Placental pathology in maternal autoimmune diseases-new insights and clinical implications

Ramya T., Umamaheswari G., Chaitra V.


Background: Pregnancy in women with autoimmune diseases is frequently associated with placental insufficiency leading to adverse perinatal outcome. Aim of the study was to investigate the presence and possible clinical significance of placental lesions in mothers with different autoimmune disorders.

Methods: In this retrospective study, 11 placentas from 10 mothers with diverse autoimmune diseases including systemic lupus Erythematosus (SLE), antiphospholipid antibodies (APLA), idiopathic thrombocytopenic purpura (ITP) and antinuclear antibodies (ANA) were studied.

Results: Placental correlates were reduced placental weight, maternal vascular under perfusion, abruption, villitis of unknown etiology, multifocal chorangiomatosis, distal villous immaturity, massive perivillous fibrin deposition/maternal floor infarction and foetal thrombotic vasculopathy. Of the 11 pregnancies 3 were untreated (1 SLE, 2 APLA) and resulted in intrauterine foetal demise. The lesions were more severe in these cases. All the treated pregnancies resulted in live born babies (8), of which 3 were growth restricted, 2 were complicated with oligohydramnios and 3 were delivered preterm.

Conclusions: In this group of diverse autoimmune disorders, placental lesions were not specific for each of them. Apart from maternal vascular under perfusion, lesions like villitis of unknown etiology, distal villous immaturity and massive perivillous fibrin deposition were identified and may recur in subsequent pregnancies and treatment should be directed towards modifying it. The placental examination should be mandatory in all cases of maternal autoimmunity and pregnancies with poor foetal outcome.


Maternal autoimmune diseases, Maternal vascular under perfusion, Placental lesions

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Park AL. Placental pathology in antiphospholipid syndrome, In: Hughes’ Syndrome, Khamashta MA. Springer-Verlag, London. 2006;362-74.

Gómez-Puerta JA. Diagnosis and classification of the antiphospholipid syndrome. J Autoimmunity. 2014;48-49:20-25.

Aringer M, Dorner T. Toward new criteria for systemic lupus erythematosus-a standpoint. Lupus. 2016;25:805-11.

Perepu U, Rosenstein L. Maternal thrombocytopenia in pregnancy. Obstetr Gynecol. 2013;3(1):6.

Rebecca N. Baergen. Umbilical Cord Pathology. Surg pathol. 2013;6:61-85.

Raymond W. Redline. Fetal Thrombotic Vasculopathy. Pathology Case Reviews. 2010;15: 37-9.

Saleemuddin A, Tanbirojn P, Sirios K. Obstetric and Perinatal Complications in Placentas with Fetal Thrombotic Vasculopathy. Pediatric and Developmental Pathology. 2010;13:459-64.

Baergen RN. Manual of Pathology of the Human Placenta, New York, Springer; 2011.

Benirschke K, Burton GJ, Baergen RN. Pathology of the Human Placenta, Sixth Edition, New York, Springer-Verlag; 2012.

Redline RW. The Placenta. Aliya N. Husain, J. Thomas Stocker, and Louis P. Dehner. Stocker and Dehner’s: Pediatric Pathology, 4 th Edition. Wolters Kluwer;2016:325-350.

Rodger MA, Walker MC. Is thrombophilia associated with placenta-mediated pregnancy complications? A prospective cohort study. Journal of thrombosis and Haemostasis. 2014;12:469-78.

Vijayalakshmi B, Kittali S. Morphological Changes of Placenta in Cases of Pre-eclampsia and Perinatal Outcome. Internat J Scient Study. 2015;3(5):137-42.

Redline RW. Distal villous immaturity. Mini- Symposium: Placental and Trophoblastic pathology. Diagnost Histopathol. 2012;18(5):189-94.

Bagby C, Raymond W. Redline. Multifocal Chorangiomatosis. Pediatr Development Pathol. 2011;14:38-44.

McKay EM. Placental diagnoses-placental abruption. In: Amy Heerema-McKenney, Edwina J. Popek and Monique E. De Paepe. eds. Diagnostic Pathology: Placenta, first edition. AMIRSYS publishing, part II. 2015;7-2.

Chan JS. Villitis of unknown etiology and massive chronic intervillositis. Surgical pathology clinics. 2013;6(1):115-26.

Romero R, Whitten A. Maternal Floor Infarction/Massive Perivillous Fibrin Deposition: A Manifestation of Maternal Antifetal Rejection. Am J Reprod Immunol. 2013;70(4):285-98.