Neonatal outcomes following preterm birth classified according to placental features

Catov, Janet M.; Scifres, Christina; Caritis, Steve N.; Bertolet, Marnie; Larkin, Jacob; Parks, W. Tony

doi:10.1016/j.ajog.2016.12.022

Cited by 110 publications

(69 citation statements)

References 53 publications

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“…PTB is the single major cause of death and disability in children up to 5 years of age in the developed world and the leading single cause of global perinatal mortality and morbidity 3– 5 ; approximately 15 million babies are born preterm each year worldwide, and a million of these children die 5, 6 . Preterm infants are also at significantly greater risk of serious perinatal complications 7– 10 . While many children born preterm lead a normal and healthy life, a significant proportion experience life-long disability and health issues 11 .…”

Section: Introductionmentioning

confidence: 99%

“…Many different causes of spontaneous PTB (sPTB) have been identified, the most common of which in singleton pregnancies are likely to be intrauterine inflammation (IUI)/intrauterine infection, placental malperfusion, or other placental abnormalities 1, 2, 7, 13, 14 . Inflammation appears to be a common mechanism underpinning multiple aetiologies 15– 17 .…”

Section: Introductionmentioning

confidence: 99%

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Recent advances in the prevention of preterm birth

Keelan

Newnham

2017

F1000Res

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Preterm birth (PTB) remains a major obstetric healthcare problem and a significant contributor to perinatal morbidity, mortality, and long-term disability. Over the past few decades, the perinatal outcomes of preterm neonates have improved markedly through research and advances in neonatal care, whereas rates of spontaneous PTB have essentially remained static. However, research into causal pathways and new diagnostic and treatment modalities is now bearing fruit and translational initiatives are beginning to impact upon PTB rates. Successful PTB prevention requires a multifaceted approach, combining public health and educational programs, lifestyle modification, access to/optimisation of obstetric healthcare, effective prediction and diagnostic modalities, and the application of effective, targeted interventions. Progress has been made in some of these areas, although there remain areas of controversy and uncertainty. Attention is now being directed to areas where greater gains can be achieved. In this mini-review, we will briefly and selectively review a range of PTB prevention strategies and initiatives where progress has been made and where exciting opportunities await exploitation, evaluation, and implementation.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Recent advances in the prevention of preterm birth

Keelan

Newnham

2017

F1000Res

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“…It is defined as inflammation of the chorion, amnion and placenta, and robust presence of polymorphonuclear leukocytes (PMNs), amnion basement membrane thickening and chorionic microabscesses (60, 146, 232, 265, 266). Often, CHORIO co-occurs with decidual vasculopathy, villous infarction, and increased perivillous and intervillous fibrin deposition (267). Significantly, CHORIO affects placental permeability and blood flow (267), facilitating HI and transmission of inflammation to fetuses of all gestational ages (262).…”

Section: Clinical Presentation Of Choriomentioning

confidence: 99%

“…Often, CHORIO co-occurs with decidual vasculopathy, villous infarction, and increased perivillous and intervillous fibrin deposition (267). Significantly, CHORIO affects placental permeability and blood flow (267), facilitating HI and transmission of inflammation to fetuses of all gestational ages (262). With histological signs of CHORIO present in as many as 42% of placentas from unremarkable pregnancies (261,262), it is paramount that greater understanding of the role of sterile and non-sterile placental inflammation in pregnancy be ascertained.…”

Section: Clinical Presentation Of Choriomentioning

confidence: 99%

The Unifying Effects of Maternal-Placental-Fetal Axis Dysregulation on Neurodevelopment Following Infectious and Toxic In Utero Insults

Yellowhair¹,

Oppong²,

Maxwell³

et al. 2017

MRAJ

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Homeostasis during pregnancy and in the in utero environment is essential for prenatal development. Prenatal maturation is hallmarked by an orchestrated and rigorous developmental program characterized by critical cascades in multiple organ systems. During these critical periods of development, however, potential vulnerability to injury exists throughout pregnancy. Indeed, the developing central nervous system (CNS) is extremely vulnerable to environmental insults throughout the entirety of gestation. These insults can adversely affect the developing brain and spinal cord, and permanently alter the neurodevelopmental trajectory. Specifically, in utero insults and dysregulation of the maternal-placentalfetal axis can change molecular, cellular, structural, and functional development of the CNS, culminating in adverse outcomes and neurological disorders throughout postnatal life. In this review, we will discuss common infectious and toxin-induced in utero insults that have recently garnered attention, including Zika virus, prenatal opioid and alcohol exposure, and chorioamnionitis. The goals are to identify common pathophysiological mechanisms, to emphasize the urgent need for new diagnostic tools, and to promote a broader understanding of the diverse array of neurological outcomes presenting in these children throughout their lifespan. With an increasing number of infants exposed to in utero infections and toxins, and the expanding public health awareness of the consequences of Zika infection, the opioid crisis, alcohol consumption during pregnancy, and the frequency of preterm birth in the United States, familiarity with the underlying mechanisms of each of these insults is paramount to improve the diagnosis and treatment for this exceedingly vulnerable patient population.

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“…Indicated preterm births are dominantly related to clinical conditions such as preeclampsia and fetal growth restriction, and placental lesions evidencing maternal malperfusion are more commonly seen in these cases, or those that are spontaneous but after 28 weeks [9,10]. Examination of the placenta can therefore provide useful information about the aetiology underlying threatened preterm labour and delivery.…”

Section: Introductionmentioning

confidence: 99%

Placental inflammation and its relationship to cervicovaginal fetal fibronectin in preterm birth

Krogt¹,

Ridout

Seed

et al. 2017

European Journal of Obstetrics & Gynecology and Reproductiv

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words Main text word count: 1864 words Condensation: 25words:There is a significant association between a positive fetal fibronectin and inflammatory placental pathology. Infective morbidity may be increased in women with a raised quantitative fFN who deliver preterm. Short title: Placental inflammation and fFN in women who deliver preterm Abstract ObjectiveLate miscarriage and preterm birth are frequently thought to be associated with inflammation and infection, although in most cases the underlying cause of early delivery remains unknown. The placenta is the organ that links mother and fetus during pregnancy, and postnatal examination may provide useful information about pathophysiology.The relationship between placental pathological lesions and predictive markers of early delivery has not been explored. We sought to characterize preterm deliveries according to placental pathology and relate these to the performance of reliable predictive markers, fetal fibronectin and cervical length. Study DesignThis is a retrospective subanalysis from a larger prospective cohort study on sonographic cervical length, quantitative fetal fibronectin and risk of spontaneous preterm birth. Our cohort was comprised of high-risk asymptomatic women attending the Prematurity Surveillance Clinic at St Thomas' Hospital between 2002 and 2015, who went on to have a late miscarriage or preterm delivery (16 to 36 +6 weeks') and who had available placental histology.The placental pathology of these preterm deliveries was characterized according to the lesions identified, and categorized (according to the Redman classification) into inflammatory (e.g. chorioamnionitis) or non-inflammatory (histologically normal or vascular lesions indicating e.g. malperfusion).We sought to relate placental findings to the performance of reliable predictive markers, in women who delivered early. Standard clinical cut offs for cervical length (< 25mm) and fetal fibronectin (>50 ng/mL) were used to identify the proportion of preterm births that were accurately predicted by the tests or who showed a false negative result, in relation to their placental histology findings. Binomial logistic regression was carried out to evaluate the relationship between placental inflammation, quantitative fFN and cervical length as continuous variables. Results105 women who had a late miscarriage or preterm delivery (16-36 +6 weeks') and available placenta pathology were identified. 66% (42/64) of those with inflammatory placental pathology had a positive fetal fibronectin swab result compared to 15% (6/41) of those with noninflammatory placental pathology (chi-squared 25.9, 95% CI 31.5 to 65.6, p<0.0001).A logistic regression model subanalysis of women in whom both CL and quantitative fFN results were available (n=66) revealed a highly statistically significant relationship with inflammatory placental lesions (p=0.003 and p=0.001 respectively). Placental inflammation was found to be associated with both increasing levels of fFN and a shortening cervix. ConclusionThere...

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Neonatal outcomes following preterm birth classified according to placental features

Abstract: Placental pathology provides important insight into subtypes of preterm birth with adverse neonatal outcomes. Co-occurrence of malperfusion and inflammation/infection, especially among spontaneous preterm births, may be a novel pattern of placental injury linked to severe adverse outcomes.

Cited by 110 publications

References 53 publications

Recent advances in the prevention of preterm birth

Recent advances in the prevention of preterm birth

The Unifying Effects of Maternal-Placental-Fetal Axis Dysregulation on Neurodevelopment Following Infectious and Toxic In Utero Insults

Placental inflammation and its relationship to cervicovaginal fetal fibronectin in preterm birth

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