The relationship between placental histology and cervical ultrasonography in women at risk for pregnancy loss and spontaneous preterm birth

Guzman, Edwin R.; Shen‐Schwarz, Susan; Benito, Carlos; Vintzileos, Anthony M.; Lake, Marian; Lai, Yu‐Ling

doi:10.1016/s0002-9378(99)70303-0

Cited by 30 publications

(23 citation statements)

References 8 publications

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“…Independently, placental histology was associated with shortening cervical length. This is similar to the results of other studies [14,15]. However when taken together, an increasing quantitative fFN was significantly associated with inflammation, more than a shortening cervix.…”

Section: Commentsupporting

confidence: 91%

“…Although previous work has related intrauterine infection to a short cervix [14,15], this is the first study to report specifically on the strong relationship between fFN and placental inflammation. The high morbidity and mortality associated with maternal and neonatal infection justifies in-depth investigation into this area, as well as important implications resulting from the potential to predict aetiology.…”

Section: Commentmentioning

confidence: 87%

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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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Section: Commentsupporting

confidence: 91%

Section: Commentmentioning

confidence: 87%

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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“…However, it is unclear whether the primary defect is a short cervix which predisposes to ascending infection or whether low-grade inflammation leads to a short mid-trimester cervix with subsequent development of preterm delivery. It is known that women with cervicitis are at significantly increased risk of preterm delivery (Creatsas et al, 1995); previous studies using amniotic fluid or placental cultures confirm that inflammation rather than culture positive amniotic fluid infection has the strongest association with preterm delivery (Hillier et al, 1988;Sebire et al, 1996) and significantly more acute inflammatory lesions are present in placentas from patients in whom cervical shortening is present compared to those where it is not (Guzman et al, 1999). Advances in therapeutic interventions will therefore rely heavily on adequate understanding of the pathophysiology since cervical cerclage, for example, is unlikely to be effective in cases in which significant inflammation is already present.…”

Section: Discussionmentioning

confidence: 99%

Histological chorioamnionitis in relation to clinical presentation at 14-40 weeks of gestation

Sebire¹

2001

Journal of Obstetrics and Gynaecology

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This study examines the prevalence of histological inflammation of the fetal membranes according to gestational age and mode of clinical presentation in a series of 179 consecutive placentas evaluated in a single centre. The frequency of histological inflammation between clinical groups was compared and relation between the prevalence of inflammation and gestational age examined using regression analysis. One hundred and seventy-nine placentas were examined. Histological inflammation was present in 65 (38%) cases including 37/52 (71%) pregnancies presenting with spontaneous preterm labour and delivery (PTL), 23/36 (64%) with preterm prelabour rupture of membranes (PPROM), 1/20 (5%) with vaginal bleeding but no contractions (PVB), 1/13 (8%) with intrauterine death but no labour (IUD), 1/28 (4%) with iatrogenic delivery, 0/4 with termination of pregnancy and 2/20 (10%) delivering spontaneously at term. The prevalence of histological inflammation was significantly higher in those with PTL or PPROM compared to the other groups (P<0.0001). The frequency of histological inflammation was associated with gestational age (F=57.2, P<0.0001, R=0.91), with a peak prevalence (>90%) at 20-24 weeks' gestation.

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“…Un raccourcissement du col en échographie, surtout au deuxième trimestre, est lié à l'existence de signes histologiques de chorioamniotite aiguë ou chronique [107]. Bien qu'un col court facilite l'ascension de germes dans l'utérus, il est également vraisemblable que chez certaines femmes, le raccourcissement du col s'effectue en réponse à une infection intra-utérine préexistante.…”

Section: Marqueurs éChographiques (Longueur Du Col Utérin)unclassified

Prématurité et infection : état des connaissances

Petit

Abergel

Dedet

et al. 2012

Journal de Gynécologie Obstétrique et Biologie de la Reproducti

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The relationship between placental histology and cervical ultrasonography in women at risk for pregnancy loss and spontaneous preterm birth

Cited by 30 publications

References 8 publications

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

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

Histological chorioamnionitis in relation to clinical presentation at 14-40 weeks of gestation

Prématurité et infection : état des connaissances

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