Amer J Perinatol
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 Ayodele1, Nathan S. Fox1, 2, 3, Simi Gupta1, 2, 3, Jessica Spiegelman1, Daniel H. Saltzman1, 2, 3, Whitney Booker4, Andrei Rebarber1, 2, 3
  • 1Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
  • 2Maternal Fetal Medicine Associates, PLLC, New York, New York
  • 3Carnegie Imaging for Women, PLLC, New York, New York
  • 4Department of Obstetrics and Gynecology, Columbia University, New York, New York
Further Information

Publication History

06 June 2017

19 August 2017

Publication Date:
14 September 2017 (eFirst)


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.