Towards standardized criteria for diagnosing chronic intervillositis of unknown etiology: A systematic review

• Published in: Placenta (Eastbourne) Vol. 61; pp. 80 - 88
• Main Authors: Bos, M., Nikkels, P.G.J., Cohen, D., Schoones, J.W., Bloemenkamp, K.W.M., Bruijn, J.A., Baelde, H.J., van der Hoorn, M.L.P., Turner, R.J.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-01-2018
• Subjects: Chronic intervillositis; Chronic intervillositis of unknown etiology; Fetal loss; Intra uterine growth restriction; Miscarriage; Small for gestational age; Chronic intervillositis of unknown etiology; Intra uterine growth restriction; Fetal loss; CIUE; Chronic intervillositis; Small for gestational age; Miscarriage
• ISSN: 0143-4004; 1532-3102
• DOI: 10.1016/j.placenta.2017.11.012

Chronic intervillositis of unknown etiology (CIUE) is a poorly understood, relatively rare condition characterized histologically by the intervillous infiltration of mononuclear cells in the placenta. Clinically, CIUE is associated with poor pregnancy outcome (e.g., impaired fetal growth, preterm birth, fetal death) and high risk of recurrence in subsequent pregnancies. Because CIUE is not defined consistently, it is essential to clearly define this condition. We therefore review the published definitions of CIUE. In addition, we provide an overview of the reviewed histopathological and maternal characteristics, obstetric features, and pregnancy outcomes. Medical publication databases were searched for articles published through February 2017. Eighteen studies were included in our systematic review. The sole inclusion criterion used in all studies was the presence of intervillous infiltrates. Overall, CIUE was characterized by adverse pregnancy outcome. Miscarriage occurred in 24% of cases, with approximately half of these miscarriages defined as late. Impaired growth was commonly observed, 32.4% of pregnancies reached term, and the live birth rate was 54.9%. The high recurrence rate (25.1%) of the intervillous infiltrates in subsequent pregnancies underscores the clinical relevance of CIUE, the need for increased awareness among pathologists and clinicians, and the need for further research. Criteria for the diagnosis of CIUE are proposed and a Delphi study could be used to resolve any controversy regarding these criteria. Future studies should be designed to characterize the full clinical spectrum of CIUE.
•CIUE is a poorly understood condition.•CIUE is characterized by mononuclear cells in the intervillous space of the placenta.•CIUE is frequently associated with poor pregnancy outcome.•Up to 25% recurrence rate in subsequent pregnancies has been reported after CIUE.•Future studies on CIUE should determine the full spectrum of CIUE.