THE CORRELATION BETWEEN PLACENTAL PATHOLOGY AND INTRAVENTRICULAR HEMORRHAGE IN THE PRETERM INFANT

The aim of this study is to better understand the relationship between placental pathology and risk of intraventricular hemorrhage (IVH). We address two specific hypotheses. 1) Morphologic correlates of pregnan cy-induced hypertension (PM) are associated with a decreased risk of I VH. 2) Morphologic correlates of amniotic sac inflammation (ASI) are a ssociated with an increased risk of IVH. Maternal, neonatal, and place ntal data were analyzed by univariate and multivariate methods in this prospective cohort study of 1095 very low birth weight infants. A clu ster analysis model was used to categorize the placental pathologic fe atures into clusters, the two main ones being PM and ASI. Deliveries w ere subdivided by the interval between membrane rupture and delivery a s an index of preexisting infection (<1 h) and ascending infection (gr eater than or equal to 1 h). Univariate analysis supports both hypothe ses. However, in multivariate models that adjusted for such potential confounders as gestational age, labor, and route of delivery, the only associations that persisted were the increased risk of IVH associated with the presence of chorionic or umbilical vasculitis in infants bor n within 1 h of membrane rupture. Placental correlates of PM do not pr ovide additional information about NH risk independent of the presence of other components of the PM and ASI clusters, and confounders such as gestational age, labor, and route of delivery. Placental correlates of ASI, specifically the fetal responses of chorionic and umbilical v asculitis to preexisting infection, are associated with an increased r isk of IVH independent of confounders. Cytokines may provide the link between placental inflammation and fetal/neonatal brain hemorrhage.