Role of the Placenta in Preterm Birth: A Review

Morgan, Terry K.

doi:10.1055/s-0035-1570379

Cited by 196 publications

(172 citation statements)

References 38 publications

(88 reference statements)

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“…The three placental pathologies showed no abnormalities, especially no chorioamnionitis. However, it is already known from literature that preterm birth is a multifactorial syndrome and that infection is a less common cause of preterm birth than previously suspected, especially after 32 weeks' of gestation …”

Section: Discussionmentioning

confidence: 96%

The diagnostic value of fetal fibronectin testing in clinical practice

Cornelissen

Oostrum

Woude

et al. 2020

J of Obstet and Gynaecol

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Aim To evaluate the clinical management to withhold treatment for preterm labor in symptomatic women with an intermediate cervical length and negative fetal fibronectin (fFN) testing. Methods A retrospective cohort study was performed in a tertiary care teaching hospital in the Netherlands. Pregnant women with a gestational age between 23+5 to 34+0 weeks, with the presence of regular uterine contractions accompanied by a cervical length between 15 and 30 mm and intact membranes, who underwent fFN testing were included to obtain the diagnostic value of fFN testing for preterm delivery within 7 days. Results Fetal fibronectin testing has an extremely high negative predictive value (100%) and sensitivity (100%) for delivery within 7 days, in singleton and multiple pregnancies. However, specificity (64%) and positive predictive value (10%) of fFN testing in singleton pregnancies are low. Blood present on the fFN sample does not affect the reliability of the fFN test; the negative predictive value remains 100%. Conclusion Women with symptoms of early preterm labor, intact membranes, a cervical length between 15 and 30 mm and negative fFN testing do not deliver within 7 days. Administration of corticosteroids and tocolytics can safely be withhold. Furthermore, blood on the fFN sample does not change the reliability of the fFN test.

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Section: Discussionmentioning

confidence: 96%

The diagnostic value of fetal fibronectin testing in clinical practice

Cornelissen

Oostrum

Woude

et al. 2020

J of Obstet and Gynaecol

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“…Preterm livebirths are different from term livebirths and do not reflect healthy ongoing pregnancies at a given gestational age. Placental abnormalities, including foetal inflammatory markers, are also associated with preterm birth . To account for this, we conducted a sensitivity analysis restricting controls to term births and results were consistent.…”

Section: Commentmentioning

confidence: 99%

The association of stillbirth with placental abnormalities in growth‐restricted and normally grown fetuses

Freedman

Silver

Gibbins

et al. 2019

Paediatric Perinatal Epid

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Background Stillbirth, defined as foetal death ≥20 weeks’ gestation, is associated with poor foetal growth and is often attributed to placental abnormalities, which are also associated with poor foetal growth. Evaluating inter‐relationships between placental abnormalities, poor foetal growth, and stillbirth may improve our understanding of the underlying mechanisms for some causes of stillbirth. Objective Our primary objective was to determine whether poor foetal growth, operationalised as small for gestational age (SGA), mediates the relationship between placental abnormalities and stillbirth. Methods We used data from the Stillbirth Collaborative Research Network study, a population‐based case‐control study conducted from 2006‐2008. Our analysis included 266 stillbirths and 1135 livebirths. We evaluated associations of stillbirth with five types of placental characteristics (developmental disorders, maternal and foetal inflammatory responses, and maternal and foetal circulatory disorders) and examined mediation of these relationships by SGA. We also assessed exposure‐mediator interaction. Models were adjusted for maternal age, race/ethnicity, education, body mass index, parity, and smoking status. Results All five placental abnormalities were more prevalent in cases than controls. After adjustment for potential confounders, maternal inflammatory response (odds ratio [OR] 2.58, 95% confidence interval [CI] 1.77, 3.75), maternal circulatory disorders OR 4.14, 95% CI 2.93, 5.84, and foetal circulatory disorders OR 4.58, 95% CI 3.11, 6.74 were strongly associated with stillbirth, and the relationships did not appear to be mediated by SGA status. Associations for developmental disorders and foetal inflammatory response diverged for SGA and non‐SGA births, and strong associations were only observed when SGA was not present. Conclusions Foetal growth did not mediate the relationships between placental abnormalities and stillbirth. The relationships of stillbirth with maternal and foetal circulatory disorders and maternal inflammatory response appear to be independent of poor foetal growth, while developmental disorders and foetal inflammatory response likely interact with foetal growth to affect stillbirth risk.

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“…Disturbed sleep during early pregnancy—such as occurs in chronic snorers—likely contributes to an increased inflammatory response that could disrupt the normal remodelling of maternal blood vessels that perfuse the placenta . Placental insufficiency—due to uteroplacental hypoperfusion—could then occur, leading to a higher risk of earlier delivery …”

Section: Commentmentioning

confidence: 99%

Associations of snoring frequency and intensity in pregnancy with time‐to‐delivery

Dunietz

Shedden

Lisabeth

et al. 2018

Paediatric Perinatal Epid

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Background Sleep disordered-breathing (SDB) is linked to adverse pregnancy outcomes. However, little is known about the association of SDB with timing of delivery. We examined the association of snoring frequency, a key SDB marker, and snoring intensity, a correlate of SDB severity, with time-to-delivery among a cohort of pregnant women. Methods In this prospective cohort study, 1,483 third trimester pregnant women were recruited from the University of Michigan prenatal clinics. Women completed a questionnaire about their sleep, and demographic and pregnancy information was abstracted from medical charts. After exclusion of those with hypertension or diabetes, 954 women were classified into two groups by their snoring-onset timing, chronic or pregnancy-onset. Within each of these groups, women were divided into four groups based on their snoring frequency and intensity: non-snorers, infrequent-quiet, frequent-quiet, or frequent-loud snorers. Cox proportional hazard regression models were used to investigate the association between snoring frequency and intensity and time-to-delivery, adjusting for maternal characteristics. Results Chronic snoring was reported by half of the pregnant women, and of those, 7% were frequent-loud snorers. Deliveries before 38 weeks’ gestation are completed occurred among 25% of women with chronic, frequent-loud snoring. Compared with pre-pregnancy non-snorers, women with chronic frequent-loud snoring had an increased hazard-ratio for delivery; [adjusted HR=1.60, (95% CI 1.04, 2.45)]. Conclusions Snoring frequency and intensity is associated with time-to-delivery in women absent of hypertension or diabetes. Frequent-loud snoring may have a clinical utility to identify otherwise low-risk women who are likely to deliver earlier.

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Role of the Placenta in Preterm Birth: A Review

Cited by 196 publications

References 38 publications

The diagnostic value of fetal fibronectin testing in clinical practice

The diagnostic value of fetal fibronectin testing in clinical practice

The association of stillbirth with placental abnormalities in growth‐restricted and normally grown fetuses

Associations of snoring frequency and intensity in pregnancy with time‐to‐delivery

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