The relationship between placental histopathology findings and perinatal outcome in preterm infants.
OBJECTIVE
To determine the correlation between placental histopathology findings and perinatal outcome in preterm infants.


METHODS
Placental histopathology in 774 neonates delivered at 24-32 weeks between 1992 and 2000 was classified as follows: 254 (33%) had histological chorioamnionitis, 263 (34%) had coagulation-related lesions, 228 (30%) had vasculopathy. Perinatal outcome was compared between cases positive and negative for each histopathological classification.


RESULTS
Histological chorioamnionitis occurred in 46% of cases with premature rupture of membranes and 45% with preterm labor. Positivity versus negativity for histological chorioamnionitis was associated with earlier presentation (191 vs. 205 days, p = 0.0001) and delivery (199 days vs. 209 days, p = 0.0001), increased risk of intraventricular hemorrhage (71% vs. 23%, p = 0.001, odds ratio (OR) 2.2), bronchopulmonary dysplasia (26% vs. 15%, p = 0.0001, OR 2), retinopathy (36% vs. 24%, p = 0.001, OR 1.8), neonatal sepsis (28% vs. 13%, p = 0.0001, OR 2.5) and neonatal death (12% vs. 7%, p = 0.012, OR 2). Vasculopathy versus no vasculopathy was associated with decreased birth weight (1245 g vs. 1341 g, p = 0.011), decreased Apgar score at 5 min (20% vs. 13%, p = 0.011, OR 1.7) and necrotizing enterocolitis (6% vs. 2%, p = 0.001, OR 4). Cases positive for coagulation-related lesions correlated only with necrotizing enterocolitis (5% vs. 2%, p = 0.02, OR 2.6).


CONCLUSIONS
The presence of histological chorioamnionitis significantly increases the risk of earlier delivery and neonatal mortality. Vascular and coagulation placental findings increase the risk of necrotizing enterocolitis.
Morristown Memorial Hospital, New Jersey, USA.
D
D
Ogunyemi
M
M
Murillo
U
U
Jackson
N
N
Hunter
B
B
Alperson
D001034:Apgar Score; D001724:Birth Weight; D001778:Blood Coagulation Disorders / Q000150:complications / Q000473:pathology; D002821:Chorioamnionitis / Q000150:complications / Q000473:pathology; D020345:Enterocolitis, Necrotizing / Q000209:etiology; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000209:etiology; D007234:Infant, Premature; D007752:Obstetric Labor, Premature / Q000209:etiology; D010920:Placenta / Q000098:blood supply / Q000473:pathology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D014652:Vascular Diseases / Q000150:complications / Q000473:pathology