Placental changes in pregnancies complicated by intrahepatic cholestasis: increased perivillous fibrin deposition and umbilical cord abnormalities

Sara Bulić; Sandra Zekić-Tomaš

doi:10.48188/so.7.10

Authors

Sara Bulić University of Split School of Medicine, Split, Croatia
Sandra Zekić-Tomaš Department of Pathology, Forensic Medicine, and Cytology, University Hospital of Split, Split, Croatia

DOI:

https://doi.org/10.48188/so.7.10

Abstract

Aim: To assess the frequency of pathohistological lesions in placentas from pregnancies complicated by intrahepatic cholestasis and compare them with placentas from uncomplicated term pregnancies.
Methods: This retrospective cross-sectional study included placentas collected at the University Hospital of Split from 1 January 2021 to 31 December 2022. The study group consisted of placentas from pregnancies with clinically diagnosed cholestasis, while the control group included placentas from uncomplicated term pregnancies. Demographic, clinical, and pathohistological data were obtained from hospital records and compared using appropriate statistical tests.
Results: We analyzed 28 placentas from pregnancies with cholestasis and 30 from uncomplicated pregnancies, including 16 twin pregnancies in the cholestasis group. Mothers in the cholestasis group were older (33 years, standard deviation (SD) = 3 vs. 31 years, SD = 4; P = 0.012) and had a lower gestational age at delivery (36 weeks, SD = 4.9 vs. 38 weeks, SD = 0.9; P < 0.001). Newborns had lower birth weight (2802 g ± 664 vs. 3388 g, SD = 362; P = 0.0001) and more frequent intrauterine growth restriction (14.3% vs. 0%, P = 0.019). Placentas had shorter umbilical cords (27 cm, SD = 10 vs. 44 cm, SD = 12; P < 0.001), a higher coiling index (0.28 vs. 0.20; P = 0.027), and more frequent perivillous fibrin deposition (14 cases vs. 1 case; P < 0.001). No significant differences were found in placental size, weight, thickness, umbilical cord diameter, or vascular or inflammatory lesions.
Conclusion: Cholestasis in pregnancy was associated with specific placental morphological changes and adverse neonatal outcomes. However, the intepretation of our findings is limited by our small sample size, the design of our study, and the inclusion of twin pregnancies in our sample. Further studies are needed to clarify these associations.