DOI: 10.47582/jompac.1980315 ISSN: 2717-7505

Placental NLRP3 expression across placenta accreta spectrum, placenta previa, and other non-PAS placental pathologies: an immunohistochemical study

Dinçer Sümer, Hitay Cemre Metindoğan, Firdevs Şahin Duran, Ahmet Arif Filiz, Özgür Volkan Akbulut, Büşra Seçilir, Furkan Akın, Zehra Yılmaz, Şevki Çelen, Ali Çağlar
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Aims: Placenta accreta spectrum (PAS) is characterized by abnormal trophoblast invasion and is associated with substantial maternal morbidity. This study aimed to evaluate placental NLRP3 protein expression across PAS, placenta previa, and other non-PAS placental pathologies. Methods: This retrospective study included 52 placental specimens: 26 PAS cases, 11 placenta previa cases, and 15 other non-PAS placental pathologies. NLRP3 expression was assessed immunohistochemically using a semi-quantitative scoring system. Logistic regression and receiver operating characteristic (ROC) analyses were performed to evaluate the association of NLRP3 with PAS. Results: NLRP3 staining scores differed significantly across the three study groups (p=0.036). However, none of the pairwise comparisons remained statistically significant after Bonferroni correction, although PAS showed a trend toward higher NLRP3 expression than other non-PAS placental pathologies before correction (uncorrected p=0.018), these findings should be considered exploratory. In univariable logistic regression, higher NLRP3 expression was associated with PAS (OR 1.318, 95% CI 1.041–1.669, p=0.022). After adjustment, the number of previous cesarean deliveries remained independently associated with PAS (aOR 8.621, 95% CI 2.325–31.959, p=0.001), whereas NLRP3 expression showed a borderline independent association (aOR 1.480, 95% CI 0.988–2.216, p=0.057). ROC analysis demonstrated modest discriminative performance in this cohort (AUC 0.685, 95% CI 0.540–0.830, p=0.022). Conclusion: Placental NLRP3 expression showed a trend toward higher expression in PAS but pairwise differences did not remain statistically significant after Bonferroni correction. Accordingly, these findings should be considered exploratory and hypothesis-generating. Although NLRP3 may be involved in inflammatory pathways related to abnormal placentation, its diagnostic performance was modest and its independent predictive value appeared limited after adjustment for established clinical risk factors.

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