Are Placental histopathological (HPE) findings tell tales of Outcomes in Preterm Neonates ?
Somalika Pal MD (1), Ashish Jain MD (1), Siddarth Ramji MD (1), Shyamlata Jain MD (2)
(1) Department of Neonatology, Maulana Azad Medical College & Lok Nayak Hospital, New Delhi,India 110002, (2) Department of Pathology, Maulana Azad Medical College & Lok Nayak Hospital, New Delhi,India 110002
Preterm placental HPE provides clues to the underlying cause of premature birth and may potentially be tell-tales of outcomes. The study evaluates the association of HPE of preterm placenta with early neonatal outcomes.
Placenta of liveborn preterms from 22 to 36 weeks were subjected to blinded expert HPE.Outcomes of these preterms were observed upto 15 days for mortality and common neonatal morbidities. Chi square and logistic regression used for analysis.
A cohort of 520 live preterm births studied with mean birth weight (BW)1871±521 grams, mean gestational age (GA) 34.2±2.2wks with 55.8%(290) being growth retarded. 89.3% (464) survived beyond 15 days. HPE was unremarkable in 63.2%(329). Some pathology (ANY) seen in 36.7%(191) included Histological chorioamnionitis/funisitis (HCA), Funisitis(F),Maternal vascular lesions (HMVM), Fetal vascular lesions(HFVM),other inflammatory lesions(HINFL) in 125(24.0%), 16 (1.5%), 85(16.4%),3(0.6%), 17(3.3 %) respectively. BW was significantly lesser with HCA (p=0.04) or HFVM(p=0.01) whereas GA with HCA(p=0.00), F(p=0.00), HFVM (p=0.01)or ANY(p= 0.02).
Neonatal outcomes; Hyaline membrane disease (HMD), hypoglycaemia, jaundice and polycythemia were not significantly associated with any HPE findings.There was an increased odds of ; Mortality with HCA(2.4;1.3-4.4), ANY(1.9;1.1-3.2) and HFVM(p=0.04); early onset sepsis(EOS) with HCA(4.3;2.1-9.1), F(8.1;2.3-28.5), HFVM( 12.1;1.0-142.3) and ANY (3.3;1.6-6.8); Non-HMDrespiratory distress with HCA(1.9;2.0-3.1), F(5.5;2.0-15.4),HMVM(1.9;1.1-3.2), HINFL(3.0;1.1-8.2)and ANY(2.0;1.3-3.0); patent ductus arteriosus(PDA) with HCA (3.7;1.3-10.8) and F(7.7;1.4-41.4); severe perinatal asphyxia (PA) with F(5.1; 1.0-25.7). Though not significant,HMVM was associated with IUGR.
Lower BW or GA, neonatal mortality and early morbidities(EOS,Non-HMD,PDA and PA)are significantly associated with specific HPE findings. This may reflect an important causal association requiring further study.
The study was granted ethical clearance by institutional ethical committee (F.No/11/IEC/MAMC/2016/4). Enrollment into study was after obtaining written informed consent from parents of neonates.