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Seminars in Pediatric Neurology Jul 2022Abnormal neurodevelopmental outcomes are associated with multiple factors including prematurity, intrauterine infection, maternal comorbidities as well as fetal... (Review)
Review
Abnormal neurodevelopmental outcomes are associated with multiple factors including prematurity, intrauterine infection, maternal comorbidities as well as fetal anomalies. Within the past decade, new standardized terminology in placental pathology has emerged, emphasizing the current understanding of processes that play a role in placental dysfunction. Factors playing a major role in the abnormal development of the placenta include abnormalities in blood flow and perfusion of the fetal and maternal compartments of the placenta termed fetal vascular malperfusion and maternal vascular malperfusion, respectively. Concepts reviewed include massive perivillous fibrin deposition, chronic villitis, meconium-associated injury as well as chorioamnionitis. Each have a temporal effect on the placental vascular tree and may reflect an altered maternal inflammatory response. In this article we highlight pathologic placental findings which when present can serve to explain, at least in part, altered neurodevelopment in the child, adolescent and adult. Lesions with a propensity for recurrence in future pregnancies are discussed.
Topics: Adolescent; Adult; Brain; Child; Chorioamnionitis; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Placenta; Placenta Diseases; Pregnancy
PubMed: 35868734
DOI: 10.1016/j.spen.2022.100975 -
Ultrasound in Obstetrics & Gynecology :... Jul 2022Doppler techniques are needed for the evaluation of the intraplacental circulation and can be of great value in the diagnosis of placental anomalies. Highly sensitive... (Review)
Review
Doppler techniques are needed for the evaluation of the intraplacental circulation and can be of great value in the diagnosis of placental anomalies. Highly sensitive Doppler techniques can differentiate between the maternal (spiral arteries) and fetal (intraplacental branches of the umbilical artery) components of the placental circulation and assist in the evaluation of the placental functional units. A reduced number of placental functional units can be associated with obstetric complications, such as fetal growth restriction. Doppler techniques can also provide information on decidual vessels and blood movement. Abnormal decidual circulation increases the risk of placenta accreta. Doppler evaluation of the placenta greatly contributes to the diagnosis and clinical management of placenta accreta, vasa previa, placental infarcts, placental infarction hematoma, maternal floor infarction, massive perivillous fibrin deposition and placental tumors. However, it has a limited role in the diagnosis and clinical management of placental abruption, placental hematomas, placental mesenchymal dysplasia and mapping of placental anastomoses in monochorionic twin pregnancies. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Female; Fetal Growth Retardation; Humans; Infarction; Placenta; Placenta Accreta; Placenta Diseases; Pregnancy; Ultrasonography, Doppler; Ultrasonography, Prenatal
PubMed: 34806234
DOI: 10.1002/uog.24816 -
International Journal of Molecular... Mar 2022We are pleased to present this Special Issue of , entitled 'Placental Related Disorders of Pregnancy' [...].
We are pleased to present this Special Issue of , entitled 'Placental Related Disorders of Pregnancy' [...].
Topics: Female; Humans; Placenta; Placenta Diseases; Pregnancy
PubMed: 35408880
DOI: 10.3390/ijms23073519 -
The Veterinary Clinics of North... Apr 2023A variety of infectious agents including viral, bacterial, and fungal organisms can cause equine abortion and placentitis. Knowledge of normal anatomy and the common... (Review)
Review
A variety of infectious agents including viral, bacterial, and fungal organisms can cause equine abortion and placentitis. Knowledge of normal anatomy and the common pattern distribution of different infectious agents will assist the practitioner in evaluating the fetus and/or placenta, collecting appropriate samples for further testing, and in some cases, forming a presumptive diagnosis. In all cases, it is recommended to confirm the diagnosis with molecular, serologic, or microbiological testing. If a causative agent can be identified, then appropriate biosecurity and vaccination measures can be instituted on the farm.
Topics: Pregnancy; Female; Animals; Horses; Placenta Diseases; Abortion, Veterinary; Horse Diseases; Placenta
PubMed: 36737287
DOI: 10.1016/j.cveq.2022.11.001 -
Fetal and Pediatric Pathology Aug 2022Placental hepatic heterotopia is a benign lesion with unclear histogenesis hypothesized to be of hepatocytic differentiation of yolk sac elements. Of the 14 hepatic...
Placental hepatic heterotopia is a benign lesion with unclear histogenesis hypothesized to be of hepatocytic differentiation of yolk sac elements. Of the 14 hepatic heterotopia cases previously reported, 12 cases occurred in preterm labor. A case of intraplacental hepatic heterotopia in a 27-year-old female with pre-term delivery at 31 + 5 weeks gestational age is described. Histopathological examination revealed a well-demarcated lesion with cohesive, monotonous cells and pale to clear cytoplasm. The differential diagnoses of this lesion included benign, primary and metastatic malignant entities. The lesional cells expressed HepPar-1, CAM 5.2, Glypican-3, and AFP, consistent with cells of hepatic origin. Intraplacental hepatic heterotopia is associated with premature labor. Distinguishing this lesion from maternal and fetal malignancies with similar histopathological presentation has important clinical implications in patient care.
Topics: Adult; Choristoma; Female; Fetus; Humans; Infant, Newborn; Liver; Obstetric Labor, Premature; Placenta; Placenta Diseases; Pregnancy
PubMed: 33399014
DOI: 10.1080/15513815.2020.1865490 -
American Journal of Physiology.... Aug 2020The risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to maternal and newborn health has yet to be determined. Several reports suggest pregnancy does... (Review)
Review
The risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to maternal and newborn health has yet to be determined. Several reports suggest pregnancy does not typically increase the severity of maternal disease; however, cases of preeclampsia and preterm birth have been infrequently reported. Reports of placental infection and vertical transmission are rare. Interestingly, despite lack of SARS-CoV-2 placenta infection, there are several reports of significant abnormalities in placenta morphology. Continued research on pregnant women infected with SARS-CoV-2 and their offspring is vitally important.
Topics: Abortion, Spontaneous; Betacoronavirus; COVID-19; Cesarean Section; Coronavirus Infections; Delivery, Obstetric; Female; Fetal Death; Gestational Age; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Pandemics; Placenta Diseases; Pneumonia, Viral; Pregnancy; Pregnancy Complications, Infectious; Premature Birth; SARS-CoV-2; Severity of Illness Index
PubMed: 32574110
DOI: 10.1152/ajpendo.00287.2020 -
Current Oncology Reports Feb 2020Cancer diagnosis in young pregnant women challenges oncological decision-making. The International Network on Cancer, Infertility and Pregnancy (INCIP) aims to build on... (Review)
Review
PURPOSE OF REVIEW
Cancer diagnosis in young pregnant women challenges oncological decision-making. The International Network on Cancer, Infertility and Pregnancy (INCIP) aims to build on clinical recommendations based on worldwide collaborative research.
RECENT FINDINGS
A pregnancy may complicate diagnostic and therapeutic oncological options, as the unborn child must be protected from potentially hazardous exposures. Pregnant patients should as much as possible be treated as non-pregnant patients, in order to preserve maternal prognosis. Some approaches need adaptations when compared with standard treatment for fetal reasons. Depending on the gestational age, surgery, radiotherapy, and chemotherapy are possible during pregnancy. A multidisciplinary approach is the best guarantee for experience-driven decisions. A setting with a high-risk obstetrical unit is strongly advised to safeguard fetal growth and health. Research wise, the INCIP invests in clinical follow-up of children, as cardiac function, neurodevelopment, cancer occurrence, and fertility theoretically may be affected. Furthermore, parental psychological coping strategies, (epi)genetic alterations, and pathophysiological placental changes secondary to cancer (treatment) are topics of ongoing research. Further international research is needed to provide patients diagnosed with cancer during pregnancy with the best individualized management plan to optimize obstetrical and oncological care.
Topics: Adaptation, Psychological; Female; Humans; Infant, Newborn; Infertility, Female; Internationality; Neoplasms; Patient Care Team; Placenta Diseases; Pregnancy; Pregnancy Complications, Neoplastic; Pregnancy Outcome; Registries
PubMed: 32025953
DOI: 10.1007/s11912-020-0862-7 -
Anesthesia and Analgesia Sep 2023
Topics: Female; Humans; Pregnancy; Placenta Accreta
PubMed: 37590798
DOI: 10.1213/ANE.0000000000006324 -
Molecular Reproduction and Development Aug 2020Decidualization is a crucial precedent to embryo implantation, as its impairment is a major contributor to female infertility and pregnancy complications. Unraveling the... (Review)
Review
Decidualization is a crucial precedent to embryo implantation, as its impairment is a major contributor to female infertility and pregnancy complications. Unraveling the molecular mechanisms involved in the impairment of decidualization has been a subject of interest in the field of reproductive medicine. Evidence from several experimental settings show that exposure to bisphenol A (BPA), an endocrine-disrupting chemical, affects the expression of several molecules that are involved in decidualization. Both low and high doses of BPA impair decidualization through the dysregulation of estrogen (ER) and progesterone (PR) receptors. Exposure to low doses of BPA leads to decreased levels and activities of several antioxidant enzymes, increased activity of endothelial nitric oxide synthase (eNOS), and increased production of nitric oxide (NO) via the upregulation of ER and PR. Consequently, oxidative stress is induced and decidualization becomes impaired. On the other hand, exposure to high doses of BPA downregulates ER and PR and impairs decidualization through two distinct pathways. One is through the upregulation of early growth response-1 (EGR1) via increased phosphorylation of extracellular signal-regulated protein kinases 1 and 2; and the other is through a reduced serum glucocorticoid-induced kinase-1 (SGK1)-mediated downregulation of epithelial sodium channel-α and the induction of oxidative stress. Thus, regardless of the dose, BPA can impair decidualization to trigger infertility and pregnancy complications. This warrants the need to adopt lifestyles that will decrease the tendency of getting exposed to BPA.
Topics: Animals; Benzhydryl Compounds; Decidua; Embryo Implantation; Embryo Implantation, Delayed; Endocrine Disruptors; Female; Humans; Phenols; Placenta Diseases; Pregnancy; Signal Transduction
PubMed: 32691498
DOI: 10.1002/mrd.23400 -
JAMA Dec 2023Cannabis use is increasing among reproductive-age individuals and the risks associated with cannabis exposure during pregnancy remain uncertain.
IMPORTANCE
Cannabis use is increasing among reproductive-age individuals and the risks associated with cannabis exposure during pregnancy remain uncertain.
OBJECTIVE
To evaluate the association between maternal cannabis use and adverse pregnancy outcomes known to be related to placental function.
DESIGN, SETTING, AND PARTICIPANTS
Ancillary analysis of nulliparous individuals treated at 8 US medical centers with stored urine samples and abstracted pregnancy outcome data available. Participants in the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be cohort were recruited from 2010 through 2013; the drug assays and analyses for this ancillary project were completed from June 2020 through April 2023.
EXPOSURE
Cannabis exposure was ascertained by urine immunoassay for 11-nor-9-carboxy-Δ9-tetrahydrocannabinol using frozen stored urine samples from study visits during the pregnancy gestational age windows of 6 weeks and 0 days to 13 weeks and 6 days (visit 1); 16 weeks and 0 days to 21 weeks and 6 days (visit 2); and 22 weeks and 0 days to 29 weeks and 6 days (visit 3). Positive results were confirmed with liquid chromatography tandem mass spectrometry. The timing of cannabis exposure was defined as only during the first trimester or ongoing exposure beyond the first trimester.
MAIN OUTCOME AND MEASURE
The dichotomous primary composite outcome included small-for-gestational-age birth, medically indicated preterm birth, stillbirth, or hypertensive disorders of pregnancy ascertained by medical record abstraction by trained perinatal research staff with adjudication of outcomes by site investigators.
RESULTS
Of 10 038 participants, 9257 were eligible for this analysis. Of the 610 participants (6.6%) with cannabis use, 32.4% (n = 197) had cannabis exposure only during the first trimester and 67.6% (n = 413) had ongoing exposure beyond the first trimester. Cannabis exposure was associated with the primary composite outcome (25.9% in the cannabis exposure group vs 17.4% in the no exposure group; adjusted relative risk, 1.27 [95% CI, 1.07-1.49]) in the propensity score-weighted analyses after adjustment for sociodemographic characteristics, body mass index, medical comorbidities, and active nicotine use ascertained via urine cotinine assays. In a 3-category cannabis exposure model (no exposure, exposure only during the first trimester, or ongoing exposure), cannabis use during the first trimester only was not associated with the primary composite outcome; however, ongoing cannabis use was associated with the primary composite outcome (adjusted relative risk, 1.32 [95% CI, 1.09-1.60]).
CONCLUSIONS AND RELEVANCE
In this multicenter cohort, maternal cannabis use ascertained by biological sampling was associated with adverse pregnancy outcomes related to placental dysfunction.
Topics: Female; Humans; Infant; Infant, Newborn; Pregnancy; Cannabis; Cohort Studies; Dronabinol; Hallucinogens; Marijuana Abuse; Maternal Exposure; Placenta; Placenta Diseases; Pregnancy Outcome; Premature Birth; Stillbirth; Pregnancy Complications
PubMed: 38085313
DOI: 10.1001/jama.2023.21146