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Histologic Chorioamnionitis in Pregnancies Complicated by Preeclampsia and the Effect on Neonatal Outcomes

  • Maternal Fetal Medicine/Biology: Original Article
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Abstract

Histological chorioamnionitis (HC) is a common placental finding that represents acute/chronic inflammation and can affect neonatal outcomes. We aimed to examine the effect of HC on neonatal outcomes in pregnancies complicated by preeclampsia. All pregnancies with the diagnosis of preeclampsia at 24–42 weeks between 2008 and 2019 were reviewed. Placental lesions were classified according to the “Amsterdam” criteria. Composite adverse neonatal outcome included ≥1 early complication. Maternal and neonatal outcomes were compared between cases with and without HC. Multivariable regression analysis was performed to identify independent associations with adverse neonatal outcome. Compared to preeclampsia without HC (n=517), preeclampsia with HC (n=55) was characterized by a more advanced gestational age (p<0.001) and a higher rate of nulliparity (p=0.02). Diabetes was more prevalent in preeclampsia without HC (p=0.039) as was a history of previous preeclampsia (p=0.048). Neonates in the preeclampsia with HC group had higher rates of adverse neonatal outcome (p<0.001) and Apgar scores <7 at 5 min (p=0.034) despite a higher birthweight (p=0.005). Preeclampsia without HC was associated with smaller placentas and a higher rate of placental maternal vascular malperfusion lesions (p=0.014 and p<0.001 respectively). By multivariate analysis, gestational age and HC were independently associated with adverse neonatal outcome (aOR 0.88 95% CI 0.76–0.96, and aOR 1.33, 95% CI 1.11–3.09, respectively). In preeclampsia, concomitant HC was associated with adverse neonatal outcome despite a more advanced gestational age and higher neonatal birthweight. This inflammatory mechanism probably plays a role in a more severe subgroup of preeclampsia cases, causing an additional risk for the developing fetus.

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Abbreviations

PE:

Preeclampsia

HC:

Histological chorioamnionitis

MVM:

maternal vascular malperfusion

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Author notes

  1. Michal Levy and Liat Mor contributed equally to this work.

Authors and Affiliations

  1. Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Holon, Israel

    Michal Levy, Liat Mor, Michal Kovo, Tal Marfogel, Jacob Bar & Eran Weiner

  2. Department of Pathology, The Edith Wolfson Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Holon, Israel

    Letizia Schreiber

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  1. Michal Levy
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Correspondence to Liat Mor.

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Ethical approval was waived by the local Ethics Committee (approval number: 0042-10-WOMC) in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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Levy, M., Mor, L., Kovo, M. et al. Histologic Chorioamnionitis in Pregnancies Complicated by Preeclampsia and the Effect on Neonatal Outcomes. Reprod. Sci. 28, 2029–2035 (2021). https://doi.org/10.1007/s43032-021-00469-7

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