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Avagliano L, Monari F, Po’ G, Salerno C, Mascherpa M, Maiorana A, Facchinetti F, Bulfamante GP. The Burden of Placental Histopathology in Stillbirths Associated With Maternal Obesity. Am J Clin Pathol 2020; 154:225-235. [PMID: 32338725 DOI: 10.1093/ajcp/aqaa035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Obesity is an increasing health problem that has become a common medical disorder among women of childbearing age, representing worldwide a risk factor for stillbirth. The aim of the study is to evaluate the association between placental histopathologic findings and obesity in stillbirth. METHODS Placentas were analyzed according to the Amsterdam consensus statement. Histologic findings in stillbirth from obese and lean mothers were analyzed and compared with those observed in liveborn controls. RESULTS Stillbirth in obese mothers displayed placental pathology in all gestational ages, mostly at term of pregnancy. The most observed placental lesions were those consistent with maternal vascular malperfusion of the placental bed. Decidual arteriopathy and placental infarcts appeared specifically associated with maternal obesity. Moreover, obese women with stillbirth showed the highest cumulative number of placental lesions. CONCLUSIONS Considering the significant association between stillbirth, maternal obesity, and placental histopathologic findings, health care providers should be aware about the importance of placental examination in obese women, especially in stillborn cases. The high prevalence of lesions consistent with vascular malperfusion of the placental bed suggests that stillbirth prevention strategies in obese women should rely on the development of tools to study and improve decidual artery functioning early in pregnancy.
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Affiliation(s)
- Laura Avagliano
- Department of Health Sciences, San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | - Francesca Monari
- Obstetrics and Gynecology Unit, Mother-Infant and Adult Department of Medical and Surgical Sciences, Modena, Italy
| | - Gaia Po’
- Obstetrics and Gynecology Unit, Mother-Infant and Adult Department of Medical and Surgical Sciences, Modena, Italy
| | - Cristina Salerno
- Obstetrics and Gynecology Unit, Mother-Infant and Adult Department of Medical and Surgical Sciences, Modena, Italy
| | - Margaret Mascherpa
- Department of Health Sciences, San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | - Antonino Maiorana
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Facchinetti
- Obstetrics and Gynecology Unit, Mother-Infant and Adult Department of Medical and Surgical Sciences, Modena, Italy
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Kumar M, Vajala R, Bhutia P, Singh A. Factors contributing to late stillbirth among women with pregnancy hypertension in a developing country. Hypertens Pregnancy 2020; 39:236-242. [PMID: 32396487 DOI: 10.1080/10641955.2020.1757699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate the factors associated with late stillbirth among women with hypertensive disorders of pregnancy (HDP). MATERIAL AND METHODS The clinical details of women with HDP having late stillbirth were compared with controls having livebirth. RESULTS Total 208 cases and 288 controls were included in the study. Inadequate antenatal visits (p < 0.001, OR-5.92). birth weight < 2000 gms (p < 0.001, OR 10.3) and BW/PW ratio > 8 contributed significantly (p = 0.0001, OR-5.6) to stillbirth. CONCLUSION Poor antenatal care, birth weight below 2000gms and high BW/PW ratio was associated with a higher risk of stillbirth.
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Affiliation(s)
- Manisha Kumar
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College , New Delhi, India
| | - Ravi Vajala
- Department of Statistics, Lady Sri Ram College , New Delhi, India
| | - PhunstokDoma Bhutia
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College , New Delhi, India
| | - Abha Singh
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College , New Delhi, India
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Shelmerdine SC, Hutchinson JC, Ward L, Sekar T, Ashworth MT, Levine S, Sebire NJ, Arthurs OJ. Feasibility of INTACT (INcisionless TArgeted Core Tissue) biopsy procedure for perinatal autopsy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:667-675. [PMID: 31271478 PMCID: PMC7317589 DOI: 10.1002/uog.20387] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/18/2019] [Accepted: 06/21/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To determine the feasibility and tissue yield of a perinatal incisionless ultrasound-guided biopsy procedure, the INcisionless Targeted Core Tissue (INTACT) technique, in the context of minimally invasive autopsy. METHODS Cases of perinatal death in which the parents consented for minimally invasive autopsy underwent postmortem magnetic resonance imaging and an INTACT biopsy procedure, defined as needle biopsy of organs via the umbilical cord, performed under ultrasound guidance. In each case, three cores of tissue were obtained from seven target organs (both lungs, both kidneys, heart, spleen and liver). Biopsy success was predefined as an adequate volume of the intended target organ for pathological analysis, as judged by a pathologist blinded to the case and biopsy procedure. RESULTS Thirty fetuses underwent organ sampling. Mean gestational age was 30 weeks (range, 18-40 weeks) and mean delivery-to-biopsy interval was 12 days (range, 6-22 days). The overall biopsy success rate was 153/201 (76.1%) samples, with the success rates in individual organs being highest for the heart and lungs (93% and 91%, respectively) and lowest for the spleen (11%). Excluding splenic samples, the biopsy success rate was 150/173 (86.7%). Histological abnormalities were found in 4/201 (2%) samples, all of which occurred in the lungs and kidneys of a fetus with pulmonary hypoplasia and multicystic kidney disease. CONCLUSIONS Incisionless ultrasound-guided organ biopsy using the INTACT procedure is feasible, with an overall biopsy success rate of over 75%. This novel technique offers the ideal combination of an imaging-led autopsy with organ sampling for parents who decline the conventional invasive approach. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S. C. Shelmerdine
- Department of Clinical RadiologyGreat Ormond Street Hospital for ChildrenLondonUK
- UCL Great Ormond Street Institute of Child HealthGreat Ormond Street Hospital for ChildrenLondonUK
| | - J. C. Hutchinson
- UCL Great Ormond Street Institute of Child HealthGreat Ormond Street Hospital for ChildrenLondonUK
- Department of HistopathologyGreat Ormond Street Hospital for ChildrenLondonUK
| | - L. Ward
- Department of HistopathologyGreat Ormond Street Hospital for ChildrenLondonUK
| | - T. Sekar
- Department of HistopathologyGreat Ormond Street Hospital for ChildrenLondonUK
| | - M. T. Ashworth
- Department of HistopathologyGreat Ormond Street Hospital for ChildrenLondonUK
| | - S. Levine
- Department of HistopathologyGreat Ormond Street Hospital for ChildrenLondonUK
| | - N. J. Sebire
- UCL Great Ormond Street Institute of Child HealthGreat Ormond Street Hospital for ChildrenLondonUK
- Department of HistopathologyGreat Ormond Street Hospital for ChildrenLondonUK
| | - O. J. Arthurs
- Department of Clinical RadiologyGreat Ormond Street Hospital for ChildrenLondonUK
- UCL Great Ormond Street Institute of Child HealthGreat Ormond Street Hospital for ChildrenLondonUK
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Jaiman S, Romero R, Pacora P, Jung E, Bhatti G, Yeo L, Kim YM, Kim B, Kim CJ, Kim JS, Qureshi F, Jacques SM, Erez O, Gomez-Lopez N, Hsu CD. Disorders of placental villous maturation in fetal death. J Perinat Med 2020; 0:/j/jpme.ahead-of-print/jpm-2020-0030/jpm-2020-0030.xml. [PMID: 32238609 PMCID: PMC8262362 DOI: 10.1515/jpm-2020-0030] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/21/2020] [Indexed: 12/22/2022]
Abstract
Objective The aims of this study were to ascertain the frequency of disorders of villous maturation in fetal death and to also delineate other placental histopathologic lesions in fetal death. Methods This was a retrospective observational cohort study of fetal deaths occurring among women between January 2004 and January 2016 at Hutzel Women's Hospital, Detroit, MI, USA. Cases comprised fetuses with death beyond 20 weeks' gestation. Fetal deaths with congenital anomalies and multiple gestations were excluded. Controls included pregnant women without medical/obstetrical complications and delivered singleton, term (37-42 weeks) neonate with 5-min Apgar score ≥7 and birthweight between the 10th and 90th percentiles. Results Ninety-two percent (132/143) of placentas with fetal death showed placental histologic lesions. Fetal deaths were associated with (1) higher frequency of disorders of villous maturation [44.0% (64/143) vs. 1.0% (4/405), P < 0.0001, prevalence ratio, 44.6; delayed villous maturation, 22% (31/143); accelerated villous maturation, 20% (28/143); and maturation arrest, 4% (5/143)]; (2) higher frequency of maternal vascular malperfusion lesions [75.5% (108/143) vs. 35.7% (337/944), P < 0.0001, prevalence ratio, 2.1] and fetal vascular malperfusion lesions [88.1% (126/143) vs. 19.7% (186/944), P < 0.0001, prevalence ratio, 4.5]; (3) higher frequency of placental histologic patterns suggestive of hypoxia [59.0% (85/143) vs. 9.3% (82/942), P < 0.0001, prevalence ratio, 6.8]; and (4) higher frequency of chronic inflammatory lesions [53.1% (76/143) vs. 29.9% (282/944), P < 0.001, prevalence ratio 1.8]. Conclusion This study demonstrates that placentas of women with fetal death were 44 times more likely to present disorders of villous maturation compared to placentas of those with normal pregnancy. This suggests that the burden of placental disorders of villous maturation lesions is substantial.
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Affiliation(s)
- Sunil Jaiman
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Pathology, Hutzel Women’s Hospital, Wayne State University School of Medicine, Detroit, MI, USA
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
- Detroit Medical Center, Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Florida International University, Miami, Florida, USA
| | - Percy Pacora
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Eunjung Jung
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Gaurav Bhatti
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Lami Yeo
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Yeon Mee Kim
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Bomi Kim
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Chong Jai Kim
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jung-Sun Kim
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Pathology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Faisal Qureshi
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Pathology, Hutzel Women’s Hospital, Wayne State University School of Medicine, Detroit, MI, USA
| | - Suzanne M. Jacques
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Pathology, Hutzel Women’s Hospital, Wayne State University School of Medicine, Detroit, MI, USA
| | - Offer Erez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Nardhy Gomez-Lopez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Chaur-Dong Hsu
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan, USA
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Cuneo BF, Kaizer AM, Clur SA, Swan H, Herberg U, Winbo A, Rydberg A, Haugaa K, Etheridge S, Ackerman MJ, Dagradi F, Killen SA, Wacker-Gussmann A, Benson DW, Wilde A, Pan Z, Lam A, Spazzolini C, Horigome H, Schwartz PJ. Mothers with long QT syndrome are at increased risk for fetal death: findings from a multicenter international study. Am J Obstet Gynecol 2020; 222:263.e1-263.e11. [PMID: 31520628 DOI: 10.1016/j.ajog.2019.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Most fetal deaths are unexplained. Long QT syndrome is a genetic disorder of cardiac ion channels. Affected individuals, including fetuses, are predisposed to sudden death. We sought to determine the risk of fetal death in familial long QT syndrome, in which the mother or father carries the long QT syndrome genotype. In addition, we assessed whether risk differed if the long QT syndrome genotype was inherited from the mother or father. OBJECTIVE This was a retrospective review of pregnancies in families with the 3 most common heterozygous pathogenic long QT syndrome genotypes in KCNQ1 (LQT1), KCNH2 (LQT2), or SCN5A (LQT3), which occur in approximately 1 in 2000 individuals. The purpose of our study was to compare pregnancy and birth outcomes in familial long QT syndrome with the normal population and between maternal and paternal carriers of the long QT syndrome genotype. We hypothesized that fetal death before (miscarriage) and after (stillbirths) 20 weeks gestation would be increased in familial long QT syndrome compared with the normal population and that the parent of origin would not affect birth outcomes. STUDY DESIGN Our study was a multicenter observational case series of 148 pregnancies from 103 families (80 mothers, 23 fathers) with familial long QT syndrome (60 with LQT1, 29 with LQT2, 14 with LQT3) who were recruited from 11 international centers with expertise in hereditary heart rhythm diseases, pediatric and/or adult electrophysiology, and high-risk pregnancies. Clinical databases from these sites were reviewed for long QT syndrome that occurred in men or women of childbearing age (18-40 years). Pregnancy outcomes (livebirth, stillbirth, and miscarriage), birthweights, and gestational age at delivery were compared among long QT syndrome genotypes and between maternal vs paternal long QT syndrome-affected status with the use of logistic regression analysis. RESULTS Most offspring (80%; 118/148) were liveborn at term; 66% of offspring (73/110) had long QT syndrome. Newborn infants of mothers with long QT syndrome were delivered earlier and, when the data were controlled for gestational age, weighed less than newborn infants of long QT syndrome fathers. Fetal arrhythmias were observed rarely, but stillbirths (fetal death at >20 weeks gestation) were 8 times more frequent in long QT syndrome (4% vs approximately 0.5%); miscarriages (fetal death at ≤20 weeks gestation) were 2 times that of the general population (16% vs 8%). The likelihood of fetal death was significantly greater with maternal vs paternal long QT syndrome (24.4% vs 3.4%; P=.036). Only 10% of all fetal deaths underwent postmortem long QT syndrome testing; 2 of 3 cases were positive for the family long QT syndrome genotype. CONCLUSION This is the first report to demonstrate that mothers with long QT syndrome are at increased risk of fetal death and to uncover a previously unreported cause of stillbirth. Our results suggest that maternal effects of long QT syndrome channelopathy may cause placental or myometrial dysfunction that confers increased susceptibility to fetal death and growth restriction in newborn survivors, regardless of long QT syndrome status.
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Lou SK, Keating S, Kolomietz E, Shannon P. Diagnostic Utility of Pathological Investigations in Late Gestation Stillbirth: A Cohort Study. Pediatr Dev Pathol 2020; 23:96-106. [PMID: 31333057 DOI: 10.1177/1093526619860353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Near term unexpected stillbirth is a common, complex diagnostic challenge. We review a large cohort of near term to term gestation unexpected fetal deaths to document the common patterns of pathology and evaluate the utility of various standard autopsy procedures. METHODS A total of 123 perinatal autopsies consisting of 94 intrauterine fetal deaths (IUFDs) and 29 intrapartum deaths (IPDs) were reviewed. Deaths were classified according to the laboratory investigations establishing cause of death. RESULTS Cause of death was attributable to placental pathology without autopsy in 55.3% of IUFD and 17% of IPD. Correlative findings at autopsy increased the ability to establish cause of death in 86.2% of IUFD and 62% of IPD. Histology was largely corroborative, with the brain, lungs, and heart demonstrating significant changes in 46%, 34.5%, and 13.8%, respectively. Microbiology was corroborative but demonstrated single organism growth in 6 of 29 cases of fatal acute chorioamnionitis. Newborn metabolic screening revealed only elevated thyroid-stimulating hormone levels in 3 cases, of questionable relevance. Aneuploidy was established by screening molecular studies in 5 IUFDs, all of which had external or visceral dysmorphism. Karyotype was established in 69 cases and was not contributory in any of the IPD: 3 IUFDs had changes of unknown significance. Cause of death was not established at autopsy in 9% of IUFD and 10% of IPD. DISCUSSION This is the largest uniformly investigated cohort of late gestation unexpected fetal deaths studied. We confirm the importance of both placental and fetal autopsy in establishing cause of death. Autopsy histology, microbiology, and cytogenetics provide important but largely corroborative data.
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Affiliation(s)
- Si Kei Lou
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Sarah Keating
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Elena Kolomietz
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Patrick Shannon
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
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Campbell J, Evans MJ. Normally Grown Non-dysmorphic Stillbirth Post 38 Weeks Gestation and Reduced Fetal Movements: A Matter of Reserve? A Retrospective Study. JOURNAL OF FETAL MEDICINE 2020. [DOI: 10.1007/s40556-019-00230-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AbstractThis study investigates the relationship between placental weight relative to birthweight and risk of stillbirth in non-dysmorphic fetuses ≥ 38 weeks gestation with no evidence of intrauterine growth restriction. This is a retrospective study of stillbirths who underwent post-mortem between 1st Jan 2011 and 31st Dec 2018 in South East Scotland (n = 55). The control group (n = 74) was matched for gestation, age of mother and maternal BMI. There was a significant difference (p = 0.0117) in the mean ratio of birth weight to placental weight (BW:PW) between the stillbirth group (8.17) and control group (7.33). Cases of stillbirths where the mother had reported reduced fetal movements (RFM) had a higher BW:PW compared to controls (p = 0.024). Within the RFM stillbirth group, 5/6 (83%) cases showed significant changes of maternal vascular malperfusion (MVM) and/or fetal vascular malperfusion (FVM); whilst within the RFM control group, 5/15 (33%) cases showed significant changes of MVM and/or FVM. There is a significantly higher BW:PW within the stillbirth group than within the control group, both groups show changes of MVM and/or FVM and our supposition is that these changes have a greater impact on placental reserve when the birthweight is high relative to placental weight. Reduced fetal movements may indicate diminished placental reserve. We propose that the ability to predict a high BW:PW within pregnancies where the mothers report RFM may help to prevent late stillbirth in non-IUGR infants.
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Kristi B A, Ditte N H, Caroline H, Marianne S, Astrid P, Jens B F, David A P, Anne S. Placental diffusion-weighted MRI in normal pregnancies and those complicated by placental dysfunction due to vascular malperfusion. Placenta 2020; 91:52-58. [PMID: 32174307 DOI: 10.1016/j.placenta.2020.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/19/2020] [Accepted: 01/21/2020] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Our aim was to assess placental function by diffusion-weighted magnetic resonance imaging (MRI) using intravoxel incoherent motion (IVIM) analysis in uncomplicated pregnancies and pregnancies complicated by placental dysfunction. METHODS 31 normal pregnancies and 9 pregnancies complicated by placental dysfunction (birthweight ≤ -2SD and histological signs of placental vascular malperfusion) were retrieved from our placental MRI research database. MRI was performed at gestational weeks 20.1-40.6 in a 1.5 T system using 10 b-values (0-1000 s/mm2). Regions of interest were drawn covering the entire placenta in five transverse slices. Diffusion coefficient (D), pseudodiffusion coefficient (D*) and perfusion fraction (f) were estimated by IVIM analysis. RESULTS In normal pregnancies, placental f decreased linearly with gestational age (r = -0.522, p = 0.002) being 26.2% at week 20 and 18.8% at week 40. D and D* were 1.57 ± 0.03 and 31.7 ± 3.1 mm2/s (mean ± SD), respectively, and they were not correlated with gestational age. In complicated pregnancies, f was significantly reduced (mean Z-score = -1.16; p = 0.02) when compared to the group of normal pregnancies, whereas D and D* did not differ significantly between groups. Subgroup analysis demonstrated that f was predominantly reduced in dysfunctional placentas characterized by fetal vascular malperfusion (mean Z-score = -2.11, p < 0.001) rather than maternal vascular malperfusion (mean Z-score = -0.40, p = 0.42). In addition, f was negatively correlated with uterine artery pulsatility index (r = -0.396, p = 0.01). DISCUSSION Among parameters obtained by the IVIM analysis, only f revealed significant differences between the normal and the dysfunctional placentas. Subgroup analysis suggests that placental f may be able to discriminate non-invasively between different histological types of vascular malperfusion.
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Affiliation(s)
- Anderson Kristi B
- Department of Pathology, Aalborg University Hospital, Ladegaardsgade 3, 9000, Aalborg, Denmark.
| | - Hansen Ditte N
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark
| | - Haals Caroline
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark
| | - Sinding Marianne
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark
| | - Petersen Astrid
- Department of Pathology, Aalborg University Hospital, Ladegaardsgade 3, 9000, Aalborg, Denmark
| | - Frøkjær Jens B
- Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark; Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Peters David A
- Department of Clinical Engineering, Central Denmark Region, Nørrebrogade 44, 8000, Aarhus C, Denmark
| | - Sørensen Anne
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark
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Graham N, Heazell AEP. When the Fetus Goes Still and the Birth Is Tragic: The Role of the Placenta in Stillbirths. Obstet Gynecol Clin North Am 2019; 47:183-196. [PMID: 32008668 DOI: 10.1016/j.ogc.2019.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Because of the critical role that placental structure and function plays during pregnancy, abnormal placental structure and function is closely related to stillbirth: when an infant dies before birth. However, understanding the role of the placental and specific lesions is incomplete, in part because of the variation in definitions of lesions and in classifying causes of stillbirths. Nevertheless, placental abnormalities are seen more frequently in stillbirths than live births, with placental abruption, chorioamnionitis, and maternal vascular malperfusion most commonly reported. Critically, some placental lesions affect the management of subsequent pregnancies. Histopathological examination of the placenta is recommended following stillbirth.
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Affiliation(s)
- Nicole Graham
- Faculty of Biological, Medical and Human Sciences, Maternal and Fetal Health Research Centre, School of Medical Sciences, University of Manchester, Manchester Academic Health Science Centre, St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, 5th Floor (Research), Oxford Road, Manchester M13 9WL, UK
| | - Alexander E P Heazell
- Faculty of Biological, Medical and Human Sciences, Maternal and Fetal Health Research Centre, School of Medical Sciences, University of Manchester, Manchester Academic Health Science Centre, St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, 5th Floor (Research), Oxford Road, Manchester M13 9WL, UK.
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Abstract
Placental dysfunction is a major contributing factor to fetal growth restriction. Placenta-mediated fetal growth restriction occurs through chronic fetal hypoxia owing to poor placental perfusion through a variety of mechanisms. Maternal vascular malperfusion is the most common placental disease contributing to fetal growth restriction; however, the role of rare placental diseases should not be overlooked. Although the features of maternal vascular malperfusion are identifiable on placental pathology, antepartum diagnostic methods are evolving. Placental imaging and uterine artery Doppler, used in conjunction with angiogenic growth factors (specifically placenta growth factor and soluble fms-like tyrosine kinase-1), play an increasingly important role.
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Shelmerdine SC, Hutchinson JC, Arthurs OJ, Sebire NJ. Latest developments in post-mortem foetal imaging. Prenat Diagn 2019; 40:28-37. [PMID: 31525275 DOI: 10.1002/pd.5562] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/29/2019] [Accepted: 09/07/2019] [Indexed: 12/11/2022]
Abstract
A sustained decline in parental consent rates for perinatal autopsies has driven the development of less-invasive methods for death investigation. A wide variety of imaging modalities have been developed for this purpose and include post-mortem whole body magnetic resonance imaging (MRI), ultrasound, computed tomography (CT) and micro-focus CT techniques. These are also vital for "minimally invasive" methods, which include potential for tissue sampling, such as image guidance for targeted biopsies and laparoscopic-assisted techniques. In this article, we address the range of imaging techniques currently in clinical practice and those under development. Significant advances in high-field MRI and micro-focus CT imaging show particular promise for smaller and earlier gestation foetuses. We also review how MRI biomarkers such as diffusion-weighted imaging and organ volumetric analysis may aid diagnosis and image interpretation in the absence of autopsy data. Three-dimensional printing and augmented reality may help make imaging findings more accessible to parents, colleagues and trainees.
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Affiliation(s)
- Susan C Shelmerdine
- Department of Radiology Great Ormond Street Hospital for Children NHS Foundation Trust London, London, UK.,UCL Great Ormond Street Institute of Child Health London, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre London, London, UK
| | - John C Hutchinson
- Department of Radiology Great Ormond Street Hospital for Children NHS Foundation Trust London, London, UK.,UCL Great Ormond Street Institute of Child Health London, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre London, London, UK
| | - Owen J Arthurs
- Department of Radiology Great Ormond Street Hospital for Children NHS Foundation Trust London, London, UK.,UCL Great Ormond Street Institute of Child Health London, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre London, London, UK
| | - Neil J Sebire
- Department of Radiology Great Ormond Street Hospital for Children NHS Foundation Trust London, London, UK.,UCL Great Ormond Street Institute of Child Health London, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre London, London, UK
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62
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Kingdon C, Roberts D, Turner MA, Storey C, Crossland N, Finlayson KW, Downe S. Inequalities and stillbirth in the UK: a meta-narrative review. BMJ Open 2019; 9:e029672. [PMID: 31515427 PMCID: PMC6747680 DOI: 10.1136/bmjopen-2019-029672] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 07/25/2019] [Accepted: 08/14/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To review what is known about the relationship between stillbirth and inequalities from different disciplinary perspectives to inform stillbirth prevention strategies. DESIGN Systematic review using the meta-narrative method. SETTING Studies undertaken in the UK. DATA SOURCES Scoping phase: experts in field, exploratory electronic searches and handsearching. Systematic searches phase: Nine databases with no geographical or date restrictions. Non-English language studies were excluded. STUDY SELECTION Any investigation of stillbirth and inequalities with a UK component. DATA EXTRACTION AND SYNTHESIS Three authors extracted data and assessed study quality. Data were summarised, tabulated and presented graphically before synthesis of the unfolding storyline by research tradition; and then of the commonalities, differences and interplays between narratives into resultant summary meta-themes. RESULTS Fifty-four sources from nine distinctive research traditions were included. The evidence of associations between social inequalities and stillbirth spanned 70 years. Across research traditions, there was recurrent evidence of the social gradient remaining constant or increasing, fuelling repeated calls for action (meta-theme 1: something must be done). There was less evidence of an effective response to these calls. Data pertaining to socioeconomic, area and ethnic disparities were routinely collected, but not consistently recorded, monitored or reported in relation to stillbirth (meta-theme 2: problems of precision). Many studies stressed the interplay of socioeconomic status, deprivation or ethnicity with aggregated factors including heritable, structural, environmental and lifestyle factors (meta-theme 3: moving from associations towards intersectionality and intervention(s)). No intervention studies were identified. CONCLUSION Research investigating inequalities and stillbirth in the UK is underdeveloped. This is despite repeated evidence of an association between stillbirth risk and poverty, and stillbirth risk, poverty and ethnicity. A specific research forum is required to lead the development of research and policy in this area, which can harness the multiple relevant research perspectives and address the intersections between different policy areas. PROSPERO REGISTRATION NUMBER CRD42017079228.
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Affiliation(s)
- Carol Kingdon
- Research in childbirth and health, University of Central Lancashire, Preston, UK
| | - Devender Roberts
- Department of Obstetrics, Liverpool Womens NHS Foundation Trust, Liverpool, UK
| | - Mark A Turner
- Department of Women's and Childrens Health, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | | | - Nicola Crossland
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | | | - Soo Downe
- Research in childbirth and health, University of Central Lancashire, Preston, UK
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63
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Zile I, Ebela I, Rumba-Rozenfelde I. Maternal Risk Factors for Stillbirth: A Registry-Based Study. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E326. [PMID: 31266254 PMCID: PMC6681231 DOI: 10.3390/medicina55070326] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/26/2019] [Accepted: 06/28/2019] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The number of stillbirths has reduced more slowly than has maternal mortality or mortality in children younger than 5 years, which were explicitly targeted in the Millennium Development Goals. Placental pathologies and infection associated with preterm birth are linked to a substantial proportion of stillbirths. Appropriate preconception care and quality antenatal care that is accessible to all women has the potential to reduce stillbirth rates. The aim of the present study was to assess potential risk factors associated with stillbirth within maternal medical diseases and obstetric complications. Materials and Methods: Retrospective cohort study (2001-2014) was used to analyse data from the Medical Birth Register on stillbirth and live births as controls. Adjusted Odds ratios (aOR) with 95% confidence intervals (CI) were estimated. Multiple regression model adjusted for maternal age, parity and gestational age. Results: The stillbirth rate was 6.2 per 1000 live and stillbirths. The presence of maternal medical diseases greatly increased the risk of stillbirth including diabetes mellitus (aOR = 2.5; p < 0.001), chronic hypertension 3.1 (aOR = 3.1; p < 0.001) and oligohydromnios/polyhydromnios (aOR = 2.4; p < 0.001). Pregnancy complications such as intrauterine growth restriction (aOR = 2.2; p < 0.001) was important risk factor for stillbirth. Abruption was associated with a 2.8 odds of stillbirth. Conclusions: Risk factors most significantly associated with stillbirth include maternal history of chronic hypertension and abruptio placenta which is a common cause of death in stillbirth. Early identification of potential risk factors and appropriate perinatal management are important issues in the prevention of adverse fetal outcomes and preventive strategies need to focus on improving antenatal detection of fetal growth restriction.
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Affiliation(s)
- Irisa Zile
- Faculty of Medicine, Department of Paediatrica, University of Latvia, Raiņa bulvāris 19, Riga, LV-1050, Latvia.
- The Centre for Disease Prevention and Control of Latvia, Duntes 22, k-5, Riga, LV-1005, Latvia.
| | - Inguna Ebela
- Faculty of Medicine, Department of Paediatrica, University of Latvia, Raiņa bulvāris 19, Riga, LV-1050, Latvia
| | - Ingrida Rumba-Rozenfelde
- Faculty of Medicine, Department of Paediatrica, University of Latvia, Raiņa bulvāris 19, Riga, LV-1050, Latvia
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64
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Pacora P, Romero R, Jaiman S, Erez O, Bhatti G, Panaitescu B, Benshalom-Tirosh N, Jung Jung E, Hsu CD, Hassan SS, Yeo L, Kadar N. Mechanisms of death in structurally normal stillbirths. J Perinat Med 2019; 47:222-240. [PMID: 30231013 PMCID: PMC6349478 DOI: 10.1515/jpm-2018-0216] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 07/20/2018] [Indexed: 01/05/2023]
Abstract
Objectives To investigate mechanisms of in utero death in normally formed fetuses by measuring amniotic fluid (AF) biomarkers for hypoxia (erythropoietin [EPO]), myocardial damage (cardiac troponin I [cTnI]) and brain injury (glial fibrillary acidic protein [GFAP]), correlated with risk factors for fetal death and placental histopathology. Methods This retrospective, observational cohort study included intrauterine deaths with transabdominal amniocentesis prior to induction of labor. Women with a normal pregnancy and an indicated amniocentesis at term were randomly selected as controls. AF was assayed for EPO, cTnI and GFAP using commercial immunoassays. Placental histopathology was reviewed, and CD15-immunohistochemistry was used. Analyte concentrations >90th centile for controls were considered "raised". Raised AF EPO, AF cTnI and AF GFAP concentrations were considered evidence of hypoxia, myocardial and brain injury, respectively. Results There were 60 cases and 60 controls. Hypoxia was present in 88% (53/60), myocardial damage in 70% (42/60) and brain injury in 45% (27/60) of fetal deaths. Hypoxic fetuses had evidence of myocardial injury, brain injury or both in 77% (41/53), 49% (26/53) and 13% (7/53) of cases, respectively. Histopathological evidence for placental dysfunction was found in 74% (43/58) of these cases. Conclusion Hypoxia, secondary to placental dysfunction, was found to be the mechanism of death in the majority of fetal deaths among structurally normal fetuses. Ninety-one percent of hypoxic fetal deaths sustained brain, myocardial or both brain and myocardial injuries in utero. Hypoxic myocardial injury was an attributable mechanism of death in 70% of the cases. Non-hypoxic cases may be caused by cardiac arrhythmia secondary to a cardiac conduction defect.
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Affiliation(s)
- Percy Pacora
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan,Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan,Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan
| | - Sunil Jaiman
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Offer Erez
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan,Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Gaurav Bhatti
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Bogdan Panaitescu
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Neta Benshalom-Tirosh
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan,Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Eun Jung Jung
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Chaur-Dong Hsu
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Sonia S. Hassan
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan,Department of Physiology, Wayne State University School of Medicine, Detroit, Michigan
| | - Lami Yeo
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Nicholas Kadar
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan,Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
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Shahid S, Khalid E, Fatima SS, Khan GM. Evaluation of soluble TNF-like weak inducer of apoptosis (sTWEAK) levels to predict preeclampsia in early weeks of pregnancy. Eur J Obstet Gynecol Reprod Biol 2019; 234:165-170. [PMID: 30708268 DOI: 10.1016/j.ejogrb.2019.01.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/02/2019] [Accepted: 01/14/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) is linked to endothelial dysfunction; a key factor in pre-eclamptic pathogenesis. This study aimed to compare sTWEAK levels during pregnancy to assess for its prognostic ability. MATERIALS AND METHODS Sixty three high risk pregnant women were followed up from 12 weeks of gestation till term. Serum levels of sTWEAK and platelet derived growth factor (PlGF), blood pressure, serum glucose, uric acid, urea/creatinine and liver function tests were measured. Subjects were stratified according to the ACOG criteria as women who developed PE, or PIH or remained normotensive at term. A negative control group of normotensive healthy pregnant women (n = 17) was also recruited for comparison. RESULTS Baseline sTWEAK levels were lower (4.03 ± 0.37 ng/dl) in HR cohort that developed PE and further reduced at term (1.93 ± 0.23 ng/dl) as compared to HR subjects who remained normotensive and negative control group (30.53 ± 0.79 ng/dl; p < 0.01). Likewise PlGF levels were significantly lower (74.22 ± 10.11 pg/ml) in HR cohort that developed PE (p = 0.013). At term 39.68% (n = 22) HR subjects with low sTWEAK developed PIH and 34.92% (n = 24) developed PE. In terms of high risk characteristics observed in the HR group; 73% of the subjects were multiparous, whereas 26.98% reported to have developed PE in previous pregnancies. CONCLUSION sTWEAK levels at early pregnancy weeks were found to be low in high risk females who developed PE at follow up versus normotensive pregnant women. Baseline TWEAK might serve as an independent variable for prediction of pre-eclampsia; however longitudinal studies with larger sample size are required to ascertain the causal relation.
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Affiliation(s)
- Sana Shahid
- Department of Physiology, Sir Syed College of Medical Sciences for Girls, Karachi, Pakistan
| | - Erum Khalid
- Department of Obstetrics and Gynecology, Taj Medical Complex, Hamdard University, Pakistan
| | - Syeda Sadia Fatima
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan.
| | - Ghulam Mustafa Khan
- Department of Physiology, Basic Medical Science Institute, Karachi, Pakistan
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Ladhani NNN, Fockler ME, Stephens L, Barrett JF, Heazell AE. No 369 - Prise en charge de la grossesse aprés une mortinaissance. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1684-1700. [DOI: 10.1016/j.jogc.2018.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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No. 369-Management of Pregnancy Subsequent to Stillbirth. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1669-1683. [DOI: 10.1016/j.jogc.2018.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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68
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Fitzgerald W, Gomez-Lopez N, Erez O, Romero R, Margolis L. Extracellular vesicles generated by placental tissues ex vivo: A transport system for immune mediators and growth factors. Am J Reprod Immunol 2018; 80:e12860. [PMID: 29726582 PMCID: PMC6021205 DOI: 10.1111/aji.12860] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 03/27/2018] [Indexed: 12/12/2022] Open
Abstract
PROBLEM To study the mechanisms of placenta function and the role of extracellular vesicles (EVs) in pregnancy, it is necessary to develop an ex vivo system that retains placental cytoarchitecture and the primary metabolic aspects, in particular the release of EVs and soluble factors. Here, we developed such a system and investigated the pattern of secretion of cytokines, growth factors, and extracellular vesicles by placental villous and amnion tissues ex vivo. METHODS OF STUDY Placental villous and amnion explants were cultured for 2 weeks at the air/liquid interface and their morphology and the released cytokines and EVs were analyzed. Cytokines were analyzed with multiplexed bead assays, and individual EVs were analyzed with recently developed techniques that involved EV capture with magnetic nanoparticles coupled to anti-EV antibodies and flow cytometry. RESULTS Ex vivo tissues (i) remained viable and preserved their cytoarchitecture; (ii) maintained secretion of cytokines and growth factors; (iii) released EVs of syncytiotrophoblast and amnion epithelial cell origins that contain cytokines and growth factors. CONCLUSION A system of ex vivo placental villous and amnion tissues can be used as an adequate model to study placenta metabolic activity in normal and complicated pregnancies, in particular to characterize EVs by their surface markers and by encapsulated proteins. Establishment and benchmarking the placenta ex vivo system may provide new insight in the functional status of this organ in various placental disorders, particularly regarding the release of EVs and cytokines. Such EVs may have a prognostic value for pregnancy complications.
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Affiliation(s)
- Wendy Fitzgerald
- Section of Intercellular Interactions, Eunice Kennedy-Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI
| | - Nardhy Gomez-Lopez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy-Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
- Department of Immunology, Microbiology and Biochemistry, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Offer Erez
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy-Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy-Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
| | - Leonid Margolis
- Section of Intercellular Interactions, Eunice Kennedy-Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI
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70
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Chaiworapongsa T, Romero R, Erez O, Tarca AL, Conde-Agudelo A, Chaemsaithong P, Kim CJ, Kim YM, Kim JS, Yoon BH, Hassan SS, Yeo L, Korzeniewski SJ. The prediction of fetal death with a simple maternal blood test at 20-24 weeks: a role for angiogenic index-1 (PlGF/sVEGFR-1 ratio). Am J Obstet Gynecol 2017; 217:682.e1-682.e13. [PMID: 29037482 PMCID: PMC5951183 DOI: 10.1016/j.ajog.2017.10.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/29/2017] [Accepted: 10/01/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fetal death is an obstetrical syndrome that annually affects 2.4 to 3 million pregnancies worldwide, including more than 20,000 in the United States each year. Currently, there is no test available to identify patients at risk for this pregnancy complication. OBJECTIVE We sought to determine if maternal plasma concentrations of angiogenic and antiangiogenic factors measured at 24-28 weeks of gestation can predict subsequent fetal death. STUDY DESIGN A case-cohort study was designed to include 1000 randomly selected subjects and all remaining fetal deaths (cases) from a cohort of 4006 women with a singleton pregnancy, enrolled at 6-22 weeks of gestation, in a pregnancy biomarker cohort study. The placentas of all fetal deaths were histologically examined by pathologists who used a standardized protocol and were blinded to patient outcomes. Placental growth factor, soluble endoglin, and soluble vascular endothelial growth factor receptor-1 concentrations were measured by enzyme-linked immunosorbent assays. Quantiles of the analyte concentrations (or concentration ratios) were estimated as a function of gestational age among women who delivered a live neonate but did not develop preeclampsia or deliver a small-for-gestational-age newborn. A positive test was defined as analyte concentrations (or ratios) <2.5th and 10th centiles (placental growth factor, placental growth factor/soluble vascular endothelial growth factor receptor-1 [angiogenic index-1] and placental growth factor/soluble endoglin) or >90th and 97.5th centiles (soluble vascular endothelial growth factor receptor-1 and soluble endoglin). Inverse probability weighting was used to reflect the parent cohort when estimating the relative risk. RESULTS There were 11 fetal deaths and 829 controls with samples available for analysis between 24-28 weeks of gestation. Three fetal deaths occurred <28 weeks and 8 occurred ≥28 weeks of gestation. The rate of placental lesions consistent with maternal vascular underperfusion was 33.3% (1/3) among those who had a fetal death <28 weeks and 87.5% (7/8) of those who had this complication ≥28 weeks of gestation. The maternal plasma angiogenic index-1 value was <10th centile in 63.6% (7/11) of the fetal death group and in 11.1% (92/829) of the controls. The angiogenic index-1 value was <2.5th centile in 54.5% (6/11) of the fetal death group and in 3.7% (31/829) of the controls. An angiogenic index-1 value <2.5th centile had the largest positive likelihood ratio for predicting fetal death >24 weeks (14.6; 95% confidence interval, 7.7-27.7) and a relative risk of 29.1 (95% confidence interval, 8.8-97.1), followed by soluble endoglin >97.5th centile and placental growth factor/soluble endoglin <2.5th, both with a positive likelihood ratio of 13.7 (95% confidence interval, 7.3-25.8) and a relative risk of 27.4 (95% confidence interval, 8.2-91.2). Among women without a fetal death whose plasma angiogenic index-1 concentration ratio was <2.5th centile, 61% (19/31) developed preeclampsia or delivered a small-for-gestational-age neonate; when the 10th centile was used as the cut-off, 37% (34/92) of women had these adverse outcomes. CONCLUSION (1) A maternal plasma angiogenic index-1 value <2.5th centile (0.126) at 24-28 weeks of gestation carries a 29-fold increase in the risk of subsequent fetal death and identifies 55% of subsequent fetal deaths with a false-positive rate of 3.5%; and (2) 61% of women who have a false-positive test result will subsequently experience adverse pregnancy outcomes.
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Affiliation(s)
- Tinnakorn Chaiworapongsa
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Roberto Romero
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI; Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI.
| | - Offer Erez
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Adi L Tarca
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Agustin Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI
| | - Piya Chaemsaithong
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Chong Jai Kim
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yeon Mee Kim
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Jung-Sun Kim
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Bo Hyun Yoon
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sonia S Hassan
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Lami Yeo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Steven J Korzeniewski
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI
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71
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Salavati N, Gordijn SJ, Sovio U, Zill-E-Huma R, Gebril A, Charnock-Jones DS, Scherjon SA, Smith GCS. Birth weight to placenta weight ratio and its relationship to ultrasonic measurements, maternal and neonatal morbidity: A prospective cohort study of nulliparous women. Placenta 2017; 63:45-52. [PMID: 29183631 DOI: 10.1016/j.placenta.2017.11.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 11/12/2017] [Accepted: 11/13/2017] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Birth weight to placenta weight (BWPW)-ratio is an indicator of the ability of the placenta to maintain adequate nutrient supply to the fetus. We sought to investigate the relationship between BWPW-ratio with fetal growth, utero-placental Doppler and neonatal and maternal morbidity. METHODS We studied a group of 3311 women recruited to a prospective cohort study of nulliparous women (Rosie Hospital, Cambridge, UK) who delivered a live born infant at term and whose placental weight and birth weight were known. Ultrasonic indices and BWPW ratio were converted to gestational age adjusted z scores. Analysis of continuous variables was by multivariable linear regression. BWPW ratio was also categorized (lowest or highest quintile, both referent to quintiles 2 to 4) and associations with adverse outcomes analyzed using multivariable logistic regression. RESULTS Lowest quintile of BWPW-ratio was associated (adjusted odds ratio [95% CI], P) with both neonatal morbidity (1.55 [1.12-2.14], 0.007) and maternal diabetes (1.75 [1.18-2.59], 0.005). Highest quintile of BWPW ratio was associated with a reduced risk of maternal obesity (0.71 [0.53 to 0.95], 0.02) and preeclampsia (0.51 [0.31 to 0.84], 0.008), but higher (adjusted z score [95% CI], P) uterine artery Doppler mean pulsatility index (PI) at 20 weeks of gestation (0.09 [0.01-0.18], 0.04) and umbilical artery Doppler PI at 36 weeks of gestation (0.16 [0.07-0.25], <0.001). CONCLUSION BWPW-ratio is related to ultrasonic measurements and both neonatal and maternal morbidity. Therefore, this ratio may be an indicative marker of immediate and longer term health risks for an individual.
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Affiliation(s)
- N Salavati
- Department of Obstetrics and Gynaecology, University Medical Centre of Groningen, University of Groningen, The Netherlands.
| | - S J Gordijn
- Department of Obstetrics and Gynaecology, University Medical Centre of Groningen, University of Groningen, The Netherlands.
| | - U Sovio
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK; Centre for Trophoblast Research (CTR), Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK.
| | - R Zill-E-Huma
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK.
| | - A Gebril
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK.
| | - D S Charnock-Jones
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK; Centre for Trophoblast Research (CTR), Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK.
| | - S A Scherjon
- Department of Obstetrics and Gynaecology, University Medical Centre of Groningen, University of Groningen, The Netherlands.
| | - G C S Smith
- Department of Obstetrics and Gynaecology, University of Cambridge, NIHR Cambridge Comprehensive Biomedical Research Centre, Cambridge, UK; Centre for Trophoblast Research (CTR), Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK.
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72
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Stone PR, Burgess W, McIntyre J, Gunn AJ, Lear CA, Bennet L, Mitchell EA, Thompson JMD. An investigation of fetal behavioural states during maternal sleep in healthy late gestation pregnancy: an observational study. J Physiol 2017; 595:7441-7450. [PMID: 29023736 DOI: 10.1113/jp275084] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/02/2017] [Indexed: 12/21/2022] Open
Abstract
KEY POINTS Fetal behavioural state in healthy late gestation pregnancy is significantly affected by maternal position overnight. Maternal left lateral position is the one most frequently adopted at sleep onset. The maternal position at sleep onset is maintained the longest overnight. Fetal state 1F is more common in maternal supine positions overnight. Fetal state 4F is less common in maternal supine sleep positions. Fetal state and maternal sleep position are independently associated with fetal heart rate variability. Maternal sleep position significantly affects fetal heart rate and heart rate variability and affects circadian fetal heart rate patterns. ABSTRACT Fetal behavioural states (FBS) are measures of fetal wellbeing. Maternal position affects FBS with supine position being associated with an increased likelihood of fetal quiescence consistent with the human fetus adapting to a lower oxygen consuming state. Several studies have now confirmed the association between sleep position and risk of late intrauterine death. We designed this study to observe the effects of maternal sleep positions overnight in healthy late gestation pregnancy. Twenty-nine healthy women had continuous fetal ECG recordings overnight. Two blinded observers assigned fetal states in 5 min blocks. Measures of fetal heart rate variability (FHRV) were calculated from ECG beat to beat data. Maternal position was determined from infrared video recording. Compared to state 2F (active sleep), 4F (active awake-high activity) occurred almost exclusively when the mother was in a left or right lateral position. State 1F (quiet sleep) was more common when the mother was supine [odds ratio (OR) 1.30, 95% confidence interval (CI) 1.11-1.52] and less common on the maternal right side with the left being the referent position (OR 0.81, 95% CI, 0.70-0.93). State 4F was more common between 21.00 and 01.00 h than between 01.00 and 07.00 h (OR 2.83, 95% CI 2.32-3.47). In each fetal state, maternal position had significant effects on fetal heart rate and measures of FHRV. In healthy late gestation pregnancy, maternal sleep position affects FBS and heart rate variability. These effects are probably fetal adaptations to positions which may produce a mild hypoxic stress.
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Affiliation(s)
- Peter R Stone
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Wendy Burgess
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Jordan McIntyre
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Alistair J Gunn
- The Fetal Physiology and Neuroscience Group, Department of Physiology, Faculty of Medical and Health Sciences The University of Auckland, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Christopher A Lear
- The Fetal Physiology and Neuroscience Group, Department of Physiology, Faculty of Medical and Health Sciences The University of Auckland, Auckland, New Zealand
| | - Laura Bennet
- The Fetal Physiology and Neuroscience Group, Department of Physiology, Faculty of Medical and Health Sciences The University of Auckland, Auckland, New Zealand
| | - Edwin A Mitchell
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - John M D Thompson
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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73
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Falco ML, Sivanathan J, Laoreti A, Thilaganathan B, Khalil A. Placental histopathology associated with pre-eclampsia: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:295-301. [PMID: 28436167 DOI: 10.1002/uog.17494] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/08/2017] [Accepted: 04/10/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Pre-eclampsia (PE) is associated with impaired trophoblastic invasion and typical villous and vascular placental lesions. The primary aim of this study was to quantify the prevalence of placental histopathological lesions in pregnancies complicated by PE. METHODS MEDLINE, EMBASE and CINAHL were searched electronically, and relevant articles reporting on placental histopathological lesions were assessed according to the following criteria: study design, number of pregnancies included, severity of PE and whether the pathologist was blinded to the clinical information. Prospective and retrospective case-control studies including ≥ 100 pregnancies were included in the systematic review. The incidence of each type of histological lesion according to the Perinatal Section of the Society for Pediatric Pathology classification in pre-eclamptic and normal pregnancies was identified, and lesions were categorized into two main groups: villous lesions and vascular lesions. Random-effects meta-analysis of proportions was used for analysis. Between-study heterogeneity was assessed using the I2 statistic. RESULTS The search yielded 717 citations, and a total of eight studies (four blinded and four non-blinded) were included in the review. In unblinded studies, the pooled prevalence of villous lesions was 11.6% and 48.2% in normal and pre-eclamptic pregnancies, respectively, giving a pooled odds ratio (OR) of 7.59. In blinded studies, the pooled prevalence of villous lesions was 18.5% and 42.0% in normal and pre-eclamptic pregnancies, respectively, giving a pooled OR of 4.28. In unblinded studies, the pooled prevalence of vascular lesions was 8.1% and 37.3% in normal and pre-eclamptic pregnancies, respectively, giving a pooled OR of 20.34. In blinded studies, the pooled prevalence of vascular lesions was 9.8% and 38.9%, in normal and pre-eclamptic pregnancies, respectively, giving a pooled OR of 7.08. CONCLUSIONS In blinded studies, the incidence of both placental villous and vascular histopathological lesions is four- to seven-fold higher in pre-eclamptic than in normal pregnancies. Greater differences are reported in unblinded studies. Despite the higher probability (point prevalence) of finding abnormal placental pathology in pregnancies with PE, placental lesions are not specific to the diagnosis of PE. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M L Falco
- Fetal Medicine Unit, St George's University of London and St. George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - J Sivanathan
- Fetal Medicine Unit, St George's University of London and St. George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - A Laoreti
- Fetal Medicine Unit, St George's University of London and St. George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - B Thilaganathan
- Fetal Medicine Unit, St George's University of London and St. George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - A Khalil
- Fetal Medicine Unit, St George's University of London and St. George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
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74
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Cox P, Marton T, Hargitai B, Coetzee A, Bowen C, Penman D, Evans M, Gannon C, French P, Cohen M, Holden S, Allotey J, Evans C, Murphy A, Turner K, Cullinane C, Stahlschmidt J, Kokai G, Al Adnani M, Marnerides A, Vadgama B, McPartland J. Re: Stillbirth collection by Man et al. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:281-282. [PMID: 28169497 DOI: 10.1002/uog.17380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/28/2016] [Indexed: 06/06/2023]
Affiliation(s)
- P Cox
- Perinatal Pathology, Birmingham Women's Hospital, Mindelsohn Way, Birmingham, B15 2TG, UK
| | - T Marton
- Perinatal Pathology, Birmingham Women's Hospital, Mindelsohn Way, Birmingham, B15 2TG, UK
| | - B Hargitai
- Perinatal Pathology, Birmingham Women's Hospital, Mindelsohn Way, Birmingham, B15 2TG, UK
| | - A Coetzee
- Perinatal Pathology, Birmingham Women's Hospital, Mindelsohn Way, Birmingham, B15 2TG, UK
| | - C Bowen
- Paediatric Pathology, Queen Elizabeth University Hospital, Glasgow, UK
| | - D Penman
- Paediatric Pathology, Queen Elizabeth University Hospital, Glasgow, UK
| | - M Evans
- Perinatal Pathology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - C Gannon
- Perinatal Pathologist, Bangor, Northern, Ireland
| | - P French
- Paediatric Pathology, Queen Elizabeth University Hospital, Glasgow, UK
| | - M Cohen
- Pathology, Sheffield Children's Hospital NHS Trust, Sheffield, UK
| | - S Holden
- Paediatric & Perinatal Pathology, Southampton General Hospital, Southampton, UK
| | - J Allotey
- Paediatric Pathology, Queen's Medical Centre, Nottingham, UK
| | - C Evans
- Paediatric Pathology, Queen's Medical Centre, Nottingham, UK
| | - A Murphy
- Paediatric Pathology, Queen's Medical Centre, Nottingham, UK
| | - K Turner
- Paediatric & Perinatal Pathology, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - C Cullinane
- Paediatric & Perinatal Pathology, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J Stahlschmidt
- Paediatric & Perinatal Pathology, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - G Kokai
- Paediatric Pathology, Alder Hey Children's Hospital, Liverpool, UK
| | - M Al Adnani
- Paediatric & Perinatal Pathology, St Thomas' Hospital, London, UK
| | - A Marnerides
- Paediatric & Perinatal Pathology, St Thomas' Hospital, London, UK
| | - B Vadgama
- Paediatric & Perinatal Pathology, Southampton General Hospital, Southampton, UK
| | - J McPartland
- Paediatric Pathology, Alder Hey Children's Hospital, Liverpool, UK
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75
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McDermott M. Stillbirth: a lot done… a lot more to do. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:553-555. [PMID: 27854383 DOI: 10.1002/uog.17220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- M McDermott
- Departments of Paediatric Laboratory Medicine, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
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76
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Man J, Hutchinson JC, Heazell AE, Ashworth M, Levine S, Sebire NJ. Stillbirth and intrauterine fetal death: factors affecting determination of cause of death at autopsy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:566-573. [PMID: 27781317 DOI: 10.1002/uog.16016] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES There have been several attempts to classify cause of death (CoD) in stillbirth; however, all such systems are subjective, allowing for observer bias and making comparisons between systems challenging. This study aimed to examine factors relating to determination of CoD using a large dataset from two specialist centers in which observer bias had been reduced by classifying findings objectively and assigning CoD based on predetermined criteria. METHODS Detailed autopsy reports from intrauterine deaths in the second and third trimesters during 2005-2013 were reviewed and findings entered into a specially designed database, in which CoD was assigned using predefined objective criteria. Data regarding CoD categories and factors affecting determination of CoD were examined. RESULTS There were 1064 intrauterine deaths, including 246 early intrauterine fetal deaths (IUFD) (< 20 weeks), 179 late IUFDs (20-23 weeks) and 639 stillbirths (≥ 24 weeks' gestation). Overall, around 40% (n = 412) had a clear CoD identified, whilst around 60% (n = 652) were classified as 'unexplained', including around half with identified risk factors or lesions of uncertain significance, with the remaining half (n = 292 (45%)) being entirely unexplained. A stepwise increase in the proportion of unexplained deaths was observed with increasing maceration. Black and Asian women had significantly greater proportions of deaths due to ascending infection, whilst women aged over 40 years had significantly increased placenta-related CoDs. There was no significant difference in CoD distribution according to maternal body mass index or with increasing postmortem interval. Around half of those with an identifiable CoD could be identified from clinical review and external fetal examination or imaging, with most of the remainder being determined following placental examination. CONCLUSIONS Based on objective criteria, many intrauterine deaths throughout gestation remain unexplained despite autopsy examination. The rate of unexplained death varies from around 30% to 60% depending on interpretation of the significance of features. CoD determination is dependent on both the classification system used and subjective interpretation, such that variation in the proportion of 'unexplained' cases is based largely on speculation regarding mechanisms of death. Novel methods to determine objectively the mechanism of death at postmortem examination are required. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J Man
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
- University College London, Institute of Child Health, London, UK
| | - J C Hutchinson
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
- University College London, Institute of Child Health, London, UK
| | - A E Heazell
- Department of Obstetrics and Gynaecology, St Mary's Hospital, Manchester, UK
| | - M Ashworth
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
| | - S Levine
- Department of Histopathology, St George's Hospital, London, UK
| | - N J Sebire
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
- University College London, Institute of Child Health, London, UK
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77
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Man J, Hutchinson JC, Ashworth M, Jeffrey I, Heazell AE, Sebire NJ. Organ weights and ratios for postmortem identification of fetal growth restriction: utility and confounding factors. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:585-590. [PMID: 27781326 DOI: 10.1002/uog.16017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The postmortem fetal brain:liver weight ratio is commonly used as a marker of nutrition for diagnosis of fetal growth restriction (FGR). However, there are limited data regarding the effects of intrauterine retention, fetal maceration and postmortem interval on organ weights and their ratios at autopsy. Our aims were to examine the relationships between gestational-age-adjusted and sex-adjusted fetal organ weights at autopsy, cause of intrauterine death and effects of intrauterine retention, and to determine whether the brain:liver weight ratio is a reliable marker of FGR in intrauterine death. METHODS As part of a larger study examining autopsy findings in intrauterine death, data from two specialist centers in London were collated in a specially designed database. Autopsy and clinical information for > 1000 intrauterine deaths between 2005 and 2013 were extracted. Adjusted (delta) organ weights were calculated by plotting against gestational age female and male brain, liver, thymus, heart, combined kidney, combined lung, spleen and combined adrenal gland weights. Polynomial regression was used to determine best fit and to calculate expected (50th centile) organ weights and deviations from expected. We compared adjusted organ weights and body:organ weight ratios in fetuses which were small-for-gestational age (SGA) at autopsy (birth weight < 10th centile for normal live births) vs those in fetuses which were not, and in macerated vs non-macerated fetuses. RESULTS The majority of fetal organs (brain, liver, heart, thymus, lungs, kidneys and thyroid) in SGA fetuses were significantly lighter than those in non-SGA fetuses. Body:organ weight ratios for thymus, liver and spleen were significantly greater in SGA fetuses, indicating these organs to be disproportionately small. The majority of organs were significantly lighter in macerated compared with non-macerated fetuses and body:organ weight ratios for most organs (liver, thymus, lung, pancreas, adrenal gland, kidney, heart) were significantly greater in macerated compared with non-macerated fetuses. When SGA cases with demonstrable placental histological abnormalities were compared with other SGA cases, there was a significant difference in the brain:liver weight ratio (median, 6 vs 3.5). CONCLUSION Changes after intrauterine death lead to loss of fetal weight, with preferential weight loss of visceral organs such as the liver. Maceration therefore affects the brain:liver weight ratio and adjustment should be made for such changes during interpretation of ratios. Fetal organ weights may be affected significantly by mechanism of death and postmortem changes. The fetal brain:liver weight ratio may provide useful information regarding intrauterine growth status at time of death, provided that adjustment is made for effects of intrauterine retention and that appropriate cut-off values are used. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J Man
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
- University College London, Institute of Child Health, London, UK
| | - J C Hutchinson
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
- University College London, Institute of Child Health, London, UK
| | - M Ashworth
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
| | - I Jeffrey
- Department of Histopathology, St George's Hospital, London, UK
| | - A E Heazell
- Department of Obstetrics and Gynaecology, Manchester University, Manchester, UK
| | - N J Sebire
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
- University College London, Institute of Child Health, London, UK
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