Impact of Co-Existing Placental Pathologies in Pregnancies Complicated by Placental Abruption and Acute Neonatal Outcomes

Abstract

Placental abruption (PA) is a concern for maternal and neonatal morbidity. Adverse neonatal outcomes in the setting of PA include higher risk of prematurity. Placental pathologies include maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM), acute chorioamnionitis, and villitis of unknown etiology (VUE). We aimed to investigate how placental pathology contributes to acute neonatal outcome in PA. A retrospective cohort study of all placentas with PA were identified. Exposures were MVM, FVM, acute chorioamnionitis and VUE. The primary outcome was NICU admission and the secondary outcomes included adverse base deficit and Apgar scores, need for resuscitation, and small-for-gestational age. A total of 287 placentas were identified. There were 160 (59.9%) of placentas with PA alone vs 107 (40.1%) with PA and additional placental pathologies. Odds of NICU admission were more than two times higher in pregnancies with placental pathologies (OR = 2.37, 95% CI 1.28–4.52). These estimates were in large part mediated by prematurity and birthweight, indirect effect acting through prematurity was OR 1.79 (95% CI 1.12–2.75) and through birthweight OR 2.12 (95% CI 1.40–3.18). Odds of Apgar score ≤ 5 was more than four times higher among pregnancies with placental pathologies (OR = 4.56, 95% CI 1.28–21.26). Coexisting placental pathology may impact Apgar scores in pregnancies complicated by PA. This knowledge could be used by neonatal teams to mobilize resources in anticipation of the need for neonatal resuscitation.

Impact of COVID-19 on Subclinical Placental Thrombosis and Maternal Thrombotic Factors

“…These could lead to clinical preeclampsia, preterm birth, fetal demise and fetal growth restriction [ 8 ]. Furthermore, placental pathology was associated with more severe neonatal outcomes, with a higher rate of admission to the NICU [ 31 ]. Nevertheless, a recent meta-analysis of 30 studies concluded that the incidence of vascular and inflammatory lesions was comparable to that of non-COVID-19 pregnancies, and there was no specific lesion associated with COVID-19 [ 32 ].…”

Diagnostic or Therapeutic Strategies for Pregnancy Complications

“…Women who had more severe placental lesions of maternal vascular malperfusion after preeclampsia had a three-fold increased risk of screening as high-risk for CVD compared to women without these lesions [ 3 ]. Interestingly, fetal health can also be investigated through placental pathology, where the odds of neonatal intensive care unit (NICU) admission were twice as high in pregnancies with placental pathologies in addition to placental abruption [ 4 ]. Furthermore, inflammation in the extra-placental membranes showed that the inflammatory milieu of amniotic fluid increases with chorio-deciduitis grade, but not amnionitis of these membranes [ 5 ].…”