Placental Lesions Associated With Cerebral Palsy and Neurologic Impairment Following Term Birth

Abstract

Objective. —The aim of this study was to determine the association of placental findings with cerebral palsy and related forms of neurologic impairment (NI) following birth at ≥37 weeks gestation (term). Design. —In a retrospective comparison, placentas from 40 term infants with NI ascertained on the basis of clinicopathologic review for medicolegal consultation were compared with placentas from 176 consecutive meconium-stained term infants at low risk for NI. Results. —After stratification for severity, 9 lesions were significantly increased in placentas from infants with NI: 5 lesions generally considered to occur within days of the time of labor and delivery (meconium-associated vascular necrosis, severe fetal chorioamnionitis, chorionic vessel thrombi, increased nucleated red blood cells, and findings consistent with abruptio placenta) and 4 lesions generally believed to have their onset long before labor and delivery (diffuse chronic villitis, extensive avascular villi, diffuse chorioamnionic hemosiderosis, and perivillous fibrin). Findings independently associated with NI by logistic regression in this descriptive study were severe fetal chorioamnionitis (odds ratio [OR], 13.2; 95% confidence interval [CI], 1.2–144); extensive avascular villi (OR, 9.0; 95% CI, 1.6–51); and diffuse chorioamnionic hemosiderosis (OR, 74.8; 95% CI, 6.3–894). The risk of NI increased as a function of the number of lesions present (OR, 10.1; 95% CI, 5.1–20 for each additional lesion), particularly when lesions generally considered to occur near the time of labor and those believed to occur well before labor were found in the same placenta (OR, 94.2; 95% CI, 11.9–747). Conclusions. —These findings suggest that placental pathology can contribute to an understanding of the mechanisms that contribute to NI at term.