Periventricular leukomalacia (PVL) occurs commonly in premature infants. The white matter injury is considered to be principally a consequence of ischemic insult to vascular watershed zones with high intrinsic vulnerability. However, other factors, eg., bacterial endotoxins, have also been implicated. In premature newborns with PVL, we observed a high incidence (50%) of presumed antenatal infection compared with controls, based on clinical data. In this study, we describe placental abnormalities associated with cystic PVL and assess their clinical relevance in its pathogenesis.
The study population comprised 51 premature newborns (birthweight < 1500g) with cystic PVL whose placentas were reviewed by gross and microscopic examinations. All placentas were abnormal. There was a high incidence of inflammation involving chorion / amnion (73%), umbilical cord (49%), fetal surface vessels (43%), decidua (16%) and villitis of unknown etiology (6%). Possible chronic hypoxic changes included villous dysmaturity (22%), villous or decidual infarction (20%). Acute hypoxic changes included meconium staining(12%), intravillous hemorrhage/edema (36%), decidual hemorrhage (10%). No case had fetal surface vessel thrombosis.
