Startseite Placental malperfusion as a possible mechanism of preterm birth in patients with Müllerian anomalies
Artikel
Lizenziert
Nicht lizenziert Erfordert eine Authentifizierung

Placental malperfusion as a possible mechanism of preterm birth in patients with Müllerian anomalies

  • Jovana Lekovich EMAIL logo , Joshua Stewart , Sarah Anderson , Erin Niemasik , Nigel Pereira und Stephen Chasen
Veröffentlicht/Copyright: 17. September 2016

Abstract

Objective:

Müllerian anomalies are associated with increased risk of miscarriage, intrauterine growth restriction (IUGR) and preterm birth. While a commonly implicated cause is restricted expansion of endometrial cavity, alternatively it could be due to abnormal placentation. We sought to examine clinical and histopathologic factors associated with preterm delivery in women with Müllerian anomalies.

Study design:

One hundred and eleven singleton pregnancies in 85 women were analyzed retrospectively. There were 42 pregnancies with bicornaute, 24 with unicornuate, 24 with septate, 19 with didelphys and one each with arcuate and T-shaped uterus. Primary outcomes included gestational age at delivery, placental histopathology, placenta previa and accreta.

Results:

Twenty-eight (25.2%) of pregnancies were delivered prior to term. Of those, only 14 (50%) were due to preterm labor or preterm premature rupture of membranes (PPROM). Histological evidence of placental malperfusion was present in 22% of all pregnancies and those delivered at an earlier median gestational age [34 (IQR 31–37) vs. 37 weeks (IQR 34–39); P=0.001]. Malperfusion was more common in preterm than in full term births (46% vs. 14%; P=0.04). Conversely, inflammation was not more common in preterm compared to term deliveries (17.9% vs. 16.9%; P=0.89). Five pregnancies had placenta previa, three of which were complicated by accreta.

Conclusion:

Placental malperfusion, rather than inflammation, was more commonly associated with preterm births in women with uterine anomalies.


Corresponding author: Jovana Lekovich, MD, Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Avenue, 6th Floor, New York, NY 10021, USA, Tel.: +(646) 962-3317, Fax: +(646) 962-2534

References

[1] Acien P. Embryological observations on the female genital tract. Hum Reprod. 1992;7:437.10.1093/oxfordjournals.humrep.a137666Suche in Google Scholar

[2] American Fertility Society. The AFS classification of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, Mullerian anomalies and intrauterine adhesions. Fertil Steril. 1988;49:944–55.10.1016/S0015-0282(16)59942-7Suche in Google Scholar

[3] Salim R, Regan L, Woelfer B, Backos M, Jurkovic D. A comparative study of the morphology of congenital uterine anomalies in women with and without a history of recurrent first trimester miscarriage. Hum Reprod. 2003;18:162–6.10.1093/humrep/deg030Suche in Google Scholar

[4] Acien P. Incidence of mullerian defects in fertile and infertile women. Hum Reprod. 1997;12:1372–6.10.1093/oxfordjournals.humrep.a019588Suche in Google Scholar

[5] Gomez R, Romero R, Edwin SS, David C. Pathogenesis of preterm labor and preterm premature rupture of membranes associated with intraamniotic infection. Infect Dis Clin North Am. 1997;11:135–76.10.1016/S0891-5520(05)70347-0Suche in Google Scholar

[6] Yoon BH, Romero R, Moon JB, Shim SS, Kim M, Kim G, et al. Clinical significance of intra-amniotic inflammation in patients with preterm labor and intact membranes. Am J Obstet Gynecol. 2001;185:1130–6.10.1067/mob.2001.117680Suche in Google Scholar

[7] Cunningham FG, Leveno KJ, Bloom ST, Hauth JC, Rouse D, Spong CY. Reproductive tract abnormalities. In: Cunningham FG, Leveno KJ, Bloom ST, Hauth JC, Rouse D, Spong CY, editors. Williams obstetrics, chapter 40, 23rd ed. New York: McGraw-Hill, 2012:890–8.Suche in Google Scholar

[8] Rackow BW, Arici A. Reproductive performance of women with mullerian anomalies. Curr Opin Obstet Gynecol. 2007;19: 229–37.10.1097/GCO.0b013e32814b0649Suche in Google Scholar

[9] Zreik TG, Troiano RN, Ghoussoub RA, Olive DL, Arici A, McCarthy SM. Myometrial tissue in uterine septa. J Am Assoc Gynecol Laparosc. 1998;5:155–60.10.1016/S1074-3804(98)80082-0Suche in Google Scholar

[10] Dabirashrafi H, Bahadori M, Mohammad K, Alavi M, Moghadami-Tabrizi N, Zandinejad K, et al. Septate uterus: new idea on the histologic features of the septum in this abnormal uterus. Am J Obstet Gynecol. 1995;172:105–7.10.1016/0002-9378(95)90093-4Suche in Google Scholar

[11] Boyar IH, Boynukalın FK, Boyar N, Vural M. B-Lynch suture technique to control postpartum hemorrhage in a patient with mullerian anomaly. J Turk Ger Gynecol Assoc. 2011;12:47–9.10.5152/jtgga.2011.10Suche in Google Scholar PubMed PubMed Central

[12] Kaplanoğlu M. The uterine sandwich method for placenta previa accreta in mullerian anomaly: combining the B-lynch compression suture and an intrauterine gauze tampon. Case Rep Obstet Gynecol. 2013;2013:236069.10.1155/2013/236069Suche in Google Scholar

[13] Beckmann CR, Ling FW, Barzansky BM, Herbert WN, Laube DW, Smith RP. Obstetrics and gynecology. 6th ed. Baltimore, MD: Lippincott Williams & Wilkins, 2010.Suche in Google Scholar

[14] Redline RW, Ariel I, Baergen RN, Desa DJ, Kraus FT, Rob- erts DJ, et al. Fetal vascular obstructive lesions: nosology and reproducibility of placental reaction patterns. Pediatr Dev Pathol. 2004;7:443–52.10.1007/s10024-004-2020-xSuche in Google Scholar

[15] Redline RW, Boyd T, Campbell V, Hyde S, Kaplan C, Khong TY, et al. Maternal vascular underperfusion: nosology and reproducibility of placental reaction patterns. Pediatr Dev Pathol. 2004;7:237–49.10.1007/s10024-003-8083-2Suche in Google Scholar

[16] Redline RW, Heller D, Keating S, Kingdom J. Placental diagnostic criteria and clinical correlation-a workshop report. Placenta. 2005;26(Suppl A):S114–7.10.1016/j.placenta.2005.02.009Suche in Google Scholar

[17] Mercer BM. Preterm premature rupture of the membranes: current approaches to evaluation and management. Obstet Gynecol Clin North Am. 2005;32:411–28.10.1016/j.ogc.2005.03.003Suche in Google Scholar

[18] Iams JD, Romero R, Culhane JF, Goldenberg RL. Primary, secondary, and tertiary interventions to reduce the morbidity and mortality of preterm birth. Lancet. 2008;371: 164–75.10.1016/S0140-6736(08)60108-7Suche in Google Scholar

[19] Romero R, Miranda J, Chaemsaithong P, Chaiworapongsa T, Kusanovic JP, Dong Z, et al. Sterile and microbial-associated intra-amniotic inflammation in preterm prelabor rupture of membranes. J Matern Fetal Neonatal Med. 2015;12:1394–409.10.3109/14767058.2014.958463Suche in Google Scholar PubMed PubMed Central

[20] da Fonseca EB, Bittar RE, Carvalho MH, Zugaib M. Prophylactic administration of progesterone by vaginal suppository to reduce the incidence of spontaneous preterm birth in women at increased risk: a randomized placebo-controlled double-blind study. Am J Obstet Gynecol. 2003;188: 419–24.10.1067/mob.2003.41Suche in Google Scholar PubMed

[21] Oyelese Y, Smulian JC. Placenta previa, placenta accreta, and vasa previa. Obstet Gynecol. 2006;107:927–41.10.1097/01.AOG.0000207559.15715.98Suche in Google Scholar PubMed

[22] Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, Knight M. Incidence and risk factors for placenta accreta/increta/percreta in the UK: a national case-control study. PLoS One. 2012;7:e52893.10.1371/journal.pone.0052893Suche in Google Scholar PubMed PubMed Central

[23] Gielchinsky Y, Rojansky N, Fasouliotis SJ, Ezra Y. Placenta accreta-summary of 10 years: a survey of 310 cases. Placenta. 2002;23:210–4.10.1053/plac.2001.0764Suche in Google Scholar PubMed

[24] Thurn L, Lindqvist PG, Jakobsson M, Colmorn LB, Klungsoyr K, Bjarnadóttir RI, et al. Abnormally invasive placenta-prevalence, risk factors and antenatal suspicion: results from a large population-based pregnancy cohort study in the Nordic countries. BJOG. 2016;123:1348–55.10.1111/1471-0528.13547Suche in Google Scholar PubMed

[25] Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol. 2005;192: 1458–61.10.1016/j.ajog.2004.12.074Suche in Google Scholar PubMed

  1. The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2016-2-29
Accepted: 2016-8-3
Published Online: 2016-9-17
Published in Print: 2017-1-1

©2017 Walter de Gruyter GmbH, Berlin/Boston

Artikel in diesem Heft

  1. Frontmatter
  2. Editorial
  3. What’s new in preterm birth prediction and prevention?
  4. Academy’s Corner
  5. Antenatal corticosteroids: current controversies
  6. Review articles
  7. The safety of progestogen in the prevention of preterm birth: meta-analysis of neonatal mortality
  8. Cervical pessary for the prevention of preterm birth: is it of any use?
  9. Maternal and neonatal outcomes following expectant management of preterm prelabour rupture of membranes before viability
  10. Highlight articles
  11. Placental malperfusion as a possible mechanism of preterm birth in patients with Müllerian anomalies
  12. Nifedipine increases fetoplacental perfusion
  13. Effect of sleep disorders on threatened premature delivery
  14. Risk of recurrent preterm birth among women according to change in partner
  15. Biomarkers of spontaneous preterm birth: a systematic review of studies using multiplex analysis
  16. Influence of transvaginal ultrasound examination on quantitative vaginal fibronectin measurements: a prospective evaluation study
  17. Evaluation of quantitative fFn test in predicting the risk of preterm birth
  18. The value of ultrasound measurement of cervical length and parity in prediction of cesarean section risk in term premature rupture of membranes and unfavorable cervix
  19. Comparison of the duo of insulin-like growth factor binding protein-1/alpha fetoprotein (Amnioquick duo+®) and traditional clinical assessment for diagnosing premature rupture of fetal membranes
  20. Efficacy of a prospective community-based intervention to prevent preterm birth
  21. Maternal complications in settings where two-thirds of extremely preterm births are delivered by cesarean section
  22. The risk of neonatal respiratory morbidity according to the etiology of late preterm delivery
  23. Thyroid dysfunction in preterm neonates exposed to iodine
  24. Congress Calendar
  25. Congress Calendar
Heruntergeladen am 1.10.2025 von https://www.degruyterbrill.com/document/doi/10.1515/jpm-2016-0075/html
Button zum nach oben scrollen