Placental pathology after resolved antepartum sepsis: Evidence of persistent vascular and inflammatory injury

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BACKGROUND: Sepsis during pregnancy is associated with increased risks of fetal growth restriction, preeclampsia, and placental abruption even after maternal recovery. Characterizing placental pathology after antepartum sepsis may clarify mechanisms linking infection to subsequent pregnancy complications. METHODS: We performed placental histopathologic analysis on individuals delivering at a single institution. Cases had resolved antepartum sepsis (defined as clinical recovery ≥7 days before delivery), and controls were individuals without an antepartum infection hospitalization. Exclusion criteria included multifetal gestation, fetal anomalies, TORCH infections, and delivery <34 weeks' gestation (chosen to minimize gestational age-dependent histologic variability). All placentas were reviewed by a subspecialty placental pathologist and lesions characterized according to the Amsterdam criteria. Clinical characteristics and histopathologic findings were compared using Fisher's exact and Wilcoxon rank-sum tests. RESULTS: Twenty-two sepsis-exposed pregnancies and 49 controls were included. The most common infection sources were urinary tract (36.4%) and respiratory (36.4%), diagnosed at a mean (SD) gestational age of 25.3 (9.2) weeks. The sepsis group was younger (31.6 [4.6] vs 34.6 [4.7] years; p = 0.017) and had higher rates of tobacco use (13.6% vs 0%; p = 0.027) and pregestational diabetes (13.6% vs 0%; p = 0.027). Sepsis-exposed placentas had significantly higher rates of maternal vascular malperfusion (31.8% vs 0%; p < 0.001), placental infarction (13.6% vs 0%; p = 0.027), avascular villi (27.3% vs 4.1%; p = 0.009), histologic chorioamnionitis (50.0% vs 17.0%; p = 0.015), and meconium-staining (50.0% vs 14.3%; p = 0.003). CONCLUSIONS: Resolved antepartum sepsis is associated with increased placental vascular and inflammatory pathology, suggesting lasting placental injury after severe systemic infection that may underlie adverse pregnancy outcomes.

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