Poster session I Clinical obstetrics, epidemiology, fetus, medical-surgical complications, neonatalogy, physiology/endocrinology, prematurity: Abstracts 87 - 236| Volume 208, ISSUE 1, SUPPLEMENT , S53-S54, January 01, 2013

92: Placental pathology, first-trimester biomarkers, and adverse pregnancy outcomes (APO)


      To investigate the association of placental pathology (Path) findings in pregnancies with APO and first-trimester biomarkers.

      Study Design

      This is a prospective study of first-trimester screening for APO. Path were reviewed by two perinatal pathologists blinded to clinical outcomes. First, we determine the association between Path lesions and APO including: preterm birth [PTB (delivery < 37 weeks)], preeclampsia (PE), gestational hypertension (GH) and small for gestational age (SGA) infants (birthweight <10th percentile). We then compare the mean levels of serum analytes (PAPP-A, PP13, ADAM12s, PLGF), and uterine artery Doppler PI (UADPI) obtained at 11-14 weeks gestation in cases with APO and abnormal placental histology (PlacHist) to a control group without APO or abnormal Path. Path were classified as: lesions of maternal under perfusion (LMUP) including a composite of: infarct, decidual vasculopathy, distal villous hypoplasia); lesions of reduced placental reserve (LRPR)including: avascular villi, perivillous fibrin/intervillous thrombo-hematoma, villitis); and Infectious/inflammatory (INFL) lesions (chorioamnionitis, funisitis/chorionic vasculitis). Statistical analysis was performed using chi-squared, paired t-test and ANOVA.


      Among 193 Path reviewed, LMUP were seen in 59 (30.7%); LRPR in 63 (32.85),and INFL in 65 (34.2%). PE was significantly associated with LMUP (p=0.005) and INFL (p=0.003). PTB < 28 weeks was the only sub-group of PTB with a significant association with INFL: 75% versus 31% (p<=0.002). SGA and GH were not significantly associated with any PlacHist abnormality. Significant differences were seen in mean levels of PAPPA, ADAM12s and PLGF in cases of PE and PTB with specific Path lesions compared with controls (Table). UADPI was not significantly different between the cases with APO and abnormal Path.
      Tabled 1Placental lesions seen in cases with preeclampsia and preterm birth
      Table thumbnail grr4


      Our findings provide evidence linking placental pathology with mal-secretion of analytes in first-trimester in pregnancies with APO, especially PE.