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Placental pathology is necessary to understand common pregnancy complications and achieve an improved taxonomy of obstetrical disease. American journal of obstetrics and gynecology The importance of a fully functioning placenta for a good pregnancy outcome is unquestioned. Loss of function can lead to pregnancy complications and is often detected by a thorough placental pathologic examination. Placental pathology has advanced the science and practice of obstetrics and neonatal-perinatal medicine by classifying diseases according to underlying biology and specific patterns of injury. Many past obstacles have limited the incorporation of placental findings into both clinical studies and day-to-day practice. Limitations have included variability in the nomenclature used to describe placental lesions, a shortage of perinatal pathologists fully competent to analyze placental specimens, and a troubling lack of understanding of placental diagnoses by clinicians. However, the potential use of placental pathology for phenotypic classification, improved understanding of the biology of adverse pregnancy outcomes, the development of treatment and prevention, and patient counseling has never been greater. This review, written partly in response to a recent critique published in a major obstetrics-gynecology journal, reexamines the role of placental pathology by reviewing current concepts of biology; explaining the most recent terminology; emphasizing the usefulness of specific diagnoses for obstetrician-gynecologists, neonatologists, and patients; previewing upcoming changes in recommendations for placental submission; and suggesting future improvements. These improvements should include further consideration of overall healthcare costs, cost-effectiveness, the clinical value added of placental assessment, improvements in placental pathology education and practice, and leveraging of placental pathology to identify new biomarkers of disease and evaluate novel therapies tailored to specific clinicopathologic phenotypes of both women and infants. 10.1016/j.ajog.2022.08.010
The nightmare of obstetricians - the placenta accreta spectrum in primiparous pregnant women. Ginekologia polska OBJECTIVES:The incidence of PAS is increasing day by day as a life-threatening condition. The purpose of the present study was to determine the factors affecting PAS formation in primiparous pregnant women and to define possible risk factors for the mother and the baby. MATERIAL AND METHODS:Bursa Yüksek İhtisas Training and Research Hospital, department of obstetrics and gynecology, Bursa, Turkey, between June 2016 and December 2020. A total of 58,895 patients were included in the study. After the exclusion criteria, the study was continued with 27 primiparous PAS and 54 non-primiparous PAS patients. The primary purpose is to evaluate PAS risk factors. The secondary aim is to examine maternal and neonatal characteristics. RESULTS:When the parameters that are significant in terms of PAS risk factors were analyzed by Logistic Regression Analysis, it was found that the increase in age also increased the development of PAS 1.552 times (95% CI: 1.236-1.948) and a history of abortion was 7.928. times (95% CI: 1.408-44.654) and 11,007 times (95% CI: 2.059-58.832) with history of myomectomy; postoperative HB values (p < 0.001), an estimated amount of bleeding (p < 0.001), need for transfusion (p = 0.002), and use of drains ( < 0.001) were statistically significant different between two groups. When the neonatal results between patients with and without PAS were examined, birth weight (p < 0.001) and gestational week ( < 0.001) were statistically significant. CONCLUSIONS:PAS does not occur only in multiparous patients who have a history of previous cesarean section. It may also occur in primiparous patients and is a life-threatening condition. 10.5603/GP.a2022.0141
"The Killer Placenta" - a threat to the lives of young women giving birth by cesarean section. Ginekologia polska OBJECTIVES:It is necessary to create a universal algorithm for the management of placenta accreta spectrum in order to minimize morbidity and mortality in young patients giving birth by caesarean section. MATERIAL AND METHODS:This was a retrospective study of seven women before the age of 30 selected out of larger group of 40 pregnant patients. The patients were hospitalized in the Clinical Department of Perinatology, Gynecology and Obstetrics in Ruda Śląska, which is a 3rd level reference department. The inclusion criterion was the suspicion of placent accreta spectrum, based on clinical condition, ultrasound examination and magnetic resonance imaging. RESULTS:A patient with a diagnosed placenta accreta spectrum should be provided with a highly specialized 3rd level referential center by an experienced multidisciplinary team of specialists. There should be free access to the blood bank, adult intensive care unit and neonatal intensive care unit. According to the results of this study, the recommended time of cesarean section is 34 + 0 - 36 + 6 weeks of pregnancy. Hysterectomy after the cesarean section is a method of choice for a placenta increta or percreta. It is the most difficult surgery in obstetrics, with a high risk of intraoperative complications. Damage to the urinary system is the most common complication of perinatal hysterectomy. Preoperative placement of ureteral catheters reduces the risk of intraoperative damage. CONCLUSIONS:It is necessary to plan individual procedure for women who has low-lying or previa placenta, and who has history of prior cesarean section - in this group the risk of placenta accreta spectrum is higher. 10.5603/GP.a2021.0235
Maternal vascular malperfusion of the placental bed is a common pathophysiological process that underlies fetal death, early fetal growth restriction, and related hypertensive disorders. American journal of obstetrics and gynecology 10.1016/j.ajog.2022.03.042
Placenta percreta: the ghost of the accreta opera. American journal of obstetrics and gynecology 10.1016/j.ajog.2022.06.063
Searching for placenta percreta: a prospective cohort and systematic review of case reports. American journal of obstetrics and gynecology BACKGROUND:Placenta percreta is described as the most severe grade of placenta accreta spectrum and accounts for a quarter of all cases of placenta accreta spectrum reported in the literature. OBJECTIVE:We investigated the hypothesis that placenta percreta, which has been described clinically as placental tissue invading through the full thickness of the uterus, is a heterogeneous category with most cases owing to primary or secondary uterine abnormality rather than an abnormally invasive form of placentation. STUDY DESIGN:We have evaluated the agreement between the intraoperative findings using the International Federation of Gynecology and Obstetrics classification with the postoperative histopathology diagnosis in a prospective cohort of 101 consecutive singleton pregnancies presenting with a low-lying placenta or placenta previa, a history of at least 1 prior cesarean delivery and ultrasound signs suggestive of placenta accreta spectrum. Furthermore, a systematic literature review of case reports of placenta percreta, which included histopathologic findings and gross images, was performed. RESULTS:Samples for histologic examination were available in 80 of 101 cases of the cohort, which were managed by hysterectomy or partial myometrial resection. Microscopic examination showed evidence of placenta accreta spectrum in 65 cases (creta, 9; increta, 56). Of 101 cases included in the cohort, 44 (43.5%) and 54 (53.5%) were graded as percreta by observer A and observer B, respectively. There was a moderate agreement between observers. Of note, 11 of 36 cases that showed no evidence of abnormal placental attachment at delivery and/or microscopic examination were classified as percreta by both observers. The systematic literature review identified 41 case reports of placenta percreta with microscopic images and presenting symptomatology, suggesting that most cases were the consequence of a uterine rupture. The microscopic descriptions were heterogeneous, and all descriptions demonstrated histology of placenta creta rather than percreta. CONCLUSION:Our study supported the concept that placenta accreta is not an invasive disorder of placentation but the consequence of postoperative surgical remodeling or a preexisting uterine pathology and found no histologic evidence supporting the existence of a condition where the villous tissue penetrates the entire uterine wall, including the serosa and beyond. 10.1016/j.ajog.2021.12.030
Placenta accreta spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging. Jauniaux Eric,Collins Sally,Burton Graham J American journal of obstetrics and gynecology Placenta accreta spectrum is a complex obstetric complication associated with high maternal morbidity. It is a relatively new disorder of placentation, and is the consequence of damage to the endometrium-myometrial interface of the uterine wall. When first described 80 years ago, it mainly occurred after manual removal of the placenta, uterine curettage, or endometritis. Superficial damage leads primarily to an abnormally adherent placenta, and is diagnosed as the complete or partial absence of the decidua on histology. Today, the main cause of placenta accreta spectrum is uterine surgery and, in particular, uterine scar secondary to cesarean delivery. In the absence of endometrial reepithelialization of the scar area the trophoblast and villous tissue can invade deeply within the myometrium, including its circulation, and reach the surrounding pelvic organs. The cellular changes in the trophoblast observed in placenta accreta spectrum are probably secondary to the unusual myometrial environment in which it develops, and not a primary defect of trophoblast biology leading to excessive invasion of the myometrium. Placenta accreta spectrum was separated by pathologists into 3 categories: placenta creta when the villi simply adhere to the myometrium, placenta increta when the villi invade the myometrium, and placenta percreta where the villi invade the full thickness of the myometrium. Several prenatal ultrasound signs of placenta accreta spectrum were reported over the last 35 years, principally the disappearance of the normal uteroplacental interface (clear zone), extreme thinning of the underlying myometrium, and vascular changes within the placenta (lacunae) and placental bed (hypervascularity). The pathophysiological basis of these signs is due to permanent damage of the uterine wall as far as the serosa, with placental tissue reaching the deep uterine circulation. Adherent and invasive placentation may coexist in the same placental bed and evolve with advancing gestation. This may explain why no single, or set combination of, ultrasound sign(s) was found to be specific for the depth of abnormal placentation, and accurate for the differential diagnosis between adherent and invasive placentation. Correlation of pathological and clinical findings with prenatal imaging is essential to improve screening, diagnosis, and management of placenta accreta spectrum, and standardized protocols need to be developed. 10.1016/j.ajog.2017.05.067
Special Report of the Society for Maternal-Fetal Medicine Placenta Accreta Spectrum Ultrasound Marker Task Force: Consensus on definition of markers and approach to the ultrasound examination in pregnancies at risk for placenta accreta spectrum. Shainker Scott A,Coleman Beverly,Timor-Tritsch Ilan E,Bhide Amarnath,Bromley Bryann,Cahill Alison G,Gandhi Manisha,Hecht Jonathan L,Johnson Katherine M,Levine Deborah,Mastrobattista Joan,Philips Jennifer,Platt Lawrence D,Shamshirsaz Alireza A,Shipp Thomas D,Silver Robert M,Simpson Lynn L,Copel Joshua A,Abuhamad Alfred, American journal of obstetrics and gynecology Placenta accreta spectrum includes the full range of abnormal placental attachment to the uterus or other structures, encompassing placenta accreta, placenta increta, placenta percreta, morbidly adherent placenta, and invasive placentation. The incidence of placenta accreta spectrum has increased in recent years, largely driven by increasing rates of cesarean delivery. Prenatal detection of placenta accreta spectrum is primarily made by ultrasound and is important to reduce maternal morbidity associated with the condition. Despite a large body of research on various placenta accreta spectrum ultrasound markers and their screening performance, inconsistencies in the literature persist. In response to the need for standardizing the definitions of placenta accreta spectrum markers and the approach to the ultrasound examination, the Society for Maternal-Fetal Medicine convened a task force with representatives from the American Institute of Ultrasound in Medicine, the American College of Obstetricians and Gynecologists, the American College of Radiology, the International Society of Ultrasound in Obstetrics and Gynecology, the Society for Radiologists in Ultrasound, the American Registry for Diagnostic Medical Sonography, and the Gottesfeld-Hohler Memorial Ultrasound Foundation. The goals of the task force were to assess placenta accreta spectrum sonographic markers on the basis of available data and expert consensus, provide a standardized approach to the prenatal ultrasound evaluation of the uterus and placenta in pregnancies at risk of placenta accreta spectrum, and identify research gaps in the field. This manuscript provides information on the Placenta Accreta Spectrum Task Force process and findings. 10.1016/j.ajog.2020.09.001
Placental formation in early pregnancy: how is the centre of the placenta made? Boss Anna L,Chamley Lawrence W,James Joanna L Human reproduction update BACKGROUND:Correct development of the placenta is critical to establishing pregnancy and inadequate placentation leads to implantation failure and miscarriage, as well as later gestation pregnancy disorders. Much attention has been focused on the placental trophoblasts and it is clear that the trophoblast lineages arise from the trophectoderm of the blastocyst. In contrast, the cells of the placental mesenchyme are thought to arise from the inner cell mass, but the details of this process are limited. Due to ethical constraints and the inaccessibility of very early implantation tissues, our knowledge of early placentation has been largely based on historical histological sections. More recently, stem cell technologies have begun to shed important new light on the origins of the placental mesenchymal lineages. OBJECTIVE AND RATIONALE:This review aims to amalgamate the older and more modern literature regarding the origins of the non-trophoblast lineages of the human placenta. We highlight ways in which rapidly developing stem cell technologies may shed new light on these crucial peri-implantation events. SEARCH METHODS:Relevant articles were identified using the PubMed database and Google Scholar search engines. A pearl growing method was used to expand the scope of papers relevant to the cell differentiation events of non-trophoblast placental lineages. OUTCOMES:At the start of pregnancy, cells of the extraembyronic mesoderm migrate to underlie the primitive trophoblast layers forming the first placental villi. The mesenchymal cells in the villus core most likely originate from the hypoblast of the embryo, but whether cells from the epiblast also contribute is yet to be determined. This is important because, following the formation of the villus core, vasculogenesis and haematopoiesis take place in the nascent placenta before it is connected to the embryonic circulation, making it likely that haematopoietic foci, placental macrophages, endothelial cells and vascular smooth muscle cells all arise in the placenta de novo. Evidence from the stem cell field indicates that these cells could directly differentiate from the extraembryonic mesoderm. However, the lineage hierarchy involved in cell fate decisions has not been well-established. Mesodermal progenitors capable of differentiating into both vascular and haematopoietic lineages can be derived from human embryonic stem cells, but the identification of such stem cells in the placenta is lacking. Future work profiling rare progenitor populations in early placentae will aid our understanding of early placentation. WIDER IMPLICATIONS:Understanding the origins of the cell lineages of the normal placenta will help us understand why so many pregnancies fail and address mechanisms that may salvage some of these losses. 10.1093/humupd/dmy030
Preeclampsia, placental insufficiency, and autism spectrum disorder or developmental delay. Walker Cheryl K,Krakowiak Paula,Baker Alice,Hansen Robin L,Ozonoff Sally,Hertz-Picciotto Irva JAMA pediatrics IMPORTANCE:Increasing evidence suggests that autism spectrum disorder (ASD) and many forms of developmental delay (DD) originate during fetal development. Preeclampsia may trigger aberrant neurodevelopment through placental, maternal, and fetal physiologic mechanisms. OBJECTIVE:To determine whether preeclampsia is associated with ASD and/or DD. DESIGN, SETTING, AND PARTICIPANTS:The Childhood Autism Risks from Genetics and the Environment (CHARGE) study is a population-based, case-control investigation of ASD and/or DD origins. Children from 20 California counties aged 24 to 60 months at the time of recruitment and living in catchment areas with a biological parent fluent in English or Spanish were enrolled from January 29, 2003, through April 7, 2011. Children with ASD (n = 517) and DD (n = 194) were recruited through the California Department of Developmental Services, the Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, and referrals. Controls with typical development (TD) (n = 350) were randomly selected from birth records and frequency matched on age, sex, and broad geographic region. Physicians diagnosing preeclampsia were masked to neurodevelopmental outcome, and those assessing neurodevelopmental function were masked to preeclampsia status. EXPOSURES:Preeclampsia and placental insufficiency were self-reported and abstracted from medical records. MAIN OUTCOMES AND MEASURES:The Autism Diagnostic Observation Schedule and Autism Diagnostic Interview-Revised were used to confirm ASD, whereas children with DD and TD were confirmed by Mullen Scales of Early Learning and Vineland Adaptive Behavior Scales and were free of autistic symptoms. Hypotheses were formulated before data collection. RESULTS:Children with ASD were twice as likely to have been exposed in utero to preeclampsia as controls with TD after adjustment for maternal educational level, parity, and prepregnancy obesity (adjusted odds ratio, 2.36; 95% CI, 1.18-4.68); risk increased with greater preeclampsia severity (test for trend, P = .02). Placental insufficiency appeared responsible for the increase in DD risk associated with severe preeclampsia (adjusted odds ratio, 5.49; 95% CI, 2.06-14.64). CONCLUSIONS AND RELEVANCE:Preeclampsia, particularly severe disease, is associated with ASD and DD. Faulty placentation manifests in the mother as preeclampsia with vascular damage, enhanced systemic inflammation, and insulin resistance; in the placenta as oxygen and nutrient transfer restriction and oxidative stress; and in the fetus as growth restriction and progressive hypoxemia. All are potential mechanisms for neurodevelopmental compromise. 10.1001/jamapediatrics.2014.2645
Mechanisms of early placental development in mouse and humans. Nature reviews. Genetics The importance of the placenta in supporting mammalian development has long been recognized, but our knowledge of the molecular, genetic and epigenetic requirements that underpin normal placentation has remained remarkably under-appreciated. Both the in vivo mouse model and in vitro-derived murine trophoblast stem cells have been invaluable research tools for gaining insights into these aspects of placental development and function, with recent studies starting to reshape our view of how a unique epigenetic environment contributes to trophoblast differentiation and placenta formation. These advances, together with recent successes in deriving human trophoblast stem cells, open up new and exciting prospects in basic and clinical settings that will help deepen our understanding of placental development and associated disorders of pregnancy. 10.1038/s41576-019-0169-4
Impact of the 2017 ACC/AHA Guideline for High Blood Pressure on Evaluating Gestational Hypertension-Associated Risks for Newborns and Mothers. Hu Jie,Li Yuanyuan,Zhang Bin,Zheng Tongzhang,Li Jun,Peng Yang,Zhou Aifen,Buka Stephen L,Liu Simin,Zhang Yiming,Shi Kunchong,Xia Wei,Rexrode Kathryn M,Xu Shunqing Circulation research RATIONALE:In 2017, the American College of Cardiology (ACC)/American Heart Association (AHA) released a new hypertension guideline for nonpregnant adults, using lower blood pressure values to identify hypertension. However, the impact of this new guideline on the diagnosis of gestational hypertension and the associated maternal and neonatal risks are unknown. OBJECTIVE:To estimate the impact of adopting the 2017 ACC/AHA guideline on detecting gestational blood pressure elevations and the relationship with maternal and neonatal risk in the perinatal period using a retrospective cohort design. METHODS AND RESULTS:This study included 16 345 women from China. Systolic and diastolic blood pressures of each woman were measured at up to 22 prenatal care visits across different stages of pregnancy. Logistic and linear regressions were used to estimate associations of blood pressure categories with the risk of preterm delivery, early-term delivery, and small for gestational age, and indicators of maternal liver, renal, and coagulation functions during pregnancy. We identified 4100 (25.1%) women with gestational hypertension using the 2017 ACC/AHA guideline, compared with 4.2% using the former definition. Gestational hypertension, but not elevated blood pressure (subclinical blood pressure elevation), was significantly associated with altered indicators of liver, renal, and coagulation functions during pregnancy for mothers and increased risk of adverse birth outcomes for newborns; adjusted odds ratios (95% CIs) for gestational hypertension stage 2 were 2.23 (1.18-4.24) for preterm delivery, 2.05 (1.67-2.53) for early-term delivery, and 1.43 (1.13-1.81) for small for gestational age. CONCLUSIONS:Adopting the 2017 ACC/AHA guideline would result in a substantial increase in the prevalence of gestational hypertension; subclinical blood pressure elevations during late pregnancy were not associated with increased maternal and neonatal risk in this cohort. Therefore, the 2017 ACC/AHA guideline may improve the detection of high blood pressure during pregnancy and the efforts to reduce maternal and neonatal risk. Replications in other populations are required. 10.1161/CIRCRESAHA.119.314682
Placental Origins of Chronic Disease. Physiological reviews Epidemiological evidence links an individual's susceptibility to chronic disease in adult life to events during their intrauterine phase of development. Biologically this should not be unexpected, for organ systems are at their most plastic when progenitor cells are proliferating and differentiating. Influences operating at this time can permanently affect their structure and functional capacity, and the activity of enzyme systems and endocrine axes. It is now appreciated that such effects lay the foundations for a diverse array of diseases that become manifest many years later, often in response to secondary environmental stressors. Fetal development is underpinned by the placenta, the organ that forms the interface between the fetus and its mother. All nutrients and oxygen reaching the fetus must pass through this organ. The placenta also has major endocrine functions, orchestrating maternal adaptations to pregnancy and mobilizing resources for fetal use. In addition, it acts as a selective barrier, creating a protective milieu by minimizing exposure of the fetus to maternal hormones, such as glucocorticoids, xenobiotics, pathogens, and parasites. The placenta shows a remarkable capacity to adapt to adverse environmental cues and lessen their impact on the fetus. However, if placental function is impaired, or its capacity to adapt is exceeded, then fetal development may be compromised. Here, we explore the complex relationships between the placental phenotype and developmental programming of chronic disease in the offspring. Ensuring optimal placentation offers a new approach to the prevention of disorders such as cardiovascular disease, diabetes, and obesity, which are reaching epidemic proportions. 10.1152/physrev.00029.2015
The Human Placenta in Diabetes and Obesity: Friend or Foe? The 2017 Norbert Freinkel Award Lecture. Desoye Gernot Diabetes care The placenta plays a key role in sustaining fetal growth and development. Due to its position between mother and fetus, it is exposed to changes in the intrauterine environment in both circulations. The relative influence of changes in those circulations depends on the period of gestation. Early in pregnancy, maternal influences prevail and may affect the complex biological processes characteristic for this pregnancy period, such as placentation, early cell differentiation, and spiral artery remodeling. It is still unclear whether the placenta early in pregnancy is a friend or foe for the fetus. Later in pregnancy, when the fetal circulation is gradually establishing, fetal signals gain importance in regulating placental structure and function. Many of the placental alterations seen at term of pregnancy are the result of fetoplacental interactions often driven by fetal signals associated with maternal diabetes or obesity. These alterations, such as hypervascularization or enhanced cholesterol removal from placental endothelial cells, can be regarded as adaptations to maintain homeostasis at the fetoplacental interface and, thus, to protect the fetus. However, extreme conditions such as poorly controlled diabetes or pronounced obesity may exceed placental homeostatic capacity, with potentially adverse consequences for the fetus. Thus, in late pregnancy, the placenta acts mostly as a friend as long as the environmental perturbations do not exceed placental capacity for mounting adaptive responses. 10.2337/dci17-0045
Gray scale ultrasound for the investigation of early pregnancy. Defoort P,Van Eyck J,De Schryver D,Thiery M,Martens G European journal of obstetrics, gynecology, and reproductive biology 73 early gestations (6-14 wk) were investigated with gray scale ultrasound. 7 of them ended in spontaneous first-trimester abortion, and in all of these the findings were characteristic for spontaneous interruption of pregnancy. The remaining 66 continued to term. Regression analysis was performed with respect to the diameter of the gestation sac, the fetal crown-rump length, and the placental surface and thickness. The method is considered appropriate for the diagnosis of early abortion and the study of placental morphology and morphometry. On the basis of the results obtained with gray scale techniques, various concepts derived from B-scan observations (e.g. implantation locus and early twin observation) will have to be corrected.
Fetal cardiac remodeling and dysfunction is associated with both preeclampsia and fetal growth restriction. Youssef Lina,Miranda Jezid,Paules Cristina,Garcia-Otero Laura,Vellvé Kilian,Kalapotharakos Grigorios,Sepulveda-Martinez Alvaro,Crovetto Francesca,Gomez Olga,Gratacós Eduard,Crispi Fatima American journal of obstetrics and gynecology BACKGROUND:Preeclampsia and fetal growth restriction share some pathophysiologic features and are both associated with placental insufficiency. Fetal cardiac remodeling has been described extensively in fetal growth restriction, whereas little is known about preeclampsia with a normally grown fetus. OBJECTIVE:To describe fetal cardiac structure and function in pregnancies complicated by preeclampsia and/or fetal growth restriction as compared with uncomplicated pregnancies. STUDY DESIGN:This was a prospective, observational study including pregnancies complicated by normotensive fetal growth restriction (n=36), preeclampsia with a normally grown fetus (n=35), preeclampsia with fetal growth restriction (preeclampsia with a normally grown fetus-fetal growth restriction, n=42), and 111 uncomplicated pregnancies matched by gestational age at ultrasound. Fetal echocardiography was performed at diagnosis for cases and recruitment for uncomplicated pregnancies. Cord blood concentrations of B-type natriuretic peptide and troponin I were measured at delivery. Univariate and multiple regression analysis were conducted. RESULTS:Pregnancies complicated by preeclampsia and/or fetal growth restriction showed similar patterns of fetal cardiac remodeling with larger hearts (cardiothoracic ratio, median [interquartile range]: uncomplicated pregnancies 0.27 [0.23-0.29], fetal growth restriction 0.31 [0.26-0.34], preeclampsia with a normally grown fetus 0.31 [0.29-0.33), and preeclampsia with fetal growth restriction 0.28 [0.26-0.33]; P<.001) and more spherical right ventricles (right ventricular sphericity index: uncomplicated pregnancies 1.42 [1.25-1.72], fetal growth restriction 1.29 [1.22-1.72], preeclampsia with a normally grown fetus 1.30 [1.33-1.51], and preeclampsia with fetal growth restriction 1.35 [1.27-1.46]; P=.04) and hypertrophic ventricles (relative wall thickness: uncomplicated pregnancies 0.55 [0.48-0.61], fetal growth restriction 0.67 [0.58-0.8], preeclampsia with a normally grown fetus 0.68 [0.61-0.76], and preeclampsia with fetal growth restriction 0.66 [0.58-0.77]; P<.001). Signs of myocardial dysfunction also were observed, with increased myocardial performance index (uncomplicated pregnancies 0.78 z scores [0.32-1.41], fetal growth restriction 1.48 [0.97-2.08], preeclampsia with a normally grown fetus 1.15 [0.75-2.17], and preeclampsia with fetal growth restriction 0.45 [0.54-1.94]; P<.001) and greater cord blood B-type natriuretic peptide (uncomplicated pregnancies 14.2 [8.4-30.9] pg/mL, fetal growth restriction 20.8 [13.1-33.5] pg/mL, preeclampsia with a normally grown fetus 31.8 [16.4-45.8] pg/mL and preeclampsia with fetal growth restriction 37.9 [15.7-105.4] pg/mL; P<.001) and troponin I as compared with uncomplicated pregnancies. CONCLUSION:Fetuses of preeclamptic mothers, independently of their growth patterns, presented cardiovascular remodeling and dysfunction in a similar fashion to what has been previously described for fetal growth restriction. Future research is warranted to better elucidate the mechanism(s) underlying fetal cardiac adaptation in these conditions. 10.1016/j.ajog.2019.07.025
Comprehensive imaging review of abnormalities of the umbilical cord. Moshiri Mariam,Zaidi Sadaf F,Robinson Tracy J,Bhargava Puneet,Siebert Joseph R,Dubinsky Theodore J,Katz Douglas S Radiographics : a review publication of the Radiological Society of North America, Inc A complete fetal ultrasonographic (US) study includes assessment of the umbilical cord for possible abnormalities. Knowledge of the normal appearance of the umbilical cord is necessary for the radiologist to correctly diagnose pathologic conditions. Umbilical cord abnormalities can be related to cord coiling, length, and thickness; the placental insertion site; in utero distortion; vascular abnormalities; and primary tumors or masses. These conditions may be associated with other fetal anomalies and aneuploidies, and their discovery should prompt a thorough fetal US examination. Further workup and planning for a safe fetal delivery may include fetal echocardiography and karyotype analysis. Doppler US is a critical tool for assessment and diagnosis of vascular cord abnormalities. US also can be used for follow-up serial imaging evaluation of conditions that could result in fetal demise. Recent studies suggest that three- or four-dimensional Doppler US of the fetal umbilical cord and abdominal vasculature allows more accurate diagnosis of vascular abnormalities. Doppler US also is invaluable in assessment of fetal growth restriction since hemodynamic changes in the placenta or fetus would appear as a spectral pattern of increased resistance to forward flow in the fetal umbilical artery. Early detection of umbilical cord abnormalities and close follow-up can reduce the risk of morbidity and mortality and assist in decision making. 10.1148/rg.341125127
Placental size at birth. Woods D L,Malan A F,de V Heese H,van Schalkwyk D J South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde The placentas of 1,081 infants born to Coloured primigravidas in Cape Town were examined. The values for gross and trimmed placental weight, chorionic surface area and thickness are given for each week of gestation from 32 to 41 weeks. These results indicate the pattern of placental growth and provide a basis for further studies to evaluate deviations of intra-uterine growth in this population.
Case note descriptions of the placenta: are they worthwhile? Penfold P,Drury L,Lewis L,Royston J P,Hytten F E British journal of obstetrics and gynaecology In 429 placentae, measurements were made of weight, diameter, shape, eccentricity of the cord and weight and length of the cord, and the results were compared with Apgar score of the infant at birth and its standardized birth weight. There was no evidence that cord eccentricity, placental shape or "thickness", or the dimensions of the cord had any significant relation to the growth of the fetus or its condition at birth. The value of routine recording of crude measurements and qualitative assessments of the placenta in case notes is questioned. 10.1111/j.1471-0528.1979.tb10606.x
[Evaluation of placental thickness in pregnancy in cases of intrauterine retardation of fetal development]. Malinowski J E,Smolarczyk R,Groniowski J,Marcyniak M Ginekologia polska
Ultrasonographic scanning of placental thickness and the prenatal diagnosis of homozygous alpha-thalassaemia 1 in the second trimester. Ko T M,Tseng L H,Hsu P M,Hwa H L,Lee T Y,Chuang S M Prenatal diagnosis In order to evaluate the association between placental thickness (PT) and fetal homozygous alpha-thalassaemia 1 before the appearance of classic ultrasound findings of haemoglobin (Hb) Bart's hydrops fetalis, a total of 473 pregnancies were collected. The control group included 422 normal pregnancies with a gestational age from 14 to 23 weeks and the study group included 51 affected fetuses in the same gestational period. Fetal biparietal diameter (BPD) and PT were measured by high-resolution ultrasound. PT was evaluated against BPD. In the control group, the PT generally increased in parallel with the advancement of gestational age. All PT measurements in the study group were above the mean PT of their respective gestational week in the control group. Forty-six (90 per cent) of the pregnancies in the study group had PT larger than the mean plus two standard deviations of the control group. This study suggests that ultrasound measurement of PT may be a useful aid in the prenatal diagnosis of Hb Bart's hydrops fetalis before its classic findings become apparent in the late second trimester or third trimester.
Ultrasound measurement of placental thickness to detect pregnancies affected by homozygous alpha-thalassaemia-1. Ghosh A,Tang M H,Lam Y H,Fung E,Chan V Lancet (London, England) Homozygous alpha-thalassaemia-1, a common cause of hydrops fetalis, is usually diagnosed invasively. We measured placental thickness by ultrasound at 10-21 weeks' gestation in 231 at-risk pregnancies. 60 were affected (by DNA analysis). The sensitivity and specificity in detecting affected pregnancies at cut-off of mean placental thickness plus 2 SD before 12 weeks' gestation were 0.72 (95% CI 0.52-0.93) and 0.97 (0.9-1.0). After 12 weeks sensitivity increased to 0.95 (0.89-1.0) and by 18 weeks reached 1.0 (0.60-0.99) without change in specificity. Selection of pregnancies at risk by measurement of placental thickness will reduce the number of invasive diagnostic procedures. 10.1016/s0140-6736(94)91644-6
Placental thickness. Hoddick W K,Mahony B S,Callen P W,Filly R A Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine The sonograms of 200 randomly selected singleton pregnancies were reviewed. Placental thickness was measured and correlated with menstrual age. The placenta was demonstrated to increase in thickness with advancing menstrual age. At no stage of pregnancy was the normal placenta greater than 4 cm in thickness. Potential pitfalls in measuring placental thickness are addressed, as well as potential causes of aberrations in placental thickness.
Prediction of low birth weight infants from ultrasound measurement of placental diameter and placental thickness. Habib Fawzia A Annals of Saudi medicine BACKGROUND:The aim of the study was to help to predict low birth weight infants by measuring placental diameter and thickness. SUBJECTS AND METHODS:A prospective study was conducted of 70 consecutive singleton pregnancies to evaluate placental diameter and thickness by ultrasonographic measurement at 36 weeks gestation. The individual data were fitted to a logistic regression analysis. RESULTS:A "warning limit" of a placental diameter of 18 cm and placental thickness of 2 cm at 36 weeks gestation were calculated to predict low birth weight infants. CONCLUSION:Ultrasonographic placental diameter and thickness measurements appears to be of prognostic value in identifying the subsequent occurrence of fetal growth retardation. 10.5144/0256-4947.2002.312
Placental thickness at mid-pregnancy as a predictor of Hb Bart's disease. Tongsong T,Wanapirak C,Sirichotiyakul S Prenatal diagnosis The measurement of placental thickness can effectively differentiate normal pregnancies from affected pregnancies requiring invasive work-up. The objective was to evaluate the efficacy of placental thickness at mid-pregnancy in predicting fetal Hb Bart's disease in pregnancies at risk. Among 17 254 pregnant women screened for severe thalassaemia between June 1994 and December 1998, 345 pregnancies at risk for having a fetus with Hb Bart's disease underwent ultrasound examinations and cordocentesis at 18-21 gestational weeks. Before cordocentesis, the placental thickness was measured and recorded. The definite fetal diagnosis was performed with high performance liquid chromatography. The efficacy of placental thickness in predicting Hb Bart's disease was evaluated by sensitivity and specificity. Various cut-off values of the placental thickness were used for calculation and the best cut-off value was determined by a receiver-operating characteristic (ROC) curve. Of 345 pregnancies at risk, 70 fetuses with Hb Bart's disease were finally diagnosed. The mean placental thickness (+/-SD) of the normal pregnancies and pregnancies with Hb Bart's fetuses were significantly different, 24.6+/-5.2 mm and 34. 5+/-6.7 mm, respectively (Student's t-test, p<0.001). The sensitivity and specificity of placental thickness in prediction were calculated for various cut-off values. Based on the ROC curve, the best cut-off value was 30 mm (>30 mm considered abnormal), giving a sensitivity of 88.57 per cent, specificity of 90.18 per cent, positive-predictive value of 78.48 per cent and negative-predictive value of 96.87 per cent. For couples at risk, when sonographic placental thickness is normal, the risk of having an Hb Bart's fetus is markedly decreased. The measurement of placental thickness can effectively, though not absolutely, differentiate the normal pregnancies from affected ones requiring invasive work-up.
Is assisted reproduction associated with abnormal placentation? Joy Jolly,Gannon Caroline,McClure Neil,Cooke Inez Pediatric and developmental pathology : the official journal of the Society for Pediatric Pathology and the Paediatric Pathology Society Artificial reproductive technologies (ART) and conception following a period of untreated infertility (>1 year) are independently associated with increased pregnancy complications in both singleton and multiple pregnancies. It is unknown if placental dysfunction associated with macroscopic and/or microscopic histological discrepancies might explain some of these variances. Our aim was to compare the histopathology of placentae from singleton pregnancies belonging to 3 groups, as follows: conception as a result of ART; spontaneous conception (<1 year of trying); and conception following untreated infertility (>1 year). Pathological examination of placentae from singleton pregnancies of nonsmoking, age-matched primiparous women with no significant medical history and no known uterine congenital anomalies was performed by a single pathologist blinded to the groups. Features were compared using analysis of variance and chi-square tests. A total of 89 placental pathology reports were available (control  =  39, infertility  =  17, ART  =  33). The mean placental thickness was significantly higher in the ART group when compared to the spontaneous conception group (P  =  0.02). There were significantly more placental hematomas in the ART group (P  =  0.04) compared to the other groups. There were no significant differences in rates of abnormal placental shapes or abnormal cord insertions. There were no statistically significant differences in the incidence of microscopic placental lesions, nor were there any statistically significant differences in the incidence of macroscopic and microscopic placental lesions between the infertility group and the other groups. Placentae of ART pregnancies show significantly increased thickness and a higher incidence of hematomas. Increased placental thickness has previously been linked to increased perinatal risk. 10.2350/11-11-1115-OA.1
Are placental lakes of any clinical significance? Thompson M O,Vines S K,Aquilina J,Wathen N C,Harrington K Placenta The aim of this study was to determine prospectively whether an association exists between the finding of placental lakes at the 20 week scan and an increased risk of uteroplacental complications or a poor pregnancy outcome. We studied the placental appearances in 1,198 consecutive second trimester ultrasound scans performed for routine foetal abnormality screening at our institution. The placental thickness was measured at its widest diameter in the sagittal plane and the presence or absence of placental lakes was recorded. The birth weight in each case was plotted against the centile charts in use at the hospital and recorded. Specific outcome measures included foetal growth restriction (IUGR) with a birth weight below the 5th centile, pre-eclampsia, placental abruption, and perinatal deaths. Placental lakes were seen in 17.8 per cent of the scans. There was no significant association with either maternal socio-demographic factors or perinatal mortality (OR 0.94, 95 per cent CI 0.35-2.51). No association was seen with maternal cigarette smoking (OR 1.07, 95 per cent CI 0.75-1.52), a birth weight below the 5th centile (OR 0.68, 95 per cent CI 0.39-1.18), the development of pregnancy induced hypertension (OR 0.68, 95 per cent CI 0.35-1.32), severe pre-eclampsia (OR 0.72, 95 per cent CI 0.21-2.50), or placental abruption (OR 1.79, 95 per cent CI 0.46-6.99). A finding of placental lakes was six times more likely with a thick placenta >3 cm at 20 weeks gestation (OR 6.30, 95 per cent CI 4.39 to 9.05). A finding of placental lakes during the second trimester ultrasound scan does not appear to be associated with uteroplacental complications or an adverse pregnancy outcome. The lesions are more prevalent with increasing placental thickness.
Antenatal screening for circumvallate placenta. Suzuki Shunji Journal of medical ultrasonics (2001) PURPOSE:Prenatal recognition of circumvallate placenta is important because the condition may lead to some serious perinatal complications. METHODS:The possibility of antenatal ultrasonographic screening for circumvallate placenta was examined by measuring the thickness of the placenta at the thickest point. The study group consisted of 722 unselected patients with uncomplicated singleton pregnancies seen for routine ultrasonographic examination between 18 and 21 weeks' gestation. Data were collected from 11 deliveries complicated by completely circumvallate placenta and from 711 unaffected controls. RESULTS:The average thickness of the placenta was 2.22 ± 0.36 cm in the control subjects, whereas it was 2.74 ± 0.53 cm (P = 0.01 versus control) for circumvallate placentas. When a placental thickness greater than 3.0 cm was demonstrated, 19.4% (6/31) had a circumvallate placenta at delivery (P < 0.01). CONCLUSION:The current results suggest that measurement of placental thickness is useful for screening for circumvallate placenta. 10.1007/s10396-007-0168-5
Placental characteristics and birthweight. Salafia Carolyn M,Zhang Jun,Charles Adrian K,Bresnahan Michaeline,Shrout Patrick,Sun Wenyu,Maas Elizabeth M Paediatric and perinatal epidemiology Standard gross placental measures capture dimensions relevant to specific placental functions. Our objective was to determine their accountability independent of placental weight for variance in birthweight, an important proxy for intrauterine 'adequacy' in fetal origins studies. The sample consisted of 24 152 singleton liveborn children of the Collaborative Perinatal Project delivered from 34 to 42 completed weeks gestation, with complete data for six placental measures (placental disc shape, umbilical cord length, distance from cord insertion to nearest margin, large diameter, small diameter, placental thickness) and placental weight. Associations between birthweight and placental measures were examined using multiple linear regression. Placental weight alone accounted for 36.6% of birthweight variation; the six other placental measures accounted for 28.1%. Combined, all placental measures accounted for 39.1% of birthweight variation. Seven maternal characteristics (age, height, weight, parity, socio-economic status, cigarette use, and race) were investigated to determine whether their known associations with birthweight were mediated by placental markers. Analysis suggested that the impact of all maternal characteristics except smoking was consistent with mediation by placental characteristics. 10.1111/j.1365-3016.2008.00935.x
Placental thickness in the first half of pregnancy. Tongsong Theera,Boonyanurak Pongrak Journal of clinical ultrasound : JCU PURPOSE:This study was conducted to establish normal values of placental thickness during the first half of pregnancy. METHODS:Normal pregnant women with singleton pregnancies between 8 and 20 weeks of gestation were recruited into the study. All the newborns were normal at birth. Placental thickness was measured perpendicularly through the thickest part of the placenta on transabdominal scans. The placental thickness data were analyzed for mean, standard deviation, 95% confidence interval, and 2.5(th), 5(th), 50(th), 95(th), and 97.5(th) percentile for each week of gestational age. The best-fit mathematical model was derived by regression analysis. RESULTS:The total number of measurements was 333 and the number of measurements for each week of gestational age ranged from 9 to 37. Regression analysis yielded the following linear equation of the relationship: placental thickness (in mm) = gestational age (in weeks) x 1.4-5.6 (r = 0.82). CONCLUSION:We have established a nomogram for placental thickness. This resource may be a useful aid in the early detection of placental abnormalities, such as hydropic placenta secondary to hemoglobin Bart's disease. 10.1002/jcu.20023
Ultrasound of the placenta: a systematic approach. Part I: Imaging. Abramowicz J S,Sheiner E Placenta Diagnostic ultrasound has been in use in clinical obstetrics for close to half-a-century. However, in the literature, examination of the placenta appears to be treated with less attention than the fetus or the pregnant uterus. This is somewhat unexpected, given the obvious major functions this organ performs during the entire pregnancy. Examination of the placenta plays a foremost role in the assessment of normal and abnormal pregnancies. A methodical sonographic evaluation of the placenta should include: location, visual estimation of the size (and, if appearing abnormal, measurement of thickness and/or volume), implantation, morphology, anatomy, as well as a search for anomalies, such as additional lobes and tumors. Additional assessment for multiple gestations consists of examining the intervening membranes (if present). The current review considers the various placental characteristics, as they can be evaluated by ultrasound, and the clinical significance of abnormalities of these features. Numerous and varied pathologies of the placenta can be detected by routine ultrasound. It is incumbent on the clinician performing obstetrical ultrasound to examine the placenta in details and in a methodical fashion because of the far reaching clinical significance and potentially avoidable severe consequences of many of these abnormalities. 10.1016/j.placenta.2007.12.006
Variable placental thickness affects placental functional efficiency independent of other placental shape abnormalities. Yampolsky M,Salafia C M,Shlakhter O,Misra D P,Haas D,Eucker B,Thorp J Journal of developmental origins of health and disease Our previous work suggests that stressors that impact placental vascular growth result in a deformed chorionic surface shape, which reflects an abnormal placental three-dimensional shape. We propose to use variability of placental disk thickness as a reflector of deviations in placental vascular growth at the finer level of the fetal stems. We hypothesize that increased variability of thickness is associated with abnormal chorionic surface shape, but will be a predictor of reduced placental functional efficiency (smaller baby for a given placental weight) independent of shape. These measures may shed light on the mechanisms linking placental growth to risk of adult disease. The sample was drawn from the Pregnancy, Infection and Nutrition Study. In all, 94.6% of the cohort consented to placental examination. Of the 1023 delivered at term, those previously sectioned by the Pathology Department were excluded, leaving 587 (57%) cases with intact placentas that were sliced and photographed. The chorionic surface shape and the shape of a central randomly oriented placental slice were analyzed and measures were compared using correlation. Lower mean placental disk thickness and more variable disk thickness were each strongly and significantly correlated with deformed chorionic plate shapes. More variable disk thickness was strongly correlated with reduced placental efficiency independent of abnormal chorionic surface shape. Variability of placental disk thickness, simple to measure in a single randomly oriented central slice, may be an easily acquired measure that is an independent indicator of lowered placental efficiency, which may in turn program the infant and result in increased risk for development of adult diseases. 10.1017/S2040174411000195
Non-linear and gender-specific relationships among placental growth measures and the fetoplacental weight ratio. Misra D P,Salafia C M,Miller R K,Charles A K Placenta GOALS:Fetal growth depends on placental growth; the fetoplacental weight ratio (FPR) is a common proxy for the balance between fetal and placental growth. Male and female infants are known to have differing vulnerabilities in fetal life, during parturition and in infancy. We hypothesized that these differences may be paralleled by differences in how birth weight (BW) and the fetoplacental weight ratio (FPR) are affected by changes in placental proportions. MATERIALS AND METHODS:Placental proportion measures (disk shape, larger and smaller chorionic diameters, chorionic plate area calculated as the area of an ellipse with the 2 given diameters, disk thickness, cord eccentricity and cord length) were available for 24,601 participants in the Collaborative Perinatal Project delivered between >34 and <43 completed weeks. The variables were standardized and entered into multiple automated regression splines (MARS 2.0, Salford Systems, Vista CA) to identify nonlinearities in the relationships of placental growth measures to BW and FPR with results compared for male and female infants. RESULTS:Changes in chorionic plate growth in female compared to male infants resulted in a greater change in BW and FPR. The positive effects of umbilical cord length on BW reversed at the mean umbilical cord length in females and at +0.08 SD in male infants. CONCLUSIONS:Female infants' BW and FPR are each more responsive to changes in placental chorionic plate growth dimensions than males; this may account for greater female resilience (and greater male vulnerability) to gestational stressors. The effect of umbilical cord length on FPR may be due to longer cords carrying greater fetal vascular resistance. Again male fetuses show a higher "threshold" to the negative effects of longer cords on FPR. 10.1016/j.placenta.2009.09.008
Placental growth disorders and perinatal adverse outcomes in Brazilian HIV-infected pregnant women. Dos Reis Helena Lucia Barroso,Boldrini Neide Aparecida Tosato,Rangel Ana Fernanda Ribeiro,Barros Vinicius Felipe,Merçon de Vargas Paulo Roberto,Miranda Angélica Espinosa PloS one Fetal and placental growth disorders are common in maternal human immunodeficiency virus (HIV) infection and can be attributed to both the infection and comorbidities not associated with HIV. We describe placental growth disorders and adverse reproductive outcomes in HIV-infected pregnant women whose delivery occurred between 2001-2014 in Vitoria, Brazil. Cases with gestational age (GA) ≥ than 22 weeks validated by ultrasonography, with placental and fetal weight dimensions at birth, were studied. Outcomes were summarized as proportions of small (SGA), appropriate (AGA), and large (LGA) for GA when the z-score values were below -1.28, between -1.28 and +1.28, or above +1.28, respectively. Of 187 fetal attachment requisitions, 122(65.2%) women and their newborns participated in the study. The median maternal age was 28 years and 81(66.4%) underwent ≥ 6 prenatal visits. A total of 81(66.4%) were diagnosed before current pregnancy; 68(55.7%) exhibited criteria for acquired immunodeficiency syndrome (AIDS); 64(52.4%) had detectable viral load; 25(20.5%) cases presented SGA placental weight and 6(4.9%) SGA placental thickness. SGA placental area was observed in 41(33.6%) cases, and among the SGA placental weight cases 12(48%) were also SGA fetal weight. Preterm birth (PTB) occurred in 15.6%(19/122) of cases; perinatal death in 4.1%(5/122) and HIV vertical transmission in 6 of 122 (4.9%). Women, ≥36 years old, were 5.7 times more likely to have PTB than those under 36. Also, patients with AIDS-defining criteria were 3.7 times more likely to have PTB. Prenatal care was inversely associated with PTB. Statistically significant associations were observed between AGA placental area and Protease Inhibitor usage and between SGA placental weight and SGA area. We found a prevalence of placental growth disorders in HIV-infected pregnant women and values higher than international reference values. The restriction of placental growth was a common disorder, possibly attributed to virus effects or a combination of antiretroviral regimens. 10.1371/journal.pone.0231938
2D-Ultrasound and endocrinologic evaluation of placentation in early pregnancy and its relationship to fetal birthweight in normal pregnancies and pre-eclampsia. Suri S,Muttukrishna S,Jauniaux E Placenta OBJECTIVES:To study the relationships between 2D ultrasound measurements of placentation and maternal serum (MS) levels of PAPP-A, inhibin A and fβhCG in early pregnancy and subsequent fetal growth in pregnancies with a normal and abnormal outcome. STUDY DESIGN:Prospective population-based cohort study of 301 pregnancies with a normal outcome, 18 with a pregnancy complicated by pre-term delivery (PTD) and 14 with subsequent pre-eclampsia (PE). MAIN OUTCOME MEASURES:Basal placental surface area, placental thickness, ellipsivity and volume; MS PAPP-A and fβhCG at 11-13 + 6 weeks, MS inhibin A at 15-22 weeks and birthweight centile at delivery. RESULTS:In the normal group, the basal surface area showed a significantly (P < 0.001) positive correlation with placental thickness and placental ellipsivity. With the exception of placental ellipsivity, all other placental ultrasound parameters were significantly related with birthweight centile. Inhibin A showed a significant (P < 0.005) correlation with birthweight centiles. The basal plate surface area and MS PAPP-A were significantly (P < 0.01 and P < 0.001, respectively) lower and MS inhibin A significantly (P < 0.01) higher in PE than in controls. No changes were found in pregnancies complicated by PTD. CONCLUSION:The basal plate surface area at 11-14 weeks reflects indirectly normal and abnormal placentation and development of the definitive placenta. Combined with MS PAPP-A and/or inhibin A levels this parameter could be useful in identifying from the end of the first trimester, pregnancies subsequently complicated with PE. 10.1016/j.placenta.2013.05.003
A thick placenta: a predictor of adverse pregnancy outcomes. Miwa Ichiro,Sase Masakatsu,Torii Mayumi,Sanai Hiromi,Nakamura Yasuhiko,Ueda Kazuyuki SpringerPlus PURPOSE:The aim of this study is to evaluate the efficacy of an ultrasonographic measurement of placental thickness and the correlation of a thick placenta with adverse perinatal outcome. METHODS:Placental thickness was measured in single gravidas, 16 to 40 weeks of gestation, between 2005 and 2009. Placentas were considered to be thick if their measured thickness were above the 95th percentile for gestational age. RESULTS:The incidence of thick placentas was 4.3% (138/3,183). Perinatal morbidity and neonatal conditions were worse in cases with thick placenta rather than without thick placenta. CONCLUSIONS:Ultrasonographic measurement of placental thickness is a simple method to estimate placental size. Thick placenta may be a useful predictor of adverse pregnancy outcomes. 10.1186/2193-1801-3-353
Relation between pregestational obesity and characteristics of the placenta. Rosado-Yépez Paola I,Chávez-Corral Dora V,Reza-López Sandra A,Leal-Berumen Irene,Fierro-Murga Ricardo,Caballero-Cummings Selene,Levario-Carrillo Margarita The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians To evaluate the morphology of the placenta in patients with pregestational overweight (OW), pregestational obesity (PGOB), or normal weight. A cross-sectional study including women ( = 114) ≥20 years of age with a singleton pregnancy was carried out. The groups were integrated according to pregestational body mass index (BMI): 51 patients had a normal BMI (18.5-24.99 kg/m), 30 were overweight (25-29.99 kg/m), and 33 women were obese (≥30.0 kg/m). A morphometric study of the placenta was performed and the placental maturity index (PMI) was calculated according to the formula: PMI = number of vasculo-syncytial membranes (VSM) in 1 mm/VSM thickness. In the histopathological study, the presence of infarcts, calcifications, hemorrhage, thrombosis, fibrosis, cysts, and edema was determined. The weight and length of newborns at birth were greater in the group with PGOB ( < .01). We observed a lower number of VSM (29 ± 9 versus 39 ± 13 and 34 ± 11) and a greater thickness (1.05 ± 0.24 versus 0.95 ± 0.08 and 0.89 ± 0.09) and, therefore, a lower PMI (29.75 ± 12.63 versus 40.88 ± 15.25 and 39.28 ± 14.4) in the group of women with PGOB compared with the group of women with OW or normal weight ( < .01). The histopathological analyses showed a greater frequency of edema and cysts in the PGOB group. PGOB is associated with a higher placental weight and newborn weight, a lower PMI, and the presence of histopathological alterations. The preceding points highlight the importance of promoting an appropriate pregestational weight in women of reproductive age. 10.1080/14767058.2019.1573222
Ultrasound assessment of placental function: the effectiveness of placental biometry in a low-risk population as a predictor of a small for gestational age neonate. McGinty Patricia,Farah Nadine,Dwyer Vicky O,Hogan Jennifer,Reilly Amanda,Turner Michael J,Stuart Bernard,Kennelly Máireád M Prenatal diagnosis OBJECTIVE:The aims of the study were to establish reference ranges for placental length and thickness in a low-risk obstetric population and to assess the likelihood of a small for gestational age (SGA) neonate on the basis of placental length at 18-24 weeks' gestation. METHODS:Placental length and thickness were measured by two sonographers in 520 singleton pregnancies. Uterine artery Doppler studies and a placental morphological assessment were also performed. Placental size was correlated with the birthweight centiles at delivery. RESULTS:A placental length <10th centile between the gestational age of 18 and 24 weeks is a significant factor associated with SGA neonate [odds ratio (OR) = 2.8, 95% CL, 1.1-6.9]. An abnormal uterine artery Doppler is a significant factor for SGA neonate (OR = 3.4, 95% CL, 1.6-7.4). There was a weak relationship between cord insertion <2 cm from the placental margin and an SGA neonate (OR = 1.8, 95% CL, 0.4-8.2). CONCLUSION:We have provided reference ranges for placental length and thickness from 18 to 24 weeks' gestation. A single measurement of placental length incorporated into the anatomy scan may assist in the early detection of a group at risk of delivering an SGA neonate. 10.1002/pd.3870
Allometric metabolic scaling and fetal and placental weight. Salafia C M,Misra D P,Yampolsky M,Charles A K,Miller R K Placenta BACKGROUND:We tested the hypothesis that the fetal-placental relationship scales allometrically and identified modifying factors of that relationship. MATERIALS AND METHODS:Among women delivering after 34 weeks but prior to 43 weeks' gestation, 24,601 participants in the Collaborative Perinatal Project (CPP) had complete data for placental gross proportion measures, specifically, placental weight (PW), disk shape, larger and smaller disk diameters and thickness, and umbilical cord length. The allometric metabolic equation was solved for alpha and beta by rewriting PW = alpha(BW)beta as ln(PW) = ln alpha + beta[ln(BW)]. alpha(iota) was then the dependent variable in regressions with p < 0.05 significant. RESULTS:Mean beta was 0.78 + 0.02 (range 0.66, 0.89), which is consistent with the scaling exponent 0.75 predicted by Kleiber's Law. Gestational age, maternal age, maternal BMI, parity, smoking, socioeconomic status, infant sex, and changes in placental proportions each had independent and significant effects on alpha. CONCLUSIONS:We find an allometric scaling relation between the placental weight and the birthweight in the CPP cohort with an exponent approximately equal to 0.75, as predicted by Kleiber's Law. This implies that: (1) placental weight is a justifiable proxy for fetal metabolic rate when other measures of fetal metabolic rate are not available; and (2) the allometric relationship between placental and birthweight is consistent with the hypothesis that the fetal-placental unit functions as a fractal supply limited system. Furthermore, our data suggest that the maternal and fetal variables we examined have at least part of their effects on the normal balance between placental weight and birth weight via effects on gross placental growth dimensions. 10.1016/j.placenta.2009.01.006
Relationship between Sonographic Placental Thickness and Gestational Age in Normal Singleton Fetuses in Enugu, Southeast Nigeria. Agwuna K K,Eze C U,Ukoha P O,Umeh U A Annals of medical and health sciences research BACKGROUND:The accuracy of common ultrasound parameters for the estimation of gestational age (GA) decreases as pregnancy advances in age. Hence, there is need to explore other parameters that may complement the established fetal biometric parameters in predicting GA in late pregnancy. AIM:The aim of this study is to determine the relationship between the sonographic placental thickness (PT) and GA in the second and third trimesters. SUBJECTS AND METHODS:A cross-sectional study of 627 normal pregnant women with GA between 14 and 40 weeks was conducted at the University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu from May 2013 to February 2014 by sonography. Anteroposterior diameter of the placenta was measured at the level of the umbilical cord insertion. The last menstrual period of the women, femur length, biparietal diameter, head circumference, and abdominal circumference of the fetus were measured for GA estimation. Descriptive statistics, regression analysis, and independent sample -test were used in statistical analysis. RESULTS:Mean PT was 23.2 (2.8) mm in the second trimester and 36.1 (3.6) mm in the third trimester. There was a significant difference between the values in the present study and values from similar studies in other populations ( < 0.04). There was a strong relationship between GA and PT and the following mathematical relationships for the second and third trimesters were obtained in the GA = 0.982 (PT) + 3.614 and GA = 0.977 (PT) + 3.354, respectively. CONCLUSION:Population-specific charts for PT may be used to estimate GA in the second and third trimesters. 10.4103/amhsr.amhsr_457_15
Birth weight correlates with size but not shape of the normal human placenta. Haeussner E,Schmitz C,von Koch F,Frank H-G Placenta INTRODUCTION:Studies on developmental programming rely on various measures of size and form of the human placenta. Size and form are not independent of each other and covariation patterns were not determined systematically. METHODS:Twenty-two morphologic parameters were determined on 418 placentas from uncomplicated singleton pregnancies. We determined (i) placenta weight and birth weight, (ii) form parameters such as diameters, thickness, roundness, and eccentricity of cord insertion, and (iii) shape variability by geometric morphometry. Geometric morphometry analyzes shape variability independent of size. We define the technical terms form and shape according to the language of geometric morphometry. RESULTS:Placenta weight correlated with birth weight. The form parameters correlated variably with placenta weight and shape. Shape variability did not correlate with birth weight and placenta weight. DISCUSSION AND CONCLUSIONS:The correlation of placenta weight with birth weight stays a cornerstone of prenatal programming. Shape analysis shows that form parameters are hybrids of size and shape. Shape variability can be interpreted as an outcome of adaptation of a placenta to maternal factors and the associated uterine habitat. Correlation analysis of the whole data array provides a rigorous statistical frame to interpret published data and plan new studies. 10.1016/j.placenta.2013.04.011
Two-dimensional sonographic placental measurements in the prediction of small-for-gestational-age infants. Schwartz N,Wang E,Parry S Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology OBJECTIVES:To determine the utility of two-dimensional (2D) sonographic placental measurements in the prediction of small-for-gestational-age (SGA) infants. METHODS:The maximal diameter along the fetal surface of the placenta and the maximal placental thickness were measured at 18-24 weeks' gestation, and the measurements repeated in the orthogonal plane. 'Biometric lags' were calculated as the difference between sonographic gestational age, estimated using each of a number of fetal biometric measurements, and actual gestational age. These variables were analyzed individually and in combination as predictors of birth weight<10(th) percentile (SGA<10) and <5(th) percentile (SGA<5). RESULTS:1909 singleton pregnancies were included. Mean placental diameter (SGA<10, P<0.001; SGA<5, P=0.002) and thickness (SGA<10, P<0.006; SGA<5, P=0.065) were significantly smaller in SGA pregnancies. The biometric lags were greater in SGA pregnancies, the lag in abdominal circumference (AC) being the most predictive of SGA (P<0.0001). Multivariable models were significantly predictive of both SGA<10(th) percentile (area under the receiver-operating characteristics curve (AUC) =0.7404) and <5(th) percentile (AUC=0.7204), the best fitting models including AC lag and mean placental diameter and thickness. CONCLUSIONS:2D placental measurements taken in mid-gestation are significantly associated with the incidence of SGA. Biometric lags can improve the predictive ability further. These easily obtained variables should be considered in future efforts to develop a clinically useful predictive model for adverse outcome of pregnancy. 10.1002/uog.11136
Placental thickness: its correlation with ultrasonographic gestational age in normal and intrauterine growth-retarded pregnancies in the late second and third trimester. Mathai Betty M,Singla Subhash C,Nittala Pramod P,Chakravarti Rajesh J,Toppo Julius N Journal of obstetrics and gynaecology of India OBJECTIVE:The aim was to study the correlation of placental thickness, measured at the level of the umbilical cord insertion, with the ultrasonographic gestational age in normal and IUGR pregnancies in the late second and third trimester. MATERIALS AND METHODS:A total of 498 patients were observed for correlation of the placental thickness with ultrasonographic gestational age and their outcomes by dividing them into Group A (outcome fetal weight < 2,500 g, n = 122) and Group B (fetal weight > 2,500 g, n = 376). The mean placental thickness was calculated at the umbilical cord insertion in both groups along with ultrasonographic fetal age and estimated fetal weight. The mean values of placental thickness along with respective standard deviation were calculated from the 24th to 39th week of gestational age. RESULTS:A positive correlation was observed between placental thickness and ultrasonographic gestational age in both groups (p value of 0.01), with Pearson's correlation coefficient ("r") values of 0.325 in Group A and 0.135 in Group B. Regression analysis yielded linear equations of relationship with placental thickness and gestational age in both groups. The placental thickness was also found to be lower in Group A between 26 and 27 weeks and 30 and 31 weeks, having mean values of 2.48 ± 0.063 cm (p value of 0.042) and 2.76 ± 0.552 (p value of 0.05) in Group A as compared to 3.04 ± 0.25 and 3.13 ± 0.183 cm in Group B. CONCLUSIONS:Placental thickness measured at the level of umbilical cord insertion can be used as an accurate sonographic indicator in assessment of gestational age in singleton pregnancies because of its linear correlation. 10.1007/s13224-012-0316-8
Placental morphometry in hypertensive disorders of pregnancy and its relationship with birth weight in a Latin American population. Marques Melina Rodero,Grandi Carlos,Nascente Lígia Moschen de Paula,Cavalli Ricardo Carvalho,Cardoso Viviane Cunha Pregnancy hypertension OBJECTIVE:To assess the placental morphometry in pregnancies with hypertensive disorders of pregnancy (HDP) and its relationship with birth weight (BW). STUDY DESIGN:Cohort study of placental morphometry and fetal outcomes of 954 pregnancies at a university hospital in Ribeirão Preto, São Paulo, Brazil, in 2010. HDP categories were: chronic (CH), gestational (GH), preeclampsia (PRE) and pre-eclampsia superimposed on chronic hypertension (CH + PRE). Associations between BW and placental measures (PM) in pregnancies were evaluated by multiple linear regression analyses. MAIN OUTCOME MEASURES (PM):Placental weight (PW, g), largest and smallest diameters (cm), thickness (cm), eccentricity, area (cm), volume (cm), BW/PW ratio and PW/BW ratio (efficiency). RESULTS:The frequencies of each HDP categories were 6.5% CH; 7.6% GH; 6.1% PRE, and 2.0% CH + PRE. PW, largest and smallest diameters, area and BW/PW ratio were statistically different between HDP and the normotensive group, with the lowest values for CH + PRE; the remaining measures showed no difference. BW was lower in HDP than in the normotensive group (p = 0.016). BW and PW were highly correlated in the presence of HDP (r = 0.79, p < 0.001). Sixty-seven percent of BW variability was accounted for PM (p < 0.001), and increased to 81% when maternal variables, gestational age and sex were added (p < 0.001). CONCLUSIONS:Hypertensive disorders of pregnancy significantly influence the growth of both the placenta and the fetus. PM explain 67% of BW variability, and CH + PRE was the category with the strongest association to the results. 10.1016/j.preghy.2018.06.020
Placental size at 19 weeks predicts offspring bone mass at birth: findings from the Southampton Women's Survey. Holroyd C R,Harvey N C,Crozier S R,Winder N R,Mahon P A,Ntami G,Godfrey K M,Inskip H M,Cooper C, Placenta OBJECTIVES:In this study we investigate the relationships between placental size and neonatal bone mass and body composition, in a population-based cohort. STUDY DESIGN:914 mother-neonate pairs were included. Placental dimensions were measured via ultrasound at 19 weeks gestation. Dual X-ray absorptiometry (DXA) was performed on the neonates within the first two weeks of life. RESULTS:We observed positive relationships between placental volume at 19 weeks, and neonatal bone area (BA; r = 0.26, p < 0.001), bone mineral content (BMC; r = 0.25, p < 0.001) and bone mineral density (BMD; r = 0.10, p = 0.001). Thus placental volume accounted for 6.25% and 1.2% of the variation in neonatal BMC and BMD respectively at birth. These associations remained after adjustment for maternal factors previously shown to be associated with neonatal bone mineral accrual (maternal height, smoking, walking speed in late pregnancy, serum 25(OH) vitamin D and triceps skinfold thickness). CONCLUSIONS:We found that placental volume at 19 weeks gestation was positively associated with neonatal bone size and mineral content. These relationships appeared independent of those maternal factors known to be associated with neonatal bone mass, consistent with notion that such maternal influences might act through modulation of aspects of placental function, e.g. utero-placental blood flow or maternal nutrient concentrations, rather than placental size itself. Low placental volume early in pregnancy may be a marker of a reduced postnatal skeletal size and increased risk of later fracture. 10.1016/j.placenta.2012.04.007
Morphometrical analysis of placental functional efficiency in normotensive versus preeclamptic South African black women. Maduray K,Moodley J,Naicker T Hypertension in pregnancy OBJECTIVE:To assess the umbilical cord centrality, placental morphometrics, and functional efficiency in preeclampsia. METHODS:Placental morphometry of normotensive (n = 69) and preeclamptic (n = 69) patients was evaluated. RESULTS:There was a significant reduction in mean placental surface area (p = 0.0001), length (p = 0.0001), thickness (p = 0.016), and volume (p = 0.0001) in the preeclamptic than in the normotensive groups. Umbilical cord insertion was predominantly eccentric with marginal in early (29%) and late-onset preeclampsia (16%). Placental and birth weight was lower (p = 0.0001) in preeclampsia than in the normotensive group. Placental efficiency was reduced in early-onset preeclampsia. CONCLUSION:This study demonstrates reduced placental morphometrics with impaired placental efficiency in preeclampsia. 10.3109/10641955.2016.1150488
Placental thickness measurement is difficult in some cases. Takahashi Hironori,Matsubara Shigeki Acta obstetricia et gynecologica Scandinavica 10.1111/aogs.13443
Pilot study of placental tissue collection, processing, and measurement procedures for large scale assessment of placental inflammation. Sjaarda Lindsey A,Ahrens Katherine A,Kuhr Daniel L,Holland Tiffany L,Omosigho Ukpebo R,Steffen Brian T,Weir Natalie L,Tollman Hannah K,Silver Robert M,Tsai Michael Y,Schisterman Enrique F PloS one BACKGROUND:Placental dysfunction is related to many pregnancy complications, but collecting placental specimens for investigation in large scale epidemiologic studies is often infeasible. Standard procedures involving immediate collection after birth and snap freezing are often cost prohibitive. We aimed to collect pilot data regarding the feasibility and precision of a simpler approach, the collection of tissue samples following 24 hours of refrigeration of whole placentae at 4°C, as compared to the "gold standard" of snap freezing excised tissue within 40 minutes of delivery for the assessment of inflammatory cytokines. METHODS:Placentae were collected from 12 women after delivering live-born singleton babies via uncomplicated vaginal delivery. Two placentae were utilized to establish laboratory tissue processing and assay protocols. The other 10 placentae were utilized in a comparison of three tissue collection conditions. Specifically, key inflammatory cytokines were measured in 3 sections, representing three collection conditions. Sections 1 (full thickness) and 2 (excised prior to freezing) were obtained within 40 minutes of delivery and snap frozen in liquid nitrogen, and section 3 (full thickness) was obtained after refrigerating the placenta at 4°C for 24 hours. RESULTS:IL-6, IL-10, and IL-8 all had comparable concentrations and variability overall in all three section types. Levels of tumor necrosis factor alpha (TNF-α) were too low among samples to reliably measure using immunoassay. CONCLUSIONS:Refrigeration of placentae prior to processing does not appear to compromise detection of these cytokines for purposes of large scale studies. These findings provide a framework and preliminary data for the study of inflammatory cytokines within the placenta in large scale and/or resource-limited settings. 10.1371/journal.pone.0197039
The correlation of ultrasonographic placental architecture with placental histology in the low-risk primigravid population. Cooley Sharon M,Donnelly Jennifer C,Walsh Thomas,McMahon Corrina,Gillan John,Geary Michael P Journal of perinatal medicine AIM:To determine the association, if any, between placental architecture findings assessed ultrasonographically at 22 and 36 weeks and placental histology. METHODS:There was prospective recruitment of 1011 low-risk primigravids from the antenatal clinic at the Rotunda Hospital, Dublin, Ireland. Ultrasound of the placenta was performed at 22 and 36 weeks and histological assessment was made of the placenta of all participants. RESULTS:Complete data pertaining to ultrasound and placental histology was available for 810 women (80%). Placental calcification on ultrasound in the third trimester was associated with a higher incidence of placental infarction identified following placental histology (80.0% vs. 21.5%; P=0.009: r=0.115). The placental thickness on ultrasound in the second trimester was less in cases complicated by chorioamnionitis (2.62 cm vs. 3.07 cm; P=0.039: r=-0.176). Chronic villitis was associated with a statistically significant increased incidence of antenatal placental infarction identified on ultrasound in the third trimester (10.7% vs. 1.9%; P=0.020: r=0.113). Intervillous thrombi occurred more frequently in cases with reduced placental thickness on ultrasound in the second trimester (3.0 cm vs. 3.3 cm; P=0.035: r=-0.171). CONCLUSIONS:Antenatal ultrasound of the placenta may aid detection of placental disease, particularly in the identification of placental infarction. 10.1515/jpm-2013-0015
Placental hyperinflation and the risk of adverse perinatal outcome. Porat S,Fitzgerald B,Wright E,Keating S,Kingdom J C P Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology OBJECTIVES:To determine the pathological basis and clinical associations of excessively thick placentae observed at second-trimester ultrasound examination. METHODS:In a retrospective cohort of 19 singleton high-risk second-trimester pregnancies noted to have a placental length-to-maximum thickness ratio ≤ 2.0, maximum sonographic placental thickness was correlated with clinical outcome, maximum placental thickness after delivery and placental pathological findings. Results were compared with those of an intermediate group of 21 high-risk pregnancies with normal placental dimensions and a control group of 18 low-risk pregnancies also with normal placental dimensions. Increased maximum placental thickness (> 28 mm) and abnormal placental deflation following delivery (pathology - sonography difference in maximum placental thickness < -2 mm) were defined by the upper and lower quartile values, respectively, in the control group. RESULTS:The study group exhibited significantly more adverse outcomes and gross pathological placental features compared with both intermediate and control groups. Despite increased sonographic maximum placental thickness in the study group (median, 55 (range, 40-75) mm compared with both the intermediate group (median, 27 (range, 22-41) mm, P < 0.0001) and the control group (median 26 (range, 23-36) mm, P < 0.0001)), all three groups had similar maximal placental thickness following delivery (study group: median, 24 (range, 10-50) mm vs intermediate group: median, 27 (range, 15-40) mm, P = 0.82 and vs control group: median, 28.5 (range, 18-44), P = 0.42). Pathology-sonography difference in maximum placental thickness in the study group (median, -30 (range, -42 to 0) mm) was significantly greater than that in either the intermediate (median, -2 (range, -11 to 9) mm, P < 0.0001) or the control (median, 1.5 (range, -10 to 18) mm, P < 0.0001) group and was significantly associated with abnormal development of the gas-exchanging placental villi (distal villous hypoplasia) (P = 0.0001). CONCLUSIONS:Increased second-trimester sonographic maximum placental thickness represents a pathological finding associated with severe adverse perinatal outcome. This observation is due to overinflation of the intervillous space by maternal blood rather than to adaptive formation of functional placental tissue. 10.1002/uog.12386
Placental thickness in the second trimester: a pilot study to determine the normal range. Lee Anna J,Bethune Michael,Hiscock Richard J Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine OBJECTIVES:We sought to determine the normal sonographically measured placental thickness in millimeters at the second-trimester scan (18 weeks to 22 weeks 6 days) and determine whether the measurement should be adjusted for gestational age and the placental site. METHODS:We conducted a cross-sectional observational pilot study involving 114 consecutive patients with singleton pregnancies presenting for routine second-trimester sonography between 18 weeks and 22 weeks 6 days. RESULTS:The unadjusted overall mean placental thickness was 24.6 (SD, 7.29) mm. The placental thickness was normally distributed. On multivariable analysis, the predicted mean thickness was 6.6 mm (95% confidence interval, 4.4 to 8.8 mm; P < .001) less in anterior compared to posterior or fundal placentas and increased by 0.6 mm (95% confidence interval, -0.5 to 1.7 mm; P = .27) for each week increase in gestation after 18 weeks CONCLUSIONS:The placental position and possibly gestational age need to be considered when determining placental thickness. Anterior placentas are approximately 7 mm thinner than posterior or fundal placentas. Anterior placentas of greater than 33 mm and posterior placentas of greater than 40 mm should be considered abnormally thick.
Variety in placental shape: when does it originate? Salafia C M,Yampolsky M,Shlakhter A,Mandel D H,Schwartz N Placenta OBJECTIVES:Observational and empirical evidence suggest that the average placental shape is round with a centrally inserted umbilical cord. Yet variability of shape is common. When in pregnancy do shape and cord insertion variations originate? MATERIALS AND METHODS:Placental measures from published datasets obtained ultrasonographically at 11-14 weeks and/or at term were correlated. RESULTS:Significant correlations were found between the normalized distance of cord insertion to the margin at 11-14 weeks with the same quantity at delivery (r = 0.509, p < 0.0001). First trimester cord marginality was not correlated with two measures of roundness of the delivered placenta (p = 0.448, and p = 0.812). There was a strong correlation between delivered placental thickness and first trimester cord marginality (r = -0.368, p = 0.009). There was a significant relationship between the cord marginality at 11-14 weeks and the mean chorionic vascular density at delivery (r = -0.287, p = 0.015). Placental position in the uterine cavity influences cord marginality at delivery. Modeling suggests that placental growth in the first trimester is non-round. Placental shape at 11-14 weeks is found to be irregular. This irregularity is not correlated with the roundness of the delivered placenta. Both empirically, and in the context of IVF pregnancies, deformation of the vasculogenic zone yields a bi-lobate placental shape. CONCLUSIONS:Our findings strongly support the hypothesis that abnormal cord insertion and a multi-lobate shape result from early influences on the placental growth, such as the shape of the vasculogenic zone, or placental position in the uterus, rather than trophotropism later in pregnancy. 10.1016/j.placenta.2011.12.002
The role of obesity and gestational diabetes on placental size and fetal oxygenation. Bianchi Chiara,Taricco Emanuela,Cardellicchio Manuela,Mandò Chiara,Massari Maddalena,Savasi Valeria,Cetin Irene Placenta INTRODUCTION:Maternal pregestational obesity is a significant risk factor for adverse pregnancy outcomes, such as gestational diabetes. Both these conditions can have an impact on placental development and affect maternal-fetal exchanges, compromising fetal metabolic status. The aim of the study is to investigate the influence of pre-pregnancy BMI on placental size and to evaluate the role of obesity and gestational diabetes mellitus (GDM) on fetal oxygenation in overweight and obese pregnant women. METHODS:208 normal weight (NW), 57 overweight (OW) and 69 obese (OB) women were studied at elective cesarean section (CS) at term. 10 OW and 24 OB women were affected by GDM. Maternal, fetal and placental data were collected. Respiratory gases and acid-base balance were measured in umbilical venous and arterial blood. RESULTS:Placental weight and thickness were higher in OB pregnancies. Lower fetal-placental ratios (F/P) were found in GDM pregnancies, both OW and OB. Fetuses from OB mothers were more hypoxic and acidemic compared to NW, particularly when complicated by GDM. DISCUSSION:In agreement with previous studies, our data show that placentas from OB and GDM pregnancies are heavier and thicker, suggesting that an unbalanced pregestational nutritional status can decrease the placental efficiency in maternal-fetal exchanges. Fetuses from obese women are also hypoxic and acidemic, while fetuses from gestational diabetic mothers are hypoxic, reflecting that an altered pre-pregnancy BMI can affect fetal oxygenation, and GDM can play an additional detrimental role, thus worsening placental function and fetal oxygenation. 10.1016/j.placenta.2020.10.013
Placental MRI in intrauterine fetal growth restriction. Damodaram M,Story L,Eixarch E,Patel A,McGuinness A,Allsop J,Wyatt-Ashmead J,Kumar S,Rutherford M Placenta OBJECTIVE:Our objectives were to determine if MR imaging of the placenta could demonstrate a specific placental phenotype in small for gestational age fetuses with increasing severity of fetal growth restriction, and if MRI findings at the time of scan could be used to predict fetal or neonatal mortality. METHOD:We included singleton growth restricted fetuses with increasing severity of fetal growth restriction secondary to placental insufficiency. 20 growth restricted fetuses and 28 normal fetuses were scanned once during pregnancy at varying gestations. MRI scans were performed on a 1.5T system using ssFSE sequences through the uterus. Data was collected on the severity of fetal growth restriction and pregnancy outcome, including clinical neonatal details, perinatal mortality, and birthweight and centile. Placental volume, maximal placental thickness, the placental thickness to volume ratio, the placenta to amniotic fluid signal intensity ratio, and the presence of abnormal signal intensity consistent with placental pathology were noted. In a subset of patients, histopathological diagnosis was compared with the MRI appearance of the placenta. RESULTS:There was a significant increase in the placental volume affected by pathology in growth restricted fetuses (p < 0.001). The placental appearance was also thickened and globular, with an increase in the placental thickness to volume ratio (p < 0.001). Although placental volume increased with increasing gestation, it remained reduced in the growth restricted fetuses (p = 0.003). There was a significant correlation between the severity of fetal growth restriction and the placental volume affected by pathology, the placental thickness to volume ratio, and the placental volume. ROC analysis showed that fetal or neonatal death was predicted by the percentage of abnormal signal intensity consistent with placental pathology (p = 0.002). The presence of a thickened, globular placenta and a maximal placental thickness to volume ratio above the 95% confidence limit for gestation was significantly associated with an increased incidence of fetal or neonatal mortality (relative risk = 1.615, p = 0.001 and relative risk = 7, p < 0.001). CONCLUSIONS:The MRI appearance of the placenta provides an indication of the severity and underlying disease process in fetal growth restriction. In units where MRI imaging of the growth restricted fetus occurs, we suggest that the assessment of the placenta should also occur as it may contribute to management decisions in cases at the threshold of viability. It may have a role to play in monitoring disease severity, and the effect of future interventions designed to improve placental function. 10.1016/j.placenta.2010.03.001
Placental morphometry in relation to daughters' percent mammographic breast density at midlife. Cohn Barbara A,Cirillo Piera M,Krigbaum Nickilou Y,Zimmermann Lauren M,Flom Julie D,Terry Mary Beth Reproductive toxicology (Elmsford, N.Y.) Intrauterine and early-life exposures, including intrauterine smoke exposures and infant growth are associated with mammographic breast density (MBD), a strong breast cancer risk factor. We investigated whether placental morphometry, which is affected by intrauterine smoke exposure and also influences infant growth, predicts %MBD at ages 37-47. In 247 daughters in the Child Health and Development Studies, we found that larger placental surface area and placental thickness were associated with lower %MBD (-0.32 per cm, 95% CI -0.6, -0.05; -37.8 per 0.5 cm, 95% CI= -73.3, -2.3 respectively) independent of mothers' smoking, age, weight, parity and daughters' birthweight and age at mammogram. We also observed a positive interaction between placental surface area and thickness (p < 0.05) such that the highest breast dense area was observed for offspring with the thickest and largest placentas. Factors that impact placental morphometry, in addition to in utero smoke exposure, may influence adult breast architecture and breast cancer risk. 10.1016/j.reprotox.2019.11.001
Correlation of ultrasound placental diameter & thickness with gestational age. Pakistan journal of medical sciences BACKGROUND & OBJECTIVES:Estimation of fetal maturity is common in obstetric practice especially when the women do not keep accurate menstrual records. An accurate establishment of expected date of delivery is fundamental to the management of both high risk and normal pregnancies. The objective of this study was to determine the placental diameter (PD), placental thickness (PT) and to establish a correlation between PD, PT and gestational age. METHODS:This is an observational cross-sectional study that examines by means of ultrasonography the correlation between placental diameter and thickness with gestational age in Enugu, South East, Nigeria. RESULTS:A total of 400 healthy subjects were recruited in 3 trimester of pregnancy having fulfilled the inclusion criteria. PD and PT in this study did not correlate with parity. There is a linear increase of gestational age and placental thickness and diameter. These increases heighten between 38 week gestation and 40 weeks' gestation. 205.0±1.4, 43.00±0.0 to 215.0±1.4, 46.00±2.8 respectively. CONCLUSION:Placental thickness and Placental diameter can be used to predict gestational age. It is therefore advised to use PT & PD in ultrasound obstetric assessment especially when Last menstrual period (LMP) is not clear. 10.12669/pjms.36.5.1938
Placental volume at 11 weeks is associated with offspring bone mass at birth and in later childhood: Findings from the Southampton Women's Survey. Woolford S J,Curtis E M,D'Angelo S,Mahon P,Cooke L,Cleal J K,Crozier S R,Godfrey K M,Inskip H M,Cooper C,Harvey N C Placenta OBJECTIVES:To investigate associations between placental volume (PV) at 11 weeks' gestation and offspring bone outcomes at birth, 6 years and 8 years. METHODS:3D ultrasound scanning was used to assess 11 week PV in a subset (n = 236) of the Southampton Women's Survey (a prospective mother-offspring cohort). Maternal anthropometric measures and lifestyle information were obtained pre-pregnancy and at 11 weeks' gestation. Offspring dual-energy x-ray absorptiometry scanning was performed within 2 weeks postnatally and at 6 and 8 years. Linear regression was used to assess associations between PV and bone outcomes, adjusting for offspring age at DXA and sex, and maternal age, height, smoking status, walking speed and triceps skinfold thickness. β are SD change in bone outcome per SD change in PV. RESULTS:In adjusted models, 11 week PV was positively associated with bone area (BA) at all time points, with evidence of persisting associations with increasing childhood age (birth: n = 80, β = 0.23 [95%CI = 0.03, 0.42], 6 years: n = 110, β = 0.17 [-0.01, 0.36], 8 years: n = 85, β = 0.13 [-0.09, 0.36]). Similar associations between 11 week PV and bone mineral content (BMC) were observed. Associations with size-corrected bone mineral content were weaker at birth but strengthened in later childhood (birth: n = 78, β = 0.07 [-0.21, 0.35], 6 years: n = 107, β = 0.13 [-0.08, 0.34], 8 years: n = 71, β = 0.19 [-0.05, 0.43]). CONCLUSIONS:11 week PV is associated with DXA bone measures at birth, with evidence of persisting associations into later childhood. Further work is required to elucidate the contributions of placental morphology and function to gestational influences on skeletal development. 10.1016/j.placenta.2020.07.017
Prevalence, placenta development, and perinatal outcomes of women with hypertensive disorders of pregnancy at Komfo Anokye Teaching Hospital. Awuah Stephen Poku,Okai Isaac,Ntim Emmanuel Amankwah,Bedu-Addo Kweku PloS one BACKGROUND:One of the most common medical problems associated with pregnancy is hypertension. Hypertensive disorders of pregnancy (HDP), which has been attributable to abnormal placentation may have adverse effects on both mother and foetus if left unchecked. The objective of this study was to determine the prevalence of this condition and its effect on placental morphology as well as maternal and perinatal outcomes. MATERIALS AND METHODS:This was a prospective case-control study, conducted at Komfo Anokye Teaching Hospital (KATH), Ghana between February 2018 and July 2018. The progression of pregnancy in normotensive and hypertensive pregnant women, and the eventual perinatal outcomes were closely followed. Statistical analysis was performed using IMB-SPSS version 23. Associations were considered significant at p values of ≤ 0.05. RESULTS:From a total of 214 deliveries recorded during the period of study, 84 (39.25%) were hypertensives. Forty four (52%) of the hypertensives had preeclampsia, 28 (33.3%) had gestational hypertension, 6 (7.1%) had eclampsia, 4 (4.8%) had chronic hypertension, and 2 (2.4%) had preeclampsia superimposed on chronic hypertension. The frequency of placental haematoma, placental infarction, and placental calcification in the normotensives were significantly (p = 0.001) lower than that of the hypertensives. The mean placental weight (p = 0.01), placental volume (p = 0.001), placental diameter (p = 0.03), and placental thickness (p = 0.001) of the normotensives were significantly higher than those of the hypertensives. The number of normotensives in whom labour was induced, who had their babies delivered by caesarean section, and who were admitted after they had given birth were significantly (p = 0.001) lower than that of hypertensives who underwent similar procedures. No stillbirths were recorded in the normotensives compared with four in the hypertensives. The number of babies delivered to the normotensives who were admitted to the NICU was significantly (p = 0.001) lower than those delivered by hypertensives. CONCLUSION:There was a high prevalence of hypertensive disorders of pregnancy in the study site. Pregnant women who developed HDP are at a risk of developing placental abnormalities that adversely affected perinatal outcomes. These adverse effects can be curtailed by embarking on a vigorous health education drive. 10.1371/journal.pone.0233817
Small for gestational age infants and the association with placental and umbilical cord morphometry: a digital imaging study. Ismail Khadijah I,Hannigan Ailish,Kelehan Peter,Fitzgerald Brendan,O'Donoghue Keelin,Cotter Amanda The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians Individual placental and umbilical cord morphometry have been previously identified to have an association with fetal growth. This study aims to identify which of the morphometric measurements in combination are associated with pregnancies with small for gestational age (SGA) infants using digital imaging of the delivered placenta. This study examined 1005 placentas from consecutively delivered singleton pregnancies in a tertiary center. Standardized images of each placenta were taken. Placental weight and thickness; umbilical cord length and diameter were measured on gross examination. Distance from the placental cord insertion site to placental margin, length and breadth of the placenta and placental chorionic surface area were measured digitally using ImageJ software. Logistic regression models and area under the curve (AUC) were used to identify the best subset of morphometric measurements to classify infants as SGA (<10th centile). Overall, 141 (14%) infants were SGA. The morphometric measurements at delivery most strongly associated with the classification of infants as SGA were placental weight (AUC = 0.806) and placental surface area (AUC = 0.749). Of the potential antenatal morphometric measurements, umbilical cord diameters, both placental (AUC = 0.644) and fetal end (AUC = 0.629) were most strongly associated with SGA. A logistic regression model with maternal age, smoking status, current history of preeclampsia, umbilical cord length, placental weight, birthweight-to-placental weight ratio and umbilical cord diameter (placental end) had a sensitivity of 53% and a false-positive rate of 2% (AUC = 0.945) for the classification of infants as SGA. Placental and umbilical cord morphometry measured at delivery are different between SGA and non-SGA infants. Further studies are warranted to investigate the feasibility and accuracy of ultrasound to measure placental and umbilical cord morphometry during pregnancy. 10.1080/14767058.2019.1582628
Placental thickness correlates with placenta accreta spectrum (PAS) disorder in women with placenta previa. Li Yan,Choi Hailey H,Goldstein Ruth,Poder Liina,Jha Priyanka Abdominal radiology (New York) OBJECTIVE:To evaluate the association of placental thickness with placenta accreta spectrum disorder in placenta previa. METHODS:In this IRB-approved, retrospective study, ultrasound (US) reports were retrospectively queried for keyword previa. US performed closest to mid-gestation were included. Three measurements were performed at the thickest portion of the placenta on longitudinal transabdominal images. Operative reports and surgical pathology were used as the reference standard. Statistical analysis was performed using unpaired T-tests and receiver operating curve (ROC) analysis. RESULTS:Sixty-five patients with placenta previa were included: 38 with PAS disorder and 27 without PAS disorder, clinically or pathologically. 38/38 (100%) patients of PAS group and 16/27 (59.3%) patients of non-PAS group had history of prior cesarean section. The average placental thickness was 4.3 cm (range 1.8 cm to 7.8 cm) for PAS group and 3.0 cm (range 0.6 cm to 5.3 cm) for non-PAS group (p < 0.001). Placental thickness in patients without PAS disorder and history of prior cesarean section was 3.1 (± 1.1) cm. This was statistically different from patients who had history of prior cesarean section with PAS diagnosis (4.3 cm, P<0.01). Using ROC analysis, a threshold measurement of 4.5 cm leads to sensitivity of 50% and specificity of 96%. CONCLUSION:Our results demonstrate that among women with placenta previa, increased placental thickness at lower uterine segment correlates with placenta accreta spectrum disorder. A threshold of 4.5 cm can be useful for screening patients with placenta previa and risks factors for PAS. 10.1007/s00261-020-02894-9
Prediction of hypertension in pregnancy in high risk women using maternal factors and serial placental profile in second and third trimester. Hasija Aayushi,Balyan Kirti,Debnath Ekta,V Ravi,Kumar Manisha Placenta INTRODUCTION:To evaluate the role of placental profile markers in second and third trimester of pregnancy in predicting hypertensive disorders of pregnancy (HDP) in women at high risk of preeclampsia. METHOD:Women who were at high risk of preeclampsia underwent βhCG, ultrasound assessment of placental length, thickness and its ratio, uterine artery Doppler at 20-24 weeks and 28-32 weeks of gestation, the outcome at delivery was noted. Those who developed HDP were cases and those with normal outcome were controls. The placental profile markers among cases and controls were compared. RESULTS:Hypertensive disorders of pregnancy was seen in 72/160 (45%) high risk women The serum β hCG levels at 20-24 weeks (p = 0.001) and 28-32 weeks (p = 0.018) was significantly high in women who had preeclampsia. Placental thickness was found to be less in among all subgroups of HDP, for preeclampsia, it was significantly low at 20-24 weeks (AUC- 0.743; sensitivity- 75%, specificity- 66.3%) and 28 weeks (AUC -0.764, sensitivity - 75.0% specificity - 78.7%). Uterine artery S/D ratio was considerable high in women with chronic hypertension (AUC -0.765), gestational hypertension (AUC -0.771) and preeclampsia (AUC -0.726) at 20-24 weeks. In preeclampsia group, uterine artery PI was highest and the best marker at 20-24 weeks (AUC -0.935, sensitivity - 100.0%, specificity - 87.6%). DISCUSSION:The placental profile markers may be used to provide closer follow up in high risk pregnancies with abnormal placental profile levels, while less intense follow up in those with normal levels, thus channelizing the resources. 10.1016/j.placenta.2021.01.005
Insights into the role of placenta thickness as a predictive marker of perinatal outcome. Sun Xiwen,Shen Jiayu,Wang Liquan The Journal of international medical research The placenta is a transitory organ indispensable for normal fetal maturation and growth. Recognition of abnormal placental variants is important in clinical practice, and a broader understanding of the significance of placental variants would help clinicians better manage affected pregnancies. Increased thickness of the placenta is reported to be a nonspecific finding but it is associated with many maternal and fetal abnormalities, including preeclampsia and abnormal fetal growth. In this review, we address the questions regarding the characteristics of placenta thickness and the relationship between thickened placenta and poor pregnancy outcomes. 10.1177/0300060521990969
Prenatal selection of cord blood donors according to the estimated fetal weight percentile and new approaches; results of a prospective cohort study. Xinxin Lin,Crovetto Francesca,González Alba,Cuadras Daniel,Sanchez Mar,Azqueta Carmen,Farssac Elisenda,Torrabadella Marta,Querol Sergio,Gomez-Roig Maria Dolores Transfusion BACKGROUND:Umbilical cord blood (UCB) donation is becoming inefficient and we recently proposed the estimated fetal weight percentile (EFWp) ≥60th as a predictor for a prenatal selection of donors. The aim of this study is to prospectively validate this and to identify new potential prenatal predictive parameters. STUDY DESIGN AND METHODS:Prospective cohort study of low-risk pregnancies undergoing third trimester ultrasound, whose UCB was collected at delivery (2016-2018) and compared with a historical cohort (2013-2016, N = 869). Several ultrasound parameters (EFWp, amniotic fluid, Doppler evaluation, placental thickness) were assessed ultrasound and perinatal data were collected. The association with standard of high quality of UCB was assessed by logistic regression analysis. RESULTS:Among 297 cases, 161 (54%) were selected according to the EFWp ≥60th for UCB units' collection. Cellular criteria for banking was achieved in 27 cases (16.8%), with an average increase of 1.7 times compared to the historical cohort (9.8%, P = .009). Selecting donors according to the 60th EFWp resulted in a higher probability of collecting clinical suitable UCB (P = .025). Among prenatal and perinatal parameters, EFWp, amniotic fluid, umbilical vein (UV) velocity, newborn weight and percentile and placental weight were significantly associated with a higher cellular content. At logistic regression analysis, significant contributors of UCB collection, were EFWp at 37-38 weeks ultrasound (OR 1.04; 95% CI: 1-1.08; P = .042) and UV velocity (OR 1.14; 95% CI: 1-1.29; P = .037). CONCLUSION:The evaluation of the EFWp equal or above 60 and the increased UV velocity can result in higher efficiency of public UCB donation programs. 10.1111/trf.16215
Placental weight and size in relation to fetal growth restriction: a case-control study. Liu Hong-Jiao,Liu Peng-Cheng,Hua Jing,Zhao Yan,Cao Jia The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians OBJECTIVE:Reductions in placental weight and size have been associated with reduced fetal growth. However, few studies have examined the association of placental weight and size with the risk of fetal growth restriction (FGR). METHODS:We enrolled 121 mother-newborn pairs, including 54 FGR cases and 67 healthy controls, from our previous case-control study. The weight, surface area, and thickness of the placenta were measured by medical professionals. RESULTS:Reduced placental weight and surface area were found to be associated with decreased birth weight. A 10-unit decrement in placental weight (g) and surface area (cm) was associated with 33.9 ( = 33.9, 95% CI, 22.1-45.7) and 24.3 ( = 24.3, 95% CI, 11.2-37.5) g decrease in birth weight, respectively. Those associations varied by infant gender and the magnitudes of effect were larger among male fetuses. Moreover, reduced placental weight and surface area were associated with increased odds of FGR. A 10-unit decrease in placental weight and surface area were associated with 21% (OR = 1.21, 95% CI, 1.08-1.44) and 19% (OR = 1.19, 95% CI, 1.06-1.41) increase in the odds of FGR. CONCLUSIONS:Our results suggest that fetuses with lower placental weight and smaller surface area are at higher risk of developing FGR. 10.1080/14767058.2019.1636371
Ultrasound evaluation of the placenta in healthy and placental syndrome pregnancies: A systematic review. Schiffer Veronique,van Haren Ashlee,De Cubber Lisa,Bons Judith,Coumans Audrey,van Kuijk Sander Mj,Spaanderman Marc,Al-Nasiry Salwan European journal of obstetrics, gynecology, and reproductive biology INTRODUCTION:An antepartum screening method to determine normal and abnormal placental function is desirable in the prevention of maternal and fetal pregnancy complications. Placental appearance can easily be obtained and evaluated using 2D ultrasonography, but surprisingly little is known about the change in placental appearance during gestation. Aim of this systematic review was to describe the antepartum placental appearance in placenta syndrome (PS) pregnancies, and to compare this to the appearance in healthy pregnancies. METHODS:A systematic review investigating placental thickness, -lakes and/or -calcifications by ultrasound examination in both uncomplicated (reference group) and PS pregnancies in relation to gestational age was performed. English literature was searched using PubMed (NCBI), EMBASE (Ovid) and the Cochrane Library, from database inception until September 2020. Data on placental thickness was presented as a continuous variable or as the proportion of abnormal placental thickness. Data on placental lakes and -calcifications was presented as prevalence (%). There was no restriction applied on the definition of placental lakes or -calcifications. Due to heterogeneity, pooling of the results was not performed. RESULTS:A total of 28 studies were included describing 1719 PS cases; consisting of 370 (21 %) cases with preeclampsia or pregnancy induced hypertension, 1341 (78 %) cases with fetal growth restriction (FGR) or small for gestational age (SGA), and 8 (1%) cases with combined clinical expressions. In addition, the reference group comprised 3315 pregnant women. Placental thickness showed an increase between the first and second trimester, which was higher in PS- compared to uncomplicated pregnancies. Placental lakes were frequently observed in FGR and SGA pregnancies, especially in the second trimester. Grade 3 calcifications were most prominent in the PS pregnancies, specifically in the late second and third trimester. Moreover, in the reference group, no grade 3 calcifications were reported before 35 weeks of gestation. CONCLUSION:Placental appearance in PS-pregnancies shows higher placental thickness and greater presence of placental lakes and -calcifications compared to uncomplicated pregnancies. Standardized definitions of (ab-)normal placental appearance and longitudinal research in both healthy and complicated pregnancies are needed to improve personalized obstetric care. 10.1016/j.ejogrb.2021.04.042
Ultrastructural abnormalities of placental villi in placentae from pregnancies complicated by intrauterine fetal growth retardation: their relationship to decidual spiral arterial lesions. Sheppard B L,Bonnar J Placenta An ultrastructural study has been made of villi adjacent to decidual spiral arteries exhibiting varying degrees of luminal occlusion in placentae from cases of intrauterine growth retardation. Partially occluded spiral arteries are associated with placental villous syncytiotrophoblast exhibiting extensive budding of surface microvilli, vacuolation of the cytoplasm, clumping of nuclear chromatin and a thickening of the underlying basement membrane. Marked degeneration of the syncytium is present in association with severely occluded spiral arteries. In contrast, the capillary endothelium of the villus retains a normal structure despite degenerative changes in villous Langhan's and stromal cells. The most extensive pathological changes in the placental villi are found distal to completely occluded spiral arteries and consist of complete necrosis of the syncytium and underlying fetal blood vessels, These findings suggest that the occlusive lesions in the maternal uterine vasculature may be the major cause of the infarction and impairment of placental function found in pregnancies complicated by fetal growth retardation.
[Placental localisation : screening and prognosis (author's transl)]. Denhez M,Bouton J M,Engelmann P,Dupray D M Journal de gynecologie, obstetrique et biologie de la reproduction Ultrasounds are the best means at present available for observing the placenta. It follows that it is necessary to appreciate the different phases that occur in placental development. Ultrasound will allow us to work out this evolution and to look for abnormalities that may develop. The placenta becomes an entity at about the 12th week of amenorrhoea. Precise localisation of the placenta is possible in the second trimester of pregnancy, but the final site of the placenta is not fixed in the uterus because different segments develop unevenly. All the same, it is necessary to make a prognosis of the risks of an abnormal insertion of the placenta at the end of pregnancy. It is therefore necessary to be precise in localising the placenta. There are several sources of error which have to be avoided: -- difficulty of exact localisation of the internal os of the cervix. -- the existence of thickening of the myometrium, which forms a reserve for uterine stretch.. These thickenings sometimes come at the same places as the placenta and it may be difficult to differentiate one from the other. -- the presence of placental folds. There are several different elements involving prognosis : -- the site of the lower edge of the placenta in relationship to the internal os. -- the site of the upper edge of the placenta in relationship to the fundus of the uterus. This, statistically, is the best index of prognosis, and so we suggest a classification. -- finally the volume of the myometrium between the lower edge of the placenta and the internal os gives an idea and allows us to work out how the lower segment can stretch. Finally, it is by combining all these elements in a study that a better prognosis can be worked out for the final site of the placenta in the uterus. It is only in the third trimester of pregnancy after the lower segment has formed that the final site of the placenta can be confirmed and that a decision can be taken on the way patient should be treated.
Morphologic changes in the hypertensive placenta. Soma H,Yoshida K,Mukaida T,Tabuchi Y Contributions to gynecology and obstetrics Pregnancy complicated by hypertension is commonly associated with placental insufficiency, thereby resulting in fetal growth retardation. Furthermore, reduced utero-placental blood flow has been recognized in cases of severe preeclampsia with hypertension. Thus, it must be assumed that histological as well as ultrastructural findings in hypertensive placentas are due to the occlusion or narrowing of the uteroplacental vasculature as well as placental ischemia. Microscopically, these placental changes include infarcts, increased syncytial knots, hypovascularity of the villi, cytotrophoblastic proliferation, thickening of the trophoblastic basement membrane, obliterative enlarged endothelial cells in the fetal capillaries and atherosis of the spiral arteries in the placental bed. In addition, ultrastructural features are characterized by a decreased number of syncytial microvilli, proliferation of cytotrophoblastic cells, focal syncytial necrosis, thickening of trophoblastic basement membrane and narrowing of the fetal capillaries, as a number of studies have demonstrated. These placental abnormalities can be seen not only in human toxemia, but also in animals with experimentally induced toxemia or with spontaneous toxemia.
Basement membrane thickening in the placentae from diabetic women. Younes B,Baez-Giangreco A,al-Nuaim L,al-Hakeem A,Abu Talib Z Pathology international A light microscopy study was carried out on 48 placentae. Seventeen placentae were obtained from non-diabetic mothers while the other 31 placentae were from both women with controlled diabetes and women who had an abnormality of the glucose tolerance test. All the women delivered at 38-40 weeks of gestation. Placentae from diabetic patients showed immaturity of the villi, hypertrophy of the capillaries and thickening of the basement membrane of the trophoblastic villi (3.2 +/- 0.35 microns) and the amniotic membrane (1.8 +/- 0.3 microns). Focal fibrinoid necrosis, an increase in the number of Hofbauer cells and dilatation of villi capillaries were also commonly observed in placentae from diabetic mothers, and the normal cuboidal cells lining the amniotic membrane tended to become tall columnar (17.6 +/- 6.3 microns) with distally located nuclei. Similar findings were observed in patients who had a potentially abnormal glucose tolerance test, which suggests the possibility of primary lesion in origin. Therefore, control of hyperglycemia may only partially prevent the development of placental abnormalities.
[Relationship between pathological changes and the expression of vascular cell adhesion molecule-1 in the placenta of patients with pregnancy-induced hypertension complicated by intrauterine growth retardation]. Wang Zhi-Jian,Yu Yan-Hong,Shen Li-Yong Di 1 jun yi da xue xue bao = Academic journal of the first medical college of PLA OBJECTIVE:To study the relationship of the pathological changes with the expression of vascular cell adhesion molecule-1(VCAM-1) in the placenta of patients with pregnancy-induced hypertension (PIH) that is complicated by intrauterine growth retardation (IUGR). METHODS:Tissue specimens of the placenta were respectively collected from 30 patients with PIH complicated by IUGR, 28 patients with IUGR, 25 patients with PIH and 30 normal women after delivery. After HE and PAS staining, the tissue sections were observed microscopically to detect morphological changes in the placenta. Immunohistochemical examination was employed to detect the expression of the VCAM-1 in the decidual vascular endothelium, syncytiotrophoblast and villous capillary vessel of the placenta in these tissue specimens. RESULTS:Significant pathological changes were observed in 22 placentas of the patients with PIH complicated by IUGR, with the incidence of 73.33 %. The pathological changes exemplified by stromal fibrosis, fibrinoid necrosis and leucocyte infiltration of the villi, increase in villous syncytial nodules, decrease in villous vascular tissues, hyperplasia of cytotrophoblasts and basal lamina thickening were more prevalent in the placentas of patients with PIH complicated by IUGR than in normal women (P<0.05). The expression of VCAM-1 in the decidual vascular endothelium and placental villous capillary vessels was observed to be significantly higher in the placentas with pathological changes than in those without (P<0.05), which was the opposite to the changes in the expression in the syncytiotrophoblast (P<0.05). CONCLUSION:Significant pathological changes can be present in the placenta of patients with PIH complicated by IUGR, and may be intimately related to abnormal expressions of VCAM-1 in the placenta.
A piece in the puzzle of intrauterine fetal death: pathological findings in placentas from term and preterm intrauterine fetal death pregnancies. Amir Hila,Weintraub Adi,Aricha-Tamir Barak,Apel-Sarid Liat,Holcberg Gershon,Sheiner Eyal The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians OBJECTIVE:To compare pathological findings of placentas from term and preterm pregnancies complicated by intrauterine fetal death (IUFD). STUDY DESIGN:A retrospective cohort study was conducted including deliveries complicated by IUFD. A comparison was made between placentas from term and preterm (<37 weeks' gestation) pregnancies complicated by IUFD. A second analysis was undertaken comparing IUFD placentas delivered before and after 34 weeks' gestation. Uteroplacental insufficiency was defined when one or more of the following pathological features were found: placental infarct, poor vascularity of the chorionic villi, intravascular thrombi and vascular occlusion. RESULTS:During the study period, 849 placentas of IUFD were examined. Gross and microscopic pathological finding were noted. When comparing gross and microscopic findings in term and preterm (<37 weeks) IUFD placentas, higher rates of calcifications, tissue congestion and cellular metaplasia were found in term vs. preterm placentas. Significantly increased rates of poor tissue vascularity, placental vascular occlusion and uteroplacental insufficiency were demonstrated in preterm IUFD placentas. When comparing pathological findings in IUFD placentas delivered before and after 34 weeks' gestation, higher rates of abnormal cord insertion, calcifications, tissue congestion, infarcts and intravascular thrombi as well as poor tissue vascularity and placental vascular occlusion were demonstrated in IUFD placentas delivered before 34 weeks. Regardless of gestational age at the time of IUFD in more than 90% of placentas vascular wall thickening was found. A third of both term and preterm placentas demonstrated histological chorioamionitis. CONCLUSIONS:A vast majority of IUFD placentas reveal numerous pathological findings that reflect uteroplacental insufficiency and abnormal blood supply. Different characteristics were noted in term and preterm placentas of pregnancies complicated by IUFD. Better definition of causes and associated placental pathological findings of IUFD might aid clinicians in counseling such patients regarding the reason and risk of recurrence in subsequent pregnancies. 10.3109/14767050902929396
Correlation between transvaginal ultrasound measured endometrial thickness and histopathological findings in Turkish women with abnormal uterine bleeding. Ozer Alev,Ozer Serdar,Kanat-Pektas Mine The journal of obstetrics and gynaecology research AIM:The present study aims to determine how transvaginal ultrasonography and histopathological examination findings are correlated in a cohort of premenopausal and postmenopausal Turkish women with abnormal uterine bleeding. METHODS:This is a retrospective review of 350 Turkish women who underwent transvaginal ultrasonography and suction curettage as a result of abnormal uterine bleeding. RESULTS:Sonographic appearance of the endometrium was normal in 244 patients (69.7%), while homogeneous thickening was detected in 47 patients (13.4%) and cystic thickening in 21 patients (6.0%). A sonographic diagnosis of endometrial polyp was made in 38 patients (10.9%). Histopathological analysis of endometrial samplings revealed proliferative endometrium (36%), secretory endometrium (24.6%), decidualization (10.9%), endometrial polyp (8.3%), endometritis (6.8%), endometrial hyperplasia (4.6%), irregular shedding (3.7%), atrophic endometrium (3.1%), endometrial cancer (1.1%) and placental retention (0.9%). The sonographic and histopathological findings correlated significantly (χ(2) = 122 768, P = 0.001; r = 0.215, P = 0.001). Approximately 51% of the women with homogeneous endometrial thickening had proliferative endometrium. Only 44.7% of the women with ultrasonographically visualized endometrial polyps had histopathologically diagnosed endometrial polyps. Nearly 57% of the women with cystic endometrial thickening had proliferative endometrium. CONCLUSION:If there is no facility for hysteroscopy or hysteroscopy-guided endometrial biopsy for women with abnormal uterine bleeding, transvaginal ultrasonography findings can be efficiently used to make a preliminary diagnosis and, thus, notify the pathologists. 10.1111/jog.12937
Hemoglobin Bart hydrops fetalis: A model for studying vascular changes in placental hypoxia. Taweevisit Mana,Thorner Paul Scott Placenta INTRODUCTION:Placental ischemia can be pre-placental (maternal), placental or post-placental (fetal), with corresponding changes in villous vasculature. Hydrops fetalis (HF) resulting from hemoglobin (Hb) Bart disease can serve as a model for intrauterine hypoxia, and placentas from such cases show a distinctive peripheral villous stromal myofibroblastic hypercellularity (PVSH). We hypothesized that Hb Bart disease, which results in profound fetal hypoxia, would lead to placental hypoxia on a post-placental basis. METHODS:We assessed villous vasculature using computerized morphometry, comparing placentas in 14 Hb Bart HF cases to 18 non-Hb Bart HF cases. Morphometric parameters were matched as closely as possible to those reported in the literature for comparison purposes. RESULTS:Villous vessels of Hb Bart HF showed significantly increased numbers of vessels (p = 0.001), longer vascular perimeter (p = 0.002), thickening of vascular endothelial layer (p = 0.038) and higher shape coefficient (p = 0.042) indicating a more branching pattern of vessels. In addition, placental villi of Hb Bart HF containing PVSH showed a longer vascular perimeter (p = 0.008) and narrower lumen (p = 0.002), with a higher shape coefficient (p = 0.03), in comparison to villi lacking PVSH. DISCUSSION:Contrary to expectations, the overall pattern of vascular changes in Hb Bart HF suggested multifactorial hypoxia: pre-placental, on the basis of the marked placentomegaly, compromising blood flow from uterine distention; placental, from hydropic villi causing a generalized diminished intervillous space; and post-placental from the greatly reduced capacity of Hb Bart to extract oxygen from the intervillous space. Standardized vascular morphometry will facilitate comparison between different conditions, for a better understanding of placental hypoxia. 10.1016/j.placenta.2016.06.009
Field ultrasound evaluation of some gestational parameters in jennies. Nervo Tiziana,Bertero Alessia,Poletto Mariagrazia,Pregel Paola,Leone Roberta,Toffoli Valentina,Vincenti Leila Theriogenology The aim of this study was to collect and analyze ultrasound measurements of fetal-maternal structures during normal and pathological pregnancies in jennies, a livestock species of growing interest. For two breeding seasons, 38 jennies of different breeds and crossbreeds aged between 3 and 18 years were monitored weekly by transrectal examination using a portable Esaote ultrasound (MyLab™ 30 GOLD VET) with a 5-7.5 MHz probe. The jennies were divided into two groups, < 250 kg and >250 kg body weight, and the dates of conception and parturition/abortion were recorded to calculate pregnancy length. Descriptive statistics were performed for the following variables: pregnancy length and maternal-fetal parameters (measurements of the orbit, gastric bubble, thorax, abdomen, gonads, heart rate, umbilical artery velocimetry, and combined utero-placental thickness). A total of 68 pregnancies were studied, 36 of which ended during the study period. The average pregnancy length was 370.82 ± 16.6 days for full-term pregnancies (N = 28, 77.8%) and 316.13 ± 36.6 days for abortions (N = 8, 22.2%). The season of conception and fetal gender did not affect the pregnancy length. Pregnancy examination can reasonably be performed by two weeks after last service if ovulation date is not known. The orbital diameter was the most reliable parameter for monitoring the physiological development of the embryo and fetus, and it was strongly related to the gestational age. No differences in fetal development were observed in relation to the mother's body weight. The combined utero-placental thickness was not associated with the gestational age and thickening and edema, frequently observed, were not associated with fetal pathologies. 10.1016/j.theriogenology.2018.11.023
Placenta in PIH. Kurdukar M D,Deshpande N M,Shete S S,Zawar M P Indian journal of pathology & microbiology A variety of changes in placental villi are known to occur in Pregnancy Induced Hypertension. In this study an attempt is made to study 49 placentae from PIH and its correlation to perinatal outcome. Quantification of villous lesions was carried out. The striking villious changes were cytotrophoblastic proliferation, paucity of vasculosyncytial membrane, trophoblastic basement membrane thickening and fibrinoid necrosis of villi. The changes were directly proportional to the severity of disease and perinatal outcome was worse with advancing grades of PIH.
Oxidant-antioxidant system changes relative to placental-umbilical pathology in patients with preeclampsia. Bulgan Kilicdag Esra,Ay Gul,Celik Aygen,Ustundag Bilal,Ozercan Ibrahim,Simsek Mehmet Hypertension in pregnancy OBJECTIVE:It is speculated that lipid peroxidation is responsible for the pathologic changes that occur in the uteroplacental vasculature of women with preeclampsia. The aim was to investigate this proposed relationship. MATERIALS AND METHODS:The prospective study involved 90 pregnant women. Thirty had mild preeclampsia, 30 had severe preeclampsia, and 30 were healthy pregnant women (controls). The data collected for each case were umbilical cord and placental pathologies, plasma malondialdehyde (MDA) level, and levels of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activity in erythrocytes. Group findings were compared. RESULTS:The mean MDA level in the severe preeclampsia group was higher than the corresponding findings in the mild preeclampsia and control groups (p < 0.001 for both). Also, the MDA level in the mild preeclampsia group was significantly higher than was the control level (p < 0.001). The mean SOD activity level in the severe preeclampsia group was lower than the corresponding results in the mild preeclampsia and control groups (p < 0.001 for both). The mean GSH-Px levels in the mild and severe preeclampsia groups were both significantly lower than was the corresponding finding in the control group (p < 0.01). Compared to the control group, both preeclampsia groups had significantly higher frequencies for placental infarction, villous fibrosis, increased numbers of syncytial nodes, and thickening of vessel walls and lumen obliteration (p < 0.001 for all). Villous fibrinoid necrosis, perivillous fibrosis, and increased villous vascularization were also significantly more frequent in both preeclampsia groups than in the control group, but the differences for these parameters were smaller (p < 0.01 for all). Examination of the samples from the placental ends of the umbilical cords revealed significantly higher frequencies of endothelial irregularity, endothelial shedding, and basal membrane thickening in both preeclampsia groups than in those of the control group (p < 0.001). The same findings were noted in the middle sections of the cords (p < 0.001). At the fetal ends of the umbilical cords, both preeclampsia groups had higher frequencies of endothelial irregularity than did the control group (p < 0.001); however, the frequencies of the more severe pathologic findings (endothelial shedding, basal membrane thickening) in the three groups were similar. CONCLUSION:The frequencies of pathologic changes in the placenta and umbilical vessels of women with preeclampsia parallel the severity of this condition. These changes also parallel plasma levels of MDA, the end product of lipid peroxidation. 10.1081/PRG-200059863
The role of asymmetric thickening of the uterine myometrium during pregnancy. Shiina Yuji,Ohnuki Tsuyoshi Archives of gynecology and obstetrics PURPOSE:This study aimed to examine the role of local uterine contractions during pregnancy depicted as asymmetric thickening of the myometrium ultrasonographically. METHODS:419 pregnant women at 12-21 weeks of gestation who visited our outpatient department were studied. These subjects visited either for regular antenatal examinations or because of ill-defined subjective symptoms. Ultrasonographic examination was conducted to detect asymmetric thickening of the uterine myometrium. Blood flow in the region of myometrial thickening was studied by color Doppler imaging. RESULTS:Among 419 subjects, 27.38 % (112/419) patients visited our outpatient department showed asymmetric thickening of myometrium. Since cervical changes or progression to labor occurred in none of the subjects, the reviewed symptoms were considered to be benign contractions. Many women with ill-defined symptoms showed asymmetric thickenings of the myometrium (73.75 % sensitivity and 84.32 % specificity). Myometrial thickening under the placenta tended to be associated with abundant blood flow (88.46 % sensitivity and 87.21 % specificity). This different pattern of the blood flow was considered to correlate to arcuate artery resistance but did not correlate to the severity of ill-defined symptoms. Among those patients having no clinical symptoms, 53 exhibited asymmetric thickening of the myometrium. This phenomenon might be the caution of ill-defined symptoms. CONCLUSION:Asymmetric thickening of the uterine myometrium during pregnancy represented the ill-defined symptoms. Different patterns of blood flow images at this local contraction did not correlate to the severity of these symptoms. 10.1007/s00404-012-2645-3
Highlighting the R1 and R2 VEGF receptors in placentas resulting from normal development pregnancies and from pregnancies complicated by preeclampsia. Istrate Mihnea,Mihu Carina,Şuşman Sergiu,Melincovici Carmen Stanca,Măluţan Andrei Mihai,Buiga Rareş,Bolboacă Sorana Daniela,Mihu Carmen Mihaela Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie Preeclampsia (PE), a pathological entity characterized by hypertension and pregnancy-related proteinuria, is a medical condition of incompletely known etiopathogenesis. Placental defects and placental angiogenesis may be a cause of this condition. The main factor that controls angiogenesis in the early stages of placental development is vascular endothelial growth factor A (VEGF-A) and its two receptors, namely VEGFR-1 and VEGFR-2. This study analyzed the immunohistochemical (IHC) expression of the two VEGF receptors, R1 and R2, in pregnancies complicated by PE compared to pregnancies with a normal evolution. The pregnancies included into the study for the harvesting of placental tissue to be microscopically analyzed were divided into two groups: the group of physiological pregnancies (22 pregnancies) and the group of pregnancies complicated by preeclampsia (13 pregnancies). For the microscopic analysis, we used the Hematoxylin-Eosin (HE), Masson's trichrome and IHC stainings. The microscopic aspects of HE and Masson's trichrome stainings most commonly found in normal development pregnancies underlie the normal process of placental senescence. In the case of pregnancies complicated by PE, the microscopic analysis of the placentas revealed fibrinoid necrosis of the vascular wall, lipid-loaded endothelial cells, diffuse trophoblastic hypertrophy, microinfarctions, calcification areas, fibrin deposits, vascular-syncytial membrane surface reduction, basement membrane thickening. According to the established marker intensity score, the VEGFR-1 and VEGFR-2 receptors were more pronounced in the placentas resulting from pregnancies complicated by preeclampsia. The present study brings arguments that support the major regulatory role of VEGF-A and of the two receptors in the normal or pathological angiogenesis in the placenta, and implicitly in the pathogenesis of preeclampsia. Further studies are needed for a more comprehensive analysis of the stages in which these factors cause alteration of the placental angiogenesis and vasculogenesis processes, so that they can intervene effectively in the treatment or prevention of this disease.
Placental enlargement in women with primary maternal cytomegalovirus infection is associated with fetal and neonatal disease. La Torre Renato,Nigro Giovanni,Mazzocco Manuela,Best Al M,Adler Stuart P Clinical infectious diseases : an official publication of the Infectious Diseases Society of America BACKGROUND:Serological testing for primary maternal cytomegalovirus (CMV) infection during pregnancy is not routine, but ultrasound studies are routine. Therefore, we evaluated placental thickening in women with primary CMV infection during pregnancy. METHODS:The study included 92 women with primary CMV infection during pregnancy and 73 CMV-seropositive pregnant women without primary CMV infection. Neonatal CMV transmission was determined by CMV culture of urine samples. Thirty-two women were treated with CMV hyperimmune globulin to either prevent or treat intrauterine CMV infection. Maximal placental thickness was measured by longitudinal (nonoblique) scanning with the ultrasound beam perpendicular to the chorial dish. Programmed placental ultrasound evaluations were performed from 16 to 36 weeks of gestation. RESULTS:At each measurement between 16 and 36 weeks of gestation, women with primary CMV infection who had a fetus or newborn with CMV disease had placentas that were significantly thicker than those of women with primary CMV infection who did not have a diseased fetus or newborn (P<.0001); the latter group, in turn, had placentas that were significantly thicker than those of seropositive control subjects (P<.0001). For both women with and women without diseased fetuses or newborns, receipt of hyperimmune globulin after primary CMV infection was associated with statistically significant reductions in placental thickness (P<.001). Placental vertical thickness values, which are predictive of primary maternal infection, were observed at each measurement from 16 to 36 weeks of gestation, and cutoff values ranged from 22 mm to 35 mm, with the best sensitivity and specificity at 28 and 32 weeks of gestation. CONCLUSIONS:Primary maternal CMV infection and fetal or neonatal disease are associated with sonographically thickened placentas, which respond to administration of hyperimmune globulin. These observations suggest that many of the manifestations of fetal and neonatal disease are caused by placental insufficiency. 10.1086/507634
Histopathological considerations of placenta in pregnancy with diabetes. Gheorman Lavinia,Pleşea I E,Gheorman V Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie The authors present the results of a study on 19 cases of pregnant women with diabetes who delivered in No. 1 Clinic of Obstetrics and Gynecology, Emergency County Hospital of Craiova, between October 1st, 2009 and September 1st, 2011. After delivery, placentas were harvested for the pathology study. The results of this study reveal: villous immaturity, villous edema, presence of basement membrane thickening, congestion of capillaries called "chorangiosis", intra- and extravillous fibrinoid and a deposit of glycogen. The authors state that although these lesions are not pathognomonic for pregnancy with diabetes, they are very suggestive and specific for this association: diabetes-pregnancy.
Placental abnormalities in ovine somatic cell clones at term: a light and electron microscopic investigation. Palmieri C,Loi P,Reynolds L P,Ptak G,Della Salda L Placenta To investigate the reasons for fetal losses after somatic cell nuclear transfer, an immunohistochemical and ultrastructural analysis of cloned placentae was performed. The main features observed were a marked reduction of villous vascularization, hypoplasia of trophoblastic epithelium, lack of binucleate cells, immaturity of placental vessels and reduced vasculogenesis. By means of transmission electron microscopy (TEM), a diffuse thickening and lamination of subtrophoblastic basement membrane (SBM) were noted in cloned placentae. These results led us to hypothesize, through an autoamplification model, that the abnormal vascularization, the ischaemia and the low development of an high specialized trophoblastic epithelium were the primary causes of the fetal loss occurring after somatic cells nuclear transfer. 10.1016/j.placenta.2006.08.003
Spectrum of changes in placenta in toxemia of pregnancy. Narasimha Aparna,Vasudeva D S Indian journal of pathology & microbiology BACKGROUND:Toxemia of pregnancy is the leading cause of maternal mortality and is an important factor in fetal wastage. The incidence is high in developing countries with malnutrition, hypoproteinemia, and poor obstetric facilities. OBJECTIVES:The present study was undertaken to analyze placental changes in the preeclampsia-eclampsia syndrome with a view to assess the significance of villous abnormalities by histopathological methods because these changes serve as a guide to the duration and severity of disease. Gross abnormalities noted were the placental infarcts, retroplacental hematoma, and calcification. RESULTS:The striking villous abnormalities observed in the study group were cytotrophoblastic proliferation (86%), thickening of the villous basement membranes (95.23%), increase in syncytial knots (90.4%), villous stromal fibrosis (92%), fibrinoid necrosis (97.82%), endarteritis obliterans (53.96%), decreased villous vascularity, and paucity of vasculosyncytial membranes (93.65%). CONCLUSIONS:The gross abnormalities and villous lesions in the preeclampsia (P < 0.001) and eclampsia syndrome (P < 0.05) were significant. 10.4103/0377-4929.77317
Microscopic lesions of placenta and Doppler velocimetry related to fetal growth restriction. Vedmedovska Natalija,Rezeberga Dace,Teibe Uldis,Melderis Ivars,Donders Gilbert G G Archives of gynecology and obstetrics PURPOSE:The purpose of the study was to find an association between the uterine and umbilical arteries blood flow patterns in growth-restricted (FGR) and normal fetuses and placental microscopic lesions. METHODS:Fifty women with prenatally suspected and post-delivery confirmed FGR of singleton fetuses were enrolled in a case-controlled follow-up study from May 2007 to December 2008. Unselected patients with appropriately growing fetuses, matched for gestational age, served as controls. Uterine and umbilical Doppler waveforms were recorded before delivery. RESULTS:Compared with control group with normal Doppler, FGR women with abnormal Doppler velocimetry of uterine and umbilical arteries had more intervillous thrombi (p = 0.01 and p < 0.0001, respectively) and villous infarctions (p = 0.02 and p = 0.0003, respectively). Thickening of the basal membrane and villitis was clearly linked to the FGR (p = 0.006 and p = 0.01). Vasculitis, on the other hand, is linked to normal growth, without affecting Doppler velocities. CONCLUSIONS:Abnormal Doppler may predict hemorrhagic and ischemic placental lesions in FGR pregnancies and may lead to future improvement of the management of current and subsequent pregnancies. 10.1007/s00404-010-1781-x
Term and preterm (<34 and <37 weeks gestation) placental pathologies associated with fetal growth restriction. Apel-Sarid Liat,Levy Amalia,Holcberg Gershon,Sheiner Eyal Archives of gynecology and obstetrics OBJECTIVE:The present study was aimed to compare term versus preterm placental pathologies associated with fetal growth restriction (FGR). STUDY DESIGN:A retrospective cohort study was performed, including all singleton deliveries of FGR with placental pathology examination. Comparison of placental findings was performed between neonates who were born at term versus preterm. Preterm was defined as <37 completed weeks of gestation, and <34 weeks gestation in another analysis. When one or more of the following pathology was found in microscopic examination of the placental tissue, the term uteroplacental insufficiency was defined: placental infarct, fibrosis of chorionic villi, thickening of blood vessels and poor vascularity of the chorionic villi. RESULTS:Macroscopic placental findings were available for 1,104 singleton FGR neonates; of these, 395 placentas had microscopic examinations. A significant greater proportion of preterm FGR cases had pathology findings associated with uteroplacental insufficiency as compared to term FGR (29.4 vs. 36.7%; OR = 1.4 95%, CI = 1.05-1.9; P = 0.019). The same pattern was seen while comparing placentas of FGR neonates who were born before and after 34 weeks (32.4 vs. 39.4%; OR = 1.4, 95% CI 1.02-1.8; P = 0.028). Syncytial knots were significantly more common in placentas from neonates who were delivered before 34 weeks of pregnancy (15.2 vs. 6.3%; OR = 2.6, 95% CI 1.3-5.6; P = 0.005). This trend was not statistically significant while comparing FGR before and after 37 weeks gestation (10.9 vs. 4.6%; OR = 2.4, 95% CI 0.99-7.7; P = 0.052). Meconial impregnation was more common among term versus preterm FGR neonates <37 weeks (22.4% vs. 7.2% OR = 3.7, 95% CI 2.3-5.9; P < 0.001), as well as among neonates who were born before and after 34 weeks of gestation (14.5 vs. 5.9%; OR = 0.4, 95% CI 0.2-0.6; P < 0.001). CONCLUSIONS:Placentas of preterm FGR neonates (either <37 weeks or <34 weeks gestation) reveal numerous pathologies reflecting uteroplacental insufficiency and abnormal blood supply. The presence of increased syncytial knots in preterm FGR neonates is probably due to exposure to hypoxia and reactive oxygen agents. 10.1007/s00404-009-1255-1
Histomorphology of the placenta and the placental bed of growth restricted foetuses and correlation with the Doppler velocimetries of the uterine and umbilical arteries. Madazli R,Somunkiran A,Calay Z,Ilvan S,Aksu M F Placenta The aim of the present study was to evaluate the histomorphology of the placenta and the placental bed and to correlate this with the Doppler study of the uterine and umbilical arteries of intrauterine growth restricted pregnancies. The study group consisted of 47 women with intrauterine growth restricted foetuses. Twenty-five uneventful pregnancies with appropriate for gestational age foetuses were selected as controls. Doppler studies of umbilical and uterine arteries were performed within the last week before delivery. Placental bed biopsies were obtained at Caesarean section with direct visualization of the placental site. The incidence of pathologic bed biopsies in control, IUGR with normal uterine artery Doppler velocimetry and IUGR with abnormal uterine artery Doppler velocimetry was 0 per cent, 16.6 per cent and 79.3 per cent respectively (P< 0.001). Placentae from IUGR cases with abnormal umbilical artery Doppler velocimetries had a significantly increased number of villous infarcts, cytotrophoblast proliferation and thickening of the villous trophoblastic basal membrane (P=0.001, P=0.038 and P=0.02 respectively). Abnormal placental bed biopsy pathology was significantly associated with abnormal uterine artery velocimetry (OR 33.7, 6.5-173.6; P< 0.001). Abnormal placental pathology was significantly associated with abnormal umbilical artery Doppler velocimetry (OR 21.04, 3.8-115.9;P< 0.001). Women with both abnormal uterine and umbilical artery Doppler velocimetries were delivered earlier and their babies had lower mean birth and placental weight (P< 0.001). In conclusion, placental bed biopsy and placental pathologies are best reflected by abnormal uterine and umbilical artery velocity waveforms, respectively. The most severe clinical outcomes and perinatal mortality are present when both uterine and umbilical districts are altered.
Placental pathology in fetal growth restriction. Vedmedovska Natalija,Rezeberga Dace,Teibe Uldis,Melderis Ivars,Donders Gilbert G G European journal of obstetrics, gynecology, and reproductive biology OBJECTIVES:One of the causes of intrauterine fetal growth restriction (FGR) can be pathology of the placenta. The aim of this study was to compare macroscopic and microscopic changes of the placentas from intrauterine growth restricted fetuses with those from normally developed fetuses, in order to test the hypothesis that vascular damage due to decreased maternal vascular perfusion may be responsible for FGR. STUDY DESIGN:Between May 2007 and December 2008 we performed detailed macroscopic and histological examination of singleton placentas of 50 consecutive neonates with fetal growth restriction (FGR group) and compared them to 50 normal fetuses, born next to an FGR case, as a control group. RESULTS:Gestational age, birth weight, spontaneous delivery rate, mean weight of the placenta and the fetal-placental weight ratio were all lower in the FGR group than in the control group (p<0.05). Thickening of the villous trophoblastic basal membrane, incidence of villous infarction, presence of thrombi or haematomas and the incidence of villitis were more common in the FGR group than in the controls (p<0.05). There were, however, no significant differences in perivillous fibrin deposition, stromal fibrosis and cytotrophoblast proliferation between the groups. In FGR women who smoked, intervillous haematomas and villous infarction were more common (p<0.05) than in controls. CONCLUSIONS:All macroscopic and microscopic pathological changes associated with FGR were directly linked to reduction of placental blood flow. As smoking is a main risk factor for these placental abnormalities these results emphasize the need to persuade women to quit smoking not only during pregnancy, but even better long before pregnancy. 10.1016/j.ejogrb.2010.11.017
INFLUENCE OF ENDOTHELIOPATHY OF SPIRAL ARTERIES ON PLACENTAL ISCHEMIA. Borzenko I,Konkov D,Kondratova I,Basilayshvili O,Gargin V Georgian medical news Recently, worldwide authors have paid particular attention to vascular endothelium in the mother-placenta-fetus system for the understanding of development of vascular network and its normal functioning, possible gestational endotheliopathy. Endothelial dysfunction is important in the development of thrombosis, neoangiogenesis and vascular remodeling, being the key to the development of obstetric and perinatal disorders. The aim of the study was to reveal morphological signs of endotheliopathy in spiral arteries in preeclampsia, which is important for understanding the development of pregnancy complications. Placentas were obtained after delivery from mothers with preeclampsia served as the material for morphological study. A comparison group included cases from women with a physiological course of pregnancy. The morphological structure was studied after proceeding of slides stained with hematoxylin and eosin, and according to van Gieson. Morphometry was used to determine the specific vascular density, specific density of connective tissue, thickness of the walls of the spiral arteries, cross sectional area of spiral arteries, endotheliocyte height, the diameter of the nuclei of endothelial cells, nuclear cytoplasmic relationships in endotheliocytes, relative volume of injured endothelial cells. As results, it was detected, that development of preeclampsia is associated with signs of remodelling of the spiral arteries. Placental spiral arteries in preeclampsia are characterized by a decrease of specific vascular density by 36,49% with a simultaneous increase of specific density of connective tissue by 43,60%, which is accompanied by thickening of the walls of the spiral arteries 2,82 times and reducing of cross sectional area of spiral arteries 1,57 times. The spiral arteries are also found to have proliferation of the endothelium, hypertrophy of the muscular layer, marked enlargement of the perivascular connective tissue with the formation of the so-called fibrous cuff, resulting in the narrowing of the lumen of the vessels, up to their obliteration. Gestational endotheliopathy is characterized by a decrease in the height of endotheliocytes from 6.19±0.07 x10-6 m to 4.78±0.06 x10-6 m, a decrease in the diameter of cells from 3.25±0.02 x10-6 m to 2.97±0.04 x10-6 m, an increase in the relative volume of damaged endotheliocytes from 6.16±0.23% to 47.07 ±3.61%.
Back to the future: examining type 2 diabetic vasculature using the gestational diabetic placenta. Samuel Rekha,Ramanathan Kavitha,Mathews Jiji E,Seshadri Mandalam S Diabetes & vascular disease research Understanding the association between the intrauterine hyperglycemic milieu and the development of adult diabetic vasculopathy is of particular relevance in India, where diabetes and vascular disease are prevalent. The gestational diabetes mellitus placenta is a valuable tool to examine blood vessels that have been exposed to hyperglycemic cues. We report an interesting observation in a cohort of gestational diabetes mellitus foetal placental vasculature from South India. Transmission electron microscopy demonstrated pericyte detachment and pericyte ghost cells reminiscent of adult type 2 diabetic retinopathy, in gestational diabetes mellitus foetal placental blood vessels that were not observed in non-gestational diabetes mellitus placentas (p ≤0.001). Endothelial cell irregularity was observed in 76% gestational diabetes mellitus foetal blood vessels as compared with 10.4% non-gestational diabetes mellitus placental vasculature (p ≤0.001). Other abnormalities noted in gestational diabetes mellitus placenta included mitochondrial abnormalities, increased micro vessel density and thickening of basement membranes. These results suggest that adult type 2 diabetic vasculopathy has developmental origins in utero. 10.1177/1479164114537509
Ultrastructural and Immunohistochemical Features of Telocytes in Placental Villi in Preeclampsia. Nizyaeva Natalia V,Sukhacheva Tatiana V,Serov Roman A,Kulikova Galina V,Nagovitsyna Marina N,Kan Natalia E,Tyutyunnik Victor L,Pavlovich Stanislav V,Poltavtseva Rimma A,Yarotskaya Ekaterina L,Shchegolev Aleksandr I,Sukhikh Gennadiy T Scientific reports A new cell type, interstitial Cajal-like cell (ICLC), was recently described in different organs. The name was recently changed to telocytes (TCs), and their typical thin, long processes have been named telopodes (Tp). TCs regulate the contractile activity of smooth muscle cells and play a role in regulating vessel contractions. Although the placenta is not an innervated organ, we believe that TCs are present in the placenta. We studied placenta samples from physiological pregnancies and in different variants of preeclampsia (PE). We examined these samples using light microscopy of semi-thin sections, transmission electron microscopy, and immunohistochemistry. Immunohistochemical examination was performed with primary antibodies to CD34, CD117, SMA, and vimentin, and TMEM16a (DOG-1), the latter was used for the diagnosis of gastrointestinal stromal tumours (GIST) consisting of TCs. We have identified a heterogenetic population of ТСs in term placentas, as these cell types differed in their localization, immunophenotype and ultrastructural characteristics. We assume TMEM16a could be used as the marker for identification of TCs. In PE we have revealed telocyte-like cells with ultrastructural signs of fibrocytes (significant process thickening and the granular endoplasmic reticulum content was increased) and a loss of TMEM16a immunohistochemical staining. 10.1038/s41598-018-21492-w
Morphological and ultrastructural changes in the placenta of the diabetic pregnant Egyptian women. Abdelhalim Nabila Yousef,Shehata Mohammed Hany,Gadallah Hanan Nabih,Sayed Walaa Mohamed,Othman Aref Ali Acta histochemica Diabetes mellitus (DM) is a chronic metabolic disease in which the body fails to produce enough insulin or increased tissue resistance to insulin. The diabetes may have profound effects on placental development and function. This study was designed to detect the placental changes in pregnancy associated with DM comparing these changes with normal placenta. The study was carried out on sixty full-term placentae; divided into three equal groups; control group (group I): placentae of normal pregnancy, uncontrolled diabetes (group II): placentae from pregnant women whose blood glucose is poorly controlled during pregnancy. Controlled diabetes (group III): includes placentae from diabetic women whose blood glucose is controlled during pregnancy. The placentae from group II tend to be heavier and exhibited immaturity of villi, villous edema, fibrosis, excessive syncytial knots formation and infarctions. In addition to, fibrinoid necrosis, increased thickness of vasculosyncytial membrane, syncytial basement membrane, microvillous abnormalities and vascular endothelial changes were demonstrated. The syncytial multivesicular knots were present in placentae of group II. The nuclei within these syncytial knots display condensed chromatin, either dispersed throughout the nucleus or in the form of dense peripheral clumps with and numerous cytoplasmic vacuoles. The syncytial basement membrane showed focal areas of increase in its thickness and irregularity. Villous cytotrophoblasts showed increased number and activity in the form of numerous secretory granules, abundant dilated RER, larger distorted mitochondria. Villous vessels showed various degrees of abnormalities in the form of endothelial cell enlargement, folding, thickening and protrusion of their luminal surfaces into vascular lumen making it narrower in caliber. In placentae of group III, most of these abnormalities decreased. In most of placentae of group III, the VSM appeared nearly normal in thickness and showed nearly normal composition of one layer of syncytiotrophoblastic cells, one layer of smooth, regular capillary endothelium and the space between them. Mild microvillous abnormalities were noted in few placentae as they appeared short and blunted with mild decrease in their number per micron. The electron picture of syncytial knots appeared nearly normal containing aggregations of small, condensed hyperchromatic nuclei, minimal vacuoles could be seen in the cytoplasm of syncytial knots. Syncytial basement membrane appeared regular and nearly normal in its thickness and composition coming in direct contact with fetal blood capillaries but mild abnormalities were noted in the basement membrane in few placentae as increased its thickness and deposition of fibers or fibrinoid. Regarding cytotrophoblasts in the terminal villi of placentae with controlled diabetes, these cells appeared nearly normal. They were scattered beneath the syncytium and were active containing mitochondria, rough endoplasmic reticulum, free ribosomes and a large nucleus with fine dispersed chromatin. The vascular ultrastructural pattern in terminal villi of placentae of this group showed no significant abnormalities and was normally distributed in the villous tree. The luminal surface of the vascular endothelium appeared regular smooth in the majority of placentae of this group. The endothelial cells appeared connected to each other with tight junctions. It could be concluded that whether if long-term diabetes is controlled or not, placentae of diabetic mother showed a variety of significant histological structural changes seen more frequently than in the placentae of pregnant women without diabetes. 10.1016/j.acthis.2018.05.008
Nonfetal Imaging During Pregnancy: Placental Disease. Jha Priyanka,Masselli Gabriele,Ohliger Michael A,Pōder Liina Radiologic clinics of North America Placenta is a vital organ that connects the maternal and fetal circulations, allowing exchange of nutrients and gases between the two. In addition to the fetus, placenta is a key component to evaluate during any imaging performed during pregnancy. The most common disease processes involving the placenta include placenta accreta spectrum disorders and placental masses. Several systemic processes such as infection and fetal hydrops can too affect the placenta; however, their imaging features are nonspecific such as placental thickening, heterogeneity, and calcifications. Ultrasound is the first line of imaging during pregnancy, and MR imaging is reserved for problem solving, when there is need for higher anatomic resolution. 10.1016/j.rcl.2019.11.004
Placental fractalkine immunoreactivity in preeclampsia and its correlation with histopathological changes in the placenta and adverse pregnancy outcomes. Usta Akin,Turan Gulay,Sancakli Usta Ceyda,Avci Eyup,Adali Ertan The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians Preeclampsia is a systemic inflammatory disorder and a major cause of maternal and fetal mortality. Fractalkine (CX3CL1) is a member of the chemokine family with multiple functions in the organization of the immune system. It is up-regulated in inflammatory disorders. During inflammation, fractalkine enhances tissue destruction and inflammatory cell invasion. We aimed to investigate the alteration of fractalkine in the placental tissues of pregnant women with preeclampsia and the correlation of this alteration with clinicopathological variables. Alteration of fractalkine in placental tissue specimens was determined immunohistochemically in 84 pregnant women: 33 women with mild preeclampsia, 19 women with severe preeclampsia, and 30 women with normal pregnancy. Preeclampsia was diagnosed using current guidelines of the American College of Obstetricians and Gynecologists. Pregnant women with mild and severe preeclampsia revealed significantly higher fractalkine expression in syncytiotrophoblast cells than in the normotensive group ( = .0051 and .0001, respectively). The expression of fractalkine in preeclampsia was positively correlated with clinical parameters including the presence of intrauterine growth restriction, systolic and diastolic blood pressure, and 24-h urine protein, whereas it was negatively correlated with plasma albumin levels and placental weight. Additionally, the pathological changes in the placenta-including the presence of syncytiotrophoblast basement membrane thickening, increased number of syncytial knots, and vascularization of terminal villi were significantly correlated with fractalkine expression in pregnant women with preeclampsia. Overexpression of fractalkine in pregnant women with preeclampsia, as well as the correlation between fractalkine expression and poor pregnancy outcomes and placental histopathological changes may be associated with the underlying mechanisms of preeclampsia. 10.1080/14767058.2018.1505854
An Objective Histopathological Scoring System for Placental Pathology in Pre-Eclampsia and Eclampsia. Donthi Deepak,Malik Preeti,Mohamed Anas,Kousar Aisha,Subramanian Ramaswamy Anikode,Manikyam Udaya K Cureus Background and objective Pre-eclampsia and eclampsia are common complications in pregnancy, and they lead to uteroplacental vascular insufficiency. More than 38% of pregnant women succumb to seizures without meeting the clinical criteria for pre-eclampsia or eclampsia. This highlights the importance of a confirmatory diagnosis of pre-eclampsia or eclampsia using the histopathological changes seen in the placenta. Hence, the present study aimed to validate an objective histopathological scoring system of the placenta for an appropriate diagnosis of pre-eclampsia or eclampsia. Material and methods In this prospective study spanning two years, 50 cases of pre-eclampsia/eclampsia and 50 control subjects with normal placenta were included. The histomorphological changes in the placenta were examined for both groups and a scoring system was formulated to assess the severity of pre-eclampsia/eclampsia syndrome. A maximum score of 2 and a minimum score of 0 was assigned for maternal floor infarcts, calcification, villous basement membrane thickening, and fibrin deposition. Syncytial knots were assigned a minimum score of 0 and a maximum score of 1. The association of various placental histopathological variables with a clinical diagnosis of pre-eclampsia, eclampsia, and control was analyzed using the chi-squared/Fisher's exact test. A one-way analysis of variance (ANOVA) test was used for comparing objective histopathological scores between pre-eclampsia, eclampsia, and control groups. A p-value of less than 0.05 was considered to be statistically significant. Results We found a significant association between each histopathological parameters of the placenta, including fibrin deposition, maternal floor infarction, calcification, villous basement membrane thickening, and syncytial knots, and clinical diagnosis of pre-eclampsia, eclampsia, and control groups. A median score of 2 significantly correlated with the normal group, while median scores of 4 and 6 correlated with pre-eclampsia and eclampsia respectively. Conclusion This comprehensive scoring system can be a basis for validating reporting patterns of the placenta in pre-eclampsia and eclampsia patients, as well as other disorders related to maternal uteroplacental insufficiency. 10.7759/cureus.11104