Am J Perinatol 2018; 35(03): 242-246
DOI: 10.1055/s-0037-1606631
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Association between Fetal Fibronectin, Cervical Length, and Amniotic Fluid Sludge with Histological Indicators of Placental Inflammation in Twin Gestations

Aboluwade Ayodele
1   Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
,
Nathan S. Fox
1   Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
2   Maternal Fetal Medicine Associates, PLLC, New York, New York
3   Carnegie Imaging for Women, PLLC, New York, New York
,
Simi Gupta
1   Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
2   Maternal Fetal Medicine Associates, PLLC, New York, New York
3   Carnegie Imaging for Women, PLLC, New York, New York
,
Jessica Spiegelman
1   Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
,
Daniel H. Saltzman
1   Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
2   Maternal Fetal Medicine Associates, PLLC, New York, New York
3   Carnegie Imaging for Women, PLLC, New York, New York
,
Whitney Booker
4   Department of Obstetrics and Gynecology, Columbia University, New York, New York
,
Andrei Rebarber
1   Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
2   Maternal Fetal Medicine Associates, PLLC, New York, New York
3   Carnegie Imaging for Women, PLLC, New York, New York
› Author Affiliations
Further Information

Publication History

06 June 2017

19 August 2017

Publication Date:
14 September 2017 (online)

Abstract

Objective The objective of this study was to evaluate the association of screening tests for preterm birth (short cervical length [CL], positive fetal fibronectin (FFN), and amniotic fluid [AF] sludge) in twin gestations with histologic evidence of placental inflammation.

Study Design Historical cohort study of 596 twin gestations delivered in a single maternal–fetal medicine practice with CL and FFN testing from 22 to 256/7 weeks. A short CL was defined as ≤25 mm. Placental lesions evaluated were chronic and acute membrane inflammation and funisitis. Fischer's exact test and logistic regression were used.

Results None of the screening tests was associated with chronic inflammation. All were associated with acute inflammation. On regression analysis, a short CL and positive FFN remained independently associated with acute inflammation (adjusted odds ratio [aOR]: 5.66 and 2.51, respectively) and funisitis (aOR: 5.66 and 7.17, respectively). AF sludge was not independently associated with acute inflammation nor funisitis.

Conclusion In twin gestations, a short CL and a positive FFN at 22 to 26 weeks are associated with acute but not chronic inflammation on placental histology. These findings imply that mechanisms underlying preterm birth in twins that result in positive screening tests weeks prior to delivery are not reflected as chronic placental inflammation. Therefore, pathologic interpretation of etiologic mechanisms for preterm birth may be limited using solely histologic reports.

 
  • References

  • 1 Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Mathews TJ. Births: final data for 2015. Natl Vital Stat Rep 2017; 66 (01) 1
  • 2 Lockwood CJ, Kuczynski E. Risk stratification and pathological mechanisms in preterm delivery. Paediatr Perinat Epidemiol 2001; 15 (Suppl. 02) 78-89
  • 3 Spiegelman J, Booker W, Gupta S. , et al. The independent association of a short cervix, positive fetal fibronectin, amniotic fluid sludge, and cervical funneling with spontaneous preterm birth in twin pregnancies. Am J Perinatol 2016; 33 (12) 1159-1164
  • 4 ACOG Practice Bulletin No. 102: management of stillbirth. Obstet Gynecol 2009; 113 (03) 748-761
  • 5 Langston C, Kaplan C, Macpherson T. , et al. Practice guideline for examination of the placenta: developed by the Placental Pathology Practice Guideline Development Task Force of the College of American Pathologists. Arch Pathol Lab Med 1997; 121 (05) 449-476
  • 6 Guzman ER, Shen-Schwarz S, Benito C, Vintzileos AM, Lake M, Lai YL. The relationship between placental histology and cervical ultrasonography in women at risk for pregnancy loss and spontaneous preterm birth. Am J Obstet Gynecol 1999; 181 (04) 793-797
  • 7 Peláez LM, Chasen ST, Baergen RN. The relationship between placental histology and cervical length in twin gestations. J Perinat Med 2010; 38 (05) 485-489
  • 8 Fox NS, Saltzman DH, Fishman A, Klauser CK, Gupta S, Rebarber A. Gestational age at cervical length and fetal fibronectin assessment and the incidence of spontaneous preterm birth in twins. J Ultrasound Med 2015; 34 (06) 977-984
  • 9 Iams JD, Goldenberg RL, Meis PJ. , et al; National Institute of Child Health and Human Development Maternal Fetal Medicine Unit Network. The length of the cervix and the risk of spontaneous premature delivery. N Engl J Med 1996; 334 (09) 567-572
  • 10 Yost NP, Bloom SL, Twickler DM, Leveno KJ. Pitfalls in ultrasonic cervical length measurement for predicting preterm birth. Obstet Gynecol 1999; 93 (04) 510-516
  • 11 Roman AS, Koklanaris N, Paidas MJ, Mulholland J, Levitz M, Rebarber A. “Blind” vaginal fetal fibronectin as a predictor of spontaneous preterm delivery. Obstet Gynecol 2005; 105 (02) 285-289
  • 12 Kusanovic JP, Espinoza J, Romero R. , et al. Clinical significance of the presence of amniotic fluid ‘sludge’ in asymptomatic patients at high risk for spontaneous preterm delivery. Ultrasound Obstet Gynecol 2007; 30 (05) 706-714
  • 13 Romero R, Dey SK, Fisher SJ. Preterm labor: one syndrome, many causes. Science 2014; 345 (6198): 760-765
  • 14 Bergh E, Rebarber A, Oppal S. , et al. The association between maternal biomarkers and pathways to preterm birth in twin pregnancies. J Matern Fetal Neonatal Med 2015; 28 (05) 504-508
  • 15 Boyer A, Cameron L, Munoz-Maldonado Y. , et al. Clinical significance of amniotic fluid sludge in twin pregnancies with a short cervical length. Am J Obstet Gynecol 2014; 211 (05) 506.e1-506.e9