Clinical significance of placental lesions

Shchegolev A.I., Serov V.N.

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, Moscow, Russia
To analyze the data available in the literature on the causes of placental lesions and their role in the development of fetal and maternal complications. The paper gives literature data on major vascular disorders and inflammatory changes in the placenta. The vascular disorders are divided into two subgroups: maternal blood flow disorders and fetal blood flow disorders. The paper presents the characteristics of histological changes in blood vessels and villous lesions in the placenta, which are caused by diminished maternal vascular perfusion and impaired fetal blood flow. It is emphasized that the exact location of a lesion, as well as the form, stage, and degree of inflammation should be indicated when placental inflammatory and immune processes are identified. Morphologically detected placental lesions are noted to be of clinical significance for the mother and fetus, which include fetal growth restriction, intrauterine fetal death, preterm labor, brain injuries, fetal respiratory distress syndrome, necrotizing enterocolitis, and congenital anomalies in a newborn baby.


placental abruption
pregnancy complications
newborn infant


  1. Милованов А.П. Патология системы мать-плацента-плод. М.: Медицина; 1999. [Milovanov A.P. Pathology of mother-placenta-fetus system. M.: Medicine; 1999. 272 p. (in Russian)]
  2. Robbins J.R., Bakardjiev A.I. Pathogens and the placental fortress. Curr. Opin. Microbiol. 2012; 15(1): 36-43.
  3. Pinar H., Carpenter M. Placenta and umbilical cord abnormalities seen with stillbirth. Сlin. Obstet. Gynecol. 2010; 53(3): 656-72.
  4. Туманова У.Н., Щеголев А.И. Поражения плаценты в генезе мертворождения. Международный журнал прикладных и фундаментальных исследований. 2017; 3 (ч. 1): 77-81. [Tumanova U.N., Shchegolev A.I. Placental lesions as the cause stillbirth. Mezhdunarodnyj zhurnal prikladnyh i fundamental’nyh issledovanij. 2017; 3 (part 1): 77-81. (in Russian)]
  5. Щеголев А.И., Павлов К.А., Дубова Е.А., Фролова О.Г. Мертворождаемость в субъектах Российской Федерации в 2010 году. Архив патологии. 2013; 75(2): 20-4. [Shchegolev A.I., Pavlov K.A., Dubova E.A., Frolova O.G. Stillbirth rates in the subjects of the Russian Federation in 2010. Arhiv patologii. 2013; 2: 20-24. (in Russian)]
  6. Щеголев А.И., Павлов К.А., Дубова Е.А., Фролова О.Г. Ранняя неонатальная смертность в Российской Федерации в 2010 г. Архив патологии. 2013; 75(4): 15-9. [Shchegolev A. I., Pavlov K. A., Dubova E. A., Frolova O. G. Early neonatal mortality in the Russian Federation in 2010. Arxiv patologii. 2013; 4: 15-19. (in Russian)]
  7. Низяева Н.В., Волкова Ю.С., Муллабаева С.М., Щеголев А.И. Методические основы изучения ткани плаценты и оптимизация режимов предподготовки материала. Акушерство и гинекология. 2014; 8: 10-8. [Nizyaeva N.V., Volkova Yu.S., Mullabaeva S.M., Shchegolev A.I. The methodical bases for placental tissue examination and the optimization of material pre-preparation regimens. Obstetrics and Gynecology. 2014; 8: 10-18.(in Russian)]
  8. Щеголев А.И. Современная морфологическая классификация повреждений плаценты. Акушерство и гинекология. 2016; 4: 14-23. [Shchegolev A.I. Current morphological classification of damages to the placenta. Akusherstvo i ginekologiya/Obstetrics and gynecology. 2016; 4: 14-23. (in Russian)]
  9. Brosens I., Pijnenborg R., Vercruysse L., Romero R. The “Great Obstetrical Syndromes” are associated with disorders of deep placentation. Am. J. Obstet. Gynecol. 2010; 204(3): 193-201.
  10. Redline R.W., Boyd T., Campbell V., Hyde S., Kaplan C., Khong T.Y. et al. Maternal vascular underperfusion: nosology and reproducibility of placental reaction patterns. Pediatr. Devel. Pathol. 2004; 7(3): 237-49.
  11. Щеголев А.И., Туманова У.Н., Ляпин В.М. Нарушения структуры и васкуляризации ворсин плаценты при задержке роста плода. Современные проблемы науки и образования. 2018; 4: 231. [Shchegolev A.I., Tumanova U.N., Lyapin V.M. Disorder of the structure and vascularization of the chorionic villi at the fetal growth restriction. Sovremennye problemy nauki i obrazovaniya. 2018; 4: 231. (in Russian)]
  12. Shchyogolev A.I., Dubova E.A., Pavlova K.A., Lyapin V.M., Sukhikh G.T. Expression of antiangiogenic factors in the placental structures in pre-eclampsia. Bull. Exp. Biol. Med. 2012; 154(2): 287-91.
  13. Stanek J. Histological features of shallow placental implantation unify early-onset and late-onset preeclampsia. Pediatr. Dev. Pathol. 2018; Oct.9: 1093526618803759. http://
  14. Щеголев А.И., Ляпин В.М., Туманова У.Н., Воднева Д.Н., Шмаков Р.Г. Гистологические изменения плаценты и васкуляризация ее ворсин при ранней и поздней преэклампсии. Архив патологии. 2016; 78(1): 13-8. Shchegolev A.I., Lyapin V.M., Tumanova U.N., Vodneva D.N., Shmakov R.G. Vascularization of the placental villi at early- and late-onset preeclampsia. Arhiv patologii. 2016; 1: 13-18. (in Russian)]
  15. Redline R.W., Minich N., Taylor H.G., Hack M. Placental lesions as predictors of cerebral palsy and abnormal neurocognitive function at school age in extremely low birth weight infants (<1kg). Pediatr. Dev. Pathol. 2007; 10(4): 282-92.
  16. Arias F., Victorio A., Cho K., Kraus F. Placental histology and clinical characteristics of patients with preterm premature rupture of membranes. Obstet. Gynecol. 1997; 89(2): 265-71.
  17. Kobayashi A., Minami S., Tanizaki Y., Shiro M., Yamamoto M., Yagi S. et al. Adverse perinatal and neonatal outcomes in patients with chronic abruption-oligohydramnios sequence. J. Obstet. Gynaecol. Res. 2014; 40(6): 1618-24. http://
  18. Redline R.W., Wilson-Costello D. Chronic peripheral separation of placenta: the significance of diffuse chorioamnionic hemosiderosis. Am. J. Clin. Pathol. 1999; 111(6): 804-10.
  19. Tikkanen M. Placental abruption: epidemiology, risk factors and consequences. Acta Obstet. Gynecol. Scand. 2011; 90(2): 140-9.
  20. Downes K.L., Grantz K.L., Shenassa E.D. Maternal, labor, delivery, and perinatal outcomes associated with placental abruption: a systematic review. Am. J. Perinatol. 2017; 34(10): 935-57. http://
  21. Щеголев А.И., Туманова У.Н., Шувалова М.П. Преждевременная отслойка плаценты в генезе мертворождения. Международный журнал прикладных и фундаментальных исследований. 2016; 7(ч. 4): 575-9. [Shchegolev A.I., Tumanova U.N., Shuvalova M.P. Premature abruptio placentae as the cause of stillbirth. Mezhdunarodnyj zhurnal prikladnyh i fundamental’nyh issledovanij. 2016; 7 (4): 575-579. (in Russian)]
  22. Туманова У.Н., Шувалова М.П., Щеголев А.И. Отслойка плаценты и ранняя неонатальная смертность (по данным Росстата в 2010-2016 годах). Международный журнал прикладных и фундаментальных исследований. 2018; 4: 86-90. [Tumanova U.N., Shuvalova M.P., Shchegolev A.I. Abruptio placentae and early neonatal mortality (according to Rosstat in 2012–2016). Mezhdunarodnyj zhurnal prikladnyh i fundamental’nyh issledovanij. 2018; 4: 86-90. (in Russian)]
  23. Askie L.M., Duley L., Henderson-Smart D.J., Stewart L.A.; PARIS Collaborative Group. Antiplatelet agents for prevention of pre-eclampsia: a meta-analysis of individual patient data. Lancet. 2007; 369(9575): 1791-8.
  24. Ogino S., Redline R.W. Villous capillary lesions of the placenta: distinctions between chorangioma, chorangiomatosis, and chorangiosis. Hum. Pathol. 2000; 31(8): 945-54.
  25. Redline R. Distal villous immaturity. Diagn. Histopathol. 2012; 18(2): 189-94.
  26. Harteman J.C., Nikkels P.G., Benders M.J., Kwee A., Groenendaal F., de Vries L.S. Placental pathology in full-term infants with hypoxic-ischemic neonatal encephalopathy and association with magnetic resonance imaging pattern of brain injury. J. Pediatr. 2013; 163(4): 968-95.
  27. Bernson-Leung M.E., Boyd T.K., Meserve E.E., Danehy A.R., Kapur K., Trenor C.C. 3rd et al. Placental pathology in neonatal stroke: a retrospective case-control study. J. Pediatr. 2018; 195: 39-47. http://
  28. Redline R.W. The umbilical cord. In: Kay H.H., Nelson D.M., Wang Y. et al., eds. The placenta: from development to disease. Wiley Blackwell; 2011: 114-21.
  29. Щеголев А.И., Туманова У.Н., Шувалова М.П., Фролова О.Г. Гипоксия как причина мертворождаемости в Российской Федерации. Здоровье, демография, экология финно-угорских народов. 2014; 3: 96-8. Shchegolev A.I., Tumanova U.N., Shuvalova M.P., Frolova O.G. Hypoxia as a cause of stillbirth in the Russian Federation. Health, demography, ecology of finno-ugric peoples. 2014; 3: 96-98. [in Russian]
  30. Parast M.M., Crum C.P., Boyd T.K. Placental histologic criteria for umbilical blood flow restriction in unexplained stillbirth. Hum. Pathol. 2008; 39(6): 948-53.
  31. de Laat M.W., van der Meij J.J., Visser G.H., Franx A., Nikkels P.G. Hypercoiling of the umbilical cord and placental maturation defect: associated pathology? Pediatr. Dev. Pathol. 2007; 10(4): 293-9.
  32. Beggan C., Mooney E.E., Downey P., Carroll S., Reardon W. A case of recurrent familial male miscarriages with hypercoiled umbilical cord: a possible X-linked association? Clin. Dysmorphol. 2014; 23(1): 26-8.
  33. Romero R., Mazor M. Infection and preterm labor. Clin. Obstet. Gynecol. 1988; 31(3): 553-84.
  34. Курносенко И.В., Долгушина В.Ф., Пастернак А.Е. Воспалительные изменения в последе у женщин с преждевременными и своевременными родами. Современные проблемы науки и образования. 2016; 3: 172. [Kurnosenko I.V., Dolgushina V.F., Pasternak A.E. Inflammatory changes in the placenta in women with preterm and timely delivery. Sovremennye problemy nauki i obrazovaniya. 2018; 4: 231. (in Russian)]
  35. Menon R., Taylor R.N., Fortunato S.J. Chorioamnionitis - a complex pathophysiologic syndrome. Placenta. 2010; 31(2): 113-20.
  36. Глуховец Б.И., Глуховец Н.Г. Восходящее инфицирование фето-плацентарной системы. М.: МЕДпресс-информ; 2006. [Gluhovec B.I., Gluhovec N.G. Ascending infection fetoplacentary system. М: the MEDPRESS-INFORM, 2006. (in Russian)]
  37. Srinivas S.K., Ernst L.M., Edlow A.G., Elovitz M.A. Can placental pathology explain second-trimester pregnancy loss and subsequent pregnancy outcomes? Am. J. Obstet. Gynecol. 2008; 199(4): 402. e1-5.
  38. Ogunyemi D., Murillo M., Jackson U., Hunter N., Alperson B. The relationship between placental histopathology findings and perinatal outcome in preterm infants. J. Matern. Fetal Neonatal Med. 2003; 13(2): 102-9.
  39. Щеголев А.И., Мишнёв О.Д., Туманова У.Н., Шувалова М.П. Неонатальный сепсис как причина перинатальной смертности в Российской Федерации. Международный журнал прикладных и фундаментальных исследований. 2016; 5(ч. 4): 589-94. [Shchegolev A.I., Mishnev O.D., Tumanova U.N., Shuvalova M.P. Neonatal sepsis as a cause of perinatal mortality in the Russian Federation. Mezhdunarodnyj zhurnal prikladnyh i fundamental’nyh issledovanij. 2016; 5 (4): 589-594. (in Russian)]
  40. Sato M., Nishimaki S., Yokota S., Seki K., Horiguchi H., An H. et al. Severity of chorioamnionitis and neonatal outcome. J. Obstet. Gynaecol. Res. 2011; 37(10): 1313-9. http://
  41. Kim C.J., Romero R., Chaemsaithong P., Kim J.S. Chronic inflammation of the placenta: definition, classification, pathogenesis, and clinical significance. Am. J. Obstet. Gynecol. 2015; 213(4, Suppl.): S53-69. http://
  42. Redline R.W. Villitis of unknown etiology: noninfectious chronic villitis in the placenta. Hum. Pathol. 2007; 38(10): 1439-46.
  43. Gundogan F., Bianchi D.W., Scherjon S.A., Roberts D.J. Placental pathology in egg donor pregnancies. Fertil. Steril. 2010; 93(2): 397-404.
  44. Torrance H.L., Bloemen M.C., Mulder E.J., Nikkels P.G., Derks J.B., de Vries L.S. et al. Predictors of outcome at 2 years of age after early intrauterine growth restriction. Ultrasound Obstet. Gynecol. 2010; 36(2): 171-7.
  45. Redline R.W., Ariel I., Baergen R.N., Desa D.J.., Kraus F.T., Roberts D.J. et al. Fetal vascular obstructive lesions: nosology and reproducibility of placental reaction patterns. Pediatr. Dev. Pathol. 2004; 7(5): 443-52.
  46. Juliano P.B., Blotta M.H., Altemani A.M. ICAM-1 is overexpressed by villous trophoblasts in placentitis. Placenta. 2006; 27(6-7): 750-7.
  47. Edmondson N., Bocking A., Machin G., Rizek R., Watson C., Keating S. The prevalence of chronic deciduitis in cases of preterm labor without clinical chorioamnionitis. Pediatr. Dev. Pathol. 2009; 12: 16-21.
  48. Boyd T.K., Redline R.W. Chronic histiocytic intervillositis: a placental lesion associated with recurrent reproductive loss. Hum. Pathol. 2000; 31(11): 1389-96.
  49. Thornburg K.L., O’Tierney P.F., Louey S. The placenta is a programming agent for car-diovascular disease Placenta. 2010; 31(Suppl.): S54-9. http://
  50. Kwon E.J., Kim Y.J. What is fetal programming?: a lifetime health is under the control of in utero health. Obstet. Gynecol. Sci. 2017; 60(6): 506-19. http://

Received 19.02.2019

Accepted 22.02.2019

About the Authors

Shchegolev, Aleksandr I., MD, professor, head of the Department of Morbid Anatomy, National Medical Research Center of Obstetrics, Gynecology, and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel: +74955314444. E-mail:
Serov, Vladimir N., MD, professor, academician of the Russian Academy of Sciences, chief researcher, National Medical Research Center of Obstetrics, Gynecology,
and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Тel.: +74954387287. E.mail:

For citation: Shchegolev A.I., Serov V.N. Clinical significance of placental lesions. Akusherstvo i Ginekologiya/Obstetrics and Gynecology.2019; (3): 54-62. (in Russian)

Similar Articles

By continuing to use our site, you consent to the processing of cookies that ensure the proper functioning of the site.