Pathological Insights into Placental Calcifications in HIV-Positive and HIV-Negative Pregnancies: Clinical Diagnostic Value of Ultrasound Versus Pathology in Obstetric and Perinatal Care in Uyo, Southern Nigeria

Abstract

Abstract Placental calcifications are frequently noted on obstetric ultrasound, yet their diagnostic value and clinical significance remain uncertain, especially in human immunodeficiency virus (HIV)-positive pregnancies. This study compared clinical obstetric findings, ultrasound assessments, and pathological examinations to determine the reliability of ultrasound in detecting placental calcifications. In this hospital-based case–control study, obstetric diagnoses, routine antenatal ultrasound reports, and detailed pathological evaluations of placentas from HIV-positive and HIV-negative mothers were analyzed. Diagnostic performance metrics, maternal factors, and the influence of HIV status, disease stage, and highly active antiretroviral therapy (HAART) use were assessed. Descriptive and inferential statistics assessed concordance between modalities, associations with gestational age, gravidity, parity, and miscarriage, and the influence of HIV status, disease stage, and HAART. Pathology confirmed placental calcifications in 114/145 cases (78.6%), with similar prevalence in HIV-positive (75.5%) and HIV-negative mothers (80.2%; p = 0.527). Ultrasound showed excellent specificity (100%) but extremely low sensitivity (0.9%), detecting only one case. Calcifications were not associated with gestational age, gravidity, parity, or miscarriage history. Among HIV-positive mothers, calcification prevalence did not differ by HIV stage (p = 0.824) or HAART use (p = 0.823). Placental calcifications are common near term in both HIV-positive and HIV-negative pregnancies. Routine ultrasound has minimal diagnostic value for detecting these lesions and should not be used as a standalone indicator of placental pathology. Pathological examination remains the definitive diagnostic method and is essential for accurate placental evaluation, particularly in high HIV-prevalence settings.