Gross Placental Morphometry and Morphological Features in Pregnancies Among Women Living with HIV: A Case–Control Study

Abstract

Objectives: Pregnancies among women living with human immunodeficiency virus (HIV) remain associated with adverse perinatal outcomes in sub-Saharan Africa despite widespread antiretroviral therapy. The placenta plays a central role in foetal growth and maternal-foetal exchange, and gross placental examination offers a low-cost approach for identifying clinically relevant abnormalities in resource-limited settings. However, data from Southern Nigeria are limited. Thus, we aimed to compare gross placental morphometry and morphological features between HIV-positive pregnant women and HIV-negative controls in Uyo, Southern Nigeria. Material and Methods: This hospital-based case-control study examined placentas from 48 HIV-positive and 96 HIV-negative mothers. Placental weights were measured before and after formalin fixation and categorised using gestational age-adjusted standards. Gross features of the foetal membranes, umbilical cord, and placental disk were systematically assessed. Between-group comparisons employed non-parametric and categorical tests, with significance set at p <0.05. Results: Placentas from women living with HIV had significantly lower weights before and after fixation compared with HIV-negative controls (p = 0.001 and p <0.001, respectively). Gestational age-adjusted placental weight categories also differed significantly between groups. Umbilical cord length was shorter in HIV-positive pregnancies (p = 0.026), and cord discolouration was more frequent (p = 0.010). Most foetal membrane and placental disk features showed no significant differences. Conclusion: Pregnancies among women living with HIV are associated with reduced placental weight, shorter umbilical cords, and increased cord discolouration, reflecting subtle but clinically relevant placental compromise. Routine gross placental examination may help identify at-risk pregnancies in resource-constrained settings.