Dominant Role of Placental Vascular Pathology in Preterm Birth Among Placenta Previa Cases: A Clinicopathological Analysis.

BACKGROUND

Placenta previa (PP) is a major cause of preterm birth, yet the role of placental vascular pathology remains unclear. This study investigated maternal, fetal, and placental histopathological factors associated with preterm delivery in PP cases, emphasizing vascular malperfusion.

METHODS

A retrospective case-control study included 88 singleton PP pregnancies without placental invasion: 56 preterm (<37 weeks) and 32 term (≥37 weeks) deliveries. Placental pathology was evaluated per the Amsterdam criteria. Multivariable logistic regression identified predictors of preterm birth.

RESULTS

Maternal vascular malperfusion (MVM) was significantly more common in preterm cases (67.9% vs. 18.8%, p < 0.001) and was a strong independent predictor (OR = 11.08; p < 0.001). Fetal vascular malperfusion (FVM) was also more frequent (80.4% vs. 56.3%, p = 0.030), but not independently significant.

CONCLUSION

Vascular lesions, especially MVM, are key drivers of preterm birth in PP. These findings highlight the importance of placental evaluation in clinical management.