Role of placental morphological audit in the diagnosis of subclinical intrauterine inflammation and in the prediction of preterm birth: original research

Abstract

DOI: 10.52705/2788-6190-2025-4-05
УДК 618.34-002-022.7:618.36-076.4:618.39-037

The objective: to determine the association between morphological features of chorioamnionitis and systemic inflammatory biomarkers, clinical, hormonal, and psychological indicators for predicting spontaneous preterm birth.
Materials and methods. The study included 223 patients whose placentas underwent postpartum morphological examination. Based on placental histology and the timing of delivery, three groups were formed: subgroup A – preterm birth with histological chorioamnionitis (n = 74); subgroup B – term birth with histological chorioamnionitis (n = 43); subgroup C – term birth without morphological signs of chorioamnionitis (n = 109). All participants underwent evaluation of C-reactive protein, leukocyte count, procalcitonin, GroEL, and cortisol levels in plasma; cervical length measurement; and assessment of psychological status using the Edinburgh Postnatal Depression Scale (EPDS). Statistical analysis included intergroup comparisons, p-value calculation, and assessment of gradient changes across subgroups.
Results. In subgroup A, the median C-reactive protein level was 12.0 mg/L, compared with 1.0 mg/L in subgroup B and 0.5 mg/L in subgroup C (p < 0.001). Leukocyte count was highest in subgroup A – 13 × 109 /L compared with 10 × 109 /L and 8.2 × 109 /L, respectively (p < 0.001). Median procalcitonin in subgroup A was 0.15 ng/mL versus 0.10 and 0.05 ng/mL (p = 0.001), while cortisol levels reached 7.3 μg/dL compared with 3.0 μg/dL and 2.8 μg/dL (p = 0.005). Psychological assessment showed a median EPDS score of 22 in subgroup A compared with 12 and 11 points (p < 0.001). Median cervical length was shortest in subgroup A – 22 mm versus 25 mm and > 35 mm (p < 0,001). Prelabor rupture of membranes occurred in 50% of subgroup A, 32.6% of subgroup B, and only isolated cases in subgroup C (p = 0.082). Prolapse of the fetal membranes was observed exclusively in subgroup A (23%; p = 0.009).
Conclusions. Histologically confirmed chorioamnionitis is associated with systemic inflammatory activation, hormonal alterations, and structural cervical changes, which substantially increase the risk of preterm birth. The observed gradient between morphological, laboratory, and clinical indicators underscores the multifactorial nature of extremely early spontaneous preterm birth. The findings support integrating morphological criteria with systemic biomarkers to develop highly accurate prediction models for preterm birth and early detection of intrauterine inflammation. The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the institution specified in the manuscript, and written informed consent was obtained from all participants. The authors declare no conflicts of interest.