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Shook LL, Batorsky RE, De Guzman RM, McCrea LT, Brigida SM, Horng JE, Sheridan SD, Kholod O, Cook AM, Li JZ, Slonim DK, Goods BA, Perlis RH, Edlow AG. Maternal SARS-CoV-2 impacts fetal placental macrophage programs and placenta-derived microglial models of neurodevelopment. J Neuroinflammation 2024; 21:163. [PMID: 38918792 PMCID: PMC11197235 DOI: 10.1186/s12974-024-03157-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/18/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND The SARS-CoV-2 virus activates maternal and placental immune responses. Such activation in the setting of other infections during pregnancy is known to impact fetal brain development. The effects of maternal immune activation on neurodevelopment are mediated at least in part by fetal brain microglia. However, microglia are inaccessible for direct analysis, and there are no validated non-invasive surrogate models to evaluate in utero microglial priming and function. We have previously demonstrated shared transcriptional programs between microglia and Hofbauer cells (HBCs, or fetal placental macrophages) in mouse models. METHODS AND RESULTS We assessed the impact of maternal SARS-CoV-2 on HBCs isolated from 24 term placentas (N = 10 SARS-CoV-2 positive cases, 14 negative controls). Using single-cell RNA-sequencing, we demonstrated that HBC subpopulations exhibit distinct cellular programs, with specific subpopulations differentially impacted by SARS-CoV-2. Assessment of differentially expressed genes implied impaired phagocytosis, a key function of both HBCs and microglia, in some subclusters. Leveraging previously validated models of microglial synaptic pruning, we showed that HBCs isolated from placentas of SARS-CoV-2 positive pregnancies can be transdifferentiated into microglia-like cells (HBC-iMGs), with impaired synaptic pruning behavior compared to HBC models from negative controls. CONCLUSION These findings suggest that HBCs isolated at birth can be used to create personalized cellular models of offspring microglial programming.
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Affiliation(s)
- Lydia L Shook
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, 55 Fruit Street, Thier Research Building, 903B, Boston, MA, 02114, USA
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | | | - Rose M De Guzman
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, 55 Fruit Street, Thier Research Building, 903B, Boston, MA, 02114, USA
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Liam T McCrea
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sara M Brigida
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, 55 Fruit Street, Thier Research Building, 903B, Boston, MA, 02114, USA
| | - Joy E Horng
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven D Sheridan
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Olha Kholod
- Thayer School of Engineering and Program, Dartmouth College, Hanover, NH, USA
| | - Aidan M Cook
- Department of Molecular and Systems Biology, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Jonathan Z Li
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Donna K Slonim
- Department of Computer Science, Tufts University, Medford, MA, USA
| | - Brittany A Goods
- Thayer School of Engineering and Program, Dartmouth College, Hanover, NH, USA
- Department of Molecular and Systems Biology, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Roy H Perlis
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrea G Edlow
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, 55 Fruit Street, Thier Research Building, 903B, Boston, MA, 02114, USA.
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.
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2
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Cromb D, Hall M, Story L, Shangaris P, Al-Adnani M, Rutherford MA, Fox GF, Gupta N. Clinical value of placental examination for paediatricians. Arch Dis Child Fetal Neonatal Ed 2024; 109:362-370. [PMID: 37751993 DOI: 10.1136/archdischild-2023-325674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023]
Abstract
The placenta contains valuable clinical information that is linked to fetal development, neonatal morbidity and mortality, and future health outcomes. Both gross inspection and histopathological examination of the placenta may identify intrinsic or secondary placental lesions, which can contribute directly to adverse neonatal outcomes or indicate the presence of an unfavourable intrauterine environment. Placental examination therefore forms an essential component of the care of high-risk neonates and at perinatal post-mortem examination. In this article, we describe the clinical value of placental examination for paediatricians and perinatal clinicians. We discuss common pathological findings on general inspection of the placenta with photographic examples and provide an overview of the placental pathological examination, including how to interpret key findings. We also address the medico-legal and financial implications of placental examinations and describe current and future clinical considerations for clinicians in regard to placental examination.
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Affiliation(s)
- Daniel Cromb
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Neonatal Unit, Evelina London Children's Hospital, St Thomas' Hospital, London, UK
| | - Megan Hall
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Women's Children and Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Lisa Story
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Women's Children and Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Panicos Shangaris
- Department of Women's Children and Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Fetal Medicine Research Institute, King's College Hospital, London, UK
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Mudher Al-Adnani
- Department of Cellular Pathology, St Thomas' Hospital, London, UK
| | - Mary A Rutherford
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Women's Children and Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Grenville F Fox
- Neonatal Unit, Evelina London Children's Hospital, St Thomas' Hospital, London, UK
| | - Neelam Gupta
- Neonatal Unit, Evelina London Children's Hospital, St Thomas' Hospital, London, UK
- GKT School of Medical Education, King's College London, London, UK
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3
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Rose SJ, Nguyen EM, Branda ME, Melo V, Vega B, Kazemi-Butterfield N, Cheek-Norgan EH, Girard S, Norgan AP, Theiler RN, Enninga EAL. Maternal Factors and Placental Pathologies Associated with a Diagnosis of Chronic Villitis. Am J Perinatol 2024; 41:e3351-e3362. [PMID: 38057089 PMCID: PMC11156567 DOI: 10.1055/a-2223-3348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
OBJECTIVE To evaluate maternal risk factors associated with chronic villitis of unknown etiology (VUE) and to describe cooccurring placental pathologies. STUDY DESIGN A retrospective case-control study was conducted using placental pathology records from deliveries ≥ 20 weeks between 2010 and 2018. Cases were placentas with documented chronic villitis without infectious cause, hereafter called VUE. Controls were placentas without this diagnosis, matched to the cases 2:1. Maternal and neonatal demographic and clinical data were collected. Descriptive statistics are reported with Fisher's exact test or a chi-squared test, as appropriate, and multivariable conditional logistic regression was conducted. RESULTS Our study included 352 cases with VUE and 657 controls. A diagnosis of gestational diabetes (p = 0.03) and gestational hypertension (p = 0.06) was 1.5 times more likely to occur in those with a VUE diagnosis. A trend was also seen for chronic hypertension (odds ratio [OR] = 1.7, p = 0.07) and preeclampsia (OR = 1.5, p = 0.09) compared with controls. Placentas with VUE, specifically high-grade VUE, were more likely to be small for gestational age (p = 0.01), and to be diagnosed with other placental findings including lymphoplasmacytic or chronic deciduitis (p < 0.01), maternal (p < 0.01) and fetal vascular malperfusion (p = 0.02), and chorionitis (acute or chronic; p < 0.01). CONCLUSION Gestational diabetes and hypertension were associated with a diagnosis of VUE, and overall, VUE placentas have more abnormal placental findings compared with control. Understanding VUE risk factors may facilitate prenatal care strategies and counseling to achieve the best outcomes for pregnant patients and their neonates. KEY POINTS · VUE is a common inflammatory lesion of the placenta.. · Gestational diabetes and hypertension are associated with a VUE diagnosis.. · Findings of other placental pathologies increase in VUE..
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Affiliation(s)
- Sherrill J. Rose
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Eliza M. Nguyen
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Megan E. Branda
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Valeria Melo
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Beatriz Vega
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nazanin Kazemi-Butterfield
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, USA
- Mayo Graduate School, Mayo Clinic, Rochester, MN, USA
| | | | - Sylvie Girard
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
- Department of Immunology, Mayo Clinic, Rochester, MN, USA
| | | | - Regan N. Theiler
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth Ann L. Enninga
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
- Department of Immunology, Mayo Clinic, Rochester, MN, USA
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Dahl J. Intraplacental Gestational Neoplasms: A Review of Clinically Relevant Diagnostically Challenging Lesions. Arch Pathol Lab Med 2024; 148:398-408. [PMID: 37977155 DOI: 10.5858/arpa.2023-0109-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 11/19/2023]
Abstract
CONTEXT.— Case studies reporting intraplacental choriocarcinoma (IPC) and intraplacental "chorangiocarcinoma" have recently increased, with IPC also represented in molecular analyses of gestational trophoblastic neoplasms. OBJECTIVE.— To provide an overview of 2 intraplacental neoplastic lesions that can have a significant impact on both mother and fetus/infant, focusing on diagnostic characteristics, and ancillary and molecular tools that support diagnosis, determine prognosis, and further elucidate the nature of these lesions. DATA SOURCES.— Data were compiled from a PubMed literature review that included diagnostic and additional keywords within the scope of study for gestational choriocarcinoma in general. Illustrative cases were retrieved from the pathology archives at Michigan Medicine, including the consultation files of the author. CONCLUSIONS.— Intraplacental gestational tumors exist along the spectrum of benign (chorangioma) to aggressive malignant (choriocarcinoma) neoplasms with a high potential for metastasis. Although most gestational choriocarcinomas follow complete hydatidiform mole, 20% to 25% occur in association with normal intrauterine gestations, including rare cases in which they are detected within the placenta (IPC). IPCs range from asymptomatic to widely metastatic, with metastases possible even when only microscopic IPCs are present. A second, even less common lesion, variably called "chorangiocarcinoma" and chorangioma with atypical trophoblast proliferation, is also reviewed. The incidence of these lesions is likely to be underestimated. Heightened suspicion and more liberal placental sampling, particularly when specific clinical features are present, may result in higher detection. Enhanced detection to provide the earliest intervention for both mother and infant may improve prognosis, particularly for asymptomatic disease that may later present with metastasis.
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Affiliation(s)
- Julia Dahl
- From the Department of Pathology, University of Michigan Health System, Ann Arbor
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5
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Scott HM, Mehta R, Branda ME, Hughes J, Kane SV, Girard S, Norgan AP, Theiler RN, Enninga EAL. Effect of Anti-TNF Biologic Exposure During Pregnancy on Villitis of Unknown Etiology Diagnoses in Patients with Autoimmune Disease. Reprod Sci 2024; 31:997-1005. [PMID: 37973775 PMCID: PMC10960686 DOI: 10.1007/s43032-023-01402-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/04/2023] [Indexed: 11/19/2023]
Abstract
Tumor necrosis factor-α (TNF-α) antagonists are highly effective in controlling autoimmune diseases. This has led to speculation that they might also be useful in treating inflammatory placental conditions, such as chronic villitis of unknown etiology (VUE). VUE affects 10-15% of term placentas and is associated with recurrent fetal growth restriction (FGR) and pregnancy loss. We aimed to evaluate outcomes in patients with autoimmune diseases with and without anti-TNF-α biologic exposure during gestation. This retrospective cohort study compared pregnant women with autoimmune disease taking anti-TNF-α biologics (n = 89) to pregnant women with autoimmune disease but not taking a biologic (n = 53). We extracted data on all patients meeting our inclusion criteria over a 20-year period. Our primary outcome was the diagnosis of VUE by histology. Our secondary outcomes were maternal and neonatal complications such as preeclampsia, FGR, and neonatal intensive care admission. Kruskal-Wallis and chi-squared tests were performed as appropriate for statistical analysis. Maternal characteristics were comparable between groups, and there was no increase in adverse pregnancy outcomes based on anti-TNF-α treatment. Exposure to anti-TNF-α therapy had no significant effect on the incidence of VUE or other obstetric complications. Within the cohort exposed to anti-TNF-α biologics during pregnancy, the rate of VUE was 9.3%, which is comparable to the reported general population risk. Our data support the safety profile of biologic use in pregnancy.
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Affiliation(s)
- Hannah M Scott
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Ave. SW, Rochester, MN, 55905, USA
| | - Ramila Mehta
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Megan E Branda
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Sunanda V Kane
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Sylvie Girard
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Ave. SW, Rochester, MN, 55905, USA
- Department of Immunology, Mayo Clinic, Rochester, MN, USA
| | - Andrew P Norgan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Regan N Theiler
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Ave. SW, Rochester, MN, 55905, USA
| | - Elizabeth Ann L Enninga
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Ave. SW, Rochester, MN, 55905, USA.
- Department of Immunology, Mayo Clinic, Rochester, MN, USA.
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6
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Schukow CP, Macknis JK. Remote Placental Sign-Out: What Digital Pathology Can Offer for Pediatric Pathologists. Pediatr Dev Pathol 2024:10935266231225799. [PMID: 38468487 DOI: 10.1177/10935266231225799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Affiliation(s)
- Casey P Schukow
- Department of Pathology, Corewell Health's Beaumont Hospital, Royal Oak, MI, USA
| | - Jacqueline K Macknis
- Department of Pathology, Corewell Health's Beaumont Hospital, Royal Oak, MI, USA
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7
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Ortinau CM, Newburger JW. Placenta-Heart-Brain Connection in Congenital Heart Disease. J Am Heart Assoc 2024; 13:e033875. [PMID: 38420776 PMCID: PMC10944051 DOI: 10.1161/jaha.124.033875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Cynthia M. Ortinau
- Department of PediatricsWashington University in St. LouisSt. LouisMOUSA
| | - Jane W. Newburger
- Department of CardiologyBoston Children’s HospitalBostonMAUSA
- Department of PediatricsHarvard Medical SchoolBostonMAUSA
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8
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Talia KL, Parra-Herran C, McCluggage WG. Macroscopic examination of gynaecological specimens: a critial and often underemphasised aspect of pathological reporting. J Clin Pathol 2024; 77:190-203. [PMID: 38373782 DOI: 10.1136/jcp-2023-208832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 12/19/2023] [Indexed: 02/21/2024]
Abstract
Pathological examination of surgical specimens and compilation of a surgical pathology report comprises a series of events which includes macroscopic examination and tissue sampling, either complete or selected. This step is critical but often overlooked in the literature and not given the attention it deserves. In this review, we discuss the macroscopic examination and grossing of gynaecological pathology specimens, with reference to national and international protocols. We provide guidance as to the degree of sampling necessary in different scenarios and stress that a common-sense approach is necessary with flexibility in the degree of sampling depending on a variety of factors.
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Affiliation(s)
- Karen L Talia
- Department of Pathology, The Royal Children's Hospital and Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Carlos Parra-Herran
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
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9
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Dehner LP. The Placenta and Neonatal Encephalopathy with a Focus on Hypoxic-Ischemic Encephalopathy. Fetal Pediatr Pathol 2023; 42:950-971. [PMID: 37766587 DOI: 10.1080/15513815.2023.2261051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023]
Abstract
Background: Placental examination is important for its diagnostic immediacy to correlate with maternal and/or fetal complications and parturitional difficulties. In a broader context, clinicopathologic studies of the placenta have addressed a range of pathogenetic questions that have led to conclusive and inconclusive results and interpretations. Methods: Recent standardized morphologic criteria and terminology of placental lesions have facilitated the ability to compare findings from studies that have focused on complications and outcomes of pregnancy. This review is an evaluation of recent studies on placental lesions associated with hypoxic-ischemic encephalopathy (HIE). Conclusion: No apparent consensus exists on whether it is fetal inflammation with the release of cytokines or chronic maternal and/or fetal vascular malperfusion is responsible for HIE with a lowering of the threshold for hypoxic ischemia. The counter argument is that HIE occurs solely as an intrapartum event. Additional investigation is necessary.
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Affiliation(s)
- Louis P Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology, Barnes-Jewish and St. Louis Children's Hospitals, State of Washington University in St. Louis Medical Center, St. Louis, MO, USA
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10
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Leizer JM, Ibrahim AM, Foulke LA, Tauber KA, Feustel P, Zelig CM. Using Middle Cerebral Artery Doppler Ultrasound to Predict Clinical Chorioamnionitis After Preterm Prelabor Rupture of Membranes. Cureus 2023; 15:e41508. [PMID: 37551247 PMCID: PMC10404386 DOI: 10.7759/cureus.41508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND In neonates, blood flow to the brain as measured by peak systolic velocity (PSV) in the middle cerebral artery (MCA) is altered in pregnancies affected by chorioamnionitis. OBJECTIVE We aim to determine whether PSV and other measures of flow in the MCA in the fetus are altered prior to the development of clinical chorioamnionitis following preterm prelabor rupture of membranes (PPROM). METHODS This was a prospective observational study. Fifty patients from one institution were recruited after being diagnosed with PPROM between 23 weeks zero days and 33 weeks six days gestation. We performed measurements of the PSV in the fetal MCA on a weekly basis following PPROM and used the value taken closest to the time of delivery for our statistical analysis. The primary outcome assessed was clinical chorioamnionitis, and the exposure of interest was MCA PSV. Additional independent variables of interest were other Doppler measures of the MCA. Secondary outcomes included histological chorioamnionitis and other measures of neonatal health, including sepsis, days in the neonatal intensive care unit (NICU), and death. RESULTS Of the 50 patients recruited to our study, eight (16%) developed clinical chorioamnionitis, similar to previously reported values in the general population. The PSV in the MCA was not significantly associated with the development of clinical chorioamnionitis. However, an elevated MCA pulsatility index (PI), a measure of resistance to flow, was associated with a higher probability of developing clinical chorioamnionitis. CONCLUSION There does not appear to be a difference in the PSV of the MCA of fetuses in pregnancies following PPROM with impending chorioamnionitis. However, elevated PI in the MCA could be a marker of impending chorioamnionitis in PPROM. Larger studies are needed to confirm these findings.
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Affiliation(s)
- Julie M Leizer
- Obstetrics and Gynecology, Robert Wood Johnson (RWJ) Barnabas Health, Eatontown, USA
| | - Ammoura M Ibrahim
- Pathology, University of Miami Miller School of Medicine, Miami, USA
| | | | | | - Paul Feustel
- Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, USA
| | - Craig M Zelig
- Obstetrics and Gynecology, Albany Medical Center, Albany, USA
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11
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Mestan KK, Leibel SL, Sajti E, Pham B, Hietalati S, Laurent L, Parast M. Leveraging the placenta to advance neonatal care. Front Pediatr 2023; 11:1174174. [PMID: 37255571 PMCID: PMC10225648 DOI: 10.3389/fped.2023.1174174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 04/24/2023] [Indexed: 06/01/2023] Open
Abstract
The impact of placental dysfunction and placental injury on the fetus and newborn infant has become a topic of growing interest in neonatal disease research. However, the use of placental pathology in directing or influencing neonatal clinical management continues to be limited for a wide range of reasons, some of which are historical and thus easily overcome today. In this review, we summarize the most recent literature linking placental function to neonatal outcomes, focusing on clinical placental pathology findings and the most common neonatal diagnoses that have been associated with placental dysfunction. We discuss how recent technological advances in neonatal and perinatal medicine may allow us to make a paradigm shift, in which valuable information provided by the placenta could be used to guide neonatal management more effectively, and to ultimately enhance neonatal care in order to improve our patient outcomes. We propose new avenues of clinical management in which the placenta could serve as a diagnostic tool toward more personalized neonatal intensive care unit management.
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Affiliation(s)
- Karen K. Mestan
- Department of Pediatrics/Division of Neonatology, University of California, San Diego School of Medicine, La Jolla, CA, USA
- Department of Pediatrics/Division of Neonatology, Rady Children's Hospital of San Diego, San Diego, CA, USA
| | - Sandra L. Leibel
- Department of Pediatrics/Division of Neonatology, University of California, San Diego School of Medicine, La Jolla, CA, USA
- Department of Pediatrics/Division of Neonatology, Rady Children's Hospital of San Diego, San Diego, CA, USA
| | - Eniko Sajti
- Department of Pediatrics/Division of Neonatology, University of California, San Diego School of Medicine, La Jolla, CA, USA
- Department of Pediatrics/Division of Neonatology, Rady Children's Hospital of San Diego, San Diego, CA, USA
| | - Betty Pham
- Department of Pediatrics/Division of Neonatology, University of California, San Diego School of Medicine, La Jolla, CA, USA
- Department of Pediatrics/Division of Neonatology, Rady Children's Hospital of San Diego, San Diego, CA, USA
| | - Samantha Hietalati
- Department of Pediatrics/Division of Neonatology, University of California, San Diego School of Medicine, La Jolla, CA, USA
- Department of Pediatrics/Division of Neonatology, Rady Children's Hospital of San Diego, San Diego, CA, USA
| | - Louise Laurent
- Department of Obstetrics, Gynecology and Reproductive Sciences/Division of Maternal Fetal Medicine, University of California, San Diego School of Medicine, La Jolla, CA, USA
- Sanford Consortium for Regenerative Medicine, La Jolla, CA, USA
| | - Mana Parast
- Sanford Consortium for Regenerative Medicine, La Jolla, CA, USA
- Department of Pathology, University of California, San Diego School ofMedicine, La Jolla, CA, USA
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12
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Bellini C, Minghetti D, Gente M. Criteria for placental examination for obstetrical and neonatal providers: a comment. Am J Obstet Gynecol 2023:S0002-9378(23)00066-2. [PMID: 36736681 DOI: 10.1016/j.ajog.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Affiliation(s)
- Carlo Bellini
- Neonatal Intensive Care Unit, Department of Mother and Child Health, Neonatal Emergency Transport Service, Istituto di Ricovero e Cura a Carattere Scientifico Gaslini, Genoa, Italy
| | - Diego Minghetti
- Neonatal Intensive Care Unit, Department of Mother and Child Health, Neonatal Emergency Transport Service, Istituto di Ricovero e Cura a Carattere Scientifico Gaslini, Genoa, Italy
| | - Maurizio Gente
- Department of Pediatrics and Infant Neuropsychiatry, Neonatal Emergency Transport Service, Sapienza University of Rome, Rome, Italy.
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