Kulkarni VG, Sunilkumar KB, Nagaraj TS, et al. - This study was intended to assess the correlations of placental maternal vascular (MVM) and fetal vascular malperfusion (FVM) to fetal and neonatal death with a focus on the most important maternal clinical conditions in the pathway to fetal and neonatal death; maternal hypertension, antepartum haemorrhage and decreased fetal growth. Researchers designed a prospective, observational cohort study conducted at two Asian sites. Using the Amsterdam Consensus framework, the placenta was assessed at both sites. They calculated the risk of placental MVM and FVM among fetal and neonatal deaths. In this study, 814 women with a fetal death, 618 with a preterm live birth and subsequent neonatal death, and 201 term live births, all with a placenta available for study, provided consent between July 2018 and January 2020 in India and Pakistan. The results demonstrate that histological assessment of the placenta, particularly for malperfusion disorders, is crucial in elucidating pathways to fetal death and likely for neonatal death in preterm infants. The findings revealed that possibly more important is the potential to focus on placental MVM and FVM during pregnancy as a means to distinguish fetuses at risk and to decrease the risk of fetal death by early delivery.