Abstract 11260: Placental Abnormalities in Fetal Congenital Heart Disease
Background: The placenta is a complex organ that influences fetal growth and development, and through vascular programming may impact long-term postnatal health and well-being. Despite its likely impact on overall prognosis, including determination of gestational age at delivery, little information exists on placental pathology in the presence of fetal congenital heart disease (CHD). Therefore, our objective was to describe and characterize the placenta in neonates with CHD.
Methods: Placental pathology from singleton neonates prenatally diagnosed with CHD born in the Special Delivery Unit at The Children's Hospital of Philadelphia was analyzed. The presence of an obstetrical delivery unit integrated into a children's hospital with a large volume of fetal CHD allowed us the unique opportunity to perform this investigation. Placental pathology reports from pregnancies complicated by fetal CHD, delivered at ≥ 37 weeks gestation from June 2008 to September 2010 were reviewed. Qualitative and quantitative placental findings, its vasculature, and umbilical cord along with birth-weight (BWT), fetal-to-placental (F/P) weight ratio and CHD type were recorded.
Results: A total of 73 placentas were analyzed. Fetal diagnosis included 28 hypoplastic left heart syndrome (HLHS), 20 transposition of the great arteries (TGA), 14 tetralogy of Fallot, and 11 pulmonic stenosis/atresia with intact ventricular septum. Average gestational age at delivery was 38.8+0.8 weeks; average BWT was 3234+489 grams. Placental cord insertion was eccentric in 61 (84%), marginal, furcate or velamentous in 6 (8%). Abnormal maturation of villi was present in 29%; chorangiosis in14%. Evidence for inflammation was present in 19%. Abnormal F/P weight ratio (as compared to published normals) was seen in 46%. Infarction was present overall in 14%, but most commonly in HLHS and TGA (25%) while fetal thrombotic vasculopathy was present in 10% of the HLHS and TGA.
Conclusion: Multiple placental abnormalities are noted in fetuses with CHD. These placental abnormalities may impact growth and development, timing of delivery and long-term outcomes. Further investigation to determine the role of placental pathology in fetal cardiovascular status and outcome is warranted.
- © 2011 by American Heart Association, Inc.