Placental pathology features associated with preterm delivery and adverse outcomes in singleton pregnancies
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Key Takeaway
Consider placental pathology features as potential markers for preterm delivery risk, but interpret associations cautiously due to observational data.
This observational review analyzed 3,723 singleton placentas with pathology data, maternal pregnancy data, and neonatal birth data. It compared placental pathology features—including maternal vascular malperfusion (MVM), maternal inflammatory response (MIR), fetal inflammatory response (FIR), and increased white blood cell count—against term placentas as a comparator. The primary outcome was the association of preterm delivery with placental pathology, with secondary outcomes covering fetal birth weight, placental weight, fetal-placental ratio, maternal race, intrauterine fetal death, and inflammatory responses.
Preterm deliveries accounted for 416 cases (11.2%) versus 3,307 term deliveries (88.8%). Compared to term, preterm deliveries had significantly lower fetal birth weight, placental weight, and fetal-placental ratio (p<0.01). In extreme preterm groups, maternal Black race was more prevalent (50.8% vs. 33.2% in term, p<0.01), and there were markedly higher associations with intrauterine fetal death (27.5%, p<0.01) and MIR/FIR (56.7%, p<0.01). Among the cohort, 614 placentas (16.5%) were from patients with preeclampsia or pregnancy-induced hypertension.
Safety and tolerability data were not reported. Key limitations include the observational design, which precludes causal conclusions, and unspecified follow-up and setting details. The study did not report funding or conflicts of interest. Practice relevance is restrained: preterm delivery was statistically associated with preeclampsia/pregnancy-induced hypertension, MVM, MIR, FIR, and increased white blood cell count, but these associations should be interpreted cautiously in clinical decision-making due to the lack of interventional evidence.
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View Original Abstract ↓
BackgroundPreterm birth is one of the most significant etiologies for neonatal morbidity and mortality. Preterm delivery is classified as iatrogenic preterm delivery and spontaneous preterm delivery. The role of placental pathology is studied.
Materials and methodsWe have previously collected placental pathology data with maternal pregnancy and neonatal birth data, and we investigated the role of placental pathology in preterm delivery. Preterm delivery was categorized as late preterm (34-36 weeks), moderate preterm (32 to 33 weeks), and extreme preterm (less than 32 weeks). Neonatal, maternal, placental gross and histologic features, and laboratory parameters were compared across groups using chi-square tests for categorical variables and Kruskal-Wallis tests for continuous variables using various programs in R-package.
ResultsTotally 3723 singleton placentas including 3307 term (88.8%) and 416 preterm placentas (11.2%) were examined with maternal pregnancy data and neonatal birth data. There were 614 placentas from patients with preeclampsia/pregnancy induced hypertension (PRE/PIH) (16.5%). Preterm delivery showed significantly lower fetal birth weight, placental weight, and fetal-placental ratio (all p<0.01). Maternal Black race was more prevalent in preterm groups (up to 50.8% in extreme preterm vs. 33.2% in term, p<0.01). Preterm delivery was statistically associated with PRE/PIH and maternal vascular malperfusion (MVM), maternal and fetal inflammatory response (MIR and FIR), and increased pre-delivery white blood count (WBC). Extreme preterm deliveries were markedly associated with intrauterine fetal death (27.5%, p<0.01) and MIR/FIR (56.7%, p<0.01). After excluding PRE/PIH patients, preterm delivery was statistically associated with MIR/FIR and increased WBC.
ConclusionsDistinct clinicopathologic profiles exist across preterm subcategories, with MVM predominating in late/moderate preterm and severe pathologic features (including fetal demise and acute inflammation) in extreme preterm. These findings highlight heterogeneous etiologies of preterm delivery.
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