title: Placental lesions associated with acute atherosis.
abstract: OBJECTIVE
  Acute atherosis is a lesion of the spiral arteries characterized by fibrinoid necrosis of the vessel wall, an accumulation of fat-containing macrophages, and a mononuclear perivascular infiltrate, which can be found in patients with preeclampsia, fetal death, small-for-gestational age, spontaneous preterm labor/premature prelabor rupture of membrane, and spontaneous mid-trimester abortion. This lesion is thought to decrease blood flow to the intervillous space which may lead to other vascular lesions of the placenta. The objective of this study was to test whether there is an association between acute atherosis and placental lesions that are consistent with maternal vascular underperfusion (MVU), amniotic fluid infection (AFI), fetal vascular thrombo-occlusive disease (FVTOD) or chronic inflammation.
  
  
  METHODS
  A retrospective cohort study of pregnant women who delivered between July 1998 and July 2014 at Hutzel Women's Hospital/Detroit Medical Center was conducted examine 16 457 placentas. The frequency of placenta lesions (diagnosed using the criteria of the Perinatal Section of the Society for Pediatric Pathology) was compared between pregnancies with and without acute atherosis.
  
  
  RESULTS
  Among 16 457 women who were enrolled, 10.2% (1671/16 457) were excluded, leaving 14 786 women who contributed data for analysis. Among them, the prevalence of acute atherosis was 2.2% (326/14 786). Women with acute atherosis were more than six times as likely as those without to have placental lesions consistent with maternal underperfusion (adjusted odds ratio - aOR: 6.7; 95% CI 5.2-8.6). To a lesser degree, acute atherosis was also associated with greater risks of having either lesions consistent with FVTOD (aOR 1.7; 95% CI 1.2-2.3) or chronic chorioamnionitis (aOR 1.9; 95% CI 1.3-3), but not with other chronic inflammatory lesions, after adjusting for gestational age at delivery. In contrast, women with acute atherosis were 60% less likely to have lesions consistent with AFI, adjusting for gestational age at delivery (aOR 0.4; 95% CI 0.3-0.5).
  
  
  CONCLUSIONS
  Acute atherosis is associated with increased risks of having placental lesions consistent with MVU, and to a lesser extent, chronic chorioamnionitis and those consistent with FVTOD.
authors.affiliation: a Department of Pathology , Haeundae Paik Hospital, Inje University College of Medicine , Busan , Korea .
authors.forename: Yeon Mee
authors.initials: YM
authors.lastname: Kim
authors.forename: Piya
authors.initials: P
authors.lastname: Chaemsaithong
authors.forename: Roberto
authors.initials: R
authors.lastname: Romero
authors.forename: Majid
authors.initials: M
authors.lastname: Shaman
authors.forename: Chong Jai
authors.initials: CJ
authors.lastname: Kim
authors.forename: Jung-Sun
authors.initials: JS
authors.lastname: Kim
authors.forename: Faisal
authors.initials: F
authors.lastname: Qureshi
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Jacques
authors.forename: Ahmed I
authors.initials: AI
authors.lastname: Ahmed
authors.forename: Tinnakorn
authors.initials: T
authors.lastname: Chaiworapongsa
authors.forename: Sonia S
authors.initials: SS
authors.lastname: Hassan
authors.forename: Lami
authors.initials: L
authors.lastname: Yeo
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Korzeniewski
mesh_terms: D000208:Acute Disease; D000328:Adult; D002821:Chorioamnionitis / Q000453:epidemiology / Q000473:pathology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007249:Inflammation / Q000453:epidemiology / Q000473:pathology; D009336:Necrosis; D010920:Placenta / Q000098:blood supply* / Q000473:pathology*; D010922:Placenta Diseases / Q000453:epidemiology / Q000473:pathology*; D011225:Pre-Eclampsia / Q000453:epidemiology / Q000473:pathology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology / Q000473:pathology; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000473:pathology; D012189:Retrospective Studies; D055988:Uterine Artery / Q000473:pathology*
keywords: Amniotic fluid infection; chronic chorioamnionitis; chronic villitis; fetal vascular thrombo-occlusive disease; ischemic placental disease; maternal anti-fetal rejection; maternal underperfusion; pregnancy