The Association of Histologic Placental Inflammation with Category II Fetal Heart Tracings

Abstract

The present study assessed whether placentas in women delivered by cesarean for category II fetal heart tracings (FHT) exhibit a higher incidence of acute inflammation than those of women delivered by cesarean for labor arrest. This case control study included singleton pregnancies ≥36 weeks of gestation delivered by cesarean for an FHT indication (cases) or because of labor arrest (controls) 2005-2009 at Prentice Women's Hospital. Exclusions were maternal diabetes, hypertension, known thrombophilia, connective tissue disorders, clinical evidence of chorioamnionitis, placental abruption, fetal anomalies, stillbirth, or an infant with a birth weight less than the 10th percentile. Women were included in the case group if the indication for cesarean delivery was based on the FHT and review of the FHT determined that they were designated as category II prior to delivery. A perinatal pathologist, unaware of indications for delivery, assessed placental inflammation in maternal and fetal compartments. Stage and grade of acute inflammation, from none to severe (scored 0-3), in the membranes, chorionic plate, chorionic vessels, and umbilical cord were assessed, and overall maternal and fetal inflammatory stages were assigned. Findings indicative of chronic inflammation were also noted. Other than lower umbilical artery cord gases in women with category II FHT, cases (n = 51) and controls (n = 27) had similar baseline characteristics and newborn outcomes, as well as similar placental pathologic findings. In uncomplicated patients, the presence or extent of placental inflammation does not appear to differ between women delivered for category II FHT and labor arrest.