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.