title: Placental inflammation is associated with rural and remote residence in the Northern Territory, Australia: a cross-sectional study.
abstract: BACKGROUND
  The Northern Territory has the highest rates of perinatal morbidity and mortality in Australia. Placental histopathology has not been studied in this high-risk group of women.
  
  
  METHODS
  This is the first study to detail the placental pathology in Indigenous women and to compare the findings with non-Indigenous women in the Northern Territory. There were a total of 269 deliveries during a three-month period from the 27(th) of June to the 27(th) of August 2009. Seventy-one (71%) percent of all placentas were examined macroscopically, sectioned then reviewed by a Perinatal Pathologist, blinded to the maternal history and outcomes.
  
  
  RESULTS
  Indigenous women were found to have higher rates of histologically confirmed chorioamnionitis and or a fetal inflammatory response compared with non-Indigenous women (46% versus 26%; OR 2.4, 95% CI 1.3-4.5). In contrast, non-Indigenous women were twice as likely to show vascular related pathology (31% versus 14%; OR 2.77, 95% CI 1.3-5.9). Indigenous women had significantly higher rates of potentially modifiable risk factors for placental inflammation including genitourinary infections, anaemia and smoking. After adjusting for confounders, histological chorioamnionitis and fetal inflammatory response was significantly associated with rural or remote residence (Adjusted OR 2.5, 95% CI 1.08 - 5.8).
  
  
  CONCLUSIONS
  This study has revealed a complex aetiology underlying a high prevalence of placental inflammation in the Northern Territory. Placental inflammation is associated with rural and remote residence, which may represent greater impact of systemic disadvantage, particularly affecting Indigenous women in the Northern Territory.
authors.affiliation: Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Tiwi, Northern Territory, Australia. cecelia.obrien@adelaide.edu.au.|Discipline of Obstetrics and Gynaecology, The University of Adelaide, Women's and Children's Hospital, North Adelaide, 5006, South Australia, Australia. cecelia.obrien@adelaide.edu.au.
authors.forename: Cecelia M
authors.initials: CM
authors.lastname: O'Brien
authors.affiliation: Department of Anatomical Pathology, The Children's Hospital, Westmead, New South Wales, Australia. susan.arbuckle@health.nsw.gov.au.
authors.forename: Susan
authors.initials: S
authors.lastname: Arbuckle
authors.affiliation: Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Tiwi, Northern Territory, Australia. Sujatha.Thomas@nt.gov.au.
authors.forename: Sujatha
authors.initials: S
authors.lastname: Thomas
authors.affiliation: Department of Anatomical Pathology, Royal Darwin Hospital, Tiwi, Northern Territory, Australia. jurgen.rode@nt.gov.au.
authors.forename: Jurgen
authors.initials: J
authors.lastname: Rode
authors.affiliation: School of Public Health, University of Sydney, Sydney, New South Wales, Australia. r.turner@unsw.edu.au.
authors.forename: Robin
authors.initials: R
authors.lastname: Turner
authors.affiliation: School of Public Health, University of Sydney, Sydney, New South Wales, Australia. heather.jeffery@sydney.edu.au.
authors.forename: Heather E
authors.initials: HE
authors.lastname: Jeffery
mesh_terms: D000328:Adult; D000740:Anemia / Q000453:epidemiology / Q000208:ethnology; D002821:Chorioamnionitis / Q000453:epidemiology / Q000208:ethnology* / Q000473:pathology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D015876:Northern Territory / Q000453:epidemiology; D010920:Placenta / Q000473:pathology*; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000453:epidemiology / Q000208:ethnology; D015995:Prevalence; D060737:Reproductive Tract Infections / Q000453:epidemiology / Q000208:ethnology; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D012907:Smoking / Q000453:epidemiology / Q000208:ethnology; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000208:ethnology; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult