Gross Presentation and Histomorphological Changes of Placentae in Patients Presenting with Intrauterine Foetal Death at Kenyatta National Hospital.

BACKGROUND There are 3.2 million annual stillbirths, at least 98% occur in low-/middle income countries, and on average, as many as two-thirds of these stillbirths are thought to occur antenatally, prior to labour. The most useful test towards a diagnosis after stillbirth is pathological examination of the placenta and the foetus. However, this pathological examination is done in less than half of the placentae after cases of stillbirth. OBJECTIVE To determine gross presentation and histomorphological changes of placentae in patients presenting with intrauterine foetal death as compared to live births. DESIGN A case control study. SETTING The Kenyatta National Hospital's labour ward and the Department of Human Pathology, University of Nairobi. SUBJECTS The cases were mothers who presented with IUFD at a gestation of 28 weeks and above. The controls were a comparative group of mothers who delivered live babies at the hospital and were matched for age. RESULTS Reduction of the mass of functioning villi was present in 11.8% of placenta in the stillbirth group compared to 2% in the live birth group (p-value 0.002). There was significant presence of other placental abnormalities in the stillbirth group (22.5%) compared to the live birth group (9.8%) (p-value-0.002). CONCLUSION This study revealed that histological examination of placenta is useful in identifying some causes of stillbirths. This knowledge may lead to preventive measures which would lower perinatal mortality.