Medically Indicated Preterm Deliveries – Are Placental Dysfunction and Vasculopathies Related?
ACOG ePoster. Randolph T. Apr 27, 2018; 212108; 9A
Todd Randolph
Todd Randolph
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Abstract
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Introduction: To examine the relationship between placental dysfunction disorders (PDD), vasculopathies (VP), medically indicated preterm delivery (miPTD) and spontaneous preterm delivery (sPTD).

Methods: Retrospective cohort study of women with singleton gestations. Preterm delivery defined as delivery prior to 37 weeks gestation. The type of delivery (term, miPTD, or sPTD) was determined, and clinical diagnoses were categorized into PDD (preeclampsia, fetal distress, IUGR, oligohydamnios, abruption, gestational hypertension) and VP (Type 1 or 2 diabetes, gestational diabetes, chronic hypertension). The prevalence for each diagnosis was examined for each type of delivery.

Results: Study population included 3049 term deliveries, 190 sPTD, and 232 miPTD. There were no significant differences in maternal age and parity among these three groups. Patients with miPTD were more likely to be non-Hispanic and to have a higher BMI. As expected, the fraction of patients with at least one PDD or VP were significantly higher for miPTB compared to sPTB and term. Also, the fraction of patients with at least one PDD AND at least one VP were markedly and significantly (p less than 0.0001) higher for miPTD (20%) compared to sPTD (4.2%) or term (2.7%). Interestingly, patients with a more severe vasculopathy or multiple concurrent vasculopathies were associated with higher rates of PTD, particularly miPTD.

Conclusion/Implications: The combination, PDD/VP, is significantly increased in miPTD versus sPTD or terms, and severe vasculopathies or concurrent vasculopathies show increased rates of PTD. These conditions may indicate severe epithelial damage resulting in poor perfusion and primary placental dysfunction requiring miPTD.
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