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Disorders of placental villous maturation are present in one-third of cases with spontaneous preterm labor.
- Source :
-
Journal of perinatal medicine [J Perinat Med] 2021 Jan 13; Vol. 49 (4), pp. 412-430. Date of Electronic Publication: 2021 Jan 13 (Print Publication: 2021). - Publication Year :
- 2021
-
Abstract
- Objectives: Spontaneous preterm labor is an obstetrical syndrome accounting for approximately 65-70% of preterm births, the latter being the most frequent cause of neonatal death and the second most frequent cause of death in children less than five years of age worldwide. The purpose of this study was to determine and compare to uncomplicated pregnancies (1) the frequency of placental disorders of villous maturation in spontaneous preterm labor; (2) the frequency of other placental morphologic characteristics associated with the preterm labor syndrome; and (3) the distribution of these lesions according to gestational age at delivery and their severity.<br />Methods: A case-control study of singleton pregnant women was conducted that included (1) uncomplicated pregnancies (controls, n=944) and (2) pregnancies with spontaneous preterm labor (cases, n=438). All placentas underwent histopathologic examination. Patients with chronic maternal diseases (e.g., chronic hypertension, diabetes mellitus, renal disease, thyroid disease, asthma, autoimmune disease, and coagulopathies), fetal malformations, chromosomal abnormalities, multifetal gestation, preeclampsia, eclampsia, preterm prelabor rupture of the fetal membranes, gestational hypertension, gestational diabetes mellitus, and HELLP (hemolysis, elevated liver enzymes and low platelet count) syndrome were excluded from the study.<br />Results: Compared to the controls, the most prevalent placental lesions among the cases were the disorders of villous maturation (31.8% [106/333] including delayed villous maturation 18.6% [62/333] vs. 1.4% [6/442], q<0.0001, prevalence ratio 13.7; and accelerated villous maturation 13.2% [44/333] vs. 0% [0/442], q<0.001). Other lesions in decreasing order of prevalence included hypercapillarized villi (15.6% [68/435] vs. 3.5% [33/938], q<0.001, prevalence ratio 4.4); nucleated red blood cells (1.1% [5/437] vs. 0% [0/938], q<0.01); chronic inflammatory lesions (47.9% [210/438] vs. 29.9% [282/944], q<0.0001, prevalence ratio 1.6); fetal inflammatory response (30.1% [132/438] vs. 23.2% [219/944], q<0.05, prevalence ratio 1.3); maternal inflammatory response (45.5% [195/438] vs. 36.1% [341/944], q<0.01, prevalence ratio 1.2); and maternal vascular malperfusion (44.5% [195/438] vs. 35.7% [337/944], q<0.01, prevalence ratio 1.2). Accelerated villous maturation did not show gestational age-dependent association with any other placental lesion while delayed villous maturation showed a gestational age-dependent association with acute placental inflammation (q-value=0.005).<br />Conclusions: Disorders of villous maturation are present in nearly one-third of the cases of spontaneous preterm labor.<br /> (© 2020 Walter de Gruyter GmbH, Berlin/Boston.)
- Subjects :
- Adult
Chronic Disease epidemiology
Female
Fetal Membranes, Premature Rupture etiology
Fetal Membranes, Premature Rupture pathology
Gestational Age
Humans
Infant, Newborn
Pregnancy
Pregnancy Outcome epidemiology
Severity of Illness Index
Chorionic Villi blood supply
Chorionic Villi immunology
Chorionic Villi pathology
Inflammation complications
Inflammation diagnosis
Obstetric Labor, Premature epidemiology
Obstetric Labor, Premature etiology
Obstetric Labor, Premature prevention & control
Placenta Diseases diagnosis
Placenta Diseases immunology
Placenta Diseases physiopathology
Subjects
Details
- Language :
- English
- ISSN :
- 1619-3997
- Volume :
- 49
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Journal of perinatal medicine
- Publication Type :
- Academic Journal
- Accession number :
- 33554577
- Full Text :
- https://doi.org/10.1515/jpm-2020-0138