Placental histopathology, maternal characteristics and neonatal outcome in cases of preterm birth in a high-risk population in South Africa

Authors

  • K E Sprong Department of Biochemistry and Microbiology, Faculty of Science, Nelson Mandela University, Gqeberha, South Africa
  • C A Wright Lancet Laboratories, Johannesburg, South Africa, Division of Anatomical Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
  • M Mabenge Department of Obstetrics and Gynaecology, Dora Nginza Hospital, Walter Sisulu University, Gqeberha, South Africa
  • S Govender Department of Biochemistry and Microbiology, Faculty of Science, Nelson Mandela University, Gqeberha, South Africa

DOI:

https://doi.org/10.7196/SAMJ.2023.v113i4.16772

Keywords:

neonatal outcome, preterm birth

Abstract

Background. Preterm birth remains a global health concern and is one of the most common pregnancy complications associated with perinatal morbidity and mortality.
Objective. To investigate placental pathology and its associations with obstetric, maternal and neonatal outcomes in the Eastern Cape region of South Africa (SA) in order to help understand its associations with preterm birth in that region.

Methods. In this prospective study, placentas were collected consecutively from patients attending a public tertiary referral hospital in SA, delivering preterm (n=100; 28 - 34 weeks gestational age) and term (n=20; >36 weeks gestational age). Placentas were submitted for histopathology, and comparisons with maternal characteristics and neonatal outcomes in preterm birth were undertaken.
Results. Histological analysis revealed pathology in all preterm placentas (100%), with maternal vascular malperfusion (47%) and abruptio placentae (41%) most commonly identified. Acute chorioamnionitis (21%) was associated with term births (p=0.002). Maternal characteristics and neonatal outcomes significantly associated with preterm birth included pre-eclampsia (p=0.006), neonatal respiratory distress syndrome (p=0.004) and neonatal jaundice (p=0.003). Intrauterine demise (p=0.004) and alcohol abuse (p≤0.005) were significantly associated with term delivery. The number of mothers delivering preterm who were HIV-positive was high (41%).

Conclusion. The pathology identified in all preterm placentas supports the need to update institutional policies for submission of placentas from all preterm births for histopathology, particularly in countries with a high burden of preterm birth.

References

World Health Organization. New global estimates on preterm birth published 2018. Geneva: WHO, 2018. https://www.who.int/news-room/detail/17-11-2018-new-globalestimates-on-preterm-birth- published (accessed 3 December 2019).

Manuck TA, Rice MM, Bailit JL, et al. Preterm neonatal morbidity and mortality by gestational age: A contemporary cohort. Am J Obstet Gynecol 2016;215(1):103.e1-103.e14. https://doi.org/10.1016/j. ajog.2016.01.004.

Chawanpaiboon S, Vogel JP, Moller A-B, et al. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob Health 2019;7(1):e37- 46. http://doi.org/10.1016/s2214-109x(18)30451-0

Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008;371(9606):75-84. http://doi.org/10.1016/s0140-6736(08)60074-4

Gilman-Sachs A, Dambaeva S, Salazar Garcia MD, et al. Inflammation induced preterm labor and birth. J Reproduct Immunol 2018;129:53-58. http://doi.org/10.1016/j.jri.2018.06.029

Romero R, Dey SK, Fisher SJ. Preterm labor: One syndrome, many causes. Science 2014;345(6198):760- 765. http://doi.org/10.1126/science.1251816

Smith GCS, Shah I, Pell JP, et al. Maternal obesity in early pregnancy and risk of spontaneous and elective preterm deliveries: A retrospective cohort study. Obstetric Gynecol Survey 2007;62(5):299- 300. http://doi.org/10.1097/01.ogx.0000261695.08686.5c

Di Renzo GC, Giardina I, Rosati A, et al. Maternal risk factors for preterm birth: a country- based population analysis. Eur J Obstetr Gynecol Reproduc Biol 2011;159(2):342-346. http://doi. org/10.1016/j.ejogrb.2011.09.024

Matoba N, Mestan KK, Collins JW. Understanding racial disparities of preterm birth through the placenta. Clinical Therapeutics 2021;43(2):287-296. http://doi.org/10.1016/j.clinthera.2020.12.013

Redline RW, Faye-Petersen O, Heller D, et al. Amniotic infection syndrome: Nosology and

reproducibility of placental reaction patterns. Pediatr Development Pathol 2003;6(5):435-448. http://

doi.org/10.1007/s10024-003-7070-y

Min AM, Saito M, Simpson JA, et al. Placental histopathology in preterm birth with confirmed

maternal infection: A systematic literature review. PLOS One 2021;16(8):e0255902. http://doi.

org/10.1371/journal.pone.0255902

Brink LT, Roberts DJ, Wright CA, et al. Placental pathology in spontaneous and iatrogenic preterm

birth: Different entities with unique pathologic features. Placenta 2022;126:54-63. http://doi.

org/10.1016/j.placenta.2022.06.004

Hackney DN, Tirumala R, Salamone LJ, et al. Do placental histologic findings of chorion-decidual

hemorrhage or inflammation in spontaneous preterm birth influence outcomes in the subsequent

pregnancy? Placenta 2014;35(1):58-63. http://doi.org/10.1016/j.placenta.2013.11.001

Roescher AM, Timmer A, Erwich JJHM, Bos AF. Placental pathology, perinatal death, neonatal outcome, and neurological development: A systematic review. PLoS ONE. 2014;9(2):e89419. http://

doi.org/10.1371/journal.pone.0089419

Redline RW. Classification of placental lesions. Am J Obstetr Gynecol 2015;213(4):S21-28. http://doi.

org/10.1016/j.ajog.2015.05.056

WorldHealthOrganization.BornTooSoon:GlobalActionReportforPretermBirth.NewYork:MoD,

PMNCH, Save the Children, WHO, 2012.

Khong TY, Mooney EE, Ariel I, et al. Sampling and definitions of placental lesions: Amsterdam

Placental Workshop Group Consensus Statement. Arch Path Laboratory Med 2016;140(7):698-713.

http://doi.org/10.5858/arpa.2015-0225-cc

Goldenberg RL, Andrews WW, Goepfert AR, et al. The Alabama Preterm Birth Study: Umbilical cord

blood Ureaplasma urealyticum and Mycoplasma hominis cultures in very preterm newborn infants.

Am J Obstetr Gynecol 2008;198(1):43.e1-43.e5. http://doi.org/10.1016/j.ajog.2007.07.033

World Health Organization. Global preterm birth estimates 2014. http://ptb.srhr.org/ (accessed 8

December 2019)

Morgan T. Role of the placenta in preterm birth: A review. Am J Perinatol 2016;33(03):258-266. http://

doi.org/10.1055/s-0035-1570379

Baergen R. Manual of Pathology of the Human Placenta. 2nd edition. Berlin: Springer, 2011.

Kulkarni VG, Sunilkumar KB, Nagaraj TS, et al. Maternal and fetal vascular lesions of malperfusion in

the placentas associated with fetal and neonatal death: results of a prospective observational study. Am

J Obstetr Gynecol 2021;225(6):660.e1-660.e12. http://doi.org/10.1016/j.ajog.2021.06.001

Tantbirojn P, Saleemuddin A, Sirois K, et al. Gross abnormalities of the umbilical cord: Related placental histology and clinical significance. Placenta 2009;30(12):1083-1088. http://doi.org/10.1016/j.

placenta.2009.09.005

Namba F, Hasegawa T, Nakayama M, et al. Placental features of chorioamnionitis colonized with

ureaplasma species in preterm delivery. Pediatr Res 2010;67(2):166-172. http://doi.org/10.1203/

pdr.0b013e3181c6e58e

Redline RW. Inflammatory response in acute chorioamnionitis. Sem Fetal Neonatal Med 2012;17(1):20-

http://doi.org/10.1016/j.siny.2011.08.003

Kim CJ, Romero R, Chaemsaithong P, Kim J-S. Chronic inflammation of the placenta: definition,

classification, pathogenesis, and clinical significance. Am J Obstetr Gynecol 2015;213(4):S53–69.

http://doi.org/10.1016/j.ajog.2015.08.041

Curtin W, Katzman P, Florescue H, Metlay L. Accuracy of signs of clinical chorioamnionitis in the term

parturient. J Perinatol 2013;33:422-428. http://doi.org/10.1038/jp.2012.135

Palmsten K, Nelson KK, Laurent LC, et al. Subclinical and clinical chorioamnionitis, fetal vasculitis,

and risk for preterm birth: A cohort study. Placenta 2018;67:54-60. http://doi.org/10.1016/j.

placenta.2018.06.001

Hillier S, Martius J, Krohn M, et al. A case-control study of chorioamnionic infection and

histologic chorioamnionitis in prematurity. Int J Gynecol Obstetr 1989;29(1):96-97. http://doi. org/10.1016/0020-7292(89)90145-8

Redline RW. The clinical implications of placental diagnoses. Sem Perinatol 2015;39(1):2-8. http:// doi.org/10.1053/j.semperi.2014.10.002

Ravishankar S, Redline RW. The placenta. Neonatal Neurol 2019;57-66. http://doi.org/10.1016/ b978-0-444-64029-1.00003-5

Chisholm KM, Norton ME, Penn AA, Heerema-McKenney A. Classification of preterm birth with placental correlates. Pediatr Dev Pathol 2018;21(6):548-560. http://doi. org/10.1177/1093526618775958

AnanthCV,GetahunD,PeltierMR,SmulianJC.Placentalabruptionintermandpretermgestations. Obstetr Gynecol 2006;107(4):785-792. http://doi.org/10.1097/01.aog.0000207560.41604.19

Ananth CV, Lavery JA, Vintzileos AM, et al. Severe placental abruption: Clinical definition and associations with maternal complications. Am J Obstetr Gynecol 2016;214(2):272.e1-272.e9. http:// doi.org/10.1016/j.ajog.2015.09.069

Malusi Z, Schubert PT, Theron GB, Wright CA. The value of histopathology of the placenta in a tertiary referral hospital in South Africa. S Afr J Obstetr Gynaecol 2019;25(2):64. http://doi. org/10.7196/sajog.1434

Rickert V. Prevalence and risk factors of chorioamnionitis among adolescents. Obstetr Gynecol 1998;92(2):254-257. http://doi.org/10.1016/s0029-7844(98)00135-5

Hannigan JH, Armant DR. Alcohol in pregnancy and neonatal outcome. Sem Neonatol 2000;5(3):243-254. http://doi.org/10.1053/siny.2000.0027

Dukes KA, Burd L, Elliott AJ, et al. The Safe Passage Study: Design, methods, recruitment, and follow-up approach. Paediatr Perinatal Epidemiol 2014;28(5):455-465. http://doi.org/10.1111/ ppe.12136

May PA, Baete A, Russo J, et al. Prevalence and characteristics of fetal alcohol spectrum disorders. Pediatrics 2014;134(5):855-866. http://doi.org/10.1542/peds.2013-3319

Roozen S, Peters G-JY, Kok G, et al. Worldwide prevalence of fetal alcohol spectrum disorders: A systematic literature review including meta-analysis. Alcoholism Clin Experimental Res 2016;40(1):18-32. http://doi.org/10.1111/acer.12939

Lange S, Probst C, Gmel G, et al. Global prevalence of fetal alcohol spectrum disorder among children and youth: A systematic review and meta-analysis. Obstet Gynecol Survey 2018;73(4):189- 191. http://doi.org/10.1097/01.ogx.0000532194.88210.00

Maxwell JR, Yellowhair TR, Davies S, et al. Prenatal alcohol exposure and chorioamnionitis results in microstructural brain injury in a preclinical investigation. Ann Pediatric Res 2020;4(1):1031.

Zar HJ, Pellowski JA, Cohen S, et al. Maternal health and birth outcomes in a South African birth

cohort study. Hill B, editor. PLOS ONE. 2019;14(11):e0222399. http://doi.org/10.1371/journal.

pone.0222399

Bernstein N, Akram M, Yaniv‐Bachrach Z, Daniyal M. Is it safe to consume traditional medicinal

plants during pregnancy? Phytotherapy Res 2020;35(4):1908-1924. http://doi.org/10.1002/

ptr.6935

Peltzer K, Phaswana-Mafuya N, Treger L. Use of traditional and complementary health practices

in prenatal, delivery and postnatal care in the context of HIV transmission from mother to child (PMTCT) in the Eastern Cape, South Africa. Afr J Trad Complementary Alternative Med 2010;6(2). http://doi.org/10.4314/ajtcam.v6i2.57087

Maputle SM, Mothiba TM, Maliwichi L. Traditional medicine and pregnancy management: Perceptions of traditional health practitioners in Capricorn District, Limpopo Province. Stud Ethno-Med 2015;9(1):67-75. http://doi.org/10.1080/09735070.2015.11905422

Satoh S, Boyer E. HIV in South Africa. Lancet 2019;394(10197):467. http://doi.org/10.1016/s0140- 6736(19)31634-4

World Health Organization. Mother-to-child transmission of HIV 2019. https://www.who.int/gho/ hiv/epidemic_response/PMTCT_text/en/ (accessed 15 December 2019).

WediCOO,KirtleyS,HopewellS,etal.PerinataloutcomesassociatedwithmaternalHIVinfection: A systematic review and meta-analysis. Lancet HIV 2016;3(1):e33-e48. http://doi.org/10.1016/ s2352-3018(15)00207-6

Liu L, Oza S, Hogan D, et al. Global, regional, and national causes of under-5 mortality in 2000 - 15: An updated systematic analysis with implications for the Sustainable Development Goals. Lancet 2016;388(10063):3027-3035. http://doi.org/10.1016/s0140-6736(16)31593-8

Santosa WB, Staines-Urias E, Tshivuila-Matala COO, Norris SA, Hemelaar J. Perinatal outcomes associated with maternal HIV and antiretroviral therapy in pregnancies with accurate gestational age in South Africa. AIDS 2019;33(10):1623-1633. http://doi.org/10.1097/ qad.0000000000002222

Kapur A, McIntyre HD, Hod M. Type 2 diabetes in pregnancy. Endocrinol Metab Clin N Am 2019;48(3):511-531. http://doi.org/10.1016/j.ecl.2019.05.009

Woodgate P, Jardine LA. Neonatal jaundice. BMJ Clin Evid 2011;2011;0319.

Ullah S, Rahman K, Hedayati M. Hyperbilirubinemia in neonates: Types, causes, clinical examinations, preventive measures and treatments: A narrative review article. Iranian J Pub Health 2016;45(5):558-568.

Thompson JMD, Irgens LM, Rasmussen S, Daltveit AK. Secular trends in socio-economic status and the implications for preterm birth. Paediatt Perinatal Epidemiol 2006;20(3):182-187. http://doi.org/10.1111/j.1365-3016.2006.00711.x

Wright C. The placenta – a Cinderella story. S Afr Fam Pract 2007;49(7):4-8. http://doi.org/10.1080/20786204.2007.10873588

Faye-Petersen OM. The placenta in preterm birth. J Clin Pathol 2008;61(12):1261-1275. http://doi.org/10.1136/jcp.2008.055244

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Published

2023-04-04

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Research

How to Cite

1.
Sprong KE, Wright CA, Mabenge M, Govender S. Placental histopathology, maternal characteristics and neonatal outcome in cases of preterm birth in a high-risk population in South Africa. S Afr Med J [Internet]. 2023 Apr. 4 [cited 2024 Jun. 15];113(4). Available from: https://samajournals.co.za/index.php/samj/article/view/934

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