Key points

  • Placental pathology may highlight conditions that can be recurrent in subsequent pregnancies and have an association with adverse fetal outcomes e.g. fetal growth restriction.  
  • Placental findings from prior pregnancies should be reviewed as part of the booking visit assessment to help inform the choice of pregnancy management pathway and if required referral pathway to an obstetrician for specialist management.   
  • Some placental pathologies may warrant specific therapies in subsequent pregnancies.  
  • When a placenta is sent for investigation, the woman should be informed, and the GP and/or pregnancy care provider should be included in the results distribution for communication in post-birth review and facilitate subsequent pregnancy planning.
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    Aim

    We encourage clinical staff to review the placental pathology from any previous pregnancies, where this has been performed, at the booking visit. Some placental pathologies may recur and worsen in subsequent pregnancies. The presence of these pathologies in previous pregnancies may indicate the need for increased fetal surveillance and/or specific therapeutic interventions in the current pregnancy. 

    Background

    Placental pathology is a contributing factor in adverse perinatal outcomes1. Many placental pathologies have a high recurrence rate, with implications for management in future pregnancies2. Pregnancy care can be optimised when risk factors for placental dysfunction are identified so that opportunities for interventions or surveillance can be incorporated into pregnancy care and birth planning. 

    The clinical information gathered at the first hospital antenatal visit is used to assess the potential risks for the current pregnancy, ensure an appropriate care pathway for the pregnant person, and commence any appropriate preventative or therapeutic treatments. To this end, the clinician conducting the first antenatal visit is required to obtain a thorough obstetric history and ensure appropriate antenatal screening tests have been performed However, it is uncommon for staff to follow-up and document placental pathology from previous pregnancies.  

    Placental pathology may have been performed in the previous pregnancy for many reasons, some of which may be of no relevance to the pregnancy which follows. However, there are several placental conditions that may recur and worsen in subsequent pregnancies e.g. chronic villitis of unknown aetiology. Follow-up of previous placental pathology is particularly important where there is a history of prior fetal growth restriction or pregnancy loss.  

    Case vignette

    A multigravida woman books into a low-risk model of care with an aim for low-intervention birth. Her first baby’s birth weight was between 5-10th centile. She has serial third-trimester growth scans which identified falling centiles. The woman’s symphyseal fundal height (SFH) trajectory was noted to be reduced just prior to 39w and additional surveillance was planned. The woman presented between her appointment and planned surveillance with absent fetal movements and a fetal death in utero was found. The baby was born with a birthweight between 1-3rd centile and placental histopathology noted villitis of unknown aetiology which has a recurrence rate of up to 50%3. Previous placental pathology, if known may have supported nuanced birth timing discussions in the context of falling centiles and SFH measurement.  

    Implications for Clinical Practice

    Where a prior pregnancy has been affected by placental dysfunction, early identification of risk factors in a subsequent pregnancy can guide the appropriate clinician or model of care, investigations, surveillance and informed decision making for women to optimise pregnancy outcomes. 

    References

    1. Menter T, Bruder E, Hösli I, Lapaire O, Raio L, Schneider H, Höller S, Hentschel R, Brandt S, Bode P, Schultzke S, Drack G; Swiss Med Wkly. 2024 Oct 14;154:3929. Academy of Fetomaternal Medicine of the Swiss Society of Gynecology and Obstetrics SSGO; Swiss Society of Pathology/Swiss Paediatric Pathology Group; Swiss Society of Neonatology. Pathologic findings of the placenta and clinical implications - recommendations for placental examination. Swiss Med Wkly. 2024 Oct 14;154:3929. doi: 10.57187/s.3929. PMID: 39465447. 
    2. Santos, J., Szymanski, L.M., Theiler, R.N., Norgan, A.P., Enninga, E.A.L., Mcduffie, M., Bulawa-Regner, L.A., Cheek-Norgan, E.H., Lamppa, J.A. and Wick, M. (2025), Enhancing the utility of placental pathology reports for clinical use. Pregnancy, 1: e70029. https://doi.org/10.1002/pmf2.70029 
    3. Mekinian A, Kolanska K, Cheloufi M, Coulomb A, Cohen J, Abisror N, Bornes M, Kayem G, Alijotas-Reig J, Fain O. Chronic Villitis of unknown etiology (VUE): Obstetrical features, outcome and treatment. J Reprod Immunol. 2021 Nov;148:103438. doi: 10.1016/j.jri.2021.103438. Epub 2021 Oct 23. PMID: 34710823. 
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