Placental villous hypermaturation is associated with idiopathic preterm birth

Terry K. Morgan*, Jorge E. Tolosa, Lisa Mele, Ronald J. Wapner, Catherine Y. Spong, Yoram Sorokin, Donald J. Dudley, Alan M Peaceman, Brian M. Mercer, John M. Thorp, Mary Jo O'sullivan, Susan M. Ramin, Dwight J. Rouse, Baha Sibai

*Corresponding author for this work

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Objective: Pregnancy complications such as intra-amniotic infection, preeclampsia, and fetal intrauterine growth restriction (IUGR) account for most cases of preterm birth (PTB), but many spontaneous PTB cases do not have a clear etiology. We hypothesize that placental insufficiency may be a potential cause of idiopathic PTB. Methods: Secondary analysis of 82 placental samples from women with PTB obtained from a multicenter trial of repeat versus single antenatal corticosteroids. Samples were centrally reviewed by a single placental pathologist masked to clinical outcomes. The histopathologic criterion for infection was the presence of acute chorioamnionitis defined as neutrophils marginating into the chorionic plate. Placental villous hypermaturation (PVH) was defined as a predominance of terminal villi (similar to term placenta) with extensive syncytial knotting. Idiopathic PTB comprised a group without another known etiology such as preeclampsia, IUGR or infection. Results: Acute chorioamnionitis was observed in 33/82 (40%) cases. Other known causes of PTB were reported in 18/82 (22%). The remaining 31/82 (38%) were idiopathic. The frequency of PVH in idiopathic PTB (26/31=84%) was similar to cases with IUGR or preeclampsia (16/18=89%), but significantly more common than PVH in the group with acute chorioamnionitis (10/33=30%) (p<0.001). Conclusions: PVH, which is a histologic marker of relative placental insufficiency, is a common finding in idiopathic PTB.

Original languageEnglish (US)
Pages (from-to)647-653
Number of pages7
JournalJournal of Maternal-Fetal and Neonatal Medicine
Volume26
Issue number7
DOIs
StatePublished - May 1 2013

Fingerprint

Premature Birth
Chorioamnionitis
Pre-Eclampsia
Placental Insufficiency
Infection
Pregnancy Complications
Growth
Fetal Development
Placenta
Multicenter Studies
Adrenal Cortex Hormones
Neutrophils

Keywords

  • Chorioamnionitis
  • Histology
  • Idiopathic preterm labor
  • Placenta
  • Tenney-Parker change

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Morgan, T. K., Tolosa, J. E., Mele, L., Wapner, R. J., Spong, C. Y., Sorokin, Y., ... Sibai, B. (2013). Placental villous hypermaturation is associated with idiopathic preterm birth. Journal of Maternal-Fetal and Neonatal Medicine, 26(7), 647-653. https://doi.org/10.3109/14767058.2012.746297
Morgan, Terry K. ; Tolosa, Jorge E. ; Mele, Lisa ; Wapner, Ronald J. ; Spong, Catherine Y. ; Sorokin, Yoram ; Dudley, Donald J. ; Peaceman, Alan M ; Mercer, Brian M. ; Thorp, John M. ; O'sullivan, Mary Jo ; Ramin, Susan M. ; Rouse, Dwight J. ; Sibai, Baha. / Placental villous hypermaturation is associated with idiopathic preterm birth. In: Journal of Maternal-Fetal and Neonatal Medicine. 2013 ; Vol. 26, No. 7. pp. 647-653.
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author = "Morgan, {Terry K.} and Tolosa, {Jorge E.} and Lisa Mele and Wapner, {Ronald J.} and Spong, {Catherine Y.} and Yoram Sorokin and Dudley, {Donald J.} and Peaceman, {Alan M} and Mercer, {Brian M.} and Thorp, {John M.} and O'sullivan, {Mary Jo} and Ramin, {Susan M.} and Rouse, {Dwight J.} and Baha Sibai",
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Morgan, TK, Tolosa, JE, Mele, L, Wapner, RJ, Spong, CY, Sorokin, Y, Dudley, DJ, Peaceman, AM, Mercer, BM, Thorp, JM, O'sullivan, MJ, Ramin, SM, Rouse, DJ & Sibai, B 2013, 'Placental villous hypermaturation is associated with idiopathic preterm birth', Journal of Maternal-Fetal and Neonatal Medicine, vol. 26, no. 7, pp. 647-653. https://doi.org/10.3109/14767058.2012.746297

Placental villous hypermaturation is associated with idiopathic preterm birth. / Morgan, Terry K.; Tolosa, Jorge E.; Mele, Lisa; Wapner, Ronald J.; Spong, Catherine Y.; Sorokin, Yoram; Dudley, Donald J.; Peaceman, Alan M; Mercer, Brian M.; Thorp, John M.; O'sullivan, Mary Jo; Ramin, Susan M.; Rouse, Dwight J.; Sibai, Baha.

In: Journal of Maternal-Fetal and Neonatal Medicine, Vol. 26, No. 7, 01.05.2013, p. 647-653.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Placental villous hypermaturation is associated with idiopathic preterm birth

AU - Morgan, Terry K.

AU - Tolosa, Jorge E.

AU - Mele, Lisa

AU - Wapner, Ronald J.

AU - Spong, Catherine Y.

AU - Sorokin, Yoram

AU - Dudley, Donald J.

AU - Peaceman, Alan M

AU - Mercer, Brian M.

AU - Thorp, John M.

AU - O'sullivan, Mary Jo

AU - Ramin, Susan M.

AU - Rouse, Dwight J.

AU - Sibai, Baha

PY - 2013/5/1

Y1 - 2013/5/1

N2 - Objective: Pregnancy complications such as intra-amniotic infection, preeclampsia, and fetal intrauterine growth restriction (IUGR) account for most cases of preterm birth (PTB), but many spontaneous PTB cases do not have a clear etiology. We hypothesize that placental insufficiency may be a potential cause of idiopathic PTB. Methods: Secondary analysis of 82 placental samples from women with PTB obtained from a multicenter trial of repeat versus single antenatal corticosteroids. Samples were centrally reviewed by a single placental pathologist masked to clinical outcomes. The histopathologic criterion for infection was the presence of acute chorioamnionitis defined as neutrophils marginating into the chorionic plate. Placental villous hypermaturation (PVH) was defined as a predominance of terminal villi (similar to term placenta) with extensive syncytial knotting. Idiopathic PTB comprised a group without another known etiology such as preeclampsia, IUGR or infection. Results: Acute chorioamnionitis was observed in 33/82 (40%) cases. Other known causes of PTB were reported in 18/82 (22%). The remaining 31/82 (38%) were idiopathic. The frequency of PVH in idiopathic PTB (26/31=84%) was similar to cases with IUGR or preeclampsia (16/18=89%), but significantly more common than PVH in the group with acute chorioamnionitis (10/33=30%) (p<0.001). Conclusions: PVH, which is a histologic marker of relative placental insufficiency, is a common finding in idiopathic PTB.

AB - Objective: Pregnancy complications such as intra-amniotic infection, preeclampsia, and fetal intrauterine growth restriction (IUGR) account for most cases of preterm birth (PTB), but many spontaneous PTB cases do not have a clear etiology. We hypothesize that placental insufficiency may be a potential cause of idiopathic PTB. Methods: Secondary analysis of 82 placental samples from women with PTB obtained from a multicenter trial of repeat versus single antenatal corticosteroids. Samples were centrally reviewed by a single placental pathologist masked to clinical outcomes. The histopathologic criterion for infection was the presence of acute chorioamnionitis defined as neutrophils marginating into the chorionic plate. Placental villous hypermaturation (PVH) was defined as a predominance of terminal villi (similar to term placenta) with extensive syncytial knotting. Idiopathic PTB comprised a group without another known etiology such as preeclampsia, IUGR or infection. Results: Acute chorioamnionitis was observed in 33/82 (40%) cases. Other known causes of PTB were reported in 18/82 (22%). The remaining 31/82 (38%) were idiopathic. The frequency of PVH in idiopathic PTB (26/31=84%) was similar to cases with IUGR or preeclampsia (16/18=89%), but significantly more common than PVH in the group with acute chorioamnionitis (10/33=30%) (p<0.001). Conclusions: PVH, which is a histologic marker of relative placental insufficiency, is a common finding in idiopathic PTB.

KW - Chorioamnionitis

KW - Histology

KW - Idiopathic preterm labor

KW - Placenta

KW - Tenney-Parker change

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U2 - 10.3109/14767058.2012.746297

DO - 10.3109/14767058.2012.746297

M3 - Article

VL - 26

SP - 647

EP - 653

JO - Journal of Maternal-Fetal and Neonatal Medicine

JF - Journal of Maternal-Fetal and Neonatal Medicine

SN - 1476-7058

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