Placental Health Score (PHS) for Early Prediction of Placental Insufficiency and Preterm Birth: A Cross-Sectional Analytical Study

TL;DR

This study introduces a Placental Health Score to predict placental insufficiency and preterm birth by analyzing placental measurements.

Contribution

The novel contribution is the development and validation of a composite score integrating placental morphometric parameters for early risk prediction.

Findings

Central placental thickness and fetal weight showed strong positive correlations with gestational age.

The PHS combines statistically significant and clinically relevant parameters to assess placental health.

The score offers a reproducible and objective tool for prenatal risk stratification.

Abstract

Background

Placental insufficiency is a pathological state in which the placenta fails to provide adequate oxygen and nutrients to the fetus, leading to impaired growth, preterm birth, and adverse neonatal outcomes. Despite its clinical relevance, diagnostic approaches remain limited, and there is a need for a quantifiable tool to assess placental health. The objective of this study was to develop a Placental Health Score (PHS) by integrating key morphometric placental parameters into a multiple linear regression model after normalization and to validate the score by assessing its correlation with gestational age and neonatal outcomes, particularly the five-minute Apgar score.

Materials and methods

A cross-sectional, analytical study was carried out over two years, from 2022 to 2024, on 50 placentas: 36 were preterm and 14 were term placentas, derived from singletons without any maternal comorbidity. Eleven morphometric parameters were assessed: placental weight, central thickness, peripheral thickness, circumference, fetal weight, birth-weight-to-placental-weight ratio (BW:PW), number of cotyledons, umbilical cord length, umbilical cord diameter, umbilical cord insertion type, and presence of knots. Placentas were collected with informed consent from the participants and approval from the Institutional Ethics Committee and the Departments of Obstetrics and Gynecology. To maintain homogeneity in the study population, pregnancies complicated by maternal comorbidities, multiple gestations, or fetal anomalies were excluded. Statistical analyses included correlation testing and regression modeling, performed with appropriate significance thresholds.

Results

Of the 11 morphometric placental parameters analyzed, five were selected for inclusion in the PHS based on their statistical association with gestational age and their established biological relevance. Central placental thickness (Spearman r = 0.64, 95% CI: 0.37 to 0.92, p < 0.001) and fetal weight (r = 0.51, 95% CI: 0.23 to 0.78, p < 0.001) showed the strongest positive correlations with gestational age, reflecting their direct relationship with placental growth and function. Although the birth-weight-to-placental-weight ratio (BW:PW) ratio exhibited a weaker, negative correlation (r = -0.24, p = 0.0913), it was retained due to its clinical importance as a functional index of placental efficiency. Similarly, cotyledon count (r = -0.05, p = 0.7187) and umbilical cord length (r = -0.02, p = 0.8984) were included for their anatomical relevance: cotyledon number reflects villous arborization and structural maturation of the placenta, while cord length is associated with fetal movement and vascular dynamics, both of which are implicated in placental insufficiency and growth restriction. Thus, the final PHS integrates both statistically supported and biologically meaningful parameters, ensuring a composite score that reflects the multifactorial nature of placental development and its role in determining gestational duration.

Conclusion

The PHS, derived from multiple morphometric parameters, provides a reproducible, objective, and clinically translatable measure of placental health. By integrating anatomical and functional indices into a single score, the PHS enables early prediction of placental insufficiency and preterm birth risk, offering a valuable tool for prenatal risk stratification and improved perinatal care.

Figures