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Clin Exp Pediatr > Accepted Articles
DOI: https://doi.org/10.3345/kjp.2019.00038    [Accepted]
Published online August 19, 2019.
Placental Histopathology in Late Preterm infants: Clinical Implications
Kristina Ericksen1, Joshua Fogel2, Rita P. Verma1 
1Department of Pediatrics, Nassau University Medical Center, East Meadow, USA
2Brooklyn College, Brooklyn, USA
Correspondence: 
Rita P. Verma, Tel: +16318755375, Fax: +15165725483, Email: ritaverma@aol.com
Received: 11 January 2019   • Revised: 2 August 2019   • Accepted: 13 August 2019
Abstract
Background
The etiopathogenesis of late preterm birth is undetermined. Placental histopathology (PH) reflects adverse intrauterine environment and is documented to be associated with preterm labor and neonatal morbidities. The placental histopathology has not been studied in late preterm infants.
Purpose
We investigated placental pathological lesion as markers of adverse intrauterine environment during late preterm labor.
Methods
In a retrospective case control study following placental histopathological and clinical variables were compared between late preterm and term neonates. Placental: chorioamnionitis, funisitis, hemorrhage, abruption, infarction, calcification, syncytial knots. Maternal : age, substance abuse, pregnancy associated diabetes mellitus and hypertension, duration of rupture of membrane, receipts of antibiotics and magnesium sulfate. Neonatal: gestational age, birth weight, race, sex, Apgar scores. Standard statistical procedures were applied to analyze data.
Results
Chorioamnionitis (50% vs. 17.8%, P< 0.001) and funisitis (20% vs.4.4%, P = 0.002) were more common in term infants. Placental infarction, although higher in late preterm infants (25.6 % vs. 14.3, P = 0.08) did not reach significance. The mothers in late preterm group were older, (30.4 vs. 28.1 years, P = 0.05; Odds ratio 1.06, 95% Confidence interval 0.998-1.12, P=0.056). They suffered from hypertension (28.9 vs. 12.9%, P =0.02) and received magnesium sulfate (48.9 vs. 20%, P < 0.001; Odds ratio 2.86, 95% CI 1.12-7.29, P < 0.05) more often. Duration of rupture of membrane was higher in term infants (13.6 vs.9.1 hours, P < 0.001). Chorioamnionitis (Odds ratio 0.33, 95% Confidence interval 0.13-0.79, P < 0.05) was associated with lower odds of late preterm delivery.
Conclusion
Placental infection does not predispose to late preterm birth. There is a non-significant predominance of vascular anomalies in late preterm placentas. Higher maternal age, magnesium sulfate therapy and maternal hypertension are clinical risk factors for late preterm labor.
Key Words: Late preterm infants, Placental histopathology, Vasculopathy, Gestation associated hypertension, Chorioamnionitis




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