MATERNAL AND FETAL INFLAMMATORY RESPONSE AS A DETERMINANT OF NEONATAL OUTCOMES IN PRETERM BIRTHS: A CLINICOPATHOLOGICAL CASE SERIES OF 30 PLACENTAS

Abstract

Background: Preterm birth is one of the major causes of neonatal morbidity and mortality worldwide. Intrauterine infection and inflammation are important contributors to spontaneous preterm labour, with chorioamnionitis being a common associated pathology. Placental histopathological examination remains the gold standard for identifying subclinical chorioamnionitis. Objective: To study the histopathological features of chorioamnionitis in preterm placentas and to correlate maternal inflammatory response (MIR) and fetal inflammatory response (FIR) with neonatal outcome. Methods: This retrospective case series included 30 placentas from preterm deliveries (<37 weeks gestation) showing histological evidence of chorioamnionitis. Routine hematoxylin and eosin stained sections were examined. Inflammatory changes were classified into maternal and fetal inflammatory responses using standard histopathological criteria. Relevant maternal and neonatal clinical details were obtained from hospital records. Results: Maternal inflammatory response was seen in all 30 cases, with Stage 2 being the most frequent pattern (56.7%). Fetal inflammatory response was identified in 46.7% of cases. Funisitis was present in 30% of cases, including necrotizing funisitis in 6.7%. Cases showing isolated maternal inflammatory response were generally associated with better neonatal outcomes. In contrast, cases with fetal inflammatory response, particularly those with funisitis, showed increased neonatal morbidity including low Apgar scores, respiratory distress, early-onset sepsis, and prolonged NICU stay. Conclusion: Fetal inflammatory response appears to have a stronger association with adverse neonatal outcomes when compared to isolated maternal inflammation. Routine placental examination in preterm deliveries may help in identifying clinically unsuspected chorioamnionitis and assist in neonatal risk assessment.