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Hypertensive disease, preterm birth, fetal growth restriction and chronic inflammatory disorders of the placenta: experiences in a single institution with a standardized protocol of investigation

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Chronic inflammatory disorders of the placenta, in particular villitis of unknown etiology (VUE), chronic deciduitis (CD), chronic chorioamnionitis (CC), chronic histiocytic intervillositis (CHI), and eosinophilic/T-cell chorionic vasculitis (ETCV) can exclusively be diagnosed histologically. Using a standardized procedure for submission and pathological–anatomical examination of placentas in a single perinatal care center, we analyzed the association of chronic placental lesions to perinatal complications.

Methods

We reviewed all singleton placentas and miscarriages that were examined histologically over a period of ten years after having implemented a standardized protocol for placental submission in our hospital. Cases with chronic inflammatory lesions were identified, and clinical data were analyzed and compared with a focus on preterm birth, hypertensive disorders, and fetal growth restriction and/or fetal demise.

Results

In 174 placentas, at least one of the chronic inflammatory entities was diagnosed. CD was the most frequent disorder (n = 95), and had strong associations with preterm birth (47.3% of all cases with CD) and intrauterine fetal demise. VUE (n = 74) was exclusively diagnosed in the third trimester. This disorder was associated with a birth weight below the 10th percentile (45% of the cases) and hypertensive disease in pregnancy. Miscarriage and intrauterine fetal demise were associated with CHI (in 66.7% of cases, n = 18).

Conclusions

Chronic inflammatory disorders are frequently observed and contribute to major obstetric and perinatal complications. Further studies are needed to get a better picture of the connection between adverse obstetric outcomes and chronic inflammation to aid in the better counseling of patients.

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Availability of data and material

The datasets generated are available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank Dr Cora Hallas for language editing.

Funding

There was no funding for this study.

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Authors and Affiliations

  1. Department of Pathology, Diakonissenkrankenhaus Flensburg, Knuthstraße 1, 24939, Flensburg, Germany

    Henning Feist

  2. Department of Obstetrics and Gynecology, Diakonissenkrankenhaus Flensburg, Flensburg, Germany

    Simin Bajwa

  3. Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Kiel, Germany

    Ulrich Pecks

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Contributions

All authors contributed to the study conception and design. Pathological–anatomical placental examination was done by HF. Data collection and analysis were performed by HF, SB and UP. The first draft of the manuscript was written by HF, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Henning Feist.

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The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki. This study protocol was conducted retrospectively from data obtained for clinical purposes. All procedures performed were in accordance with the ethical standards of the Ethics committee of the Schleswig-Holstein Physicians` chamber (reference number 021/20 I).

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Feist, H., Bajwa, S. & Pecks, U. Hypertensive disease, preterm birth, fetal growth restriction and chronic inflammatory disorders of the placenta: experiences in a single institution with a standardized protocol of investigation. Arch Gynecol Obstet 306, 337–347 (2022). https://doi.org/10.1007/s00404-021-06293-3

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