Placental inflammation and perinatal outcome

• Published in: European journal of obstetrics & gynecology and reproductive biology Vol. 108; no. 2; pp. 164 - 170
• Main Authors: Mwanyumba, F., Inion, I., Gaillard, P., Mandaliya, K., Praet, M., Temmerman, M.
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 10.06.2003; Elsevier
• Subjects: Adult; Analysis of Variance; Anemia - complications; Apgar Score; Biological and medical sciences; Birth Weight; Delivery, Obstetric; Delivery. Postpartum. Lactation; Diseases of mother, fetus and pregnancy; Disorders; Endometritis - epidemiology; Female; Gynecology. Andrology. Obstetrics; Humans; Infant Mortality; Infant, Newborn; Infant, Premature; Infant, Small for Gestational Age; Inflammation - complications; Labor, Obstetric; Leukocyte Count; Medical sciences; Parity; Placenta Diseases - complications; Placental inflammation; Pregnancy; Pregnancy Outcome; Pregnancy. Fetus. Placenta; Risk Factors; Time Factors; Tropical medicine; Kenya; Africa; Placental inflammation; Pregnancy outcome; Human; Prognosis; Pregnancy disorders; Mortality; Low birth weight; Perinatal; Inflammation; Placenta diseases; Epidemiology; Female genital diseases; Pregnancy; Pathology; Newborn diseases; Histopathology; Placenta; Prematurity; Risk factor; Uterine diseases; Endometritis
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/S0301-2115(02)00438-4

Objective: To examine the role of placental inflammation in adverse obstetrical outcome (AOO). Methods: Analysis of perinatal data of 701 randomly selected mothers of singleton infants, Mombasa, Kenya. Results: There were 661 (94.3%) live infants and 40 (5.7%) stillbirths. Out of the live born infants, 78 (12.4%) had a low birth weight (LBW < 2500 g); 33 of them were preterm and 41 small for gestational age (SGA). The incidence of neonatal sepsis and post partum endometritis was 3.6 and 19.8%, respectively. The perinatal death rate was estimated to be 7.3% (51/701). The prevalence of acute placental inflammation was 19.6%. Acute placental inflammation was independently associated with preterm low birth weight (ARR=3.8, 95% CI=1.7–8.9, P<0.01), stillbirth (ARR=2.3, 95% CI=1.1–5.0, P=0.03) and perinatal death (ARR=2.8, 95% CI=1.4–5.4, P<0.01). Women with acute placental inflammation had a two-fold higher risk for AOO (32.6 versus 15.2%, respectively, ARR=2.5, 95% CI=1.3–4.8, P<0.01). Other risk factors for AOO were bad obstetrical history, low haemoglobin level and leucocytosis. Conclusions: The incidence of adverse obstetrical outcome defined as low birth weight, low Apgar score, perinatal mortality and post partum endometritis, was high in this population. Acute placental inflammation was associated with preterm birth, stillbirth and perinatal death. More research is needed to study the role of infection in adverse obstetrical outcome, and to design interventions to decrease infectious morbidity and mortality in pregnancy.