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. 2021 Aug 12;16(8):e0255902. doi: 10.1371/journal.pone.0255902

Table 3. Identified viral infection and histopathological changes in preterm birth.

Author, Year Reported pathogenic microorganism Diagnostic method No. PTB (%) Infection Histopathological abnormalities Triad of histopathology, infection and PTB
Ategeka, 2019 [29] HIV Not mentioned 18/193 (9.4%) All women had HIV and treated with combination of ART for >90 days (67.4%), and were WHO HIV disease stage 1 (asymptomatic) (94.8%). 102/193 (52.8%) of placentas had either maternal and/or fetal histological chorioamnionitis. 44.5% (22.5% mild, 11.0% moderate, 11.0% severe) and 28.0% (17.6% mild, 9.3% moderate, 1.0% severe) of placentas had maternal and fetal histological chorioamnionitis, respectively. Risk of preterm birth was significantly associated with severe maternal histological chorioamnionitis compared to none-mild in HIV infected women (28.6% vs 6.0%; aOR 6.04; 95%CI 1.87–19.5, P = 0.003). Risk of preterm birth was not associated with fetal histological chorioamnionitis.
Feist, 2020 [32] HPV, enterovirus HPV-PCR and RT-PCR for enterovirus 14/50 (28%) HPV and enterovirus were not detected in any specimen with abnormal placental histopathology findings (VUE and CD). 20 cases with VUE and 30 cases with chronic deciduitis with plasma cells were included. A causal role for enterovirus and HPV in the development of VUE and CD was unlikely.
CD (but not VUE) was associated with PTB (4/30,15%) and PPROM (7/30, 26%).
Gichangi, 1993 [33] HIV Enzyme immunoassay (EIA), confirmed by Western Blot 117/467 (31.4%) Maternal HIV-1 positive rate was 3.1% in 216 liveborn term and 8.6% in 117 preterm births. Maternal HIV-1 was independently associated with preterm birth OR 2.1 95%CI 1.1–4.0). Preterm birth was strongly associated with histological chorioamnionitis (OR 2.3; 95%CI 1.4–3.8, P<0.001), funisitis (OR 6.7; 95%CI 3.2–14.2, P<0.001) and villitis (OR 7.8; 95%CI 12.0–35.5, P<0.001). In HIV positive mothers, preterm placentas were associated with moderate to severe chorioamnionitis (OR 3.2; 95%CI 1.1–9.5, P<0.05) and moderate to severe funisitis (OR 6.1; 95%CI 1.2–42.7, P<0.05) compared to HIV negative preterm placentas.
Ladner, 1998 [42] HIV Enzyme link immunosorbent assay (ELISA) 39/275 (14%) 275 HIV negative and 286 HIV positive placenta were examined. The rate of STDs (24–28 weeks gestation, and all treated) was not statistically different by HIV serostatus. Histological chorioamnionitis was not associated with serostatus: 27 (9.8%) HIV positive and 28 (9.8%) HIV negative women. No statistical association, independent of HIV serostatus, was found between histological chorioamnionitis and STDs. In HIV positive women but not HIV negative women, the risk of preterm birth and premature rupture of membranes was higher in histological chorioamnionitis than in controls (RR 3.0; 95%CI 1.5–6.3, P = 0.003) and (RR 2.9; 95%CI 1.4–6.1, P = 0.01).
Ombimbo, 2019 [45] HIV Not mentioned 81/101 (80.2%) 38/81 (47%) preterm placentas were HIV positive cases and 43/81 (53%) were HIV negative. Placental histopathological features including immature villi, syncytial knotting, villitis and deciduitis were not significantly different between HIV positive and negative preterm placentas. The following placental histopathological changes between HIV positive and HIV negative preterm placentas were significantly different; fibrinoid deposition with villous degeneration (59% vs 27%, P = 0.026), syncytiotrophoplast delamination (46% vs 9%, P = 0.006), increased red cell adhesion to terminal villi (50% vs 9%, P = 0.003) and increased number of capillaries (32% vs 0%, P<0.05).
Tsekoura, 2010 [50] Adenovirus PCR (placenta tissue) 37/58 (63.8%) Detection of adenovirus was higher in preterm (29/71, 40.8%) than term placentas (25/122, 20.5%), (OR 2.7; 95%CI 1.4–5.1, P = 0.002). Histological chorioamnionitis was more common in preterm than term placentas (49% vs. 19%; P = 0.025). In preterm placentas, histological chorioamnionitis was more common in adenovirus PCR-positive than adenovirus negative samples (75% vs. 36%; P = 0.026). In adenovirus PCR-positive placentas, histological chorioamnionitis was more frequent in preterm than term placentas (75% vs. 36%; P = 0.003). However, in adenovirus PCR-negative placentas, abnormal histological findings did not differ significantly between preterm and term (36% vs. 20%; P = 0.488).

Abbreviations: ART, anti-retroviral therapy; CD, chronic deciduitis; HIV, human immunodeficiency virus; HPV, human papilloma virus; OR, Odds ratio; PCR, polymerase chain reaction; VUE, villitis of unknown origin.