Maternal vascular malperfusion in spontaneous preterm birth placentas related to clinical outcome of subsequent pregnancy

Abstract

Introduction

Spontaneous preterm birth (SPTB) has several causes and its pathophysiology remains unclear. In a significant proportion of SPTB, placental histology shows signs of maternal vascular malperfusion (MVM); commonly associated with hypertensive disorders of pregnancy (HD), fetal growth restriction (FGR) and placental abruption, together referred to as clinical ischemic placental diseases (IPD). We hypothesized that women with SPTB and placental MVM are at elevated risk for IPD in a subsequent pregnancy.

Methods

We included women with SPTB in our cohort and followed the subsequent ongoing pregnancy (n = 110). Histological placental characteristics in the index were reported according to new international guidelines, and related to the clinical outcome of the subsequent pregnancy.

Results

In the SPTB placentas, we observed MVM in 61.8% (n = 68). In the subsequent pregnancies in 19.1% (n = 21) at least one clinical sign of IPD was present (HD (12.7%), FGR (5.5%) or placental abruption (0.9%)). There was no significant difference in the prevalence of clinical IPD or recurrence of SPTB in the subsequent pregnancy between women with and without placental MVM in the index pregnancy, although our study was not powered to detect small differences.

Discussion

Women with a history of SPTB have an elevated risk of IPD in the subsequent pregnancy. MVM is present in a large proportion of SPTB placentas. The presence of placental MVM in the index pregnancy does not predict clinical IPD or recurrent SPTB in a subsequent pregnancy.

Keywords:

• Ischemic placental disease
• maternal vascular malperfusion (MVM)
• placental insufficiency
• preterm birth (PTB)
• preterm labor
• spontaneous preterm birth (SPTB)

Author contributions

MdB, PvdV, and LV were involved in the conception and design of the study. PvdV performed the histological examination with assistance of HvB. LH and LV analyzed the data. LV and MdB drafted the manuscript. All authors edited the manuscript and read and approved the final version of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.