Background: The placenta plays a critical role in maintaining fetal growth and development, and histopathological examination provides important insights into maternal and fetal health. Placental lesions are frequently associated with pregnancy complications and adverse neonatal outcomes. Aim: To study pregnancy complications and correlate placental histopathological changes with maternal clinical features and neonatal outcomes in a tertiary care center. Methods: This prospective cross-sectional study was conducted in the Department of Pathology, Sree Mookambika Institute of Medical Sciences, from January 2024 to January 2025. A total of 439 placental specimens were evaluated and categorized into pathological and physiological pregnancy groups. Gross and microscopic examination was performed according to Amsterdam Placental Workshop Group guidelines using routine Hematoxylin and Eosin staining. Histopathological findings were correlated with maternal complications and neonatal outcomes. Results: Pathological placentas constituted 69.5% of cases, while adverse neonatal outcomes were observed in 56.5% of neonates. Maternal vascular malperfusion was the most common placental lesion associated with pathological pregnancies. Significant associations were observed between pathological pregnancies and small for gestational age neonates, prematurity, respiratory distress syndrome, neonatal sepsis, and prolonged neonatal hospitalization (p < 0.05). Histologically normal placentas were more commonly associated with physiological pregnancies and healthy neonatal outcomes. Conclusion: Placental histopathological abnormalities showed significant correlation with maternal pregnancy complications and adverse neonatal outcomes, emphasizing the importance of routine placental examination for early risk assessment and improved perinatal management.

Placenta, placental histopathology, maternal vascular malperfusion, pregnancy complications, neonatal outcomes, preeclampsia, prematurity, placental pathology.