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Peer-reviewedCC BY 4.0Placenta

Placental pathology after resolved antepartum sepsis: Evidence of persistent vascular and inflammatory injury

  • Christine A. Blauvelt1
  • Stephanie M. Tsoi2
  • Kiana C. Nguyen3
  • Sirirak Buarpung4
  • Megan Chidboy4
  • Nida Ozarslan4
  • Adrienne Epstein5
  • Michelle E. Roh6
  • Cynthia A. Gasper7
  • Stephanie L. Gaw1
7 affiliations
  1. 1Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
  2. 2Division of Critical Care, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
  3. 3Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, USA
  4. 4Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
  5. 5Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
  6. 6Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
  7. 7Department of Pathology, University of California San Francisco, San Francisco, CA, USA
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Abstract

Background:: Sepsis during pregnancy is associated with increased risks of fetal growth restriction, preeclampsia, and placental abruption even after maternal recovery. Characterizing placental pathology after antepartum sepsis may clarify mechanisms linking infection to subsequent pregnancy complications.

Methods:: We performed placental histopathologic analysis on individuals delivering at a single institution. Cases had resolved antepartum sepsis (defined as clinical recovery ≥7 days before delivery), and controls were individuals without an antepartum infection hospitalization. Exclusion criteria included multifetal gestation, fetal anomalies, TORCH infections, and delivery <34 weeks’ gestation (chosen to minimize gestational age-dependent histologic variability). All placentas were reviewed by a subspecialty placental pathologist and lesions characterized according to the Amsterdam criteria. Clinical characteristics and histopathologic findings were compared using Fisher’s exact and Wilcoxon rank-sum tests.

Results:: Twenty-two sepsis-exposed pregnancies and 49 controls were included. The most common infection sources were urinary tract (36.4%) and respiratory (36.4%), diagnosed at a mean (SD) gestational age of 25.3 (9.2) weeks. The sepsis group was younger (31.6 [4.6] vs 34.6 [4.7] years; p = 0.017) and had higher rates of tobacco use (13.6% vs 0%; p = 0.027) and pregestational diabetes (13.6% vs 0%; p = 0.027). Sepsis-exposed placentas had significantly higher rates of maternal vascular malperfusion (31.8% vs 0%; p < 0.001), placental infarction (13.6% vs 0%; p = 0.027), avascular villi (27.3% vs 4.1%; p = 0.009), histologic chorioamnionitis (50.0% vs 17.0%; p = 0.015), and meconium-staining (50.0% vs 14.3%; p = 0.003).

Conclusions:: Resolved antepartum sepsis is associated with increased placental vascular and inflammatory pathology, suggesting lasting placental injury after severe systemic infection that may underlie adverse pregnancy outcomes.

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Cite

BibTeXRIS
BibTeX
@article{blauvelt2026placental,
  title = {{Placental pathology after resolved antepartum sepsis: Evidence of persistent vascular and inflammatory injury}},
  author = {Christine A. Blauvelt and Stephanie M. Tsoi and Kiana C. Nguyen and Sirirak Buarpung and Megan Chidboy and Nida Ozarslan and Adrienne Epstein and Michelle E. Roh and Cynthia A. Gasper and Stephanie L. Gaw},
  journal = {Placenta},
  year = {2026},
  month = jun,
  doi = {10.1016/j.placenta.2026.06.004},
  url = {https://doi.org/10.1016/j.placenta.2026.06.004},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Placental pathology after resolved antepartum sepsis: Evidence of persistent vascular and inflammatory injury
AU  - Christine A. Blauvelt
AU  - Stephanie M. Tsoi
AU  - Kiana C. Nguyen
AU  - Sirirak Buarpung
AU  - Megan Chidboy
AU  - Nida Ozarslan
AU  - Adrienne Epstein
AU  - Michelle E. Roh
AU  - Cynthia A. Gasper
AU  - Stephanie L. Gaw
PY  - 2026
DA  - 2026/06/15
JO  - Placenta
DO  - 10.1016/j.placenta.2026.06.004
UR  - https://doi.org/10.1016/j.placenta.2026.06.004
AB  - Background:: Sepsis during pregnancy is associated with increased risks of fetal growth restriction, preeclampsia, and placental abruption even after maternal recovery. Characterizing placental pathology after antepartum sepsis may clarify mechanisms linking infection to subsequent pregnancy complications.  Methods:: We performed placental histopathologic analysis on individuals delivering at a single institution. Cases had resolved antepartum sepsis (defined as clinical recovery ≥7 days before delivery), and controls were individuals without an antepartum infection hospitalization. Exclusion criteria included multifetal gestation, fetal anomalies, TORCH infections, and delivery <34 weeks’ gestation (chosen to minimize gestational age-dependent histologic variability). All placentas were reviewed by a subspecialty placental pathologist and lesions characterized according to the Amsterdam criteria. Clinical characteristics and histopathologic findings were compared using Fisher’s exact and Wilcoxon rank-sum tests.  Results:: Twenty-two sepsis-exposed pregnancies and 49 controls were included. The most common infection sources were urinary tract (36.4%) and respiratory (36.4%), diagnosed at a mean (SD) gestational age of 25.3 (9.2) weeks. The sepsis group was younger (31.6 [4.6] vs 34.6 [4.7] years; p = 0.017) and had higher rates of tobacco use (13.6% vs 0%; p = 0.027) and pregestational diabetes (13.6% vs 0%; p = 0.027). Sepsis-exposed placentas had significantly higher rates of maternal vascular malperfusion (31.8% vs 0%; p < 0.001), placental infarction (13.6% vs 0%; p = 0.027), avascular villi (27.3% vs 4.1%; p = 0.009), histologic chorioamnionitis (50.0% vs 17.0%; p = 0.015), and meconium-staining (50.0% vs 14.3%; p = 0.003).  Conclusions:: Resolved antepartum sepsis is associated with increased placental vascular and inflammatory pathology, suggesting lasting placental injury after severe systemic infection that may underlie adverse pregnancy outcomes.
SN  - 0143-4004
SN  - 1532-3102
ER  -