Am J Perinatol 2016; 33(03): 258-266
DOI: 10.1055/s-0035-1570379
Prematurity Special Issue
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Role of the Placenta in Preterm Birth: A Review

Terry K. Morgan
1   Department of Obstetrics and Gynecology, Center for Developmental Health, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
2   Department of Pathology, Center for Developmental Health, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
› Author Affiliations
Further Information

Publication History

18 November 2015

24 November 2015

Publication Date:
05 January 2016 (online)

Abstract

Preterm birth is a multifactorial syndrome with a variety of risk factors and long-term health consequences for the child. Placental pathology provides important diagnostic information to ascertain the cause of preterm birth. For example, intra-amniotic infection is one risk factor, but accumulating evidence based on placental pathology, amniotic fluid cultures, and polymerase chain reaction studies suggests infection may be a less common cause of preterm birth than previously suspected, especially after 32 weeks' gestation. Instead, many cases of spontaneous preterm labor leading to preterm birth appear to be caused by placental insufficiency, similar to preeclampsia and fetal growth restriction. Other causes of preterm birth, including retroplacental abruption, chronic villitis, and twin gestations, also have specific placental pathology related to placental insufficiency. New insights into the underlying mechanisms regulating uteroplacental blood flow and the impact of placental malperfusion on placental health may lead to improved early gestation diagnostic testing and a revolution in preventative care for both the mother and her child.

 
  • References

  • 1 Ahman E, Zupan J. Neonatal and Perinatal Mortality: Country, Regional, and Global Estimates 2004. Geneva: WHO; 2007
  • 2 Hillier SL, Martius J, Krohn M, Kiviat N, Holmes KK, Eschenbach DA. A case-control study of chorioamnionic infection and histologic chorioamnionitis in prematurity. N Engl J Med 1988; 319 (15) 972-978
  • 3 DiGiulio DB, Romero R, Amogan HP , et al. Microbial prevalence, diversity and abundance in amniotic fluid during preterm labor: a molecular and culture-based investigation. PLoS ONE 2008; 3 (8) e3056
  • 4 Romero R, Salafia CM, Athanassiadis AP , et al. The relationship between acute inflammatory lesions of the preterm placenta and amniotic fluid microbiology. Am J Obstet Gynecol 1992; 166 (5) 1382-1388
  • 5 Combs CA, Gravett M, Garite TJ , et al; ProteoGenix/Obstetrix Collaborative Research Network. Amniotic fluid infection, inflammation, and colonization in preterm labor with intact membranes. Am J Obstet Gynecol 2014; 210 (2) 125.e1-125.e15
  • 6 DeFranco E, Teramo K, Muglia L. Genetic influences on preterm birth. Semin Reprod Med 2007; 25 (1) 40-51
  • 7 Pereira L, Reddy AP, Alexander AL , et al. Insights into the multifactorial nature of preterm birth: proteomic profiling of the maternal serum glycoproteome and maternal serum peptidome among women in preterm labor. Am J Obstet Gynecol 2010; 202 (6) 555.e1-555.e10
  • 8 Hollier LM. Preventing preterm birth: what works, what doesn't. Obstet Gynecol Surv 2005; 60 (2) 124-131
  • 9 Morgan TK, Tolosa JE, Mele L , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Placental villous hypermaturation is associated with idiopathic preterm birth. J Matern Fetal Neonatal Med 2013; 26 (7) 647-653
  • 10 Ghidini A, Salafia CM, Pezzullo JC. Placental vascular lesions and likelihood of diagnosis of preeclampsia. Obstet Gynecol 1997; 90 (4, Pt 1) 542-545
  • 11 Khong TY. Acute atherosis in pregnancies complicated by hypertension, small-for-gestational-age infants, and diabetes mellitus. Arch Pathol Lab Med 1991; 115 (7) 722-725
  • 12 Starzyk KA, Salafia CM, Pezzullo JC , et al. Quantitative differences in arterial morphometry define the placental bed in preeclampsia. Hum Pathol 1997; 28 (3) 353-358
  • 13 Morgan T, Craven C, Lalouel J-M, Ward K. Angiotensinogen Thr235 variant is associated with abnormal physiologic change of the uterine spiral arteries in first-trimester decidua. Am J Obstet Gynecol 1999; 180 (1, Pt 1) 95-102
  • 14 Salafia CM, Pezzullo JC, Ghidini A, Lopèz-Zeno JA, Whittington SS. Clinical correlations of patterns of placental pathology in preterm pre-eclampsia. Placenta 1998; 19 (1) 67-72
  • 15 Salafia CM, Minior VK, Pezzullo JC, Popek EJ, Rosenkrantz TS, Vintzileos AM. Intrauterine growth restriction in infants of less than thirty-two weeks' gestation: associated placental pathologic features. Am J Obstet Gynecol 1995; 173 (4) 1049-1057
  • 16 Arias F, Rodriquez L, Rayne SC, Kraus FT. Maternal placental vasculopathy and infection: two distinct subgroups among patients with preterm labor and preterm ruptured membranes. Am J Obstet Gynecol 1993; 168 (2) 585-591
  • 17 Kim YM, Chaiworapongsa T, Gomez R , et al. Failure of physiologic transformation of the spiral arteries in the placental bed in preterm premature rupture of membranes. Am J Obstet Gynecol 2002; 187 (5) 1137-1142
  • 18 Benirschke K, Kaufmann P , eds. Pathology of the Human Placenta. 4th ed. New York: Springer-Verlag; 2000
  • 19 Barker DJ, Bull AR, Osmond C, Simmonds SJ. Fetal and placental size and risk of hypertension in adult life. BMJ 1990; 301 (6746) 259-262
  • 20 Thornburg KL, O'Tierney PF, Louey S. Review: the placenta is a programming agent for cardiovascular disease. Placenta 2010; 31 (Suppl): S54-S59
  • 21 Misra VK, Hobel CJ, Sing CF. Placental blood flow and the risk of preterm delivery. Placenta 2009; 30 (7) 619-624
  • 22 Krebs C, Macara LM, Leiser R, Bowman AW, Greer IA, Kingdom JC. Intrauterine growth restriction with absent end-diastolic flow velocity in the umbilical artery is associated with maldevelopment of the placental terminal villous tree. Am J Obstet Gynecol 1996; 175 (6) 1534-1542
  • 23 Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Mathews TJ, Osterman MJ. Births: final data for 2008. Natl Vital Stat Rep 2010; 59 (1) 1 , 3–71
  • 24 Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008; 371 (9606) 75-84
  • 25 Kistka ZA, Palomar L, Lee KA , et al. Racial disparity in the frequency of recurrence of preterm birth. Am J Obstet Gynecol 2007; 196 (2) 131.e1-131.e6
  • 26 Dar S, Librach CL, Gunby J, Bissonnette F, Cowan L ; IVF Directors Group of Canadian Fertility and Andrology Society. Increased risk of preterm birth in singleton pregnancies after blastocyst versus Day 3 embryo transfer: Canadian ART Register (CARTR) analysis. Hum Reprod 2013; 28 (4) 924-928
  • 27 Watts DH, Krohn MA, Hillier SL, Eschenbach DA. The association of occult amniotic fluid infection with gestational age and neonatal outcome among women in preterm labor. Obstet Gynecol 1992; 79 (3) 351-357
  • 28 Katzman PJ, Metlay LA. Fetal inflammatory response is often present at early stages of intra-amniotic infection, and its distribution along cord is variable. Pediatr Dev Pathol 2010; 13 (4) 265-272
  • 29 Grigsby PL, Novy MJ, Sadowsky DW , et al. Maternal azithromycin therapy for Ureaplasma intraamniotic infection delays preterm delivery and reduces fetal lung injury in a primate model. Am J Obstet Gynecol 2012; 207 (6) 475.e1-475.e14
  • 30 Moffett A, Colucci F. Uterine NK cells: active regulators at the maternal-fetal interface. J Clin Invest 2014; 124 (5) 1872-1879
  • 31 Fisher SJ. The placental problem: linking abnormal cytotrophoblast differentiation to the maternal symptoms of preeclampsia. Reprod Biol Endocrinol 2004; 2: 53
  • 32 Moll W. Structure adaptation and blood flow control in the uterine arterial system after hemochorial placentation. Eur J Obstet Gynecol Reprod Biol 2003; 110 (Suppl. 01) S19-S27
  • 33 James JL, Cartwright JE, Whitley GS, Greenhill DR, Hoppe A. The regulation of trophoblast migration across endothelial cells by low shear stress: consequences for vascular remodelling in pregnancy. Cardiovasc Res 2012; 93 (1) 152-161
  • 34 Brosens IA, Robertson WB, Dixon HG. The role of the spiral arteries in the pathogenesis of preeclampsia. Obstet Gynecol Annu 1972; 1: 177-191
  • 35 Burton GJ, Woods AW, Jauniaux E, Kingdom JC. Rheological and physiological consequences of conversion of the maternal spiral arteries for uteroplacental blood flow during human pregnancy. Placenta 2009; 30 (6) 473-482
  • 36 Mayhew TM, Barker BL. Villous trophoblast: morphometric perspectives on growth, differentiation, turnover and deposition of fibrin-type fibrinoid during gestation. Placenta 2001; 22 (7) 628-638
  • 37 Kingdom J, Huppertz B, Seaward G, Kaufmann P. Development of the placental villous tree and its consequences for fetal growth. Eur J Obstet Gynecol Reprod Biol 2000; 92 (1) 35-43
  • 38 Ananth CV, Berkowitz GS, Savitz DA, Lapinski RH. Placental abruption and adverse perinatal outcomes. JAMA 1999; 282 (17) 1646-1651
  • 39 Redline RW. The clinical implications of placental diagnoses. Semin Perinatol 2015; 39 (1) 2-8
  • 40 Grether JK, Eaton A, Redline R, Bendon R, Benirschke K, Nelson K. Reliability of placental histology using archived specimens. Paediatr Perinat Epidemiol 1999; 13 (4) 489-495
  • 41 Paepe ME. Examination of the twin placenta. Semin Perinatol 2015; 39 (1) 27-35
  • 42 Altshuler G. Placental insights into neurodevelopmental and other childhood diseases. Semin Pediatr Neurol 1995; 2 (1) 90-99
  • 43 Schuurmans C, Kurrasch DM. Neurodevelopmental consequences of maternal distress: what do we really know?. Clin Genet 2013; 83 (2) 108-117
  • 44 Myatt L, Clifton RG, Roberts JM , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Can changes in angiogenic biomarkers between the first and second trimesters of pregnancy predict development of pre-eclampsia in a low-risk nulliparous patient population?. BJOG 2013; 120 (10) 1183-1191
  • 45 Katzman PJ. Chronic inflammatory lesions of the placenta. Semin Perinatol 2015; 39 (1) 20-26
  • 46 Rudzinski E, Gilroy M, NewBill C, Morgan T. Positive C4d immunostaining of placental villous syncytiotrophoblasts supports host-versus-graft rejection in villitis of unknown etiology. Pediatr Dev Pathol 2013; 16 (1) 7-13
  • 47 Frias AE, Schabel MC, Roberts VH , et al. Using dynamic contrast-enhanced MRI to quantitatively characterize maternal vascular organization in the primate placenta. Magn Reson Med 2015; 73 (4) 1570-1578
  • 48 Ramsey E, Donner M , eds. Placental Vasculature and Circulation. Stuttgart: Georg Thieme; 1980
  • 49 Guttmacher AE, Maddox YT, Spong CY. The Human Placenta Project: placental structure, development, and function in real time. Placenta 2014; 35 (5) 303-304