Abstract
Objective. To elucidate differences in the frequency and severity of acute chorioamnionitis (CAM) and chronic villitis in placentas from stillborns compared with liveborns at term and to evaluate other risk factors and placental findings. Design. Case-control study. Setting. All delivery wards in major Stockholm area. Population or Sample. Placentas from stillborn/case (n = 126) and liveborn/control (n = 273) neonates were prospectively collected between 2002 and 2005. Methods. CAM was assessed on a three-grade scale based on the presence and distribution of polymorphonuclear leucocytes in the chorion/amnion. The presence of vasculitis and funisitis was recorded separately. Chronic villitis was diagnosed by the presence of mononuclear cells in the villous stroma. Relevant clinical data were collected from a specially constructed, web-based database. The statistic analyses were performed using multivariable logistic regression. Results. CAM (especially severe, AOR: 7.39 CI: 3.05–17.95), villous immaturity (AOR: 7.17 CI: 2.66–19.33), villitis (<1 % AOR: 4.31 CI: 1.16–15.98; ≥1 %, AOR: 3.87 CI: 1.38–10.83), SGA (AOR: 7.52 CI: 3.06–18.48), and BMI >24.9 (AOR: 2.06 CI: 1.21–3.51) were all connected to an elevated risk of term stillbirth. Conclusions. We found that CAM, chronic villitis, villous immaturity, SGA, and maternal overweight, but not vasculitis or funisitis are independently associated with risk for stillbirth at term.
Highlights
Infection is a common cause of stillbirth, its incidence varies greatly with gestational age and between developed and developing countries [1]
Bacterial infections are associated with acute inflammation of the placental membranes, notably acute chorioamnionitis (CAM), whereas in viral infections chronic inflammation of the placental parenchyma is described [3,4,5]
There was a higher incidence of a history of miscarriage among the cases but the groups did not differ with respect to smoking habits, primiparity, previous stillbirth, severe illness or pregnancy complications, Hb at admission to maternity health care centre, and sex of the infant or delivery method (i.e., caesarean section or vaginal delivery, Table 1(a))
Summary
Infection is a common cause of stillbirth, its incidence varies greatly with gestational age and between developed and developing countries [1]. In an earlier study by our group, infection was associated with stillbirth in 24% of cases [2]. In Sweden, stillbirth is currently defined as anteor intrapartum death from the 22nd week of pregnancy; its incidence is reported to be 5.3 per 1,000 live births [2]. Bacterial infections are associated with acute inflammation of the placental membranes, notably acute chorioamnionitis (CAM), whereas in viral infections chronic inflammation of the placental parenchyma (chronic villitis) is described [3,4,5]. The main focus of this paper will be on histologically diagnosed CAM
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