A Series of Rare Chronic Histiocytic Intervillositis Cases and its Association With Fetal Growth Restriction

Abstract

Objective: To re-evaluate a series of 6 diagnosed cases of chronic histiocytic intervillositis (CHI) its relation to recurrent pregnancy losses, and fetal growth restriction (FGR).
Methods: A retrospective study was conducted where patients were identified from the Department of Obstetrics and Gynecology database in Sant Joan de Deu Hospital (HSJD), Barcelona, Spain, between 2012 and 2016.
Results: Six cases were identified. All the 6 cases (100%) had a significant history for early pregnancy losses. Two patients had a previous history of recurrent pregnancy losses (>3) prior to spontaneous preterm labor of growth restricted fetuses with pathological utero-placenta doppler studies (33.3% of cases). The common factor among all patients was the smoking habits for more than 5 cigarettes per day and early pregnancy losses in the first trimester. In addition, maternal blood analysis showed increased neutrophils percentages and absolute values in 80% of the cases. Placental histological examination was significant for diffuse infiltration of the intervillous space prominently with cluster of differentiation 68 (CD68) positive macrophages and variable amounts of fibrinoid material deposition.
Conclusion: The mononuclear nature of the inflammatory cell infiltrate and the fibrin deposition in the placenta suggests an immunological insult. Hence, we hypothesize that the maternal immune system plays a key role in these cases. Also, our report data is consistent with the known association of chronic histiocytic intervillositis and recurrent pregnancy losses and FGR. In addition, these results support the notion of the negative impact of maternal smoking on pregnancy and fetal growth. Herein, we recommend conducting further studies to unravel the unknown pathophysiology of this disease in order to improve pregnancy outcomes.