Placental histology in spontaneous and indicated preterm birth: A case control study

Nijman, Tobias A.J.; Vliet, Elvira O.G. van; Benders, Manon J. N. L.; Mol, Ben Willem J.; Franx, Arie; Nikkels, Peter G. J.; Oudijk, Martijn A.

doi:10.1016/j.placenta.2016.10.006

Cited by 64 publications

(60 citation statements)

References 20 publications

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“…In our cohort, unlike other reports [72,73] the most prevalent lesion was MUP (61%). The proportions of the specific lesions vary with the gestational age and classifications used [72,73].…”

Section: Discussioncontrasting

confidence: 93%

“…al. [72] reported a rate of 56% for acute chorioamnionitis (similar to Redline's AFI),7.4% for MUP, 4.4% for FVTOD, 1.5% for VUE 1.5% and 7.4% for chronic chorioamnionitis, Nijman et al [73] reported 40.0% for placental infectious lesions and about 20% for MUP for this gestational age. The differences between the studies may result from different population, selection criteria and classifications.…”

Section: Discussionmentioning

confidence: 86%

“…The proportions of the specific lesions vary with the gestational age and classifications used [72,73]. Thus, Lee et.…”

Section: Discussionmentioning

confidence: 99%

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Inflammatory and vascular placental lesions are associated with neonatal amplitude integrated EEG recording in early premature neonates

et al. 2017

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IntroductionPlacental histologic examination can assist in revealing the mechanism leading to preterm birth. Accumulating evidence suggests an association between intrauterine pathological processes, morbidity and mortality of premature infants, and their long term outcome. Neonatal brain activity is increasingly monitored in neonatal intensive care units by amplitude integrated EEG (aEEG) and indices of background activity and sleep cycling patterns were correlated with long term outcome. We hypothesized an association between types of placental lesions and abnormal neonatal aEEG patterns.ObjectiveTo determine the association between the placental lesions observed in extreme preterm deliveries, and their neonatal aEEG patterns and survival.Patients and methodsThis prospective cohort study included extreme premature infants, who were born ≤ 28 weeks of gestation, their placentas were available for histologic examination, and had a continues aEEG, soon after birth)n = 34). Infants and maternal clinical data were collected. aEEG data was assessed for percentage of depressed daily activity in the first 3 days of life and for sleep cycling. Associations of placental histology with clinical findings and aEEG activity were explored using parametric and non-parametric statistics.ResultsTwenty two out of the 34 newborns survived to discharge. Preterm prelabor rupture of membranes (PPROM) or chorioamnionitis were associated with placental lesions consistent with fetal amniotic fluid infection (AFI) or maternal under perfusion (MUP) (P < 0.05). Lesions consistent with fetal response to AFI were associated with absence of SWC pattern during the 1st day of life. Fetal-vascular-thrombo-occlusive lesions of inflammatory type were negatively associated with depressed cerebral activity during the 1st day of life, and with aEEG cycling during the 2nd day of life (P<0.05). Placental lesions associated with MUP were associated with depressed neonatal cerebral activity during the first 3 days of life (P = 0.007).ConclusionsDepressed neonatal aEEG patterns are associated with placental lesions consistent with maternal under perfusion, and amniotic fluid infection of fetal type, but not with fetal thrombo-oclusive vascular disease of inflammatory type. Our findings highlight the association between the intrauterine mechanisms leading to preterm parturition and subsequent depressed neonatal cerebral function early after birth, which eventually may put premature infants at risk for abnormal neurodevelopmental outcome.

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Section: Discussioncontrasting

confidence: 93%

Section: Discussionmentioning

confidence: 86%

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Inflammatory and vascular placental lesions are associated with neonatal amplitude integrated EEG recording in early premature neonates

et al. 2017

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“…5 Impaired uteroplacental perfusion has been linked to obstetrical complications including preeclampsia, placental abruption, and fetal growth restriction 6 , as well as preterm birth. 7 …”

Section: Introductionmentioning

confidence: 99%

Placental Complications Associated With Psychostimulant Use in Pregnancy

Cohen

Hernández–Dı́az

Bateman

et al. 2017

Obstetrics &Amp; Gynecology

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Objective To evaluate whether psychostimulants used to treat attention-deficit hyperactivity disorder (ADHD) are associated with risk of adverse placental-associated pregnancy outcomes including preeclampsia, placental abruption, growth restriction, and preterm birth. Methods We designed a population-based cohort study where we examined a cohort of pregnant women and their liveborn infants enrolled in Medicaid from 2000 to 2010. Women who received amphetamine–dextroamphetamine or methylphenidate monotherapy in the first half of pregnancy were compared to unexposed women. We considered atomoxetine, a non-stimulant ADHD medication, as a negative control exposure. To assess whether the risk period extended to the latter half of pregnancy, women who continued stimulant monotherapy after 20 weeks were compared to those who discontinued. Risk ratios (RRs) and 95% confidence intervals (CIs) were estimated with propensity score stratification to control for confounders. Results Pregnancies exposed to amphetamine/dextroamphetamine (n=3331), methylphenidate (n=1515), and atomoxetine (n=453) monotherapy in early pregnancy were compared to 1,461,493 unexposed pregnancies. Among unexposed women, the risks of the outcomes were 3.7% for preeclampsia, 1.4% for placental abruption, 2.9% for small for gestational age, and 11.2% for preterm birth. The adjusted RR for stimulant use was 1.29 for preeclampsia (95% CI 1.11–1.49), 1.13 for placental abruption (0.88–1.44), 0.91 for small for gestational age (SGA; 0.77–1.07) and 1.06 for preterm birth (0.97–1.16). Compared to discontinuation (n=3527), the adjusted RR for continuation of stimulant use in the latter half of pregnancy (n=1319) was 1.26 for preeclampsia (0.94–1.67), 1.08 for placental abruption (0.67–1.74), 1.37 for SGA (0.97–1.93), and 1.30 for preterm birth (1.10–1.55). Atomoxetine was not associated with the outcomes studied. Conclusion Psychostimulant use during pregnancy was associated with a small increased relative risk of preeclampsia and preterm birth. The absolute increases in risks are small and thus, women with significant ADHD should not be counseled to suspend their ADHD treatment based on these findings.

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“…Chorioamnionitis (intrauterine inflammation or infection detected in the placenta) is frequently implicated in spontaneous preterm birth, particularly in the early preterm period (<30weeks gestation) [4,5,6]. Not always obvious clinically, it can occur without symptoms and take hold within the decidua, invading the interface between the amnion and chorion, therefore reaching the amniotic cavity and fetus.…”

Section: Introductionmentioning

confidence: 99%

Placental inflammation and its relationship to cervicovaginal fetal fibronectin in preterm birth

Krogt¹,

Ridout

Seed

et al. 2017

European Journal of Obstetrics & Gynecology and Reproductiv

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words Main text word count: 1864 words Condensation: 25words:There is a significant association between a positive fetal fibronectin and inflammatory placental pathology. Infective morbidity may be increased in women with a raised quantitative fFN who deliver preterm. Short title: Placental inflammation and fFN in women who deliver preterm Abstract ObjectiveLate miscarriage and preterm birth are frequently thought to be associated with inflammation and infection, although in most cases the underlying cause of early delivery remains unknown. The placenta is the organ that links mother and fetus during pregnancy, and postnatal examination may provide useful information about pathophysiology.The relationship between placental pathological lesions and predictive markers of early delivery has not been explored. We sought to characterize preterm deliveries according to placental pathology and relate these to the performance of reliable predictive markers, fetal fibronectin and cervical length. Study DesignThis is a retrospective subanalysis from a larger prospective cohort study on sonographic cervical length, quantitative fetal fibronectin and risk of spontaneous preterm birth. Our cohort was comprised of high-risk asymptomatic women attending the Prematurity Surveillance Clinic at St Thomas' Hospital between 2002 and 2015, who went on to have a late miscarriage or preterm delivery (16 to 36 +6 weeks') and who had available placental histology.The placental pathology of these preterm deliveries was characterized according to the lesions identified, and categorized (according to the Redman classification) into inflammatory (e.g. chorioamnionitis) or non-inflammatory (histologically normal or vascular lesions indicating e.g. malperfusion).We sought to relate placental findings to the performance of reliable predictive markers, in women who delivered early. Standard clinical cut offs for cervical length (< 25mm) and fetal fibronectin (>50 ng/mL) were used to identify the proportion of preterm births that were accurately predicted by the tests or who showed a false negative result, in relation to their placental histology findings. Binomial logistic regression was carried out to evaluate the relationship between placental inflammation, quantitative fFN and cervical length as continuous variables. Results105 women who had a late miscarriage or preterm delivery (16-36 +6 weeks') and available placenta pathology were identified. 66% (42/64) of those with inflammatory placental pathology had a positive fetal fibronectin swab result compared to 15% (6/41) of those with noninflammatory placental pathology (chi-squared 25.9, 95% CI 31.5 to 65.6, p<0.0001).A logistic regression model subanalysis of women in whom both CL and quantitative fFN results were available (n=66) revealed a highly statistically significant relationship with inflammatory placental lesions (p=0.003 and p=0.001 respectively). Placental inflammation was found to be associated with both increasing levels of fFN and a shortening cervix. ConclusionThere...

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Placental histology in spontaneous and indicated preterm birth: A case control study

Cited by 64 publications

References 20 publications

Inflammatory and vascular placental lesions are associated with neonatal amplitude integrated EEG recording in early premature neonates

Inflammatory and vascular placental lesions are associated with neonatal amplitude integrated EEG recording in early premature neonates

Placental Complications Associated With Psychostimulant Use in Pregnancy

Placental inflammation and its relationship to cervicovaginal fetal fibronectin in preterm birth

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