Nine (23:7%) had villitis, only 2 cases had umbilical cord vasculitis. Of the cases with PM, 10 (58.8) had active-chronic infection while 7 (41.2%) had evidence of past infection.

Conclusion: The main placenta findings histologically in LBW babies include chorioamnionitis and placenta malaria infection. These are known contributory factors to preterm labour. Improved maternity care, health education of pregnant women to reduce ascending infection and use of intermittent preventive treatment for malaria in pregnancy will go a long way in improving outcome of pregnancy.