Neonatal outcomes following preterm birth classified according to placental features - 18/04/17
, Christina M. Scifres, MD d, Steve N. Caritis, MD a, c, Marnie Bertolet, PhD b, Jacob Larkin, MD a, c, W. Tony Parks, MD a, c, eAbstract |
Background |
Preterm birth has staggering health implications, and yet the causes of most cases are still unknown. Placental features have been understudied as an etiology for preterm birth, and the association between placental pathologic lesions and neonatal outcomes are incompletely understood.
Objective |
We sought to characterize births according to placental pathology and relate these to adverse neonatal outcomes.
Study Design |
We studied 20,091 births (15,710 term and 4381 preterm) with placental evaluations. Births were classified according to the presence or absence of placental lesions consistent with malperfusion (vasculopathy, infarct, advanced villous maturation, perivillous fibrin, fibrin deposition) and intrauterine inflammation/infection (chorioamnionitis, funisitis, vasculitis). Outcomes were gestational week of delivery, birthweight z-score, neonatal respiratory distress syndrome, and intraventricular hemorrhage.
Results |
Among all preterm births, evidence of placental malperfusion was identified more often than inflammation/infection (50.6% vs 27.3%, P < .0001). Placental malperfusion was associated with reduced fetal growth (adjusted birthweight z-score, –0.83, P < .0001) and lesions of inflammation/infection were associated with earlier delivery (adjusted difference –2.08 weeks, P < .0001) than those with no lesions. When both placental lesions were present, earlier delivery (adjusted difference –2.28 weeks, P < .0001) and reduced fetal growth (adjusted birthweight z-score difference, –0.24, P = .001) were observed more often than when neither lesion was present. Findings were similar when restricted to cases of spontaneous preterm birth. Intraventricular hemorrhage was higher in preterm births with malperfusion lesions than cases with no lesions (7.6% vs 3.4%; odds ratio, 1.98; confidence interval, 1.18–3.32), accounting for gestational age and other covariates.
Conclusion |
Placental pathology provides important insight into subtypes of preterm birth with adverse neonatal outcomes. Co-occurrence of malperfusion and inflammation/infection, especially among spontaneous preterm births, may be a novel pattern of placental injury linked to severe adverse outcomes.
Le texte complet de cet article est disponible en PDF.Key words : neonatal outcomes, placenta, prematurity
Plan
| Dr Parks is currently affiliated with the Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH. |
|
| Supported by a grant from the Commonwealth of Pennsylvania Department of Health (RFA-67-16) Maternal Lipids and Placental Function. |
|
| The authors report no conflict of interest. |
|
| Cite this article as: Catov JM, Scifres CM, Caritis SN, et al. Neonatal outcomes following preterm birth classified according to placental features. Am J Obstet Gynecol 2017;216:411.e1-14. |
Vol 216 - N° 4
P. 411.e1-411.e14 - avril 2017 Retour au numéro
Article précédent
- Pregnancy in advanced age and the risk of stroke in postmenopausal women: analysis of Women’s Health Initiative Study
- Adnan I. Qureshi, Omar Saeed, Ahmed A. Malik, M. Fareed K. Suri
- Obesity and cell-free DNA “no calls”: is there an optimal gestational age at time of sampling?
- Mary C. Livergood, Kay A. LeChien, Amanda S. Trudell
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?