Clinicopathological audit of the placenta in fetal growth restriction

Objectives: Fetal growth restriction (FGR) affects up to 15% of pregnancies in developing countries and predisposes individuals to chronic health issues in adulthood. The cause remains unexplained in many cases. This study aimed to audit histomorphological placental features to identify causes of FGR. Materials and Methods: A prospective, observational study was conducted over 3 years at a tertiary healthcare center in North India. Eighty-one placental specimens from FGR cases were microscopically evaluated independently by three histopathologists. Data were tabulated for analysis. Statistical analysis: Descriptive statistics were applied to summarize maternal, fetal, and placental findings. Results: The mean maternal age was 26.97 ± 4.18 years. Primigravidas accounted for 60.49% of cases. Among maternal causes, pregnancy-induced hypertension and bad obstetric history were most common (13.5% each). Absent end-diastolic flow on Doppler (11.1%) was the predominant placental finding; meconium-stained liquor (6.2%) was the most frequent fetal finding. Placenta was normal in 18.5% of cases. Maternal vascular malformations (MVMs) were observed in 22.2%, fetal vascular malformations in 14.8%, and inflammatory lesions in 17.3% of cases. Conclusions: The high prevalence of MVMs suggests that modifiable maternal factors significantly contribute to FGR. Placental histology helps not only in identifying etiologies but also in preventing recurrence by enabling early detection and intervention. Patient education regarding findings can encourage improved antenatal care in future pregnancies.