Placental lesions and outcome in preterm born children: the relation between placental lesions, neonatal morbidity and neurological development

The placenta is the link between the mother and her fetus during pregnancy and plays a crucial role in fetal growth and development. A less than optimal placental function as a result of placental lesions, may lead to maternal and or fetal problems. It is known that placental lesions are an important factor in fetal death. The relation between placental lesions and neonatal morbidity, however, is less clear. In this thesis we studied the relation between placental lesions and outcome in preterm infants. Whereas placental lesions consistent with constraint maternal blood supply of the placenta are known to be associated with fetal death, we found other placental lesions associated with adverse outcome in live-born infants. Both fetal vascular thrombosis and placental signs of fetal hypoxia were repeatedly associated with short term morbidity. Placental lesions associated with ascending intrauterine infection were predominantly associated with developmental outcome at early school age. The results of this thesis indicate that placental lesions are part of the pathophysiological pathway of adverse short term and long term outcomes. At this moment, pediatricians, obstetricians, and midwives have limited appreciation of the potential benefit of placental findings for neonatal care. Because of the findings in this thesis we hope to create more awareness among health care workers in the field of childbirth on the use of placental findings to guide later therapy.