Placental histopathological findings and outcomes of babies born with a 5-minute Apgar score of less than seven in a regional hospital in Gqeberha, Eastern Cape

Abstract

BACKGROUND:

Perinatal asphyxia is a major cause of neonatal death in low- and middle-income countries and is defined using the Apgar score, evidence of end organ damage, and neurological sequelae due to hypoxia.

OBJECTIVES:

To describe placental histopathology in infants born with a 5-minute Apgar score of less than 7 and a gestational age of more than 37 weeks and correlate these findings with pre-discharge outcome in the same group.

METHODS:

This was a retrospective study conducted by reviewing clinical records of deliveries between 1 January 2016 and 30 September 2018. Clinical and demographic data as well as placental histopathology findings were collected from maternal and neonatal files.

RESULTS:

A total of 82 neonatal and 82 maternal records were included in the study. All infants required resuscitation at birth and the majority of the infants with available data, 50/66 (76%) had a mildly abnormal Thompson score. Evidence of chorioamnionitis was found in 38/82 (46%) patients and vascular insufficiency in 34/82 (41%). Thirteen/82 (16%) of the placentas were normal. Twenty-five (30%) infants had poor outcomes of which 17 died. The most common placental abnormality found in infants with poor outcomes was chorioamnionitis (32%). There was no significant correlation between placental findings and neonatal outcomes (p = 0,842).

CONCLUSION:
A significant number of infants with a 5-minute Apgar score <7 had a good outcome at the time of discharge. There was no significant correlation between placental histopathology and death and/or abnormal neurological findings in the neonate in the current study.