Fetal Outcomes Associated with Placental Findings of Delayed Villous Maturation Based on Amsterdam Consensus Criteria: A Systematic Review and Meta-Analysis

Muhammad Pradhiki Mahindra¹, Muhammad Pradhika Mapindra², Hadi Waheed¹, Owen Vaughan¹, John Ciaran Hutchinson², Sara L Hillman¹, Dimitrios Siassakos¹

¹ Maternal-Fetal Medicine Department, University College London Elizabeth Garrett Anderson Institute for Women’s Health, London, United Kingdom

² Neonatology Department, University College London Elizabeth Garrett Anderson Institute for Women’s Health, London, United Kingdom

³ Department of Pediatric and Perinatal Pathology, Great Ormond Street Hospital, London, United Kingdom

Introduction

According to the Amsterdam consensus criteria, Delayed Villous Maturation (DVM) is characterised by a population of villi with centrally placed capillaries and decreased vasculosyncytial membrane. This study aims to gather and summarise the current evidence of fetal outcomes associated with placental diagnosis of DVM based on the Amsterdam criteria.

Method

Systematic screening was completed for articles published in Medline, Embase, Web of Science, and MIDIRS databases, with registration number of PROSPERO: CRD42024490995.  For risk of bias we used the Newcastle-Ottawa scale for observational studies. The random-effect model was used for meta-analysis if there were no clinical heterogeneity and statistical heterogeneity (I²) value > 50%. Senior authors resolved disagreement between reviewers.

Results

There were 52 included studies considered eligible for inclusion. By Amsterdam criteria, the conditions associated with DVM in term placentas were stillbirth [OR(95%CI)= 12.06 (3.40, 42.78) and congenital anomalies [OR(95%CI)= 6.66 (3.26, 13.61). Other fetal outcomes, including fetal growth restriction and preterm birth, were reported inconsistently.

Discussion

DVM diagnosis according to Amsterdam consensus criteria is associated with stillbirth and congenital anomalies. Diagnosis of DVM in preterm placentas is controversial. Histopathological diagnosis of DVM is inconsistent due to poor interobserver agreement. More investigations related to predisposing maternal risk factors are urgently needed to prevent DVM and the associated adverse outcomes.