Objective: To analyze the relationship of obstetric complications and neonatal outcomes with the thrombophilic status of the mother infant couples in case of demonstrated placental villous thrombosis in histopathological evaluation after delivery. Methods: Placentas of high-risk pregnancies, unexplained fetal loss or infants who needed neonatal intensive care unit (NICU) admission were collected at the time of delivery. Results: In a 6 months period, placental villous thrombosis was detected in 30 among 800 placentas. Half of the mothers had a bad obstetric outcome previously, such as at least one abortus or stillbirth. Eighteen neonates (60%) were premature. Seventy-five percent of the neonates (n = 24) needed NICU admission and the mortality rate was 9.3%. Five of the patients had congenital anomalies. Thrombophilic mutations could be evaluated in seven mothers-infant couples, all of whom had at least one positive mutation for thrombosis. Conclusions: Severe fetal vasculopathy appears to be a predisposing factor for adverse neonatal outcomes. Analyzing placentas will yield advantages as the same pathological process may repeat in subsequent pregnancies. Thrombophilic mutations should be evaluated to provide the etiology of the adverse outcome and to give prophylaxis for the future pregnancies.