Publisher's Synopsis
This book revisits the macroscopic and microscopic (pathological) findings in a realistic perspective. There is apparent disinterest in placental examination. This disinterest is mainly due to the fact that any information obtained from placental examination is retrospective and hence of no clinical use in the prospective management of the pregnancy in question. Many obvious abnormal features, which vary from abnormal shape, infarction, fibrosis to abnormal insertions of cord and membranes, can be detected at birth, but their clinical relevance to intra-partum events and perinatal outcomes are not well established. Furthermore, many of these placental features were characterized by remarkable paucity of clinical symptoms. For example, placental infarctions indicate vascular injury to placenta in the pregnancy that is being evaluated but because of the silent nature and the apparent resilience of the placental function to recover from injury their clinical importance have been underscored. Objective analysis of placental features in relation to maternal illnesses and foetal outcomes were attempted. Placental, foetal and maternal data were collated from a random sample of mothers. A systematic analysis was attempted, thereafter from the extracted data. Factors that modify its growth and abnormal morphological features were defined. Many factors modify the pregnancy outcome. They include presence or absence of maternal illnesses, maternal nutrition and optimum placental function. Relevance to growth restriction of the foetus given the numerous variables involved namely foetal, maternal and placental were analyzed. The analysis was completed in several stages. Following macroscopic morphological features were defined and their relationship to placental weight, birth weight and antenatal conditions was analyzed. The macroscopic morphological features were infarction, fibrosis, calcification, abnormal insertion of cord or membranes, abnormal shape, inappropriately small placenta and inappropriately large placenta. Foetal BMI below two standard deviations was utilized to define IUGR. Maternal nutritional contribution could not be assessed directly. Low maternal BMI below 20 was utilized to define poor maternal nutrition. Both prospective (low maternal BMI) and retrospective (Low Foetal BMI) parameters were utilized to define poor maternal nutrition in pregnancy. Critical analysis of microscopic features were also made in detail.
