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Disorders of placental villous maturation are present in one-third of cases with spontaneous preterm labor

  • Sunil Jaiman , Roberto Romero EMAIL logo , Percy Pacora , Offer Erez , Eunjung Jung , Adi L. Tarca , Gaurav Bhatti , Lami Yeo , Yeon Mee Kim , Chong Jai Kim , Jung-Sun Kim , Faisal Qureshi , Suzanne M. Jacques , Nardhy Gomez-Lopez and Chaur-Dong Hsu
Published/Copyright: January 13, 2021
Journal of Perinatal Medicine
From the journal Journal of Perinatal Medicine Volume 49 Issue 4

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.

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.

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).

Conclusions

Disorders of villous maturation are present in nearly one-third of the cases of spontaneous preterm labor.

Keywords: accelerated villous maturation; acute placental inflammation; chronic placental inflammation; delayed villous maturation; hypercapillarized villi; maternal anti-fetal rejection; maternal-fetal inflammatory response; maternal vascular malperfusion; nucleated red blood cells; placental pathology
Corresponding author: Roberto Romero, MD, D.Med.Sci. Perinatology Research Branch, NICHD/NIH/DHHS Wayne State University/Hutzel Women’s Hospital3990 John R, Box 4Detroit, MI, 48201, USA, Telephone: +(313) 993 2700, Fax: +(313) 993 2694, E-mail:

Funding source: Eunice Kennedy Shriver National Institute of Child Health and Human Development

Award Identifier / Grant number: HHSN275201300006C

Acknowledgments

The authors express our appreciation to the patients who made this work possible while attending the Center for Advanced Obstetrical Care and Research at the Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Development, National Institutes of Health, U.S. Department of Health and Human Services; Wayne State University; and the Detroit Medical Center, Detroit, Michigan. The authors are also grateful to Maureen McGerty, M.A. (Wayne State University), for editorial support.

  1. Research funding: This research was supported, in part, by the Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS); and, in part, with Federal funds from NICHD/NIH/DHHS under Contract No. HHSN275201300006C.

  2. Author contributions: Dr. Romero has contributed to this work as part of his official duties as an employee of the United States Federal Government. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The use of clinical data and biological specimens obtained from these women for research purposes was approved by the Human Investigation Committee of Wayne State University.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/jpm-2020-0138).

Received: 2020-03-30
Accepted: 2020-11-09
Published Online: 2021-01-13
Published in Print: 2021-05-26

© 2020 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. In Memorian
  3. Robert L. Brent, MD, PhD (1927–2021)
  4. Review
  5. Implications of the vaginal microbiome and potential restorative strategies on maternal health: a narrative review
  6. Original Articles – Obstetrics
  7. Disorders of placental villous maturation are present in one-third of cases with spontaneous preterm labor
  8. Gestational iron deficiency anemia is associated with preterm birth, fetal growth restriction, and postpartum infections
  9. Women with high plasma levels of PBDE-47 are at increased risk of preterm birth
  10. Racial disparities in recurrent preterm delivery risk: mediation analysis of prenatal care timing
  11. Doppler ultrasonography of the uterine artery in correlation with KANET
  12. The cumulative impact of parity on the body mass index (BMI) in a non-selected Lower Saxony population
  13. The relation between second-trimester placental elasticity and poor obstetric outcomes in low-risk pregnancies
  14. Comparison of pregnancy outcomes after second trimester amniocentesis between procedures performed by experts and non-experts
  15. Effect of vitamin D3 supplementation during pregnancy on high risk factors — a randomized controlled trial
  16. Educating future professionals in perinatal medicine: the attitude of medical and nursing students towards childbirth
  17. Original Articles – Fetus
  18. Normal values of cardiac axis (CA) measurements in healthy fetuses during the first trimester screening ultrasound
  19. Original Articles – Neonates
  20. Effects of COVID-19 pandemic on breastfeeding rates in a neonatal intensive care unit
  21. Factors associated with extubation failure in very low birth weight infants: a cohort study in the northeast Brazil
  22. Perinatal outcome of in vitro fertilization pregnancies in women with polycystic ovary syndrome by pregravid BMI
  23. Evaluation of audio-voice guided application for neonatal resuscitation: a prospective, randomized, pilot study
  24. Letter to the Editor
  25. Systematic screening for SARS-CoV-2 in pregnant women admitted for delivery: not as easy as it sounds
https://doi.org/10.1515/jpm-2020-0138
Keywords for this article
accelerated villous maturation; acute placental inflammation; chronic placental inflammation; delayed villous maturation; hypercapillarized villi; maternal anti-fetal rejection; maternal-fetal inflammatory response; maternal vascular malperfusion; nucleated red blood cells; placental pathology

Articles in the same Issue

  1. Frontmatter
  2. In Memorian
  3. Robert L. Brent, MD, PhD (1927–2021)
  4. Review
  5. Implications of the vaginal microbiome and potential restorative strategies on maternal health: a narrative review
  6. Original Articles – Obstetrics
  7. Disorders of placental villous maturation are present in one-third of cases with spontaneous preterm labor
  8. Gestational iron deficiency anemia is associated with preterm birth, fetal growth restriction, and postpartum infections
  9. Women with high plasma levels of PBDE-47 are at increased risk of preterm birth
  10. Racial disparities in recurrent preterm delivery risk: mediation analysis of prenatal care timing
  11. Doppler ultrasonography of the uterine artery in correlation with KANET
  12. The cumulative impact of parity on the body mass index (BMI) in a non-selected Lower Saxony population
  13. The relation between second-trimester placental elasticity and poor obstetric outcomes in low-risk pregnancies
  14. Comparison of pregnancy outcomes after second trimester amniocentesis between procedures performed by experts and non-experts
  15. Effect of vitamin D3 supplementation during pregnancy on high risk factors — a randomized controlled trial
  16. Educating future professionals in perinatal medicine: the attitude of medical and nursing students towards childbirth
  17. Original Articles – Fetus
  18. Normal values of cardiac axis (CA) measurements in healthy fetuses during the first trimester screening ultrasound
  19. Original Articles – Neonates
  20. Effects of COVID-19 pandemic on breastfeeding rates in a neonatal intensive care unit
  21. Factors associated with extubation failure in very low birth weight infants: a cohort study in the northeast Brazil
  22. Perinatal outcome of in vitro fertilization pregnancies in women with polycystic ovary syndrome by pregravid BMI
  23. Evaluation of audio-voice guided application for neonatal resuscitation: a prospective, randomized, pilot study
  24. Letter to the Editor
  25. Systematic screening for SARS-CoV-2 in pregnant women admitted for delivery: not as easy as it sounds
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