Periventricular Leukomalacia and Placental Histopathologic Abnormalities

Maleki, Zahra MD1; Bailis, Anya J. MD2; Argani, Cynthia H. MD2; Askin, Frederic B. MD1; Graham, Ernest M. MD2

Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e3181bdcfc4
Original Research
Abstract

OBJECTIVE: To estimate whether there are placental histopathologic abnormalities associated with neonatal periventricular leukomalacia (PVL), a major precursor of cerebral palsy.

METHODS: This is a case-control study of 167 neonates born between 23 and 34 weeks of gestation diagnosed with PVL by head ultrasonography within 6 weeks of birth, and 167 control neonates without neurologic morbidity matched by gestational age. Placentas for both case neonates and control neonates were reviewed by two perinatal pathologists who were blinded to neonatal course.

RESULTS: Neonates with PVL were significantly more likely to have positive neonatal blood (28.7%, 16.8%, P=.001) and cerebrospinal fluid (14.4%, 4.8%, P=.007) cultures. The ratio of placental weight to birth weight did not differ between groups, but neonates with PVL had significantly more chronic diffuse capsular deciduitis (20.4%, 10.8%, P=.02) and capsular decidual plasma cells (8.4%, 2.4%, P=.02). Conditional logistic regression adjusting for birth weight and the presence of multiple gestation in the identification of PVL showed a significant increase for diffuse capsular deciduitis (P=.02) and capsular decidual plasma cells (P=.03).

CONCLUSION: Periventricular leukomalacia has a significant but weak association with chronic diffuse capsular deciduitis and the presence of capsular decidual plasma cells, evidence of chronic infection but not histologic acute chorioamnionitis.

LEVEL OF EVIDENCE: II

In Brief

Periventricular leukomalacia, a major precursor of cerebral palsy, is associated with chronic diffuse capsular deciduitis and capsular decidual plasma cells but not histologic acute chorioamnionitis.

Author Information

From the 1Department of Pathology and 2Department of Gynecology & Obstetrics, Division of Maternal–Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Presented at the annual meeting of the Society for Maternal–Fetal Medicine in San Diego, California, January 26–31, 2009.

Corresponding author: Zahra Maleki, MD, Bayview Medical Center, Department of Pathology, AA Building 154B, 4940 Eastern Avenue, Baltimore, MD 21224; e-mail: zmaleki1@jhmi.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2009 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.