Placental Vascular Pathology Findings and Pathways to Preterm Delivery

Abstract

The authors examined the associations between placental vascular findings and preterm delivery in 1,053 subcohort women (239 preterm, 814 term) from a Michigan pregnancy cohort study (1998-2004). Twenty-nine placental vascular variables from microscopic examinations were grouped into 5 constructs: 3 maternal constructs-obstructive lesions (MV-O), bleeding/vessel integrity (MV-I), and lack of physiologic conversion of maternal spiral arteries (MV-D)--and 2 fetal constructs--obstructive lesions (FV-O) and bleeding/vessel integrity (FV-I). Construct-specific scores were created by adding the number of positive findings and deriving a dichotomous variable to approximate the top quintile ("high") and bottom 4 quintiles ("not high") within each construct. In multivariate polytomous logistic regression models, medically indicated preterm delivery at <35 weeks was significantly associated with high scores for each of the vascular constructs; adjusted odds ratios ranged from 2.4 to 5.4. Spontaneous preterm delivery at 35-36 weeks was significantly associated with a high score on any 1 of 3 constructs: MV-I, MV-D, and FV-I. Spontaneous preterm delivery at <35 weeks was significantly associated with a high score on 2 or more of 3 constructs: MV-I, MV-D, and FV-I; adjusted odds ratios ranged from 4.1 to 7.4. These results support a role for various placental vascular lesions in medically indicated and spontaneous preterm delivery.

Thermal skin reference values in healthy late pregnancy

“…Other complications include venous insufficiency, diagnosed using Laser Doppler or Ultrasonography, lumbar lordosis, identified using X-ray, and cramps, seen in Electromyography (Kaaja, 2009;Kelly et al, 2009). Maternal fever can result in intra-uterine hyperthermia and/or inflammation effects on the fetal brain, which may result on premature labor or ultimate fetal death (Laburn et al, 2003).…”

Maternal serum homocysteine and uterine artery pulsatility index as predictors of spontaneous preterm labor

“…Also, an in vitro study demonstrated that Hcy enhanced the rate of spontaneous contraction of myometrium isolated from human pregnant uterus. [6,9,17] The current study showed that serum Hcy level is a supportive biomarker for prediction of preterm birth. However, there are no available persuasive findings derived from larger studies for comparison because Hcy has not been extensively evaluated in biomarker trials of complicated pregnancies other than preeclampsia.…”

“…This supports the possibility of vasculopathy role in initiation of preterm labor. [6] The current study was designed to investigate the uterine artery Doppler and the maternal serum Hcy concentrations as indirect predictors of sPTD among pregnant women hospitalized with threatened preterm labor.…”

Clinico-anamnestic data and pathomorphological features of placentas in fetal growth restriction in women with chronic hypertension and secondary preeclampsia

“…С нарушени-ем ремоделирования спиральных артерий связано и раз-витие диагностированных нами в плацентах родильниц 1-й группы хронических геморрагических инфарктов с центральной локализацией и суммарной площадью более 33%. Наряду с расстройствами материнского кровообра-щения, ЗРП при ХАГ с присоединившейся ПЭ была свя-зана с виллузитом промежуточных и терминальных вор-син и с последующей гиповаскуляризацией их стромы, поскольку гестационная перестройка сосудистого компо-нента терминальных отделов ворсинчатого дерева, начи-ная с 27-й недели гестации, играет важную роль в обеспе-чении прироста массы плода [16][17][18]. С неполноценной сосудистой перестройкой в ворсинчатом хорионе, воспа-лением и низким гестационным сроком плацент связано и недоразвитие в них компенсаторных процессов в группе пациенток с ЗРП, что в сочетании с хроническими гемор-рагическими инфарктами и нарушением дифференци-ровки сосудисто-стромального компонента ворсин со-ставляет структурную основу хронической плацентарной недостаточности при ЗРП у женщин с ХАГ и присоеди-нившейся ПЭ.…”