Gross and Histopathological Findings of 111 Triplet Placentas: A Descriptive Analysis.

INTRODUCTION

Triplet pregnancies have risen in recent decades due to assisted reproductive technology (ART) and are considered high-risk. Placental evaluation is crucial to understanding their outcomes, yet pathological findings in triplet placentas remain poorly described.

DESIGN

Retrospective observational study including all triplet pregnancies followed at a tertiary referral hospital from January 2000 to December 2024, whose placentas were submitted for pathological analysis. Gross and microscopic findings were reviewed.

RESULTS

We analyzed 111 triplet pregnancies (333 fetuses). Fetal loss (miscarriage or stillbirth) occurred in 7.5%. ART accounted for 70.3% of conceptions. Median gestational age at delivery was 32 weeks (P25 = 30; P75 = 34), with 50.4% being trichorionic triamniotic. Mean placental weight was 869 ± 243 g, and median size was 22.5 cm (P25 = 18; P75 = 30). Abnormal umbilical cord insertion was found in 52.2% of cases. Central or peripheral infarcts were present in 43.8% of placentas. The most common histological findings were accelerated villous maturation (65.1%), chorangiosis (53.7%), intervillous fibrin deposits (29.4%), and villous edema (24.3%). Chronic villitis of unknown etiology was the most frequent inflammatory lesion (9.3%).

CONCLUSIONS

Triplet placentas exhibit high rates of pathological abnormalities, which may contribute to adverse outcomes. Future studies should explore associations with ART and chorionicity.