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Mount Sinai researcher discovers placenta size can determine a pregnant woman’s risk of stillbirth

August 26, 2009 – A Mount Sinai clinician-researcher has discovered that the size of a pregnant woman’s placenta can determine whether her fetus is at a high risk of stillbirth. The study concludes that if these women are screened during pregnancy, they can be treated effectively and the risk of stillbirth can be significantly reduced. 

In the study, published in Ultrasound in Obstetrics and Gynecology online on August 26, 2009, Dr. John Kingdom, Principal Investigator of the study and Maternal Fetal-Medicine Specialist at Mount Sinai Hospital in Toronto, showed that a pregnant woman is at an increased risk of extreme pre-term delivery and stillbirth if she has all three of the following: 1) a low level of pregnancy-associated plasma protein-A (PAPP-A), which is routinely tested to screen for Down syndrome, 2) an elevated alpha fetoprotein (AFP) level, tested to screen for Down syndrome and spina bifida; and 3) a small placenta.

For this research, Dr. Kingdom and his team studied 90 women with low PAPP-A and a high AFP level. During the clinical study, there were no stillbirths among the women whose placentas were screened and who were diagnosed as at risk and followed a new clinical care plan provided through Mount Sinai’s specialized Placenta Clinic.

“In North America, women are generally starting their families at a later age than before and may need reproductive assistance. These are important risk factors for stillbirths, which makes the placenta screening test crucial for maternal-fetal care,” says Dr. Kingdom. “The placenta is how the fetus receives nourishment, making a healthy placenta essential for a healthy pregnancy. Placenta screening is a simple preventative measure to address the risk of stillbirth that has a minimal impact on health-care resources and will likely save lives.” 

As a result of Dr. Kingdom’s research, Mount Sinai Hospital in Toronto has changed its clinical practice to routinely screen all pregnant women with a low PAPP-A level and a high AFP level using a placental ultrasound around the time of their 19- to 20-week fetal anatomy ultrasound. As of 2006, the Canadian stillbirth rate was 6.4 per 1,000 total births (live births and stillbirths) and is increasing.

“By detecting the potential risk of stillbirth early on, these women can be enrolled into our Placenta Clinic so that they and their health-care providers can develop a confident plan to ensure the delivery of a healthy baby.”

Mount Sinai’s Placenta Clinic is a multidisciplinary environment that cares for patients with a wide range of placental diseases. The Clinic is believed to be the only such facility in the world, and it brings together the expertise of obstetric and medical specialists, pathologists, clinical trainees and scientists.


About Mount Sinai Hospital

Mount Sinai Hospital is an internationally recognized, 472-bed acute care academic health sciences centre affiliated with the University of Toronto. It is known for excellence in the provision of compassionate patient care, innovative education, and leading-edge research. Mount Sinai’s Centres of Excellence include Women's and Infants' Health; Surgery and Oncology; Acute and Chronic Medicine; Laboratory Medicine and Infection Control, and the Samuel Lunenfeld Research Institute.


Media contact:

Melissa McDermott
Mount Sinai Hospital
416-586-4800 ext. 8306
mmcdermott@mtsinai.on.ca