Characterising delayed villous maturation: A narrative literature review
Sharanam Soni, Adam Stevens, Gauri Batra, Alexander Heazell
Abstract
The normal development of the placenta is vital for fetal growth and a healthy pregnancy outcome. Delayed villous maturation (DVM) is a placental lesion that has been implicated in stillbirth. In DVM, villi do not maturate adequately for their gestational age. DVM is characterised by larger and fewer terminal placental villi, low numbers of syncytial knots, and thicker and fewer vasculosyncytial membranes. DVM is most commonly reported in conjunction with maternal diabetes; however, the occurrence of idiopathic DVM suggests that there may be multiple mechanistic pathways that contribute to DVM. DVM can only be diagnosed through histopathological examination after birth, and there is significant interobserver variability in diagnosis. Establishing objective criteria to distinguish between DVM and healthy placentas is key to increasing the understanding of DVM. Vasculosyncytial membrane count, numbers of syncytial knots and CD15, among others, have been presented as potential diagnostic criteria in the literature. This review aims to compile information on DVM, including the pathophysiology, conditions that have reported associations with DVM and potential markers that could be used as criteria to differentiate between DVM and healthy placentas. • DVM is a placental lesion occurring late in pregnancy linked with stillbirth and other fetal complications. • DVM is diagnosed by histopathological examination after birth but there are no standardised diagnostic criteria. • Fewer syncytial knots and vasculosyncytial membranes are characteristics of DVM. • DVM is associated with pre-existing and gestational diabetes. • There are currently no suitable management or therapeutic strategies to treat DVM.