Clinical correlations of patterns of placental pathology in preterm pre-eclampsia

doi:10.1016/S0143-4004(98)90100-X

Placenta

Volume 19, Issue 1, January 1998, Pages 67-72

https://doi.org/10.1016/S0143-4004(98)90100-X Get rights and content

Abstract

The objective of this study was to determine if placental histopathology patterns are associated with clinical features of preterm pre-eclampsia. A 1989–1993 database of consecutive non-anomalous singleton livebirths delivered at 22–32 weeks gestation excluding cases of maternal diabetes mellitus and chronic hypertension included 74 cases of pre-eclampsia. Placentae were scored for uteroplacental vascular lesions and lesions of chronic inflammation and coagulation. Thirteen lesion patterns identified by factor analysis were studied in relation to the clinical features. Severe maternal proteinuria was related to placental chronic inflammation, while lower maternal antepartum platelet counts were related to placental abruption and infarct. Lower birthweight percentile and lighter placentae were related directly to uteroplacental vascular lesions. Diagnosis of HELLP and coagulopathy were less common when chronic inflammation scores were high. Serologic studies related to autoimmunity and maternal blood pressures were unrelated to placental histopathology factors. It is concluded that features of maternal and fetal compromise in preterm pre-eclampsia are related to placental histopathology patterns.

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Cited by (95)

Latent class analysis of placental histopathology: a novel approach to classifying early and late preterm births
2022, American Journal of Obstetrics and Gynecology
Citation Excerpt :
Various approaches have previously classified PTBs by patterns of histopathologic features. Previous approaches have been based on anticipated groupings of histopathology (eg, inflammatory or vascular impairment) using correlative measures, factor analysis, and predefined groups based on expert opinion.12–15 These methods may presuppose placental pathology groups, miss key histopathologic features and/or lack strong associations with clinical outcomes.
Neonatal morbidity attributable to prematurity predominantly occurs among early preterm births (<32 weeks) rather than late preterm births (32 to <37 weeks). Methods to distinguish early and late preterm births are lacking given the heterogeneity in pathophysiology and risk factors, including maternal obesity. Although preterm births are often characterized by clinical presentation (spontaneous or clinically indicated), classifying deliveries by placental features detected on histopathology reports may help identify subgroups of preterm births with similar etiology and risk factors. Latent class analysis is an empirical approach to characterize preterm births on the basis of observed combinations of placental features.
To identify histopathologic markers that can distinguish early (<32 weeks) and late preterm births (32 to <37 weeks) that are also associated with maternal obesity and neonatal outcomes.
Women with a singleton preterm birth at University of Pittsburgh Medical Center Magee-Womens Hospital (Pittsburgh, PA) from 2008 to 2012 and a placental evaluation (89% of preterm births) were stratified into early (n=900, 61% spontaneous) and late preterm births (n=3362, 57% spontaneous). Prepregnancy body mass index was self-reported at first prenatal visit and 16 abstracted placental features were analyzed. Placental subgroups (ie, latent classes) of early and late preterm births were determined separately by latent class analysis of placental features. The optimal number of latent classes was selected by comparing fit statistics. The probability of latent class membership across prepregnancy body mass indexes was estimated in early preterm births and in late preterm births by an extension of multinomial regression called pseudo-class regression, adjusting for race, smoking, education, and parity. The frequencies of severe neonatal morbidity (composite outcome: respiratory distress, bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, periventricular leukomalacia, patent ductus arteriosus, and retinopathy of prematurity), small-for-gestational-age, and length of neonatal intensive care unit stay were compared across latent classes by chi-square and Kruskal-Wallis tests.
Early preterm births were grouped into 4 latent classes based on placental histopathologic features: acute inflammation (38% of cases), maternal vascular malperfusion with inflammation (29%), maternal vascular malperfusion (25%), and fetal vascular thrombosis with hemorrhage (8%). As body mass index increased from 20 to 50kg/m², the probability of maternal vascular malperfusion and fetal vascular thrombosis with hemorrhage increased, whereas the probability of maternal vascular malperfusion with inflammation decreased. There was minimal change in the probability of acute inflammation with increasing body mass index. Late preterm births also had 4 latent classes: maternal vascular malperfusion (22%), acute inflammation (12%), fetal vascular thrombosis with hemorrhage (9%), and low-risk pathology (58%). Body mass index was not associated with major changes in likelihood of the latent classes in late preterm births. Associations between body mass index and likelihood of the latent classes were not modified by type of delivery (spontaneous or indicated) in early or late preterm births. Maternal malperfusion and fetal vascular thrombosis with hemorrhage were associated with greater neonatal morbidity than the other latent classes in early and late preterm births.
Obesity may predispose women to early but not late preterm birth through placental vascular impairment. Latent class analysis of placental histopathologic data provides an evidence-based approach to group preterm births with shared underlying etiology and risk factors.
Pregnancy outcomes in correlation with placental histopathology in subsequent pregnancies complicated by preeclampsia
2019, Pregnancy Hypertension
Citation Excerpt :
Impaired early placentation and dysfunctional trophoblast development leading to defective placental angiogenesis has been one of the primary mechanisms suggested [7,8]. Defective placentation resulting in maternal vascular malperfusion (MVM) and fetal vascular malperfusion (FVM) lesions is more profound as the clinical course of the disease is more severe [9,10]. We recently published that MVM and FVM lesions are independently associated with increased risk for recurrence of preeclampsia [11].
In attempt to deepen our understanding of the etiopathogenesis of preeclampsia we aimed to study the placental component and pregnancy outcomes in two consecutive pregnancies complicated by preeclampsia in the same patient.
Pregnancy and placental reports of all pregnancies complicated by preeclampsia between 2008 and 2018 were reviewed. Included were only cases with recurrent preeclampsia in two consecutive pregnancies Neonatal outcomes and placental histopathology were compared between the first preeclampsia delivery (first preeclampsia group) and the subsequent preeclampsia delivery (subsequent preeclampsia group), thus each subject served as her own control in two consecutive pregnancies. Placental lesions were classified according to the current “Amsterdam” criteria. Adverse neonatal outcome was defined as ≥1 early neonatal complication.
Included in the study a total of 83 cases with recurrent preeclampsia. The first preeclampsia group delivered at an earlier gestational age (35.7 ± 3.7 vs. 36.8 ± 3.1 weeks, p = 0.03) and had higher rates of severe features (44.6% vs. 25.3%, p = 0.03), placental weight <10th percentile (44.5% vs. 26.5%, p = 0.02), maternal vascular malperfusion (MVM) lesions (84.3% vs. 62.6%, p = 0.002), SGA (44.5% vs. 33.7%, p = 0.03), and adverse neonatal outcome (55.4% vs. 34.9%,p = 0.01), compared to the subsequent preeclampsia group. Using multivariate logistic regression analysis, severe features (aOR = 1.36, 95%CI = 1.12–2.36), MVM lesions (aOR = 1.12, 95%CI = 1.04–1.87) and adverse neonatal outcome (aOR = 1.26 95%CI = 1.14–2.23) were found to be independently associated with the first preeclampsia group.
The first event of preeclampsia is characterized by an earlier, more severe presentation, as well as a higher rate of MVM lesions, SGA, and adverse neonatal outcome, compared to preeclampsia in a subsequent pregnancy.
The role of placental malperfusion in the pathogenesis of preeclampsia in dichorionic twin and singleton pregnancies
2018, Placenta
Citation Excerpt :
Our main findings are as follows: (1) HDP in dichorionic-twin pregnancies is significantly less likely to be associated with placental MVM pathology and, to a lesser degree, with fetal vascular malperfusion pathology when compared to HDP in singletons; (2) This difference in the rate and severity of MVM pathology was observed in women with either PE or GHTN and remained significant in the subpopulations of women with early onset HDP and in HDP pregnancies complicated by SGA; and (3) These histopathological differences may contribute to the lower rate of prematurity and of SGA observed in the current study in twin pregnancies with HDP compared with singleton pregnancies with HDP. In singleton pregnancies, the pathogenesis of HDP is most commonly attributed to abnormal placentation which subsequently results in chronic uteroplacental hypoperfusion [10–18,27,33,41–43]. In twin gestations, the increased risk for HDP has thus far been attributed to either relative placental hypoperfusion (similar to what is observed in singleton, although the cause for placental hypoperfusion is the increased placenta mass rather than abnormal placentation) or to enhanced abnormal production of antiangiogenic proteins simply due to the greater amount of trophoblast tissue in twin pregnancies [24,25].
In singletons, the pathogenesis of hypertensive disorders of pregnancy (HDP) is attributed to abnormal placentation, characterized by maternal vascular malperfusion (MVM) lesions. Whether MVM plays a similar role in twin pregnancies is unclear. The purpose of the study was to compared placental pathology findings between dichorionic-twin and singleton pregnancies complicated by HDP.
Retrospective cohort study of women with dichorionic-twin or singleton pregnancies complicated by HDP who gave birth in a single tertiary center between 2001 and 2015. Placental abnormalities were classified into lesions associated with MVM, fetal vascular malperfusion, placental hemorrhage and chronic villitis. Placental findings and neonatal outcomes were compared between twin and singleton pregnancies.
A total of 144 women with twins and 768 women with a singleton pregnancy met the inclusion criteria. Compared with HDP singletons, twins with HDP had higher mean birth weights, were less likely to be small for gestational age and be born at <34 and at <32 weeks. Twins had lower odds for placental weight below <10th percentile (aOR 0.49, 95%CI 0.33–0.71), for MVM pathology (aOR 0.28, 95%CI 0.20–0.39) and for fetal vascular malperfusion pathology (aOR 0.65, 95%CI 0.45–0.93). These finding remained significant in the subpopulation of early onset HDP (<34 weeks) and small for gestational newborn.
Our findings support the hypothesis that MVM are less relevant to the pathogenesis of HDP in twin pregnancies and suggest that other placental or non-placental factors are responsible for the increased risk of HDP in twin pregnancies.
Pregnancy and the Kidney
2017, Textbook of Nephro-Endocrinology
If the kidney and the placenta can be viewed as an endocrine organ and pregnancy as a unique endocrine condition, then kidney disease during pregnancy represents a distinct set of clinical challenges for both the nephrologist and the endocrinologist. This chapter will detail with the major renal physiological changes during pregnancy, clinical features and pathogenesis of preeclampsia, other causes of hypertension in pregnancy, and acute and chronic renal failure, as well as renal transplantation in pregnancy. The goal is to present relevant and recent developments in the understanding of mechanisms of renal disease and/or hypertension during pregnancy with the recognition of the multifaceted nature of these conditions.
Maternal cardiovascular disease after twin pregnancies complicated by hypertensive disorders of pregnancy: A population-based cohort study
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People whose singleton pregnancy is affected by hypertensive disorders of pregnancy (HDP) are at risk of future cardiovascular disease. It is unclear, however, whether this association can be extrapolated to twin pregnancies. We aimed to compare the association between HDP and future cardiovascular disease after twin and singleton pregnancies.
We conducted a population-based retrospective cohort study that included nulliparous people in Ontario, Canada, 1992–2017. We compared the future risk of cardiovascular disease among pregnant people from the following 4 groups: those who delivered a singleton without HDP (referent) and with HDP, and those who delivered twins either with or without HDP.
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In a twin pregnancy, HDP are weaker risk factors for postpartum cardiovascular disease than in a singleton pregnancy.
Nanotechnological approaches for the treatment of placental dysfunction: recent trends and future perspectives
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Original articleClinical correlations of patterns of placental pathology in preterm pre-eclampsia

Abstract

American Journal of Medicine

European Journal of Obstetrics Gynecology and Reproductive Biology

American Journal of Obstetrics and Gynecology

American Journal of Obstetrics and Gynecology

Human Pathology

American Journal of Obstetrics and Gynecology

American Journal of Obstetrics and Gynecology

American Journal of Obstetrics and Gynecology

International Journal of Gynecology and Obstetrics

Blood

The human placental villitides: a review of chronic intrauterine infection

Current Topics in Pathology

Antigenic relationships between placenta and kidney in humans

American Journal of Obstetrics and Gynecology

On the pathogenesis of placental infarcts in preeclampsia

Journal of Obstetrics and Gynaecology of the Commonwealth

Fetal growth retardation and the arteries of the placental bed

British Journal of Obstetrics and Gynecology

Original article
Clinical correlations of patterns of placental pathology in preterm pre-eclampsia