{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T23:35:08Z","timestamp":1777073708565,"version":"3.51.4"},"reference-count":21,"publisher":"Georg Thieme Verlag KG","issue":"07","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Shallow placental implantation (SPI) contributes to adverse pregnancy outcomes. Identification of histopathological features of SPI and its clinical associations with site-specific implications remains under-explored, which forms the basis for this study.<\/jats:p>\n                  <jats:p>This retrospective study included 182 singleton placentas over 25 weeks of gestation submitted for histopathological examination. Features of SPI was identified based on extravillous trophoblast (EVT) persistence in the decidua, parenchyma, or membranes\/chorionic disc. Associations of features of SPI (any SPI, multiple SPI when more than one SPI lesion was present, and site-specific features of SPI) with clinical and placental outcomes were analyzed.<\/jats:p>\n                  <jats:p>At least one feature of SPI was present in 58.8% placentas, with multiple features in 26.9%. The most common site was membranes\/chorionic disc (40%). Features of SPI was present in parenchyma in 24.2% and in decidua in 20.3%. Presence of SPI features was significantly associated with preeclampsia (p\u2009=\u20090.0001), fetal growth restriction (FGR; p\u2009=\u20090.012), Cesarean delivery (p\u2009=\u20090.007), and chronic hypertension (p\u2009=\u20090.014) and negatively with PROM (p\u2009=\u20090.0009). Placental findings with significant association were lower placental weight (p\u2009=\u20090.042), infarction (p\u2009=\u20090.015), significant fibrin (p\u2009=\u20090.005), maternal (p\u2009&lt;\u20090.001) and fetal (p\u2009=\u20090.014) vascular malperfusion. The birth weight was significantly lower when SPI features were present (p\u2009=\u20090.013), though no significant difference was observed in major neonatal morbidities. Basal plate myometrial fibers showed association with multiple SPI (p\u2009=\u20090.023).<\/jats:p>\n                  <jats:p>Site-specific analysis revealed SPI features in parenchyma to be significantly associated with oligohydramnios and increased neonatal morbidities (hematological, gastrointestinal, and overall), in addition to other adverse outcomes associated with SPI. Decidual features of SPI were additionally associated with maternal diabetes, but showed limited neonatal impact beyond low birth weight.<\/jats:p>\n                  <jats:p>SPI features correlate significantly with major obstetric conditions, birth weight, and placental vascular pathology. Site-specific analysis shows parenchymal SPI has the greatest clinical impact, particularly on neonatal morbidities. Recognition and site-specific documentation enhance its value as an additional parameter within the maternal vascular malperfusion (MVM) spectrum.<\/jats:p>","DOI":"10.1055\/a-2708-5263","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T23:23:11Z","timestamp":1758756191000},"page":"913-924","source":"Crossref","is-referenced-by-count":0,"title":["Histologic Features Suggestive of Shallow Placental Implantation: Maternal\u2013Placental Relevance and Site-Specific Implications"],"prefix":"10.1055","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4426-6914","authenticated-orcid":false,"given":"Gayatri","family":"Ravikumar","sequence":"additional","affiliation":[{"name":"Department of Pathology, St. John's Medical College, Bangalore, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Padmavathi S.","family":"Kamath","sequence":"additional","affiliation":[{"name":"Department of Pathology, St. John's Medical College, Bangalore, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chandrakala Bada","family":"Shekharappa","sequence":"additional","affiliation":[{"name":"Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,10,8]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.semcdb.2022.03.039","article-title":"Human placental development and function","volume":"131","author":"T Cindrova-Davies","year":"2022","journal-title":"Semin Cell Dev Biol"},{"issue":"S 03","key":"ref2","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1111\/1471-0528.17613","article-title":"The great obstetrical syndromes and the placenta","volume":"130","author":"M K Hoffman","year":"2023","journal-title":"BJOG"},{"issue":"03","key":"ref3","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.ajog.2010.08.009","article-title":"The \u201cGreat Obstetrical Syndromes\u201d are associated with disorders of deep placentation","volume":"204","author":"I Brosens","year":"2011","journal-title":"Am J Obstet Gynecol"},{"issue":"04","key":"ref4","doi-asserted-by":"crossref","first-page":"615.e1","DOI":"10.1016\/j.ajog.2022.04.015","article-title":"Toward a new taxonomy of obstetrical disease: improved performance of maternal blood biomarkers for the great obstetrical syndromes when classified according to placental pathology","volume":"227","author":"R Romero","year":"2022","journal-title":"Am J Obstet Gynecol"},{"issue":"08","key":"ref5","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1034\/j.1600-0412.2003.00220.x","article-title":"Quantitative analysis of trophoblast invasion in preeclampsia","volume":"82","author":"T Naicker","year":"2003","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"12","key":"ref6","doi-asserted-by":"crossref","first-page":"1328","DOI":"10.1055\/s-0041-1735554","article-title":"Shallow placentation: a distinct category of placental lesions","volume":"40","author":"J Stanek","year":"2023","journal-title":"Am J Perinatol"},{"issue":"05","key":"ref7","doi-asserted-by":"crossref","first-page":"706","DOI":"10.5858\/arpa.2011-0645-RA","article-title":"Hypoxic patterns of placental injury: a review","volume":"137","author":"J Stanek","year":"2013","journal-title":"Arch Pathol Lab Med"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"13","DOI":"10.2350\/11-03-1000-OA.1","article-title":"Utility of diagnosing various histological patterns of diffuse chronic hypoxic placental injury","volume":"15","author":"J Stanek","year":"2012","journal-title":"Pediatr Dev Pathol"},{"issue":"07","key":"ref9","doi-asserted-by":"crossref","first-page":"698","DOI":"10.5858\/arpa.2015-0225-CC","article-title":"Sampling and definitions of placental lesions: Amsterdam Placental Workshop Group consensus statement","volume":"140","author":"T Y Khong","year":"2016","journal-title":"Arch Pathol Lab Med"},{"issue":"06","key":"ref10","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1038\/s41379-021-00747-4","article-title":"Four major patterns of placental injury: a stepwise guide for understanding and implementing the 2016 Amsterdam consensus","volume":"34","author":"R W Redline","year":"2021","journal-title":"Mod Pathol"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.placenta.2023.05.020","article-title":"Placental lesions attributed to shallow implantation, excess extravillous trophoblast and decidual hypoxia: correlation with maternal vascular malperfusion and related obstetric conditions","volume":"139","author":"A C Lechner","year":"2023","journal-title":"Placenta"},{"issue":"05","key":"ref12","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/j.placenta.2012.01.020","article-title":"Human placentation from nidation to 5 weeks of gestation. Part I: What do we know about formative placental development following implantation?","volume":"33","author":"J L James","year":"2012","journal-title":"Placenta"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1007\/s00428-025-04073-x","article-title":"Clinicopathologic correlation and interdependence of basic patterns of placental injury","author":"J Stanek","year":"2025","journal-title":"Virchows Arch"},{"issue":"23","key":"ref14","doi-asserted-by":"crossref","first-page":"4526","DOI":"10.1080\/14767058.2020.1854215","article-title":"Fetal vascular malperfusion (FVM): diagnostic implications and clinical associations","volume":"35","author":"G Ravikumar","year":"2022","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"05","key":"ref15","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1177\/1093526619837790","article-title":"Do Doppler changes reflect pathology of placental vascular lesions in IUGR pregnancies?","volume":"22","author":"G Ravikumar","year":"2019","journal-title":"Pediatr Dev Pathol"},{"issue":"10","key":"ref16","doi-asserted-by":"crossref","first-page":"1646","DOI":"10.1080\/14767058.2017.1414179","article-title":"CD15 as a marker of fetoplacental endothelial immaturity in IUGR placentas","volume":"32","author":"G Ravikumar","year":"2019","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"03","key":"ref17","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1111\/jog.12539","article-title":"Placental hypoxic overlap lesions: a clinicoplacental correlation","volume":"41","author":"J Stanek","year":"2015","journal-title":"J Obstet Gynaecol Res"},{"issue":"01","key":"ref18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0378-3782(01)00114-1","article-title":"Placental lesion multiplicity: risk factor for IUGR and neonatal cranial ultrasound abnormalities","volume":"62","author":"R M Viscardi","year":"2001","journal-title":"Early Hum Dev"},{"issue":"03","key":"ref19","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1016\/0029-7844(95)00426-2","article-title":"Placental basal plate myometrial fibers: clinical correlations of abnormally deep trophoblast invasion","volume":"87","author":"D M Sherer","year":"1996","journal-title":"Obstet Gynecol"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"4230451","DOI":"10.1155\/2020\/4230451","article-title":"Placenta creta: a spectrum of lesions associated with shallow placental implantation","volume":"2020","author":"J Stanek","year":"2020","journal-title":"Obstet Gynecol Int"},{"issue":"02","key":"ref21","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1515\/jpm-2024-0370","article-title":"Placental fetal vascular malperfusion in maternal diabetes mellitus","volume":"53","author":"J Stanek","year":"2024","journal-title":"J Perinat Med"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2708-5263.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T22:47:42Z","timestamp":1777070862000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2708-5263"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,24]]},"references-count":21,"journal-issue":{"issue":"07","published-online":{"date-parts":[[2026,4,24]]},"published-print":{"date-parts":[[2026,5]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2708-5263","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,9,24]]},"published":{"date-parts":[[2025,9,24]]}}}