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

doi:10.3109/14767058.2012.746297

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

Obstetrics and Gynecology

Research output: Contribution to journal › Article › peer-review

59 Scopus citations

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 language	English (US)
Pages (from-to)	647-653
Number of pages	7
Journal	Journal of Maternal-Fetal and Neonatal Medicine
Volume	26
Issue number	7
DOIs	https://doi.org/10.3109/14767058.2012.746297
State	Published - May 2013

Funding

The authors report no declarations of interest other than the following finanacial support. Dr Morgan was funded by the Office of Research on Women’s Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Oregon BIRCWH: HD043488-08. This research was also supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) [HD21410, HD21414, HD27869, HD27917, HD27905, HD27860, HD27861, HD27915, HD34122, HD34116, HD34208, HD34136, HD40500, HD40485, HD40544, HD40545, HD40560, HD40512, HD36801] and M01-RR-000080 from the National Center for Research Resources (NCRR) and its content is solely the responsibility of the authors and does not necessarily represent the official views of the NICHD, the National Institutes of Health and the NCRR.

Keywords

Chorioamnionitis
Histology
Idiopathic preterm labor
Placenta
Tenney-Parker change

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health
Obstetrics and Gynecology

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10.3109/14767058.2012.746297

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Morgan, T. K., Tolosa, J. E., Mele, L., Wapner, R. J., Spong, C. Y., Sorokin, Y., Dudley, D. J., Peaceman, A. M., Mercer, B. M., Thorp, J. M., O'sullivan, M. J., Ramin, S. M., Rouse, D. J., & 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

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title = "Placental villous hypermaturation is associated with idiopathic preterm birth",

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.",

keywords = "Chorioamnionitis, Histology, Idiopathic preterm labor, Placenta, Tenney-Parker change",

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",

note = "Funding Information: The authors report no declarations of interest other than the following finanacial support. Dr Morgan was funded by the Office of Research on Women{\textquoteright}s Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Oregon BIRCWH: HD043488-08. This research was also supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) [HD21410, HD21414, HD27869, HD27917, HD27905, HD27860, HD27861, HD27915, HD34122, HD34116, HD34208, HD34136, HD40500, HD40485, HD40544, HD40545, HD40560, HD40512, HD36801] and M01-RR-000080 from the National Center for Research Resources (NCRR) and its content is solely the responsibility of the authors and does not necessarily represent the official views of the NICHD, the National Institutes of Health and the NCRR.",

year = "2013",

month = may,

doi = "10.3109/14767058.2012.746297",

language = "English (US)",

volume = "26",

pages = "647--653",

journal = "Journal of Maternal-Fetal and Neonatal Medicine",

issn = "1476-7058",

publisher = "Informa Healthcare",

number = "7",

}

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

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

N1 - Funding Information: The authors report no declarations of interest other than the following finanacial support. Dr Morgan was funded by the Office of Research on Women’s Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Oregon BIRCWH: HD043488-08. This research was also supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) [HD21410, HD21414, HD27869, HD27917, HD27905, HD27860, HD27861, HD27915, HD34122, HD34116, HD34208, HD34136, HD40500, HD40485, HD40544, HD40545, HD40560, HD40512, HD36801] and M01-RR-000080 from the National Center for Research Resources (NCRR) and its content is solely the responsibility of the authors and does not necessarily represent the official views of the NICHD, the National Institutes of Health and the NCRR.

PY - 2013/5

Y1 - 2013/5

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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JO - Journal of Maternal-Fetal and Neonatal Medicine

JF - Journal of Maternal-Fetal and Neonatal Medicine

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ER -

Placental villous hypermaturation is associated with idiopathic preterm birth

Abstract

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ASJC Scopus subject areas

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