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Seminars in Perinatology Apr 2014The pregnancy disorders associated with placental ischemia share many similar pathological and pathophysiological features and are associated with the failure to deliver... (Review)
Review
The pregnancy disorders associated with placental ischemia share many similar pathological and pathophysiological features and are associated with the failure to deliver adequate nutrients and oxygen to the placenta. The origins of this deficiency are a subject of intense study. In this article, I review the genesis and consequences of this pathology addressing the similarities and the differences with the different disorders and addressing current gaps in our knowledge.
Topics: Abruptio Placentae; Endoplasmic Reticulum Stress; Female; Fetal Growth Retardation; Humans; Infant, Newborn; Ischemia; Oxidative Stress; Placenta; Placenta Diseases; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Prevalence; Risk Factors
PubMed: 24836825
DOI: 10.1053/j.semperi.2014.03.005 -
Anales Del Sistema Sanitario de Navarra 2009A haemorrhage is one of the most frequent, and potentially most serious, causes for emergency consultation during gestation. In this review we offer an overall approach... (Review)
Review
A haemorrhage is one of the most frequent, and potentially most serious, causes for emergency consultation during gestation. In this review we offer an overall approach to managing a pregnant woman who attends Accidents and Emergencies due to vaginal bleeding and then, in a more specific way, we consider how to manage some of the most frequent entities of the obstetric haemorrhage. With respect to haemorrhages in the second trimester, we give greater attention to how to manage a miscarriage, since other entities that are also frequent receive a specific evaluation in other chapters. In the second trimester three entities account for the greatest percentage of haemorrhages, such as placenta praevia, the premature detachment of the normally inserted placenta and uterine rupture. In each case we have evaluated the etiopathology, diagnostic attitude and management in the most systematic way possible.
Topics: Female; Hemorrhage; Humans; Placenta Diseases; Placenta Previa; Pregnancy; Pregnancy Complications, Hematologic; Uterine Rupture
PubMed: 19436342
DOI: 10.23938/ASSN.0190 -
Cold Spring Harbor Perspectives in... Aug 2015Preeclampsia is a pregnancy-specific disease characterized by new onset hypertension and proteinuria after 20 wk of gestation. It is a leading cause of maternal and... (Review)
Review
Preeclampsia is a pregnancy-specific disease characterized by new onset hypertension and proteinuria after 20 wk of gestation. It is a leading cause of maternal and fetal morbidity and mortality worldwide. Exciting discoveries in the last decade have contributed to a better understanding of the molecular basis of this disease. Epidemiological, experimental, and therapeutic studies from several laboratories have provided compelling evidence that an antiangiogenic state owing to alterations in circulating angiogenic factors leads to preeclampsia. In this review, we highlight the role of key circulating antiangiogenic factors as pathogenic biomarkers and in the development of novel therapies for preeclampsia.
Topics: Angiogenesis Inducing Agents; Biomarkers; Female; Humans; Placenta; Placenta Diseases; Pre-Eclampsia; Pregnancy; Prenatal Diagnosis; Signal Transduction; Vascular Endothelial Growth Factor A; Vascular Endothelial Growth Factor Receptor-1
PubMed: 26292986
DOI: 10.1101/cshperspect.a023473 -
Acta Obstetricia Et Gynecologica... Mar 2018Women with a history of placenta-related pregnancy complications, such as preeclampsia, intrauterine growth restriction or preterm delivery, have an increased risk for... (Review)
Review
INTRODUCTION
Women with a history of placenta-related pregnancy complications, such as preeclampsia, intrauterine growth restriction or preterm delivery, have an increased risk for recurrence of such complications. This recurrence is likely the result of underlying endothelial dysfunction that leads to abnormal placentation, especially in complications with an early onset. This study provides an overview of biomarkers of placental development and function in pregnancies from women with a history of placenta-related complications.
MATERIAL AND METHODS
A systematic literature search was conducted limited to human studies and including keywords related to a history of placenta-related complications and markers of placental development and function. Two independent reviewers assessed eligibility and quality of 1553 retrieved unique articles.
RESULTS
Five articles reporting on placental development and function in women with an obstetric history of preeclampsia (n = 3), intrauterine growth restriction (n = 1) and preterm delivery (n = 2) were eligible for quality assessment. We identified associations between a history of preeclampsia and abnormal placental histological findings at term in the current pregnancy, but found contradictory results regarding presence of uterine artery notching. In women with a history of very preterm delivery (<32 weeks), one study showed associations with abnormal placental histology.
CONCLUSION
Literature on the association between a history of placenta-related complications and placental development and function in subsequent pregnancies is scarce and studies are heterogeneous. However, literature shows that placenta-related pregnancy complications are associated with subsequent placental histology.
Topics: Biomarkers; Female; Fetal Growth Retardation; Humans; Placenta; Placenta Diseases; Pre-Eclampsia; Pregnancy; Premature Birth; Recurrence
PubMed: 29125627
DOI: 10.1111/aogs.13259 -
Archives of Pathology & Laboratory... Jun 2018
Topics: Humans; Placenta Diseases; Placental Circulation
PubMed: 29848028
DOI: 10.5858/arpa.2017-0542-LE -
Current Opinion in Obstetrics &... Dec 2017Antiphospholipid syndrome (APS) is defined as the association of thrombotic events and/or obstetric morbidity in patients persistently positive for antiphospholipid... (Review)
Review
PURPOSE OF REVIEW
Antiphospholipid syndrome (APS) is defined as the association of thrombotic events and/or obstetric morbidity in patients persistently positive for antiphospholipid antibodies (aPL). In this review, we will highlight the most important clinical presentations of APS with a focus on the obstetric morbidity, the current management strategies and the outlook for the future.
RECENT FINDINGS
The use of aspirin and heparin has improved the pregnancy outcome in obstetric APS and approximately 70% of pregnant women with APS have a successful pregnancy outcome. Unfortunately, the current standard of care does not prevent all pregnancy complications as the current treatment fails in 20-30% of APS pregnancies. This therefore highlights the need for alternative treatments to improve obstetrical outcome. Other treatment options are currently explored and retrospective studies show that pravastatin for example is beneficial in women with aPL-related early preeclampsia. Moreover, the immunmodulator hydroxychloroquine may play a beneficial role in the prevention of aPL-related pregnancy complications.
SUMMARY
APS is among the most frequent acquired risk factors for a treatable cause of recurrent pregnancy loss and increases the risk of conditions associated with ischaemic placental dysfunction, such as fetal growth restriction, preeclampsia, premature birth and intrauterine death. Current treatment is mainly based on aspirin and heparin. Studies to inform on alternative treatment options are urgently needed.
Topics: Abortion, Habitual; Antibodies, Antiphospholipid; Anticoagulants; Antiphospholipid Syndrome; Aspirin; Drug Therapy, Combination; Female; Fetal Death; Heparin; Humans; Placenta Diseases; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Randomized Controlled Trials as Topic; Retrospective Studies; Risk Factors; Stillbirth
PubMed: 28915160
DOI: 10.1097/GCO.0000000000000406 -
Cold Spring Harbor Perspectives in... Apr 2015In eutherian organisms, the placenta interfaces the fetal and maternal environments. Located at the placental villous surface, in direct contact with maternal blood, is... (Review)
Review
In eutherian organisms, the placenta interfaces the fetal and maternal environments. Located at the placental villous surface, in direct contact with maternal blood, is the trophoblast layer, which mediates the crucial maternal-fetal exchange of gases, nutrients, and waste products, produces hormones that support the pregnancy, and provides immunologic defense. Discovery of microRNAs (miRNAs) and their role in development, differentiation, and homeostatic resilience has increased our understanding of genomic and epigenomic networks that regulate placental function. Moreover, unique miRNA species, which are expressed by human trophoblasts and are termed "trophomiRs," may show specialized functions during normal and pathological pregnancies. Placental miRNAs, packaged within exosomes and other vesicles or bound in protein complexes, are capable of communicating distinctive signals to maternal and/or fetal tissues. Additional research may usher in the use of circulating miRNAs as pregnancy-related disease biomarkers, providing new diagnostic and therapeutic options during pregnancy.
Topics: Exosomes; Female; Gene Expression Regulation; Genetic Markers; Humans; MicroRNAs; Placenta; Placenta Diseases; Pregnancy; Sensitivity and Specificity; Trophoblasts
PubMed: 25877393
DOI: 10.1101/cshperspect.a023036 -
The Journal of Endocrinology Jan 2018Development of the early embryo takes place under low oxygen tension. Under such conditions, the embryo implants and the trophectoderm, the outer layer of blastocyst,... (Review)
Review
Development of the early embryo takes place under low oxygen tension. Under such conditions, the embryo implants and the trophectoderm, the outer layer of blastocyst, proliferate, forming the cytotrophoblastic shell, the early placenta. The cytotrophoblasts (CTBs) are the so-called epithelial 'stem cells' of the placenta, which, depending on the signals they receive, can differentiate into either extravillous trophoblast (EVT) or syncytiotrophoblast (STB). EVTs anchor the placenta to the uterine wall and remodel maternal spiral arterioles in order to provide ample blood supply to the growing fetus. STBs arise through CTB fusion, secrete hormones necessary for pregnancy maintenance and form a barrier across which nutrient and gas exchange can take place. The bulk of EVT differentiation occurs during the first trimester, before the onset of maternal arterial blood flow into the intervillous space of the placenta, and thus under low oxygen tension. These conditions affect numerous signaling pathways, including those acting through hypoxia-inducible factor, the nutrient sensor mTOR and the endoplasmic reticulum stress-induced unfolded protein response pathway. These pathways are known to be involved in placental development and disease, and specific components have even been identified as directly involved in lineage-specific trophoblast differentiation. Nevertheless, much controversy surrounds the role of hypoxia in trophoblast differentiation, particularly with EVT. This review summarizes previous studies on this topic, with the intent of integrating these results and synthesizing conclusions that resolve some of the controversy, but then also pointing to remaining areas, which require further investigation.
Topics: Animals; Cell Differentiation; Cell Lineage; Female; Humans; Hypoxia; Oxygen; Placenta Diseases; Placentation; Pregnancy; Trophoblasts
PubMed: 29259074
DOI: 10.1530/JOE-17-0402 -
Archives of Pathology & Laboratory... Jan 2007Placental mesenchymal dysplasia is characterized by placentomegaly and may be mistaken for molar pregnancy both clinically and macroscopically because of the presence of... (Review)
Review
CONTEXT
Placental mesenchymal dysplasia is characterized by placentomegaly and may be mistaken for molar pregnancy both clinically and macroscopically because of the presence of "grapelike vesicles." It may be associated with a completely normal fetus, a fetus with growth restriction, or a fetus with features of Beckwith-Wiedemann syndrome.
OBJECTIVE
To review the etiology, molecular pathology, gross and microscopic features, clinical presentation, complications, and differential diagnosis of placental mesenchymal dysplasia.
DATA SOURCES
The PubMed and the Medline databases were systematically searched for articles between 1970 and 2006. The following keywords were used: placental mesenchymal dysplasia, mesenchymal hyperplasia, molar pregnancy, pseudomolar pregnancy, Beckwith-Wiedemann syndrome, and placentomegaly. Relevant references from review articles were also searched.
CONCLUSIONS
Placental mesenchymal dysplasia should be considered in the differential diagnosis when the ultrasonographic findings show a cystic placenta. Close attention should be paid to fetal morphology for early recognition of fetal complications and to prevent unnecessary termination of pregnancy in cases associated with a normal fetus.
Topics: Beckwith-Wiedemann Syndrome; Diagnosis, Differential; Female; Fetal Growth Retardation; Humans; Hydatidiform Mole; Mesoderm; Placenta; Placenta Diseases; Placentation; Pregnancy; Ultrasonography
PubMed: 17227114
DOI: 10.5858/2007-131-131-PMD -
Frontiers in Endocrinology 2022The placenta plays a fundamental role during pregnancy for fetal growth and development. A suboptimal placental function may result in severe consequences during the... (Review)
Review
The placenta plays a fundamental role during pregnancy for fetal growth and development. A suboptimal placental function may result in severe consequences during the infant's first years of life. In recent years, a new field known as neuroplacentology has emerged and it focuses on the role of the placenta in fetal and neonatal brain development. Because of the limited data, our aim was to provide a narrative review of the most recent knowledge about the relation between placental lesions and fetal and newborn neurological development. Papers published online from 2000 until February 2022 were taken into consideration and particular attention was given to articles in which placental lesions were related to neonatal morbidity and short-term and long-term neurological outcome. Most research regarding the role of placental lesions in neurodevelopment has been conducted on fetal growth restriction and preterm infants. Principal neurological outcomes investigated were periventricular leukomalacia, intraventricular hemorrhages, neonatal encephalopathy and autism spectrum disorder. No consequences in motor development were found. All the considered studies agree about the crucial role played by placenta in fetal and neonatal neurological development and outcome. However, the causal mechanisms remain largely unknown. Knowledge on the pathophysiological mechanisms and on placenta-related risks for neurological problems may provide clues for early interventions aiming to improve neurological outcomes, especially among pediatricians and child psychiatrists.
Topics: Autism Spectrum Disorder; Female; Fetal Growth Retardation; Humans; Infant; Infant, Newborn; Infant, Premature; Placenta; Placenta Diseases; Pregnancy
PubMed: 36060976
DOI: 10.3389/fendo.2022.936171