845 Placental findings and adverse pregnancy outcomes in antepartum sepsis

Abstract

Patients admitted for sepsis during pregnancy are at increased risk for pregnancy complications, which may be related to the impact of sepsis on placental function. This study aimed to describe placental features and clinical correlates of patients with antepartum sepsis. This is a retrospective cohort study of patients that delivered at our institution from 8/1/2012 to 8/1/2018 who had an antepartum hospitalization for sepsis and clinical placental pathology analysis. Multifetal pregnancies, major fetal structural or genetic anomalies, and TORCH infections were excluded. Placental pathology reports from electronic medical records were abstracted according to the 2016 Amsterdam criteria. 70 of 15,055 patients (0.5%) had an antepartum admission for sepsis evaluation, of which 28 of 70 (40%) had placentas submitted for pathologic evaluation. Mean placental weight was 413 g ± 109 g, with 29% small for gestational age. Forty-three percent had features of maternal vascular malperfusion (MVM) and 21% had features of fetal vascular malperfusion (FVM). Meconium staining was present in 36% of cases. Signs of inflammation were also frequently seen including histologic chorioamnionitis (39%) and funisitis/phlebitis (21%). Comparison of cases that delivered within 7 days of sepsis admission and those who delivered after 7 days revealed that MVM was more common (55% vs 0%, p = 0.024) and birthweight percentile was lower (33% vs 60%, p = 0.01) if > 7 days had passed since sepsis admission. MVM lesions were associated with longer latency from sepsis admission to delivery (101 vs 47 days, p = 0.04), earlier gestational age at infection (23 vs 30 weeks, p = 0.05), and higher rates of small for gestational age infants (33% vs 0%, p = 0.02) compared with those without MVM lesions. Antepartum sepsis is associated with MVM, chorioamnionitis, and meconium in placental pathology. These findings are more frequent in patients with longer latency time between sepsis and delivery, suggesting that maternal sepsis may cause chronic placental dysfunction.View Large Image Figure ViewerDownload Hi-res image Download (PPT)