Placental histopathology, maternal characteristics and neonatal outcome in cases of preterm birth in a high-risk population in South Africa

Abstract


 
 
 
 Background. Preterm birth remains a global health concern and is one of the most common pregnancy complications associated with perinatal morbidity and mortality.Objective. To investigate placental pathology and its associations with obstetric, maternal and neonatal outcomes in the Eastern Cape region of South Africa (SA) in order to help understand its associations with preterm birth in that region.
 Methods. In this prospective study, placentas were collected consecutively from patients attending a public tertiary referral hospital in SA, delivering preterm (n=100; 28 - 34 weeks gestational age) and term (n=20; >36 weeks gestational age). Placentas were submitted for histopathology, and comparisons with maternal characteristics and neonatal outcomes in preterm birth were undertaken.Results. Histological analysis revealed pathology in all preterm placentas (100%), with maternal vascular malperfusion (47%) and abruptio placentae (41%) most commonly identified. Acute chorioamnionitis (21%) was associated with term births (p=0.002). Maternal characteristics and neonatal outcomes significantly associated with preterm birth included pre-eclampsia (p=0.006), neonatal respiratory distress syndrome (p=0.004) and neonatal jaundice (p=0.003). Intrauterine demise (p=0.004) and alcohol abuse (p≤0.005) were significantly associated with term delivery. The number of mothers delivering preterm who were HIV-positive was high (41%).
 Conclusion. The pathology identified in all preterm placentas supports the need to update institutional policies for submission of placentas from all preterm births for histopathology, particularly in countries with a high burden of preterm birth.
 
 
 

Bacterial Diversity in Placentas from Complicated Pregnancies Using 16s rRNA Gene Sequencing

“…This indicates that preterm placentas have fewer microbial constituents within their microbiome. However, the higher alpha diversity in term placentas compared to preterm placentas, and higher alpha diversity in placentas with chorioamnionitis compared to those without CAM (P=0.0061) correlates with the higher incidence of CAM in term placentas compared to preterm placentas (P=0.002) [27]. Prince et al also found that chorioamnionitis was associated with lower alpha diversity in the placental membrane microbiome, although associated with preterm birth in their study [6].…”

“…All cases were evaluated histologically by a single pathologist using a standardized placental macroscopic evaluation protocol and histology template approved and validated by the NHLS laboratory. Prof CA Wright, anatomical pathologist, a specialist in placental histology, reviewed all the placenta specimens for this study and histopathology data was published in 2023 [27]. The pathologist was blinded to all information except gestational age and whether live-born or stillbirth.…”

“…The pathologist was blinded to all information except gestational age and whether live-born or stillbirth. Based on the macroscopic and microscopic data, a histological diagnosis was made according to the Amsterdam Consensus Classification System [26,27].…”