Maternal death associated with sickle cell trait

A case report is presented of a patient with sickle cell trait who died an abrupt intrapartum death precipitated by probable peripartal cardiomopathy and apparently aggravated by intravascular sickling. Notable autopsy findings included massive sicklemia in all organ systems.

Structural aspects of a placenta from a case of maternal acute lymphatic leukaemia

After delivery of a healthy female child from a mother suffering from acute lymphatic leukaemia (35th week of gestation) the placenta was examined by light and electron microscopy. Morphologically, the villi in this placenta from a case of maternal acute lymphatic leukaemia differed from those in a normal placenta in the following respects: 1. The frequent occurrence of fibrinoid deposits on the free surface of the syncytiotrophoblast and the pronounced formation of syncytial cytoplasmic protrusions. 2. Dilatation of syncytial rough endoplasmic reticulum, numerous syncytial knots and numerous autophagosomes. 3. An excessive number of villous cytotrophoblastic cells. 4. Thickening of the trophoblastic basement membrane. 5. Bulbous endothelial cells with cytoplasm in fetal capillaries. 6. Strands of basement membrane-like material within the villous stroma. 7. Phagocytosis of nucleus-containing cells by the syncytiotrophoblast. 8. Cells with an abundant number of microtubular bundles within the villous stroma. It is suggested that phagocytosis of nucleus-containing cells (tumour cells?) by the syncytium could play a role in the prevention of transplacental metastasis.

Wernicke's encephalopathy in early pregnancy complicated by disseminated intravascular coagulation

A 29 year-old Japanese woman with hyperemesis gravidarum became comatose and died. The autopsy revealed a typical case of Wernicke's encephalopathy complicated by disseminated intravascular coagulation (DIC). Repeated vomiting and parenteral nutrition without vitamins led to Wernicke's encephalopathy and a spontaneous abortion 24 h before death triggered the induction of DIC.

[Recurring, histologically confirmed Moschcowitz syndrome during pregnancy]

A report is presented on a young woman who survived two episodes of thrombotic thrombocytopenic purpura, 5 years apart, in the 31st week of a twin and a singleton pregnancy respectively. The rare clinical picture of Moschcowitz syndrome during pregnancy is described with reference to this unique case report, and the diagnosis, etiology, therapy and clinical course are discussed.

[Asphyxial shock and disseminated intravascular coagulation (DIC) in animal experiments. 1. Histological picture (author's transl)]

The effects of subacute intra-uterine hypoxia on the haemostatic system of 205 foetuses from 49 pregnant rabbits were studied by a standardised experimental arrangement, with particular reference being made to intravascular precipitation of fibrin. The asphyxial shock thus induced was accompanied by almost all the rabbit foetuses by disseminated intravascular coagulation by which the central organs were more strongly affected, as compared to peripheral organs also restricted by the shock. The pathophysiological processes which were found to take place in the lungs and placentas of the experimental animals proved different from those in man, which was attributable to species-related differences.

[Undifferentiated cell leukosis in pregnancy]

The appearance of an undifferentiated cell leucosis during pregnancy is relatively rare. However, it is increasingly more frequently to be reckoned with this fact, since the rate of leucosis is increasing. On account of the extraordinary situation in the individual case may be difficult diagnostic and above all therapeutic decisions which are discussed with the help of the represented case.

Effect of pregnancy anaemia on cellular growth in the human placenta

The effects of pregnancy anaemia on cell number and size in human placentae were investigated. Total organ weight, protein, RNA and DNA contents were determined in 54 fresh placentae from anaemic women (haemoglobin less than 110 g/l) and another 32 placentae from women without anaemia (haemoglobin greater than or equal to 110 g/l). The placental weight was significantly reduced in pregnancy anaemia. The decrease in total placental DNA in anaemic women suggested that the reduced placental weight was due to a decrease in cell number. However, these placentae also showed evidence of compensatory cellular hypertrophy as indicated by increase in both weight per cell and protein per cell.

[Peripheral microthrombotic purpura associated with acute promyelocytic leukemia in pregnancy. A light and electron microscopic study]

A case is presented of a pregnant patient in the 28th week of gestation with promyelocytic leukemia and an unusual thrombohemorrhagic skin lesion. Ultrastructural examination revealed a microthrombotic purpura. Reduced coagulation factors increased during heparin treatment. The exacerbation of disseminated intravascular coagulation is explained by a hypercoagulable state in pregnancy in association with the as yet unknown etiology of "promyelocytic fibrinopathic leukemia".

The placenta: a diagnostic tool in sickle cell disorders

Examination of the placenta for the presence of sickling is an accurate, simple, inexpensive, and readily available technique for determining the presence of sickle cell disorders. There were 24 placental specimens out of 904 which showed evidence of sickling. The importance of this confirming procedure can be seen in the uncovering of two cases of false negative reports from conventional testing.

[Thrombotic thrombocytopenic purpura (Moschcowitz-syndrome) in pregnancy (author's transl)]

The case of a primigravida with thrombotic thrombocytopenic purpura (Moschcowitz Syndrome) is reported. The patient delivered a healthy male infant at 35 weeks gestation during a remission. The patient died at 10 days postpartum from a relapse of the disease. The special points in the differential diagnosis and treatment of thrombotic thrombocytopenic purpura during pregnancy are discussed.

Hereditary elliptical stomatocytosis: a case report

The case described demonstrates the development of elliptical stomatocytosis in a neonate and the appearance of elliptical stomatocytes in her mother whose blood film, before delivery, showed elliptocytosis. Further investigations on both individuals indicated a mild haemolytic anaemia. To our knowledge this is the second reported case of elliptical stomatocytosis.

[Morphofunctional specialization of tissue components of the mammalian placenta and adaptational value in changes in the rate of their differentiation (evolutionary and clinical aspects)]

It has been shown that in the ontogenesis of human placenta there occur regular changes in the percentage of the villi of various calibre having different interrelationships between the trophoblast, the connective tissue stroma and the fetal vessel. The changes of the number of chorial villi affected by fibrinoid and containing blood vessels under the trophoblast in late toxicoses of women and the anemic syndrom are analyzed (treated and not treated groups of women suffering from different forms of toxicosis were compared). An increased amount of chorial villi having blood vessels under the trophoblast is noted which is a morphofunctional feature of compensatory-adaptational alterations. Possible ecologo-evolutionary approaches to clearing the biological significance of adaptational changes of morphogenesis of the human placenta in pathological pregnancy are shown by the example of the analysis of morphological peculiarities of the placenta of the dolphin.

[Fibrin clots in placental vessels in intrauterine shock (author's transl)]

In 56 placentas there were fibrin clots in the vessels of the chorionic plate and the stem villi. Fifty infants survived. The fibrin clots in the relatively large placental vessels are considered to be the result of intrauterine shock. A similar pathogenetic concept is postulated as in the well-known diseminated fibrin thromboembolism which is evident in the visceral organs of children who died in the perinatal period. This identification of these fibrin clots in the vessels of the stem villi, especially in cases of so-called risk deliveries, allows the risk for newborn to be determined during their first days of life (hyaline-membrane disease, hemorrhagic diathesis, etc.). One can testify the intrauterine shock by these findings, even in newborn who survive the respiratory distress syndrome.

Differentiation of foetal and maternal erythrocytes in formol-fixed tissues

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