Aga Khan University, Karachi, Pakistan.
RTI International, Durham, North Carolina, USA.
BJOG. 2023 Nov;130 Suppl 3:43-52. doi: 10.1111/1471-0528.17643. Epub 2023 Sep 6.
To examine inflammatory lesions in placentas of stillbirths, preterm neonatal deaths and term controls in India and Pakistan.
Prospective, observational study.
Three hospitals in India and a large maternity hospital in Pakistan.
The enrolled participants with placentas available for histology evaluation included stillbirths (n = 814), preterm live births who died within 28 days of birth (n = 618) and term live birth controls (n = 201). From this same population, polymerase chain reaction (PCR) analysis for pathogens was performed on 809 stillbirth placentas, 614 neonatal death placentas and the placentas of 201 term controls. Placentas from preterm infants who lived beyond day 28 (n = 1432) were only available from India.
A prospective observational study of placental inflammatory lesions defined by the Amsterdam criteria and on the same placentas, multiplex PCR evaluation for 75 pathogens using TaqMan Array Cards.
Any placental inflammatory lesions, including chorioamnionitis, funisitis, villitis and intervillitis and their association with various pathogens.
In the Indian liveborn preterm infants, placental inflammation of any kind was present in 26.2% of those who died versus 16.6% of those who lived (p = 0.0002). Chorioamnionitis was present in 25.8% of those who died versus 16.3% of those who lived (p = 0.0002) and funisitis was present in 4.1% of those who died versus 1.5% of those who lived, (p = 0.005). Across all three sites, in the placentas of the 201 term controls, 18.9% had any inflammation, 16.9% had chorioamnionitis, 5.5% had funisitis, 0.5% had intervillitis and none had villitis. Overall, for stillbirths, any inflammation was observed in 30.2%, chorioamnionitis in 26.9%, funisitis in 5.7%, intervillitis in 6.0% and villitis in 2.2%. For the neonatal deaths, any inflammation was present in 24.9%, chorioamnionitis in 23.3%, funisitis in 8.1%, intervillitis in 1.9% and villitis in 0.5%. Compared with the placentas of term controls, in neonatal deaths, only chorioamnionitis was significantly increased (23.3% versus 16.9%, p = 0.05). Among stillbirths, the rates of any inflammation, chorioamnionitis, intervillitis and villitis were similar across the birthweight groups. However, funisitis was more common in the placentas of stillborn fetuses weighing 2500 g or more (13.8%) compared with 1.0% for those weighing less than 1000 g and 4.8% for stillborn fetuses weighing 1000-2499 g. In the PCR studies, Ureaplasma spp. were by far the most common pathogens found and generally were more commonly found in association with inflammatory lesions.
Chorioamnionitis was the most common type of placental inflammatory lesion regardless of whether the placentas evaluated were from term controls, stillbirths or neonatal deaths. For stillbirths, inflammation in each inflammation category was more common than in the term controls and significantly more so for any inflammation, chorioamnionitis, intervillitis and villitis. For neonatal deaths, compared with the placentas of term controls, all inflammation categories were more common, but only significantly so for chorioamnionitis. Ureaplasma spp. were the most common organisms found in the placentas and were significantly associated with inflammation.
在印度和巴基斯坦研究死胎、早产儿死亡和足月对照组的胎盘炎症病变。
前瞻性、观察性研究。
印度的三家医院和巴基斯坦的一家大型妇产医院。
纳入的研究对象包括有胎盘组织学评估的死胎（n=814）、出生后 28 天内死亡的早产儿活产儿（n=618）和足月活产儿对照组（n=201）。从同一人群中，对 809 例死胎胎盘、614 例新生儿死亡胎盘和 201 例足月对照组胎盘进行了聚合酶链反应（PCR）分析。存活超过 28 天的早产儿胎盘（n=1432）仅来自印度。
对胎盘炎症病变进行前瞻性观察性研究，采用阿姆斯特丹标准定义，并对同一胎盘进行 75 种病原体的多重 PCR 评估，使用 TaqMan Array Cards。
任何胎盘炎症病变，包括绒毛膜羊膜炎、脐带炎、绒毛膜炎和血管间炎及其与各种病原体的关系。
在印度的早产儿中，与存活的婴儿相比，任何类型的胎盘炎症在死亡的婴儿中更常见（26.2% vs. 16.6%，p=0.0002）。绒毛膜羊膜炎在死亡婴儿中更常见（25.8% vs. 16.3%，p=0.0002），脐带炎在死亡婴儿中更常见（4.1% vs. 1.5%，p=0.005）。在所有三个地点，在 201 例足月对照组的胎盘中，18.9%有任何炎症，16.9%有绒毛膜羊膜炎，5.5%有脐带炎，0.5%有血管间炎，无一例有绒毛膜炎。总的来说，死胎有任何炎症的比例为 30.2%，绒毛膜羊膜炎为 26.9%，脐带炎为 5.7%，血管间炎为 6.0%，绒毛膜炎为 2.2%。新生儿死亡有任何炎症的比例为 24.9%，绒毛膜羊膜炎为 23.3%，脐带炎为 8.1%，血管间炎为 1.9%，绒毛膜炎为 0.5%。与足月对照组相比，新生儿死亡中仅绒毛膜羊膜炎显著增加（23.3% vs. 16.9%，p=0.05）。在死胎中，任何炎症、绒毛膜羊膜炎、血管间炎和绒毛膜炎的发生率在不同出生体重组之间相似。然而，在体重 2500 g 或以上的死胎中，脐带炎更为常见（13.8%），而体重小于 1000 g 的死胎中为 1.0%，体重为 1000-2499 g 的死胎中为 4.8%。在 PCR 研究中，解脲脲原体是最常见的病原体，通常与炎症病变有关。
无论评估的胎盘是来自足月对照组、死胎还是新生儿死亡，绒毛膜羊膜炎都是最常见的胎盘炎症病变类型。对于死胎，每个炎症类别的炎症比足月对照组更为常见，且任何炎症、绒毛膜羊膜炎、血管间炎和绒毛膜炎的炎症更为明显。与足月对照组相比，新生儿死亡的所有炎症类别更为常见，但仅绒毛膜羊膜炎有显著差异。解脲脲原体是胎盘中最常见的病原体，与炎症有显著相关性。
