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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, MD, FRCOG, Joachim W.

Ed. by Bancalari, Eduardo / Chappelle, Joseph / Chervenak, Frank A. / Genc, Mehmet R. / Greenough, Anne / Grunebaum, Amos / Konje, Justin C. / Kurjak M.D., Asim / Romero, Roberto

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IMPACT FACTOR 2017: 1.558
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1619-3997
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Volume 45, Issue 1

Issues

Placental malperfusion as a possible mechanism of preterm birth in patients with Müllerian anomalies

Jovana Lekovich
  • Corresponding author
  • Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Avenue, 6Floor, New York, NY 10021, United States of America
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/ Joshua Stewart
  • Department of Obstetrics and Gynecology, Weill Cornell Medical Center, 525 East 68Street, New York, NY 10021, United States of America
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/ Sarah Anderson
  • Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 1700 6Avenue, South Birmingham, AL 35233, United States of America
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/ Erin Niemasik
  • Department of Obstetrics and Gynecology, Weill Cornell Medical Center, 525 East 68Street, New York, NY 10021, United States of America
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/ Nigel Pereira
  • Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Avenue, 6Floor, New York, NY 10021, United States of America
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  • De Gruyter OnlineGoogle Scholar
/ Stephen Chasen
  • Department of Obstetrics and Gynecology, Weill Cornell Medical Center, 525 East 68Street, New York, NY 10021, United States of America
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Published Online: 2016-09-17 | DOI: https://doi.org/10.1515/jpm-2016-0075

Abstract

Objective:

Müllerian anomalies are associated with increased risk of miscarriage, intrauterine growth restriction (IUGR) and preterm birth. While a commonly implicated cause is restricted expansion of endometrial cavity, alternatively it could be due to abnormal placentation. We sought to examine clinical and histopathologic factors associated with preterm delivery in women with Müllerian anomalies.

Study design:

One hundred and eleven singleton pregnancies in 85 women were analyzed retrospectively. There were 42 pregnancies with bicornaute, 24 with unicornuate, 24 with septate, 19 with didelphys and one each with arcuate and T-shaped uterus. Primary outcomes included gestational age at delivery, placental histopathology, placenta previa and accreta.

Results:

Twenty-eight (25.2%) of pregnancies were delivered prior to term. Of those, only 14 (50%) were due to preterm labor or preterm premature rupture of membranes (PPROM). Histological evidence of placental malperfusion was present in 22% of all pregnancies and those delivered at an earlier median gestational age [34 (IQR 31–37) vs. 37 weeks (IQR 34–39); P=0.001]. Malperfusion was more common in preterm than in full term births (46% vs. 14%; P=0.04). Conversely, inflammation was not more common in preterm compared to term deliveries (17.9% vs. 16.9%; P=0.89). Five pregnancies had placenta previa, three of which were complicated by accreta.

Conclusion:

Placental malperfusion, rather than inflammation, was more commonly associated with preterm births in women with uterine anomalies.

Keywords: Müllerian anomalies; preterm delivery; placental malperfusion

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About the article

Corresponding author: Jovana Lekovich, MD, Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Avenue, 6th Floor, New York, NY 10021, USA, Tel.: +(646) 962-3317, Fax: +(646) 962-2534


Received: 2016-02-29

Accepted: 2016-08-03

Published Online: 2016-09-17

Published in Print: 2017-01-01


The authors stated that there are no conflicts of interest regarding the publication of this article.


Citation Information: Journal of Perinatal Medicine, Volume 45, Issue 1, Pages 45–49, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: https://doi.org/10.1515/jpm-2016-0075.

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