Difference in adverse neonatal outcomes between preterm singletons and twins possibly explained by placental...

Area of Science:

• Perinatal Medicine
• Pathology
• Neonatology

Background:

• Preterm birth complications significantly impact neonatal outcomes.
• Understanding placental pathology is crucial for managing high-risk pregnancies.

Purpose of the Study:

• Compare placental histology in preterm singletons versus twins.
• Investigate differences between monochorionic and dichorionic twins.
• Correlate placental pathology with adverse neonatal outcomes.

Main Methods:

• Retrospective clinical data collection and prospective placental examination.
• Inclusion of 566 neonates born ≤32 weeks and/or ≤1500g (429 singletons, 137 twins).
• Assessment of maternal/fetal vascular malperfusion and placental inflammation.

Main Results:

• Singletons exhibited higher rates of maternal vascular malperfusion, fetal hypoxia, and inflammation (funisitis, chronic deciduitis, villitis).
• Monochorionic twins showed more delayed villous maturation and ischemia than dichorionic twins.
• Singleton neonates had lower birthweight and higher rates of being small for gestational age.

Conclusions:

• Histological placental abnormality rates differ between singleton and twin pregnancies.
• Gestational hypertension and specific placental abnormalities independently predict lower birthweight and small for gestational age in preterm neonates.