Poster Session 3
Category: Clinical Obstetrics
Poster Session 3
Sunitha Suresh, MD (she/her/hers)
Attending Physician
Endeavor Health
Endeavor Health System, Illinois, United States
Penelope Lialios, BS
University of Michigan
University of Michigan, Michigan, United States
Alexa A. Freedman, PhD (she/her/hers)
Assistant Professor
Northwestern University
Chicago, Illinois, United States
Linda M. Ernst, MD
Clinical Professor Pathology
Endeavor Health
Evanston, Illinois, United States
Dichorionic diamniotic (didi) gestation is associated with preterm birth (PTB), without a well described underlying cause. The purpose of this study is to utilize placental pathology to further understand the biologic mechanisms underlying increased risk of PTB in twin gestation.
Study Design:
This is a retrospective cohort study of live didi twin gestations with placental pathology available delivering at a single health system between 2017 and 2023. Placental pathology was characterized as acute inflammation (AI), fetal vascular malperfusion (FVM), maternal vascular malperfusion (MVM), and chronic inflammation (CI), with presence in either twin placenta considered as presence. Prevalence of placental pathology was compared by PTB vs term birth, and subsequently among PTB by spontaneous (sPTB) vs indicated (iPTB) preterm delivery. Frequencies were compared using chi squared tests and logistic regression was used to adjust for covariates- IVF pregnancy, maternal age, BMI, preexisting diabetes (DM), and chronic hypertension (CHTN).
Results:
373 didi twin pairs were included, of which 49% (184/373) had a PTB. Demographic characteristics were similar by PTB apart from increased DM and CHTN. In the primary analysis, PTB was associated with increased prevalence of MVM (42.4% vs 19.6%, p = < . 001, aOR 3.15 95%CI (1.94,5.11), Table 1). No other pathologies differed by PTB. Among those with a PTB, there was an increased likelihood of AI among those with sPTB vs. iPTB (aOR 4.17, 95% CI 1.88, 9.25) which was attenuated in sensitivity analyses restricted to patients who labored (aOR 1.93, 95% CI 0.71, 5.26). There was no difference in likelihood of MVM by iPTB vs sPTB (aOR 1.01, 95% CI 0.54, 1.89).
Conclusion:
PTB in twin gestation is associated with MVM. sPTB in twin gestation is associated with a higher odds of AI than iPTB; however, this association was attenuated when restricting to labored patients only. Further research is needed in understanding risk factors underlying MVM as it relates to preterm birth in the didi twin population.