Issues périnatales de 122 cas d’intervillite chronique d’étiologie indéterminée : une étude observationnelle multicentrique

Abstract : Context: chronic intervillositis of unknown etiology (CIUE) is a rare placental pathology characterized by a macrophage infiltration of the intervillous space and associated with severe obstetrical complications. Only limited retrospective case-series have been described and prognostic factors associated to perinatal issues remain to be elucidated. Objective. We aimed to describe maternal characteristics, obstetrical features, outcomes and placental histopathology of 122 CIUE. Methods: we conducted a multicenter retrospective study in five centers between 1st January 1997 and 31 July 2018. Potential CIUE diagnosis were screened in the database of Fetal and Placental pathology department. Multiple pregnancies and pregnancies with medical follow-up out of study centers were excluded. Cases with a histopathologic diagnosis of CIUE confirmed according to standardize criterion were included. This study received approval of the Research Ethics Board. Results: 122 pregnancies (102 patients) with CIUE were included in the study. Pregnancy loss rates were high with 17 (13.9%) miscarriages, 17 (13.9%) stillbirths and 18 (14.8%) medical termination of pregnancy. Of the 70 (57.4%) pregnancies which lead to a live birth, 38 (54.3%) newborns were premature and 50 (71 %) were complicated by intra uterine growth retardation (IUGR). Among the 102 patients, 22 patients had subsequent pregnancy and half of them developed a recurrent CIUE. The different therapeutic combinations proposed in our cohort did not impact on perinatal outcomes or recurrence prevention. Gradation of macrophage infiltrate was the only feature significantly associated with perinatal issue (p < 0.05). Conclusion: this study provides an extensive description of the largest cohort of CIUE reported in the literature. It confirms that CIUE is associated with high rates of adverse pregnancy outcomes including pregnancy loss, IUGR and preterm birth, and also identifies macrophagic infiltration as an important prognosis factor. Larger multicenter cohort and prospective randomized controlled trial for treatment are needed to improve knowledge and care of patients with CIUE.
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Master Thesis
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Aurélien Mattuizzi. Issues périnatales de 122 cas d’intervillite chronique d’étiologie indéterminée : une étude observationnelle multicentrique. Médecine humaine et pathologie. 2018. ⟨dumas-02075907⟩

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