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2. Correlation of macroscopic and microscopic placental lesions with obstetric and neonatal outcomes in an unselected population

Author

Jessop, Flora

Subjects
610
Abstract

Many abnormalities of the placenta are reported to be significant in the setting of maternal health problems and adverse fetal/neonatal outcomes. In specific clinicopathological circumstances - eg vascular lesions in the growth restricted fetus – correlation does exist between the placental lesion and the clinical event. Relationships between “lower grade” placental lesions and clinical outcomes are less clear. Reports of associations between selected abnormalities and clinical outcomes are largely based on retrospective case control studies: the clinical groups studied tend to be high-risk. Understanding of the significance of these lesions in the wider population is lacking. This study reports on the clinical events and placental lesions documented in 1119 unselected women delivering at the conclusion of a singleton pregnancy in a single obstetric centre. Study methodology was such that the cohort comprised low-risk mothers delivering at or close to term. The incidence of potentially adverse obstetric and neonatal events in the study population was low. 97% delivered at term. Mean birth weight was 3485 g; mean Apgar scores were 9 at 1 minute and 10 at 5 minutes. 5.9% of infants required admission to neonatal intensive care. When classified in accordance with current standard reporting guidelines, 71% of placentas were classified as normal. Inclusion of lower grade histological lesions in the reporting schedule reduced the percentage of histologically normal placentas to 58%. Funisitis was found to be significantly correlated with adverse neonatal outcome. A number of other placental lesions - including cord coiling <10th and >90th centiles, placental infarction, villitis of unknown etiology and lower grades of acute placental inflammation - were not found to be associated with adverse obstetric or neonatal events. It is concluded that a number of placental lesions may not be relevant to adverse pregnancy outcomes in a low-risk population.

Published
2012

12. Abnormal placental CD8+ T‐cell infiltration is a feature of fetal growth restriction and pre‐eclampsia.

Author

Lager, Susanne, Sovio, Ulla, Eddershaw, Elizabeth, Linden, Margaretha W., Yazar, Cansu, Cook, Emma, Happerfield, Lisa, Jessop, Flora A., Sebire, Neil J., Charnock‐Jones, D. Stephen, and Smith, Gordon C. S.

Subjects
FETAL growth retardation, PREGNANCY outcomes, PREGNANCY complications, PREECLAMPSIA, GESTATIONAL age
Abstract

Key points: Placental pathological abnormalities are more frequently observed in complicated pregnancies than in healthy pregnancies.Infiltration of CD8+ T‐cells into the placental villous tissue occurred in both fetal growth restriction and pre‐eclampsia, whereas CD79α+ B‐cell infiltration was only apparent with reduced fetal growth.Vascularization, fibrin depositions, macrophage and neutrophil infiltration in the placenta did not differ between healthy and complicated pregnancies. Fetal growth restriction (FGR) and pre‐eclampsia are severe, adverse pregnancy outcomes. Alterations in placental histology are frequently reported in these pregnancy complications and are often based upon scoring by pathologists. However, many alterations are also observed in placenta from uncomplicated pregnancies. Moreover, knowledge of disease state may bias assessment. We sought to perform an objective comparison of placental microscopic appearance in normal and complicated pregnancies. Placental villous tissue (n = 823) and edge biopsies (n = 488) from 871 individual, singleton pregnancies were collected after delivery. Cases of small‐for‐gestational age (SGA) or pre‐eclampsia were matched with healthy controls. A subset of the SGA cases displayed signs of FGR. Cases of preterm delivery were also included. Tissue sections were stained with haematoxylin and eosin or antibodies for CD8, CD14, CD31, CD79α and elastase. Images were scored by two experienced pathologists for pathological features or analysed by image analysis and stereology. Analyses were performed blind to case–control status and gestational age. Volume fraction of T‐cells increased in placentas from pregnancies complicated by pre‐eclampsia (adjusted odds ratio (aOR) 1.46, 95% CI: 1.12–1.90) and FGR (aOR 1.64, 95% CI: 1.11–2.43), whereas B‐cells only increased in FGR (aOR 1.65, 95% CI: 1.05–2.60). Pathological abnormalities in villous tissue were reported in 21.4% (88/411) of complicated pregnancies and 14.3% (52/363) of controls (OR 1.62, 95% CI: 1.12–2.37). There were no differences in the fractions of endothelial cells, fibrin deposition, macrophages and neutrophils when comparing normal and complicated pregnancies. In conclusion, FGR and pre‐eclampsia are associated with T‐cell infiltration of the placenta and placental pathological abnormalities. Key points: Placental pathological abnormalities are more frequently observed in complicated pregnancies than in healthy pregnancies.Infiltration of CD8+ T‐cells into the placental villous tissue occurred in both fetal growth restriction and pre‐eclampsia, whereas CD79α+ B‐cell infiltration was only apparent with reduced fetal growth.Vascularization, fibrin depositions, macrophage and neutrophil infiltration in the placenta did not differ between healthy and complicated pregnancies. [ABSTRACT FROM AUTHOR]

Published
2020
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