Impact of placental histopathology and maternal risk factors on neonatal morbidity in late preterm infants

Authors

  • Arife Sancaktar Department of Pediatrics, Division of Pediatric Cardiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
  • Deniz Anuk İnce Department of Pediatrics, Division of Neonatology, Baskent University Faculty of Medicine, Ankara, Turkey
  • Sebnem Kupana Ayva Department of Pathology, Ankara Etlik City Hospital, Ankara, Turkey
  • Sertac Esin Department of Gynecology and Obstetrics, Baskent University Faculty of Medicine, Ankara, Turkey
  • Mustafa Agah Tekindal Department of Biostatistics, Izmir Katip Çelebi University Faculty of Medical Sciences, Izmir, Turkey
  • Ozden Turan Department of Pediatrics, Division of Neonatology, Baskent University Faculty of Medicine, Ankara, Turkey
  • Ayse Nur Ecevit Department of Pediatrics, Division of Neonatology, Baskent University Faculty of Medicine, Ankara, Turkey

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20253066

Keywords:

Late preterm, Late preterm morbidity, Maternal risk factors, Placenta, Placental pathology

Abstract

Background: Maternal and placental risk factors are critical determinants of neonatal outcomes in preterm infants. This study aims to evaluate the impact of placental histopathological findings and maternal risk factors on neonatal morbidity and mortality among late preterm infants.

Methods: This prospective study was conducted between January and July 2018 at Başkent University Faculty of Medicine. A total of 62 late preterm infants, born via cesarean section between 34^0⁄7 and 36^6⁄7 weeks of gestation, were included. Neonatal morbidities were assessed in relation to placental histopathological features and maternal risk factors. Placental examinations included both gross and microscopic evaluations, focusing on maternal vascular malperfusion, chronic inflammation, placentomegaly, placental hematomas, and fetal obliterative vasculopathy.

Results: Placental histopathological abnormalities and maternal risk factors were significantly associated with adverse neonatal outcomes. Maternal vascular malperfusion correlated with an increased risk of hyperbilirubinemia and intracranial hemorrhage. Chronic placental inflammation was linked to polycythemia and feeding intolerance. Placentomegaly was associated with early-onset neonatal sepsis and feeding difficulties. Additionally, maternal conditions such as preeclampsia, thrombophilia, oligohydramnios, and maternal infections were found to influence neonatal morbidity.

Conclusions: Placental histopathological findings particularly maternal malperfusion, chronic inflammation, and placentomegaly appear to contribute significantly to neonatal morbidity in late preterm infants. The combined assessment of placental pathology and maternal risk factors may enhance early prediction of neonatal complications and guide postnatal clinical management.

Metrics

Metrics Loading ...

References

Raju TNK, Higgins RD, Stark AR, Leveno KJ. Optimizing care and outcome for late-preterm (near-term) infants: a summary of the workshop sponsored by the NICHD. Pediatrics. 2006;118(3):1207-14. DOI: https://doi.org/10.1542/peds.2006-0018

Jenkins AW. Near-term but still a preemie. AWHONN Lifelines. 2005;9(4):295-7. DOI: https://doi.org/10.1111/j.1552-6356.2005.tb00844.x

Wang ML, Dorer DJ, Fleming MP, Catlin EA. Clinical outcomes of near-term infants. Pediatrics. 2004;114(2):372-6. DOI: https://doi.org/10.1542/peds.114.2.372

Huff K, Rose RS, Engle WA. Late preterm infants: morbidity and mortality. Pediatr Clin North Am. 2019;66(2):387-402. DOI: https://doi.org/10.1016/j.pcl.2018.12.008

Reddy UM, Ko CW, Raju TNK, Willinger M. Delivery indications at late-preterm gestations and infant mortality rates in the United States. Pediatrics. 2009;124(1):234-40. DOI: https://doi.org/10.1542/peds.2008-3232

Chan GJ, Lee AC, Baqui AH, Tan J, Black RE. Risk of early-onset neonatal infection with maternal infection or colonization: a global systematic review and meta-analysis. PLoS Med. 2013;10(8):e1001502.

Mateus J, Fox K, Jain S, Das A, Campbell WA, Jangaard K. Preterm premature rupture of membranes: clinical outcomes of late preterm infants. Clin Pediatr (Phila). 2010;49(1):60-5. DOI: https://doi.org/10.1177/0009922809342460

Habli M, Levine RJ, Qian C, Sibai BM. Neonatal outcomes in pregnancies with preeclampsia or gestational hypertension and in normotensive pregnancies that delivered at 35, 36, or 37 weeks of gestation. Am J Obstet Gynecol. 2007;197(4):406.e1-7. DOI: https://doi.org/10.1016/j.ajog.2007.06.059

Vignoles P, Gire C, Mancini J, Pascal A, D’Ercole C, Boubli L. Gestational diabetes: a strong independent risk factor for severe neonatal respiratory failure after 34 weeks. Arch Gynecol Obstet. 2011;284(5):1099-104. DOI: https://doi.org/10.1007/s00404-010-1810-9

Chitayat L, Jovanovic L, Hod M. New modalities in the treatment of pregnancies complicated by diabetes: drugs and devices. Semin Fetal Neonatal Med. 2009;14(2):72-6. DOI: https://doi.org/10.1016/j.siny.2008.09.001

Al Fahdi F, Al Mukhaini M, Al Rahbi F. Clinical impact of abnormal placentation and placental histopathology on neonatal morbidity: Insights from recent evidence. Front Pediatr. 2024;12:1445678.

Sarmadi F, Aghaeepour N, Stevenson DK. Maternal thrombophilia and placental vascular pathology: Implications for neonatal outcomes. Am J Obstet Gynecol. 2024;231(2):145-58.

Benirschke K, Kaufmann P. Pathology of the human placenta. 3rd ed. New York: Springer-Verlag; 1995:57-115. DOI: https://doi.org/10.1007/978-1-4757-4196-4

Macpherson T. Fact and fancy: what can we really tell from the placenta? Arch Pathol Lab Med. 1991;115(7):672-81.

Kaplan C, Lowell DM, Salafia C. Structural changes associated with abnormal function in the maternal/fetal/placental unit in the second and third trimesters. Report of the working group. Arch Pathol Lab Med. 1991;115(7):709-16.

Altshuler G, Deppisch LM. Indications for placental examination: report of the working group. Arch Pathol Lab Med. 1991;115(7):701-3.

Layden HE, Agniel D, Torous V, Rana S, Hecht JL. Placental pathology and neonatal outcomes: A review of recent advances. Placenta. 2022;124:45-53.

Mor G, Aldo P, Alvero AB. The role of the placenta in pregnancy complications: From histopathology to clinical translation. Nat Rev Clin Oncol. 2024;21(3):183-197.

Haukeland S, Tveit JVH, Ebbing C. Placental lesions and neonatal outcomes in late preterm infants: A population-based cohort study. BJOG. 2023;130(12):1511-22.

Mestan KK, Leibel SL, Sajti E, Pham B, Hietalati S, Laurent L, Parast M. Leveraging the placenta to advance neonatal care. Front Pediatr. 2023;11:1174174. DOI: https://doi.org/10.3389/fped.2023.1174174

Front Immunol. Chronic inflammatory placental disorders associated roles of fibrin deposition. Front Immunol. 2022;13:825. DOI: https://doi.org/10.3389/fimmu.2022.825075

Front Immunol. Decidual macrophages and Hofbauer cells in fetal growth restriction. Front Immunol. 2024;15:123. DOI: https://doi.org/10.3389/fimmu.2024.1379537

Hamamatsu Birth Cohort Study. Placental pathology predicts infantile neurodevelopment. Nat Med. 2022;28(11):2345-52.

MDPI Imaging. Artificial intelligence in placental pathology: new diagnostic trends. MDPI Imaging. 2024;5(2):45.

Chisholm KM, Heerema-McKenney A, Tian L, Rajani K, Trivedi S, Shaw GM, et al. Correlation of preterm infant illness severity with placental histology. Placenta. 2016;39:61-9. DOI: https://doi.org/10.1016/j.placenta.2016.01.012

Lin C, Hsu Y, Chang F, Lin M, Hsieh Y. Increased incidence of respiratory distress syndrome in neonates of mothers with abnormally invasive placentation. Early Hum Dev. 2001;60(3):215-24. DOI: https://doi.org/10.1016/S0378-3782(00)00121-3

Bekku S, Mitsuda N, Ogita K, Tanimura K, Makino T. High incidence of respiratory distress syndrome in infants born to mothers with placenta previa. J Matern Fetal Med. 2000;9(2):110-3. DOI: https://doi.org/10.1002/(SICI)1520-6661(200003/04)9:2<110::AID-MFM4>3.0.CO;2-5

Yoshimoto Y, Koyama M, Irie M, Harada S. Obstetric factors associated with intracranial hemorrhage in premature infants and antenatal prediction. Nihon Sanka Fujinka Gakkai Zasshi. 1986;38(4):485-92.

Boffa MC, Lachassinne E. Infant perinatal thrombosis and antiphospholipid antibodies. Lupus. 2007;16(8):634-41. DOI: https://doi.org/10.1177/0961203307079039

Marahatta R, Dhungel BA, Pradhan P, Rai SK. Asymptomatic bacteriuria among pregnant women visiting Nepal Medical College Teaching Hospital. Nepal Med Coll J. 2011;13(2):107-10.

Chan GJ, Lee AC, Baqui AH, Tan J, Black RE. Risk of early-onset neonatal infection with maternal infection or colonization. PLoS Med. 2013;10(8):e1001502. DOI: https://doi.org/10.1371/journal.pmed.1001502

Suhonen L, Teramo K. Hypertension and preeclampsia in women with gestational glucose intolerance. Acta Obstet Gynecol Scand. 1993;72(4):269-72. DOI: https://doi.org/10.3109/00016349309068036

Langenveld J, Ravelli AC, van Kaam AH, Naaktgeboren CA, Nijman TA, van Pampus MG, et al. Neonatal outcome of pregnancies complicated by hypertensive disorders between 34 and 36 weeks: a 7-year national cohort. Am J Obstet Gynecol. 2011;205(6):547.e1-7. DOI: https://doi.org/10.1016/j.ajog.2011.07.003

Brzezinski-Sinai NA, Stavsky M, Rafaeli-Yehudai T, Hiersch L, Amsalem H. Induction of labor in cases of late preterm isolated oligohydramnios: is it justified? J Matern Fetal Neonatal Med. 2018;31(17):2302-7.

Karahanoglu E, Akpinar F, Demirdag E, Turkgeldi L, Aydin T, Doganay M, et al. Obstetric outcomes of isolated oligohydramnios at different gestational ages. J Obstet Gynaecol Res. 2016;42(9):1119-24. DOI: https://doi.org/10.1111/jog.13024

Yamada N, Sato Y, Moriuchi-Goto S, Shimizu A, Sameshima H, Iwagaki S, et al. Histological severity of fetal inflammation is useful in predicting neonatal outcome. Placenta. 2015;36(12):1490-3. DOI: https://doi.org/10.1016/j.placenta.2015.10.021

Wright E, Audette MC, Ye XY, Keating S, Sauve RS, Smith GN. Maternal vascular malperfusion and adverse perinatal outcomes in low-risk nulliparous women. Obstet Gynecol. 2017;130(5):1112-20. DOI: https://doi.org/10.1097/AOG.0000000000002264

Weiner E, Feldstein O, Tamayev L, Grinstein E, Schreiber L, Bar J. Placental lesions and neonatal outcome in preeclampsia with and without severe features. Pregnancy Hypertens. 2018;12:6-10. DOI: https://doi.org/10.1016/j.preghy.2018.02.001

Scifres CM, Parks WT, Feghali M, Sibai BM. Placental maternal vascular malperfusion and adverse outcomes in gestational diabetes mellitus. Placenta. 2017;49:10-15. DOI: https://doi.org/10.1016/j.placenta.2016.11.004

Berceanu C, Tetileanu AV, Ofiterescu AM, Radu CM, Ghelase SM, Stana LG, et al. Morphological and ultrasound findings in the placenta of diabetic pregnancies. Rom J Morphol Embryol. 2018;59(1):175-86.

Downloads

Published

2025-09-26

How to Cite

Sancaktar, A., Anuk İnce, D., Kupana Ayva, S., Esin, S., Tekindal, M. A., Turan, O., & Ecevit, A. N. (2025). Impact of placental histopathology and maternal risk factors on neonatal morbidity in late preterm infants. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 14(10), 3230–3238. https://doi.org/10.18203/2320-1770.ijrcog20253066

Issue

Section

Original Research Articles