Disorders of placental villous maturation in fetal death

Sunil Jaiman, Roberto Romero, Percy Pacora, Eunjung Jung, Gaurav Bhatti, Lami Yeo, Yeon Mee Kim, Bomi Kim, Chong Jai Kim, Jung Sun Kim, Faisal Qureshi, Suzanne M. Jacques, Offer Erez, Nardhy Gomez-Lopez, Chaur Dong Hsu

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


The aims of this study were to ascertain the frequency of disorders of villous maturation in fetal death and to also delineate other placental histopathologic lesions in fetal death. This was a retrospective observational cohort study of fetal deaths occurring among women between January 2004 and January 2016 at Hutzel Women's Hospital, Detroit, MI, USA. Cases comprised fetuses with death beyond 20 weeks' gestation. Fetal deaths with congenital anomalies and multiple gestations were excluded. Controls included pregnant women without medical/obstetrical complications and delivered singleton, term (37-42 weeks) neonate with 5-min Apgar score ≥7 and birthweight between the 10th and 90th percentiles. Ninety-two percent (132/143) of placentas with fetal death showed placental histologic lesions. Fetal deaths were associated with (1) higher frequency of disorders of villous maturation [44.0% (64/143) vs. 1.0% (4/405), P < 0.0001, prevalence ratio, 44.6; delayed villous maturation, 22% (31/143); accelerated villous maturation, 20% (28/143); and maturation arrest, 4% (5/143)]; (2) higher frequency of maternal vascular malperfusion lesions [75.5% (108/143) vs. 35.7% (337/944), P < 0.0001, prevalence ratio, 2.1] and fetal vascular malperfusion lesions [88.1% (126/143) vs. 19.7% (186/944), P < 0.0001, prevalence ratio, 4.5]; (3) higher frequency of placental histologic patterns suggestive of hypoxia [59.0% (85/143) vs. 9.3% (82/942), P < 0.0001, prevalence ratio, 6.8]; and (4) higher frequency of chronic inflammatory lesions [53.1% (76/143) vs. 29.9% (282/944), P < 0.001, prevalence ratio 1.8]. This study demonstrates that placentas of women with fetal death were 44 times more likely to present disorders of villous maturation compared to placentas of those with normal pregnancy. This suggests that the burden of placental disorders of villous maturation lesions is substantial.

Original languageEnglish (US)
Pages (from-to)345-368
Number of pages24
JournalJournal of Perinatal Medicine
Issue number4
StatePublished - May 1 2020
Externally publishedYes


  • CD15
  • accelerated villous maturation
  • delayed villous maturation
  • fetal hypoxia
  • fetal vascular malperfusion
  • hypercapillarized villi
  • intravillous hemorrhage
  • maternal vascular malperfusion
  • nucleated red blood cells
  • placental inflammatory lesions

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology


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