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Annals of Medical and Health Sciences... Jul 2014The antenatal health-care given to pregnant women has great influence on the rates of perinatal death and morbidity. Amongst the different causes of perinatal mortality,...
BACKGROUND
The antenatal health-care given to pregnant women has great influence on the rates of perinatal death and morbidity. Amongst the different causes of perinatal mortality, low birth weight (LBW) is the single most significant factor therefore placenta from all the LBW babies (LBWB) should be examined routinely to find out the likely cause.
AIMS
The aims of this study were to assess the pathological changes in the placenta in association with LBWB.
MATERIALS AND METHODS
This is a Case control study performed at Medical College Allahabad,(MLN) India. In this study, 90 placentae were included. 30 placentae from full-term vaginally delivered babies, weighing more than 2500 g were included as the control group. 60 placentae belonged to babies whose birth weight was less than 2500 g (LBW). Weight of the baby was taken within the 1(st) h of birth and Apgar score was noted. Gross and microscopic examination of placentae was done. Statistical correlation of was carried out between them by using SPSS 18 version. Chi-square test with or without yate's correction was used as and when required. P < 0.05 was taken as critical level of significance.
RESULTS
Placenta was circum-marginal in both groups. Attachment of cord was mainly central in the control group 90% (27/30), whereas eccentric attachment was prominent in patient group 66.67% (40/60). The difference was statistically significant (P < 0.001). Calcification and sub-chorionic fibrin deposition was seen in significantly higher numbers of placentae from patients than controls (P < 0.01) infarction and meconium staining were seen in placentae from patients only. Histologically placental ischemia, infarction and calcification were seen in significantly higher number of patients (P < 0.001, P < 0.001 and < 0.01 respectively). Fibrinoid necrosis, stromal fibrosis, placental dysmaturity and obstructive vasculopathy were seen in placentae from patients only.
CONCLUSION
Placental pathology among LBW infants was high in comparison to control group. The findings suggest that chronic ischemia and associated secondary changes probably lead to improper perfusion and LBWB.
PubMed: 25184093
DOI: 10.4103/2141-9248.138016 -
CMAJ : Canadian Medical Association... Jul 2002Factor V Leiden is a common genetic mutation that predisposes its carriers to venous thromboembolism. When combined with the hypercoagulable state that is characteristic... (Review)
Review
Factor V Leiden is a common genetic mutation that predisposes its carriers to venous thromboembolism. When combined with the hypercoagulable state that is characteristic of pregnancy, there is an increased risk of severe and recurrent pregnancy complications. Factor V Leiden is the most common cause of primary and recurrent venous thromboembolism in pregnancy. Factor V Leiden carriage has consistently been shown to increase the risk of early onset gestational hypertension and HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) in pregnancy. Maternal carriage of factor V Leiden is also associated with severe placental abruption and fetal growth disturbances. Although it is unclear whether factor V Leiden causes an increased risk of first trimester miscarriage, it is associated with stillbirth and placental infarction. Patients with venous thromboembolism or severe pregnancy complications should be tested for factor V Leiden and other inherited and acquired thrombophilia. Therapeutic heparin is required for acute thromboembolic events in pregnancy. Patients with factor V Leiden and a previous venous thromboembolism may, according to their level of risk, be offered either prophylactic or therapeutic heparin. The role of antithrombotic therapy in the prevention of severe pregnancy complications remains unclear.
Topics: Activated Protein C Resistance; Factor V; Female; Fetal Growth Retardation; Heterozygote; Humans; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Risk; Venous Thrombosis
PubMed: 12137081
DOI: No ID Found -
PloS One 2023To explore how placental pathology is currently used by clinicians and what placental information would be most useful in the immediate hours after delivery.
OBJECTIVE
To explore how placental pathology is currently used by clinicians and what placental information would be most useful in the immediate hours after delivery.
STUDY DESIGN
We used a qualitative study design to conduct in-depth, semi-structured interviews with obstetric and neonatal clinicians who provide delivery or postpartum care at an academic medical center in the US (n = 19). Interviews were transcribed and analyzed using descriptive content analysis.
RESULTS
Clinicians valued placental pathology information yet cited multiple barriers that prevent the consistent use of pathology. Four main themes were identified. First, the placenta is sent to pathology for consistent reasons, however, the pathology report is accessed by clinicians inconsistently due to key barriers: difficult to find in the electronic medical record, understand, and get quickly. Second, clinicians value placental pathology for explanatory capability as well as for contributions to current and future care, particularly when there is fetal growth restriction, stillbirth, or antibiotic use. Third, a rapid placental exam (specifically including placental weight, infection, infarction, and overall assessment) would be helpful in providing clinical care. Fourth, placental pathology reports that connect clinically relevant findings (similar to radiology) and that are written with plain, standardized language and that non-pathologists can more readily understand are preferred.
CONCLUSION
Placental pathology is important to clinicians that care for mothers and newborns (particularly those that are critically ill) after birth, yet many problems stand in the way of its usefulness. Hospital administrators, perinatal pathologists, and clinicians should work together to improve access to and contents of reports. Support for new methods to provide quick placenta information is warranted.
Topics: Pregnancy; Infant, Newborn; Humans; Female; Placenta; Stillbirth; Fetal Growth Retardation; Parturition; Hospitals, University
PubMed: 37289756
DOI: 10.1371/journal.pone.0286294 -
Archives of Pathology & Laboratory... Jul 2010Two relatively unknown and recently described placental membrane hypoxic lesions (laminar necrosis and microscopic chorionic pseudocysts) have never been compared with... (Comparative Study)
Comparative Study
CONTEXT
Two relatively unknown and recently described placental membrane hypoxic lesions (laminar necrosis and microscopic chorionic pseudocysts) have never been compared with time-honored, focal (infarction), and diffuse hypoxic lesions of placental parenchyma.
OBJECTIVE
To compare the effect on placental diagnosis of the above placental membrane hypoxic lesions and chorionic disc hypoxic lesions (infarctions and global hypoxic pattern of placental injury).
DESIGN
Twenty-three clinical (maternal and fetal) and 32 gross and microscopic placental features were retrospectively compared in 4590 placentas from a placental database built during a 13-year period: 168 placentas with at least one hypoxic disc lesion (infarct or global hypoxia) and at least one membrane lesion (microscopic chorionic pseudocysts or laminar necrosis (group 1), 750 placentas with at least one hypoxic villous lesion but no membrane lesion (group 2), 480 placentas with at least one membrane lesion but no villous lesion (group 3), and 3192 placentas with no hypoxic villous or membrane lesions (group 4).
RESULTS
Several clinical and fetal conditions and placental features known to be associated with in utero hypoxia had a statistically significant correlation with the index hypoxic placental lesions, both villous and membranous. Of placentas from patients associated with clinical conditions at risk for hypoxia, 15% featured only hypoxic membrane lesions without a chorionic disc hypoxic lesion.
CONCLUSIONS
Recognizing placental membrane hypoxic lesions increases the sensitivity of placental examination in diagnosing placental hypoxia by at least 15%. The risk of in utero hypoxia is increased when microscopic chorionic pseudocysts and laminar necrosis occur in conjunction with villous hypoxic lesions.
Topics: Chorion; Cysts; Databases, Factual; Female; Fetal Diseases; Fetus; Humans; Hypoxia; Infarction; Necrosis; Placenta; Placenta Diseases; Pregnancy; Retrospective Studies; Sensitivity and Specificity
PubMed: 20586626
DOI: 10.5858/2009-0280-OA.1 -
Magnetic Resonance Imaging Jun 2024Objective To develop and evaluate a diagnostic model based on MRI signs for predicting placenta accreta spectrum. Materials and Methods A total of 155 pregnant women... (Randomized Controlled Trial)
Randomized Controlled Trial
Objective To develop and evaluate a diagnostic model based on MRI signs for predicting placenta accreta spectrum. Materials and Methods A total of 155 pregnant women were included in this study, randomly divided into 104 cases in the training set and 51 cases in the validation set. There were 93 Non-PAS cases, and 62 cases in the PAS group. The training set included 62 Non-PAS cases and 42 PAS cases. Clinical factors and MRI signs were collected for univariate analysis. Then, binary logistic regression analysis was used to develop independent diagnostic models with clinical relevant risk factors or MRI signs, as well as those combining clinical risk factors and MRI signs. The ROC curve analysis was used to evaluate the diagnostic performance of each diagnostic model. Finally, the validation was performed with the validation set. Results In the training set, four clinical factors (gestity, parity, uterine surgery history, placental position) and 11 MRI features (T2-dark bands, placental bulge, T2 hypointense interface loss, myometrial thinning, bladder wall interruption, focal exophytic mass, abnormal placental bed vascularization, placental heterogeneity, asymmetric placental thickening/shape, placental ischemic infarction, abnormal intraplacental vascularity) were considered as risk factors for PAS. The AUC of the clinical diagnostic model, MRI diagnostic model, and clinical + MRI model of PAS were 0.779, 0.854, and 0.874, respectively. In the validation set, the AUC of the clinical diagnostic model, MRI diagnostic model, and clinical + MRI model of PAS were 0.655, 0.728, and 0.735, respectively. Conclusion Diagnosis model based on MRI features in this study can well predict placenta accreta spectrum.
Topics: Pregnancy; Female; Humans; Placenta; Placenta Accreta; Myometrium; Placenta Previa; Magnetic Resonance Imaging; Retrospective Studies
PubMed: 38408691
DOI: 10.1016/j.mri.2024.02.014 -
Cureus Oct 2020Background and objective Pre-eclampsia and eclampsia are common complications in pregnancy, and they lead to uteroplacental vascular insufficiency. More than 38% of...
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.
PubMed: 33240700
DOI: 10.7759/cureus.11104 -
BJOG : An International Journal of... Jul 2022To correlate clinical outcomes to pathology in SARS-CoV-2 infected placentas in stillborn and live-born infants presenting with fetal distress. (Observational Study)
Observational Study
OBJECTIVE
To correlate clinical outcomes to pathology in SARS-CoV-2 infected placentas in stillborn and live-born infants presenting with fetal distress.
DESIGN
Retrospective, observational.
SETTING
Nationwide.
POPULATION
Five stillborn and nine live-born infants from 13 pregnant women infected with SARS-CoV-2 seeking care at seven different maternity units in Sweden.
METHODS
Clinical outcomes and placental pathology were studied in 14 cases (one twin pregnancy) of maternal SARS-CoV-2 infection with impaired fetal outcome. Outcomes were correlated to placental pathology in order to investigate the impact of virus-related pathology on the villous capillary endothelium, trophoblast and other cells.
MAIN OUTCOME MEASURES
Maternal and fetal clinical outcomes and placental pathology in stillborn and live-born infants.
RESULTS
Reduced fetal movements were reported (77%) and time from onset of maternal COVID-19 symptoms to signs of fetal distress among live-born infants was 6 (3-12) days and to diagnosis of stillbirth 11 (2-25) days. Two of the live-born infants died during the postnatal period. Signs of fetal distress led to emergency caesarean section in all live-born infants with umbilical cord blood gases and low Apgar scores confirming intrauterine hypoxia. Five stillborn and one live-born neonate had confirmed congenital transmission. Massive perivillous fibrinoid deposition, intervillositis and trophoblast necrosis were associated with SARS-CoV-2 placental infection and congenital transmission.
CONCLUSIONS
SARS-CoV-2 can cause rapid placental dysfunction with subsequent acute fetal hypoxia leading to intrauterine fetal compromise. Associated placental pathology included massive perivillous fibrinoid deposition, intervillositis and trophoblast degeneration.
Topics: COVID-19; Cesarean Section; Female; Fetal Distress; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Placenta; Pregnancy; Pregnancy Complications, Infectious; Retrospective Studies; SARS-CoV-2; Stillbirth
PubMed: 35243759
DOI: 10.1111/1471-0528.17132 -
Biomedical Papers of the Medical... Dec 2017Plasminogen activator inhibitor type 1 (PAI-1) is the main physiologic inhibitor of fibrinolysis. However, it is also involved in many physiological processes such as... (Review)
Review
Plasminogen activator inhibitor type 1 (PAI-1) is the main physiologic inhibitor of fibrinolysis. However, it is also involved in many physiological processes such as extracellular matrix (ECM) proteolysis and remodeling, cell adhesion, motility, and apoptosis, angiogenesis, etc. The aim of the study was to summarize current knowledge and gain insights into the mechanisms of PAI-1 action in the processes of stromal remodeling and diseases with considerable matrix pathologies (atherosclerosis, tissue fibrosis, cancer metastasis, pregnancy related complications, etc). As a component of an early cellular response to injury, PAI-1 reacts with membrane surface proteins and participates in the initiation of intracellular signaling, specifically cytoskeletal reorganization and motility. Complexity of ECM homeostasis resides in varying relation of the plasminogen system components and other matrix constituents. Inflammatory mediators (transforming growth factor-β and interferon-γ) and hormones (angiotensin II) are in the close interdependent relation with PAI-1. Also, special attention is devoted to the role of increased PAI-1 concentrations due to the common 4G/5G polymorphism. Some of the novel mechanisms of ECM modification consider PAI-1 dependent stabilization of urokinase mediated cell adhesion, control of the vascular endothelial cadherin trafficking and interaction with endothelial cells proteasome, its relation to matrix metalloproteinase 2 and osteopontin, and oxidative inhibition by myeloperoxidase. Targeting and/or alteration of PAI-1 functions might bring benefit to the future therapeutic approaches in diseases where ECM undergoes substantial remodeling.
Topics: Animals; Atherosclerosis; Cell Movement; Embryo Implantation; Extracellular Matrix; Female; Fibrinolysis; Fibrosis; Humans; Myocardial Infarction; Neoplasm Metastasis; Placentation; Plasminogen Activator Inhibitor 1; Pregnancy; Signal Transduction; Vascular Remodeling; Wound Healing
PubMed: 29097819
DOI: 10.5507/bp.2017.046 -
American Journal of Perinatology Mar 2010We present the neonatal complications of two premature newborn infants whose placentas demonstrated placental thrombosis in the fetal circulation. Both mothers presented... (Review)
Review
We present the neonatal complications of two premature newborn infants whose placentas demonstrated placental thrombosis in the fetal circulation. Both mothers presented with a 3-day history of decreased fetal movements before delivery. The first infant presented with thrombocytopenia and disseminated intravascular coagulation. The second infant had extended bilateral extended hemorrhagic venous infarctions. Severe fetal placental vascular lesions seem to be a predisposing factor for some adverse neonatal outcomes. We present these two cases with a brief review of the literature.
Topics: Adult; Female; Fetal Diseases; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Male; Placenta; Placenta Diseases; Pregnancy; Pregnancy Complications; Pregnancy Complications, Hematologic; Thrombosis
PubMed: 19806531
DOI: 10.1055/s-0029-1239486 -
Pakistan Journal of Medical Sciences 2021To investigate the etiology, clinical manifestations, diagnosis, treatment and prognosis of neonatal cerebral infarction (NCI) to further improve the understanding of...
OBJECTIVE
To investigate the etiology, clinical manifestations, diagnosis, treatment and prognosis of neonatal cerebral infarction (NCI) to further improve the understanding of the disease.
METHODS
Clinical data and follow-up results of 33 cases of NCI in neonatal intensive care unit of a first-class hospital from September 2009 to September 2019 were retrospectively analyzed.
RESULTS
All 33 patients were diagnosed with NCI by MRI. Among them, 31 cases (93.94%) were full-term infants, 25 cases (75.76%) were mother's first birth, and 18 (54.55%) cases were males. Pregnancy complications were reported in 18 cases (54.55%), and 19 cases (57.58%) had perinatal hypoxia history. Seizures were the most common first symptom and clinical manifestation in the course of disease (81.8%). There were 27 cases (81.82%) of patent foramen ovale (PFO) among NCI cohort. Ischemic cerebral infarction occurred in 32 cases (96.97%). The middle cerebral artery and its branches were more frequently involved, mainly on the left side. The acute stage of NCI was managed by symptomatic support treatment, and the recovery stage involved mainly rehabilitation treatment. Among the 33 cases, five cases were lost to follow-up, two patients died, 26 patients survived without complications, one case had cerebral palsy, one case had language retardation, and six cases had dyskinesia. Poor prognosis was associated with the involvement of deep gray matter nuclei or multiple lobes, and intrapartum complications. Vaginal mode of delivery and longer hospital stay were associated with better prognosis.
CONCLUSIONS
Complications leading to placental circulation disorder during pregnancy and perinatal hypoxia are common high-risk factors of NCI. The seizure is the most common clinical manifestation. There is a possible correlation between PFO and NCI. Involvement of deep gray matter or multiple lobes and intrapartum complications may indicate poor prognosis, while vaginal delivery and prolonged hospitalizations are associated with better prognosis of NCI.
PubMed: 34912398
DOI: 10.12669/pjms.37.7.4720