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Placental Histopathology and Pregnancy Outcomes in “Early” vs. “Late” Placental Abruption

Reproductive Sciences volume 28, pages 351–360 (2021)Cite this article

Abstract

Placenta-associated pregnancy complications (fetal growth restriction and preeclampsia) are traditionally classified as “early” and “late” due to their different pathophysiology, histopathology, and pregnancy outcomes. As placental abruption (PA) represents another placenta-associated complication, we aimed to study if this categorization can be applied to PA as well. Pregnancy and placental reports of all pregnancies complicated by PA between November 2008 and January 2019 were reviewed. Maternal background, pregnancy outcomes, and placental histopathology were compared between cases of PA < 34 weeks (early PA group) vs. > 34 weeks (late PA group). Placental lesions were classified according to the “Amsterdam” criteria. The primary outcome was severe neonatal morbidity (≥ 1 severe neonatal complications: seizures, IVH, HIE, PVL, blood transfusion, NEC, or death). Included were 305 cases of PA, 71 (23.3%) in the early group and 234 (76.7%) in the late group. The early PA group was characterized by higher rates of vaginal bleeding upon presentation (p = 0.003), DIC (p = 0.018), and severe neonatal morbidity (p < 0.001). The late PA group was characterized by a higher rate of urgent Cesarean deliveries (p < 0.001). The early PA group was characterized by higher rates of placental maternal vascular malperfusion (MVM) lesions (p < 0.001), maternal inflammatory response (MIR) lesions (p < 0.001), placental hemorrhage (p < 0.001), and a lower feto-placental ratio (p < 0.001). Using regression analysis, we found that severe neonatal morbidity was independently associated with early abruption (aOR = 5.3, 95% CI = 3.9–7.6), placental MVM (aOR = 1.5, 95% CI = 1.2–1.9), placental MIR (aOR = 1.9, 95% CI = 1.4–2.3), and inversely associated with antenatal corticosteroids (aOR = 0.9, 95% CI = 0.6–0.98). “Early” and “late” PA significantly differ in their presentation, placental pathology, and pregnancy outcomes.

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Affiliations

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

    Noa Gonen, Michal Levy, Michal Kovo, Lilach Kornblit Noy, Eldar Volpert, Jacob Bar & Eran Weiner

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

    Letizia Schreiber

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  1. Noa Gonen
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  2. Michal Levy
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Gonen, N., Levy, M., Kovo, M. et al. Placental Histopathology and Pregnancy Outcomes in “Early” vs. “Late” Placental Abruption. Reprod. Sci. 28, 351–360 (2021). https://doi.org/10.1007/s43032-020-00287-3

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Keywords

  • Placental abryption
  • Placental pathology
  • Malperfusion
  • Neonatal outcome