Decreased placental and maternal serum TRAIL-R2 levels are associated with placenta accreta

• TRAIL-R2, also known as death receptor-5, induces apoptotic signalling.
• We examine placental and maternal serum TRAIL-R2 levels in placenta accreta.
• Lower levels of placental TRAIL-R2 are associated with placenta accreta.
• Maternal serum and placental TRAIL-R2 levels are well-correlated.
• Previous history of cesarean section is significantly associated with placenta accreta.

ObjectivesTNF-related apoptosis-inducing ligand receptor-2 (TRAIL-R2) is produced both by decidual and trophoblast cells during pregnancy and known to participate in apoptosis. In this study, we aimed to determine and to compare maternal serum and placental TRAIL-R2 levels in patients with placenta accreta, non-adherent placenta previa and in healthy pregnancies. We also aimed to analyze the association of placenta accreta with the occurrence of previous C-sections.Study designA total of 82 pregnant women were enrolled in this case–control study (27 placenta accreta patients, 26 non-adherent placenta previa patients and 29 age-, and BMI-matched healthy, uncomplicated pregnant controls). TRAIL-R2 levels were studied in both maternal serum and placental tissue homogenates. Determining the best predictor(s) which discriminate placenta accreta was analyzed by multiple logistic regression analyses. Adjusted odds ratios and 95% confidence intervals were also calculated.ResultsBoth placental and serum TRAIL-R2 levels were significantly lower in placenta accreta group (median 34.82 pg/mg and 19.85 pg/mL, respectively) when compared with both non-adherent placenta previa (median 39.24 pg/mg and 25.99 pg/mL, respectively) and the control groups (median 41.62 pg/mg and 25.87 pg/mL, respectively) (p < 0.05). Placental TRAIL-R2 levels and previous cesarean section were found to be significantly associated with placenta accreta (OR: 0.934 95% CI 0.883–0.987, p = 0.016 and OR:7.725 95% CI: 2.717–21.965, p < 0.001, respectively). Placental and serum TRAIL-R2 levels were positively correlated.ConclusionDecreased levels of placental TRAIL-R2 and previous history of cesarean section were found to be significantly associated with placenta accreta, suggesting a possible role of apoptosis in abnormal trophoblast invasion.