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Brady CA, Riley T, Batra G, Crocker I, Heazell AEP. Characterizing Histopathologic Features in Pregnancies With Chronic Histiocytic Intervillositis Using Computerized Image Analysis. Arch Pathol Lab Med 2024; 148:430-442. [PMID: 37490411 DOI: 10.5858/arpa.2022-0494-oa] [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: 04/06/2023] [Indexed: 07/27/2023]
Abstract
CONTEXT.— Chronic histiocytic intervillositis (CHI) is a rare condition characterized by maternal immune cell infiltration into the human placenta. CHI is strongly associated with fetal growth restriction, miscarriage, and stillbirth, and knowledge of its etiology, and consequently effective treatment, is limited. Currently, diagnosis is largely subjective and varies between centers, making comparison between studies challenging. OBJECTIVE.— To objectively quantify and interrelate inflammatory cells and fibrin in placentas with CHI compared with controls and determine how pathology may be altered in subsequent pregnancies following diagnosis. Macrophage phenotype was also investigated in untreated cases of CHI. DESIGN.— Computerized analysis was applied to immunohistochemically stained untreated (index) cases of CHI, subsequent pregnancies, and controls. Index placentas were additionally stained by immunofluorescence for M1 (CD80 and CD86) and M2 macrophage markers (CD163 and CD206). RESULTS.— Quantification revealed a median 32-fold increase in macrophage infiltration in index cases versus controls, with CHI recurring in 2 of 11 (18.2%) subsequent pregnancies. A total of 4 of 14 placentas (28.6%) with a diagnosis of CHI did not exhibit infiltration above controls. Macrophages in index pregnancies strongly expressed CD163. There was no significant difference in fibrin deposition between index cases and controls, although subsequent pregnancies displayed a 2-fold decrease compared with index pregnancies. CD3+ T cells were significantly elevated in index pregnancies; however, they returned to normal levels in subsequent pregnancies. CONCLUSIONS.— In CHI, intervillous macrophages expressed CD163, possibly representing an attempt to resolve inflammation. Computerized analysis of inflammation in CHI may be useful in determining how treatment affects recurrence, and alongside pathologist expertise in grading lesion severity.
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Affiliation(s)
- Chloe A Brady
- From Tommy's Maternal and Fetal Health Research Centre, St Mary's Hospital, The University of Manchester, Manchester, United Kingdom (Brady, Riley, Crocker, Heazell)
| | - Tihesia Riley
- From Tommy's Maternal and Fetal Health Research Centre, St Mary's Hospital, The University of Manchester, Manchester, United Kingdom (Brady, Riley, Crocker, Heazell)
- the Royal Bolton Hospital, Bolton NHS Foundation Trust, Bolton, United Kingdom (Riley)
| | - Gauri Batra
- the Department of Paediatric and Perinatal Pathology, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom (Batra)
| | - Ian Crocker
- From Tommy's Maternal and Fetal Health Research Centre, St Mary's Hospital, The University of Manchester, Manchester, United Kingdom (Brady, Riley, Crocker, Heazell)
| | - Alexander E P Heazell
- From Tommy's Maternal and Fetal Health Research Centre, St Mary's Hospital, The University of Manchester, Manchester, United Kingdom (Brady, Riley, Crocker, Heazell)
- Saint Mary's Hospital Managed Clinical Maternity Service, Manchester Academic Health Science Centre, Manchester, United Kingdom (Heazell)
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2
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Cornish EF, McDonnell T, Williams DJ. Chronic Inflammatory Placental Disorders Associated With Recurrent Adverse Pregnancy Outcome. Front Immunol 2022; 13:825075. [PMID: 35529853 PMCID: PMC9072631 DOI: 10.3389/fimmu.2022.825075] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/29/2022] [Indexed: 12/11/2022] Open
Abstract
Chronic inflammatory placental disorders are a group of rare but devastating gestational syndromes associated with adverse pregnancy outcome. This review focuses on three related conditions: villitis of unknown etiology (VUE), chronic histiocytic intervillositis (CHI) and massive perivillous fibrin deposition (MPFD). The hallmark of these disorders is infiltration of the placental architecture by maternal immune cells and disruption of the intervillous space, where gas exchange between the mother and fetus occurs. Currently, they can only be detected through histopathological examination of the placenta after a pregnancy has ended. All three are associated with a significant risk of recurrence in subsequent pregnancies. Villitis of unknown etiology is characterised by a destructive infiltrate of maternal CD8+ T lymphocytes invading into the chorionic villi, combined with activation of fetal villous macrophages. The diagnosis can only be made when an infectious aetiology has been excluded. VUE becomes more common as pregnancy progresses and is frequently seen with normal pregnancy outcome. However, severe early-onset villitis is usually associated with fetal growth restriction and recurrent pregnancy loss. Chronic histiocytic intervillositis is characterised by excessive accumulation of maternal CD68+ histiocytes in the intervillous space. It is associated with a wide spectrum of adverse pregnancy outcomes including high rates of first-trimester miscarriage, severe fetal growth restriction and late intrauterine fetal death. Intervillous histiocytes can also accumulate due to infection, including SARS-CoV-2, although this infection-induced intervillositis does not appear to recur. As with VUE, the diagnosis of CHI requires exclusion of an infectious cause. Women with recurrent CHI and their families are predisposed to autoimmune diseases, suggesting CHI may have an alloimmune pathology. This observation has driven attempts to prevent CHI with a wide range of maternal immunosuppression. Massive perivillous fibrin deposition is diagnosed when >25% of the intervillous space is occupied by fibrin, and is associated with fetal growth restriction and late intrauterine fetal death. Although not an inflammatory disorder per se, MPFD is frequently seen in association with both VUE and CHI. This review summarises current understanding of the prevalence, diagnostic features, clinical consequences, immune pathology and potential prophylaxis against recurrence in these three chronic inflammatory placental syndromes.
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Affiliation(s)
- Emily F. Cornish
- Elizabeth Garrett Anderson Institute for Women’s Health, Department of Maternal and Fetal Medicine, University College London, London, United Kingdom,*Correspondence: Emily F. Cornish,
| | - Thomas McDonnell
- Faculty of Engineering Science, Department of Biochemical Engineering, University College London, London, United Kingdom
| | - David J. Williams
- Elizabeth Garrett Anderson Institute for Women’s Health, Department of Maternal and Fetal Medicine, University College London, London, United Kingdom
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Borzova NY, Radjabova NR, Sotnikova NY, Kudryashova AV, Malyshkina AI. New prognostic criterion for the outcome of pregnancy in patients with threatening preterm birth. Klin Lab Diagn 2022; 67:97-100. [PMID: 35192755 DOI: 10.51620/0869-2084-2022-67-2-97-100] [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] [Indexed: 06/14/2023]
Abstract
To identify new criteria for predicting the outcome of pregnancy in women with threatened preterm labor based on the establishment of the characteristics of differentiation and functional activity of memory T-cells in the population of CD8 + T-lymphocytes. The study involved 56 women with threatened preterm labor at 22-34 weeks of pregnancy. Depending on the outcome of pregnancy, patients were divided into 3 groups: Group I included 22 women by premature labor; group II - 34 women whose pregnancy ended by deliver at term. By tricolor flow cytofluorometry method the content of peripheral Tn, Tcm, Tem and Temra cells in CD8+ population was studied. Statistical analysis was carried out using programs «Statistica for Windows 13.0», «Microsoft Excel 2019» and «MedCalc 19.3». Patients with the threat of preterm birth were characterized by a significant increase in the relative content of CD8+ T-lymphocytes in the peripheral blood compared to the control group (p=0.001). When comparing this indicator in the subgroups of women with the threat of preterm birth, it was found that preterm birth was associated with significantly higher relative CD8 + lymphocyte counts (p=0.03) compared to the indicators of the subgroup of women who gave birth on time. When evaluating the results obtained, it was found that the percentage of CD8+Temra GranzymeB-producing cells in the group of patients with threatened preterm birth, whose pregnancy ended in preterm birth, was significantly lower than in the group of women who gave birth on time (p=0.003). The content of Tcm, Tem memory cells producing GranzymeB in the subgroups of women with pregnancy outcomes of timely and preterm birth did not have significant differences compared to the control group. Thus, the prediction of preterm birth is possible with a value of GranzymeB-producing CD8 + Tem equal to 8.2% or less (sensitivity-87.9%, specificity-85%, accuracy-87.9%). Thus, the identification of a new criterion will make it possible to predict preterm birth in a timely manner and promote the choice of optimal pregnancy management tactics, reasonable prevention of fetal respiratory distress syndrome and transfer of a woman to an obstetric hospital designed to provide high-tech care to premature newborns.
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Affiliation(s)
- N Yu Borzova
- Ivanovo Scientific Research Institute of Maternity and Childhood by V.N. Gorodkov of the Russian Ministry of health
| | - Naila Rustamovna Radjabova
- Ivanovo Scientific Research Institute of Maternity and Childhood by V.N. Gorodkov of the Russian Ministry of health
| | - N Yu Sotnikova
- Ivanovo Scientific Research Institute of Maternity and Childhood by V.N. Gorodkov of the Russian Ministry of health
| | - A V Kudryashova
- Ivanovo Scientific Research Institute of Maternity and Childhood by V.N. Gorodkov of the Russian Ministry of health
| | - A I Malyshkina
- Ivanovo Scientific Research Institute of Maternity and Childhood by V.N. Gorodkov of the Russian Ministry of health
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Bouariu A, Gică N, Ciobanu AM, Scutelnicu AM, Popescu MR, Panaitescu AM. The Potential Benefit of Hydroxychloroquine in Chronic Placental Inflammation of Unknown Etiology Associated with Adverse Pregnancy Outcomes. Healthcare (Basel) 2022; 10:168. [PMID: 35052331 PMCID: PMC8775717 DOI: 10.3390/healthcare10010168] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/27/2021] [Accepted: 01/14/2022] [Indexed: 11/17/2022] Open
Abstract
The placenta is the site of connection between maternal and fetal circulation, and the liaison is established early in pregnancy. A large variety of pregnancy complications such as preterm birth, fetal growth restriction, or pregnancy loss have placental expression and can be accompanied in some cases of acute or chronic identifiable placental inflamatory lesions. Chronic placental inflammatory (CPI) lesions include chronic villitis of unknow etiology (CVUE), chronic intervillositis of unknown etiology, CIUE (also described as chronic histiocytic intervillositis, CHI), and chronic deciduits. Hydroxychloroquine (HCQ) has been prescribed with good results during pregnancy to prevent adverse perinatal outcomes in maternal autoimmune conditions. Its success has paved the way to its use in CPI as CIUE/CHI; however, to date, there are no prospective, informatively designed, controlled studies on its value in these setting. This review aims to explore the potential role of HCQ in CPI of unknown etiology. Ideally, properly designed, probably multicentric studies should be undertaken to fully understand HCQ's role for prevention of adverse pregnancy outcomes after a chronic placental inflammation.
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Affiliation(s)
- Alexandra Bouariu
- Department of Obstetrics and Gynecology Filantropia, Clinical Hospital Bucharest, 011171 Bucharest, Romania; (A.B.); (N.G.); (A.M.C.); (A.M.S.)
| | - Nicolae Gică
- Department of Obstetrics and Gynecology Filantropia, Clinical Hospital Bucharest, 011171 Bucharest, Romania; (A.B.); (N.G.); (A.M.C.); (A.M.S.)
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Anca Marina Ciobanu
- Department of Obstetrics and Gynecology Filantropia, Clinical Hospital Bucharest, 011171 Bucharest, Romania; (A.B.); (N.G.); (A.M.C.); (A.M.S.)
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Ana Maria Scutelnicu
- Department of Obstetrics and Gynecology Filantropia, Clinical Hospital Bucharest, 011171 Bucharest, Romania; (A.B.); (N.G.); (A.M.C.); (A.M.S.)
| | - Mihaela Roxana Popescu
- Department of Obstetrics and Gynecology Filantropia, Clinical Hospital Bucharest, 011171 Bucharest, Romania; (A.B.); (N.G.); (A.M.C.); (A.M.S.)
- Department of Cardiology, Elias University Hospital Bucharest, 011461 Bucharest, Romania
| | - Anca Maria Panaitescu
- Department of Obstetrics and Gynecology Filantropia, Clinical Hospital Bucharest, 011171 Bucharest, Romania; (A.B.); (N.G.); (A.M.C.); (A.M.S.)
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Bertero L, Borella F, Botta G, Carosso A, Cosma S, Bovetti M, Carosso M, Abbona G, Collemi G, Papotti M, Cassoni P, Benedetto C. Placenta histopathology in SARS-CoV-2 infection: analysis of a consecutive series and comparison with control cohorts. Virchows Arch 2021; 479:715-728. [PMID: 33934229 PMCID: PMC8088311 DOI: 10.1007/s00428-021-03097-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/14/2021] [Accepted: 03/30/2021] [Indexed: 12/18/2022]
Abstract
Infection by SARS-CoV-2 has been shown to involve a wide range of organs and tissues, leading to a kaleidoscope of clinical conditions. Within this spectrum, an involvement of the fetal-maternal unit could be expected, but, so far, the histopathological evaluation of placentas delivered by women with SARS-CoV-2 infection did not show distinct hallmarks. A consecutive series of 11 placentas, delivered by 10 women with COVID-19 admitted to our Obstetrics and Gynecology clinic have been investigated and compared to a control cohort of 58 pre-COVID-19 placentas and 28 placentas delivered by women who had a previous cesarean section. Four out of eleven placentas showed changes consistent with chronic villitis/villitis of unknown etiology (VUE), while in one case, chronic histiocytic intervillositis was diagnosed. Thrombo-hemorrhagic alterations were observed in a subset of cases. Compared to the control cohort, chronic villitis/VUE (p < 0.001), chronic deciduitis (p = 0.023), microvascular thrombosis (p = 0.003), presence of infarction areas (p = 0.047) and of accelerated villous maturation (p = 0.005) showed higher frequencies in placentas delivered by women with COVID-19. Chronic villitis/VUE (p = 0.003) and accelerated villous maturation (p = 0.019) remained statistically significant by restricting the analysis to placentas delivered after a previous cesarean section. The observed differences in terms of pathological findings could be consistent with SARS-CoV-2 pathogenesis, but just a subset of alterations remained statistically significant after adjusting for a previous cesarean section. A careful consideration of potential confounders is warranted in future studies exploring the relationship between COVID-19 and pregnancy.
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Affiliation(s)
- Luca Bertero
- Pathology Unit, Department of Medical Sciences, University of Turin and "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Fulvio Borella
- Obstetrics and Gynecology 1U, Department of Surgical Sciences, Sant'Anna Hospital, University of Turin and "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Giovanni Botta
- Pathology Unit, "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Andrea Carosso
- Obstetrics and Gynecology 1U, Department of Surgical Sciences, Sant'Anna Hospital, University of Turin and "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Stefano Cosma
- Obstetrics and Gynecology 1U, Department of Surgical Sciences, Sant'Anna Hospital, University of Turin and "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Marialuisa Bovetti
- Obstetrics and Gynecology 1U, Department of Surgical Sciences, Sant'Anna Hospital, University of Turin and "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Marco Carosso
- Obstetrics and Gynecology 1U, Department of Surgical Sciences, Sant'Anna Hospital, University of Turin and "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Giancarlo Abbona
- Pathology Unit, "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Giammarco Collemi
- Pathology Unit, Department of Medical Sciences, University of Turin and "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Mauro Papotti
- Pathology Unit, Department of Oncology, University of Turin and "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Paola Cassoni
- Pathology Unit, Department of Medical Sciences, University of Turin and "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy.
| | - Chiara Benedetto
- Obstetrics and Gynecology 1U, Department of Surgical Sciences, Sant'Anna Hospital, University of Turin and "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
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Nedberg NH, Turowski G, Guz K, Przytuła E, Uhrynowska M, Roald B, Husebekk A, Sitras V, Nystad M, Dębska M, Brojer E, Tiller H. Platelet alloimmunization is associated with low grade chronic histiocytic intervillositis - A new link to a rare placental lesion? Placenta 2021; 112:89-96. [PMID: 34329972 DOI: 10.1016/j.placenta.2021.07.291] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/01/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Maternal alloimmunization against human platelet antigen (HPA)-1a has been implied to mediate both reduced birth weight and chronic placental inflammation. Fetal growth restriction is associated with different types of chronic inflammation in the placenta, mainly chronic histiocytic intervillositis and chronic villitis. The aim of this prospective study was to do a systematic examination of placentas from HPA-1a alloimmunized pregnancies, with focus on the histopathological and immunohistochemical diagnosis of variants of chronic inflammation. MATERIAL AND METHODS In a Polish-Norwegian study, 48 placentas were examined. The histopathology of placentas from 27 HPA-1a immunized women was compared with 21 placentas from non-immunized HPA-1a negative women (controls). In the group of alloimmunized women, ten received antenatal intravenous immunoglobulin G (IVIg). Tissue sections from formalin fixed paraffin embedded placental tissue were stained with hematoxylin and eosin and microscopically examined with focus on various types of chronic placental inflammations. RESULTS Chronic histiocytic intervillositis was observed in 40.7% of placentas from HPA-1a alloimmunized pregnancies, compared to none in the control group (p = 0.001). Chronic villitis of unknown etiology was more frequently found in the alloimmunized group, however this difference was not statistically significant. Maternal administration of IVIg did not seem to protect against chronic inflammatory lesions. DISCUSSION Placentas with detectable maternal anti-HPA-1a antibodies are associated with highly increased risk of low-grade chronic histiocytic intervillositis.
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Affiliation(s)
- Nora Hersoug Nedberg
- Immunology Research Group, Department of Medical Biology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
| | - Gitta Turowski
- Department of Pathology, Center for Perinatal and Pregnancy-Related Pathology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Katarzyna Guz
- Department of Hematological and Transfusion Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Ewa Przytuła
- Department of Pathology, Centre of Medical Postgraduate Education, Warsaw, Poland
| | - Małgorzata Uhrynowska
- Department of Hematological and Transfusion Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Borghild Roald
- Department of Pathology, Center for Perinatal and Pregnancy-Related Pathology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Husebekk
- Immunology Research Group, Department of Medical Biology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Vasilis Sitras
- Department of Fetal Medicine, Oslo University Hospital, Oslo, Norway
| | - Mona Nystad
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
| | - Marzena Dębska
- Department of Obstetrics and Gynecology, Centre of Medical Postgraduate Education, Warsaw, Poland
| | - Ewa Brojer
- Department of Hematological and Transfusion Immunology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Heidi Tiller
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
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Brady CA, Williams C, Sharps MC, Shelleh A, Batra G, Heazell AEP, Crocker IP. Chronic histiocytic intervillositis: A breakdown in immune tolerance comparable to allograft rejection? Am J Reprod Immunol 2021; 85:e13373. [PMID: 33155353 PMCID: PMC7988544 DOI: 10.1111/aji.13373] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/14/2020] [Accepted: 11/03/2020] [Indexed: 12/15/2022] Open
Abstract
Chronic histiocytic intervillositis (CHI) is a pregnancy disorder characterized by infiltration of maternal macrophages into the intervillous space of the human placenta, often with accompanying perivillous fibrin deposition. CHI is associated strongly with foetal growth restriction and increased risk of miscarriage and stillbirth. Although rare, affecting 6 in every 10 000 pregnancies beyond 12 weeks' gestation, the rate of recurrence is high at 25%-100%. To date, diagnosis of CHI can only be made post-delivery upon examination of the placenta due to a lack of diagnostic biomarkers, and criteria vary across publications. No treatment options have shown proven efficacy, and CHI remains a serious obstetric conundrum. Although its underlying aetiology is unclear, due to the presence of maternal macrophages and the reported increased incidence in women with autoimmune disease, CHI is hypothesized to be an inappropriate immune response to the semi-allogeneic foetus. Given this lack of understanding, treatment approaches remain experimental with limited rationale. However, there is recent evidence that immunosuppression and antithrombotic therapies may be effective in preventing recurrence of associated adverse pregnancy outcomes. With similarities noted between the pathological features of CHI and acute rejection of solid organ transplants, further investigation of this hypothesis may provide a basis for tackling CHI and other immune-related placental conditions. This review will explore parallels between CHI and allograft rejection and identify areas requiring further confirmation and exploitation of this comparison.
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Affiliation(s)
- Chloe A. Brady
- Tommy's Maternal and Fetal Health Research CentreSt. Mary’s HospitalThe University of ManchesterManchesterUK
| | - Charlotte Williams
- Tommy's Maternal and Fetal Health Research CentreSt. Mary’s HospitalThe University of ManchesterManchesterUK
- University of ExeterExeterUK
| | - Megan C. Sharps
- Tommy's Maternal and Fetal Health Research CentreSt. Mary’s HospitalThe University of ManchesterManchesterUK
| | - Amena Shelleh
- St Mary’s HospitalManchester University NHS Foundation TrustManchesterUK
| | - Gauri Batra
- Paediatric HistopathologyCentral Manchester University Hospitals NHS Foundation TrustManchesterUK
| | - Alexander E. P. Heazell
- Tommy's Maternal and Fetal Health Research CentreSt. Mary’s HospitalThe University of ManchesterManchesterUK
- St Mary’s HospitalManchester University NHS Foundation TrustManchesterUK
| | - Ian P. Crocker
- Tommy's Maternal and Fetal Health Research CentreSt. Mary’s HospitalThe University of ManchesterManchesterUK
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8
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Goldstein JA, Gallagher K, Beck C, Kumar R, Gernand AD. Maternal-Fetal Inflammation in the Placenta and the Developmental Origins of Health and Disease. Front Immunol 2020; 11:531543. [PMID: 33281808 PMCID: PMC7691234 DOI: 10.3389/fimmu.2020.531543] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 10/06/2020] [Indexed: 12/17/2022] Open
Abstract
Events in fetal life impact long-term health outcomes. The placenta is the first organ to form and is the site of juxtaposition between the maternal and fetal circulations. Most diseases of pregnancy are caused by, impact, or are reflected in the placenta. The purpose of this review is to describe the main inflammatory processes in the placenta, discuss their immunology, and relate their short- and long-term disease associations. Acute placental inflammation (API), including maternal and fetal inflammatory responses corresponds to the clinical diagnosis of chorioamnionitis and is associated with respiratory and neurodevelopmental diseases. The chronic placental inflammatory pathologies (CPI), include chronic villitis of unknown etiology, chronic deciduitis, chronic chorionitis, eosinophilic T-cell vasculitis, and chronic histiocytic intervillositis. These diseases are less-well studied, but have complex immunology and show mechanistic impacts on the fetal immune system. Overall, much work remains to be done in describing the long-term impacts of placental inflammation on offspring health.
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Affiliation(s)
- Jeffery A. Goldstein
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Kelly Gallagher
- Department of Nutritional Sciences, College of Health and Human Development, Penn State University, University Park, PA, United States
| | - Celeste Beck
- Department of Nutritional Sciences, College of Health and Human Development, Penn State University, University Park, PA, United States
| | - Rajesh Kumar
- Section of Allergy and Immunology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital and Northwestern University, Chicago, IL, United States
| | - Alison D. Gernand
- Department of Nutritional Sciences, College of Health and Human Development, Penn State University, University Park, PA, United States
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9
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Adu-Gyamfi EA, Czika A, Gorleku PN, Ullah A, Panhwar Z, Ruan LL, Ding YB, Wang YX. The Involvement of Cell Adhesion Molecules, Tight Junctions, and Gap Junctions in Human Placentation. Reprod Sci 2020; 28:305-320. [PMID: 33146876 DOI: 10.1007/s43032-020-00364-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023]
Abstract
Placentation is a major determinant of the success of pregnancy. It is regulated by several factors such as cell adhesion molecules, tight junctions, and gap junctions. The cell adhesion molecules are integrins, cadherins, immunoglobulins, nectins, and selectins. The tight junctions are composed of claudins, occludin, and junction adhesion molecule proteins while the gap junctions are composed of connexins of varying molecular weights. During placentation, some of these molecules regulate trophoblast proliferation, trophoblast fusion, trophoblast migration, trophoblast invasion, trophoblast-endothelium adhesion, glandular remodeling, and spiral artery remodeling. There is a dysregulated placental expression of some of these molecules during obstetric complications. We have, hereby, indicated the expression patterns of the subunits of each of these molecules in the various trophoblast subtypes and in the decidua, and have highlighted their involvement in physiological and pathological placentation. The available evidence points to the relevance of these molecules as distinguishing markers of the various trophoblast lineages and as potential therapeutic targets in the management of malplacentation-mediated diseases.
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Affiliation(s)
- Enoch Appiah Adu-Gyamfi
- Department of Reproductive Sciences, School of Basic Medicine, Chongqing Medical University, Chongqing, 400016, People's Republic of China.
- Joint International Research Laboratory of Reproduction & Development, Chongqing Medical University, Box 197, No. 1 Yixueyuan Rd, Chongqing, 400016, People's Republic of China.
| | - Armin Czika
- Joint International Research Laboratory of Reproduction & Development, Chongqing Medical University, Box 197, No. 1 Yixueyuan Rd, Chongqing, 400016, People's Republic of China
| | - Philip Narteh Gorleku
- Department of Medical Imaging, School of Medical Sciences, University of Cape Coast, Cape Coast, Republic of Ghana
| | - Amin Ullah
- Joint International Research Laboratory of Reproduction & Development, Chongqing Medical University, Box 197, No. 1 Yixueyuan Rd, Chongqing, 400016, People's Republic of China
| | - Zulqarnain Panhwar
- Joint International Research Laboratory of Reproduction & Development, Chongqing Medical University, Box 197, No. 1 Yixueyuan Rd, Chongqing, 400016, People's Republic of China
| | - Ling-Ling Ruan
- Joint International Research Laboratory of Reproduction & Development, Chongqing Medical University, Box 197, No. 1 Yixueyuan Rd, Chongqing, 400016, People's Republic of China
| | - Yu-Bin Ding
- Department of Reproductive Sciences, School of Basic Medicine, Chongqing Medical University, Chongqing, 400016, People's Republic of China.
- Joint International Research Laboratory of Reproduction & Development, Chongqing Medical University, Box 197, No. 1 Yixueyuan Rd, Chongqing, 400016, People's Republic of China.
| | - Ying-Xiong Wang
- Department of Reproductive Sciences, School of Basic Medicine, Chongqing Medical University, Chongqing, 400016, People's Republic of China.
- Joint International Research Laboratory of Reproduction & Development, Chongqing Medical University, Box 197, No. 1 Yixueyuan Rd, Chongqing, 400016, People's Republic of China.
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de Moreuil C, Moineau MP, Padelli M, Lede F, Remoue A, Tremouilhac C, Merviel P, Pan Petesch B, Le Moigne E, Lacut K, Marcorelles P. First trimester serum biomarkers in pregnancies complicated with placental chronic inflammation. Eur J Obstet Gynecol Reprod Biol 2019; 241:119-125. [PMID: 31505304 DOI: 10.1016/j.ejogrb.2019.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/02/2019] [Accepted: 08/22/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study aimed at determining if first trimester serum biomarkers could predict adverse pregnancy outcomes associated with villitis (VUE) and chronic intervillositis of unknown etiology (CIUE). STUDY DESIGN Between January 2013 and June 2018, we selected from pathology department files placentas with VUE or CIUE associated with VUE and control placentas with available first trimester Down syndrome screening results. First trimester PAPP-A and βhCG levels were recorded. Placental growth factor (PlGF) levels were measured in patients with an available first trimester serum sample. Histological findings in placentas, course of pregnancies and newborns' characteristics were compared between cases and controls. RESULTS 78 cases and 75 controls were included. In cases, there were 21,8% intrauterine growth restriction (IUGR), 30,8% small for gestational age (SGA). Compared to controls, placentas from cases were smaller (425 g [IQR 370-480] vs 460 g [IQR 390-523], p = 0,03), showed more maternal vascular malperfusion features (79,5% vs 22,7%, p < 0,0001) and more fetal vascular malperfusion features (33,3% vs 12%, p = 0,002). Cases had lower PlGF (29,74 pg/ml [IQR 19,74-36,17] vs 36,37 pg/ml [IQR 27,36-49,13], p = 0,007) and βhCG levels (0,74 MoM [IQR 0,53-1,12] vs 1,00 MoM [IQR 0,72-1,53], p = 0,002) than controls. These differences resulted from lower PlGF levels in VUE patients compared to CIUE associated with VUE patients and controls (28,35 vs 34,05 and 36,37 pg/ml, p = 0,01) and from lower βhCG levels in CIUE associated with VUE patients compared to VUE patients and controls (0,65 vs 0,86 and 1, p = 0,005). CONCLUSION Low first trimester PlGF levels in cases, especially in VUE patients, suggest that reduced angiogenesis is involved in adverse pregnancy outcomes related to VUE.
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Affiliation(s)
- Claire de Moreuil
- Département de médecine interne et pneumologie, CHU de Brest, Hôpital La Cavale Blanche, Brest Cedex, France; EA 3878, GETBO, Université Bretagne Loire, Brest Cedex, France.
| | - Marie-Pierre Moineau
- Département de biochimie, CHU de Brest, Hôpital La Cavale Blanche, Brest Cedex, France
| | - Maël Padelli
- Département de biochimie, CHU de Brest, Hôpital La Cavale Blanche, Brest Cedex, France
| | - Françoise Lede
- Service d'anatomopathologie, CHU de Brest, Hôpital Morvan, Brest Cedex, France
| | - Annabelle Remoue
- Service d'anatomopathologie, CHU de Brest, Hôpital Morvan, Brest Cedex, France
| | - Christophe Tremouilhac
- EA 3878, GETBO, Université Bretagne Loire, Brest Cedex, France; Service de gynécologie et d'obstétrique, CHU de Brest, Hôpital Morvan, Brest Cedex, France
| | - Philippe Merviel
- EA 3878, GETBO, Université Bretagne Loire, Brest Cedex, France; Service de gynécologie et d'obstétrique, CHU de Brest, Hôpital Morvan, Brest Cedex, France
| | - Brigitte Pan Petesch
- EA 3878, GETBO, Université Bretagne Loire, Brest Cedex, France; Fédération de cancérologie et d'hématologie, CHU de Brest, Hôpital Morvan, Brest Cedex, France
| | - Emmanuelle Le Moigne
- Département de médecine interne et pneumologie, CHU de Brest, Hôpital La Cavale Blanche, Brest Cedex, France; EA 3878, GETBO, Université Bretagne Loire, Brest Cedex, France
| | - Karine Lacut
- Département de médecine interne et pneumologie, CHU de Brest, Hôpital La Cavale Blanche, Brest Cedex, France; EA 3878, GETBO, Université Bretagne Loire, Brest Cedex, France
| | - Pascale Marcorelles
- Service d'anatomopathologie, CHU de Brest, Hôpital Morvan, Brest Cedex, France; EA 4685 LIEN, Université Bretagne Loire, Brest Cedex, France
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11
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Feenstra ME, Schoots MH, Plösch T, Prins JR, Scherjon SA, Timmer A, van Goor H, Gordijn SJ. More Maternal Vascular Malperfusion and Chorioamnionitis in Placentas After Expectant Management vs. Immediate Delivery in Fetal Growth Restriction at (Near) Term: A Further Analysis of the DIGITAT Trial. Front Endocrinol (Lausanne) 2019; 10:238. [PMID: 31105647 PMCID: PMC6499154 DOI: 10.3389/fendo.2019.00238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 03/26/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: Management of late fetal growth restriction (FGR) is limited to adequate fetal monitoring and optimal timing of delivery. The Disproportionate Intrauterine Growth Intervention Trial At Term (DIGITAT) trial compared induction of labor with expectant management in pregnancies at (near) term complicated by suspected FGR. Findings of the DIGITAT trial were that expectant monitoring prolonged pregnancy for 10 days and increased birth weight with only 130 grams. This resulted in more infants born below the 2.3rd percentile compared to induction of labor, respectively, 12.5% in induction of labor and 30.6% in expectant monitoring group. The main placental lesions associated with FGR are maternal vascular malperfusion, fetal vascular malperfusion, and villitis of unknown etiology. We investigated whether placentas of pregnancies complicated with FGR in the expectant monitoring group reveal more and more severe pathology due to pregnancy prolongation. Material and methods: The DIGITAT trial was a multicenter, randomized controlled trial with suspected FGR beyond 36 + 0 weeks. We now analyzed all available cases (n = 191) for placental pathology. The macroscopic details were collected and histological slides were recorded and classified by a single perinatal pathologist, blinded for pregnancy details and outcome. The different placental lesions were scored based on the latest international criteria for placental lesions as defined in the Amsterdam Placental Workshop Group Consensus Statement. Results: The presence of maternal vascular malperfusion and chorioamnionitis were higher in the expectant management group (p < 0.05 and p < 0.01, respectively). No differences in placental weight and maturation of the placenta between the induction of labor and the expectant management group were seen. Fetal vascular malperfusion, villitis of unknown etiology and nucleated red blood cell count did not differ between the groups. Conclusion: Expectant management of late FGR is associated with increased maternal vascular malperfusion and chorioamnionitis. This may have implications for fetal and neonatal outcome, such as programming in the developing child influencing health outcomes later in life.
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Affiliation(s)
- Marjon E. Feenstra
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Mirthe H. Schoots
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Torsten Plösch
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Jelmer R. Prins
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Sicco A. Scherjon
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Albertus Timmer
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Harry van Goor
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Sanne J. Gordijn
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- *Correspondence: Sanne J. Gordijn
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12
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Singh AM, Sherenian MG, Kim KY, Erickson KA, Yang A, Mestan K, Ernst LM, Kumar R. Fetal cord blood and tissue immune responses to chronic placental inflammation and chorioamnionitis. Allergy Asthma Clin Immunol 2018; 14:66. [PMID: 30473713 PMCID: PMC6240933 DOI: 10.1186/s13223-018-0297-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/29/2018] [Indexed: 01/13/2023] Open
Abstract
Background Chorioamnionitis is a risk factor for future asthma development. Animal models of chorioamnionitis demonstrate increased TH17-to-Treg ratios associated with proinflammatory cytokine elevations. The association of chorioamnionitis on human neonatal immune cells systemically and within tissues is not known. Methods We enrolled two cohorts to evaluate TH17 and regulatory T cell (Treg) phenotypic markers in chorioamnionitis. From a cohort of 19 live birth infants, we collected cord blood and placenta samples to evaluate for signs of acute and chronic histologic inflammation and cell phenotype characterization. We analyzed a second cohort of stillborn infants with and without chorioamnionitis to classify and enumerate cell infiltrate phenotypes in the spleen, thymus, and lung. We used linear regression analysis determine the association of retinoic acid-related orphan receptor gamma t positive (RORγt+) and Treg cell frequency with different types of inflammation seen in the live cohort subjects. Using linear mixed models, we evaluated for any associations between chorioamnionitis and T- and B-cell with a logarithmic scale for level of expression of cellular markers. We then performed Wilcoxon rank sum tests to assess the associations between cell count and chorioamnionitis. Results In the live birth subjects with chronic placental inflammation we observed an increased proportion of RORγt+ cells in Foxp3+ cells, regardless of the presence of acute inflammation, compared to subjects with neither acute nor chronic inflammation. We also found an increased proportion of RORγt+ cells within Foxp3+ cells in subjects with acute high stage fetal and maternal inflammation compared to those without acute or chronic inflammation. In the stillborn subjects with chorioamnionitis, we observed a decrease in splenic Foxp3+ cells and an increase in lung CD3+ cells compared with subjects that did not have chorioamnionitis. Conclusion Exposure to chorioamnionitis in utero may affect immune activation in neonates with an increased frequency of RORγt+ cells systemically as well as lymphocytic infiltrate in the lung. Our findings suggest an increase in RORγt+ cells during chorioamnionitis and thus may support the known associations between chorioamnionitis with asthma.
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Affiliation(s)
- Anne Marie Singh
- 1Division of Allergy and Immunology, Department of Pediatrics, Northwestern Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, 255 E Chicago Ave, Box #60, Chicago, IL 60611 USA.,6Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, IL USA
| | - Michael G Sherenian
- 1Division of Allergy and Immunology, Department of Pediatrics, Northwestern Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, 255 E Chicago Ave, Box #60, Chicago, IL 60611 USA
| | - Kwang-Youn Kim
- 2Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Kristin A Erickson
- 6Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, IL USA
| | - Amy Yang
- 3Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Karen Mestan
- 4Division of Neonatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL USA
| | - Linda M Ernst
- 5Department of Pathology and Laboratory Medicine, Northshore University Health System, Evanston, IL USA
| | - Rajesh Kumar
- 1Division of Allergy and Immunology, Department of Pediatrics, Northwestern Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, 255 E Chicago Ave, Box #60, Chicago, IL 60611 USA
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13
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Intervillites chroniques histiocytaires : bilan et prise en charge. Rev Med Interne 2018; 39:117-121. [DOI: 10.1016/j.revmed.2017.10.422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 12/29/2022]
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14
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Chen A, Roberts DJ. Placental pathologic lesions with a significant recurrence risk - what not to miss! APMIS 2017; 126:589-601. [PMID: 29271494 DOI: 10.1111/apm.12796] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 10/25/2017] [Indexed: 01/08/2023]
Abstract
Here, we review three important placental pathologies with significant clinical implications and recurrence risks. They are, in order of most to least frequently seen, villitis of unknown etiology, chronic histiocytic intervillositis, and massive perivillous fibrin deposition (also known as maternal floor infarction). These entities occur in both preterm and term gestations and are observed more frequently with maternal and obstetric disorders including prior pregnancy loss, hypertension/preeclampsia, and autoimmune disease. They are associated with, and probably the cause of, significant perinatal morbidity and mortality including intrauterine growth restriction, fetal and neonatal demise, and fetal/neonatal neurocompromise (seizures and cerebral palsy). All three entities have high recurrence risks, with recurrence rates ranging from 34 to 100%. The histologic features of villitis of unknown etiology, chronic histiocytic intervillositis, and massive perivillous fibrin deposition are described herein. We discuss the clinical associations and suggest the subsequent clinical and pathological evaluation. Hypotheses as to the biology of these lesions are reviewed.
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Affiliation(s)
- Athena Chen
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Drucilla J Roberts
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
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15
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Bos M, Nikkels PGJ, Cohen D, Schoones JW, Bloemenkamp KWM, Bruijn JA, Baelde HJ, van der Hoorn MLP, Turner RJ. Towards standardized criteria for diagnosing chronic intervillositis of unknown etiology: A systematic review. Placenta 2017; 61:80-88. [PMID: 29277275 DOI: 10.1016/j.placenta.2017.11.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/05/2017] [Accepted: 11/20/2017] [Indexed: 12/25/2022]
Abstract
Chronic intervillositis of unknown etiology (CIUE) is a poorly understood, relatively rare condition characterized histologically by the intervillous infiltration of mononuclear cells in the placenta. Clinically, CIUE is associated with poor pregnancy outcome (e.g., impaired fetal growth, preterm birth, fetal death) and high risk of recurrence in subsequent pregnancies. Because CIUE is not defined consistently, it is essential to clearly define this condition. We therefore review the published definitions of CIUE. In addition, we provide an overview of the reviewed histopathological and maternal characteristics, obstetric features, and pregnancy outcomes. Medical publication databases were searched for articles published through February 2017. Eighteen studies were included in our systematic review. The sole inclusion criterion used in all studies was the presence of intervillous infiltrates. Overall, CIUE was characterized by adverse pregnancy outcome. Miscarriage occurred in 24% of cases, with approximately half of these miscarriages defined as late. Impaired growth was commonly observed, 32.4% of pregnancies reached term, and the live birth rate was 54.9%. The high recurrence rate (25.1%) of the intervillous infiltrates in subsequent pregnancies underscores the clinical relevance of CIUE, the need for increased awareness among pathologists and clinicians, and the need for further research. Criteria for the diagnosis of CIUE are proposed and a Delphi study could be used to resolve any controversy regarding these criteria. Future studies should be designed to characterize the full clinical spectrum of CIUE.
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Affiliation(s)
- M Bos
- Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
| | - P G J Nikkels
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - D Cohen
- Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - J W Schoones
- Walaeus Medical Library, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - K W M Bloemenkamp
- Department of Obstetrics, University Medical Center Utrecht, Wilhelmina Children's Hospital, Birth Centre, Lundlaan 6, 3584 EA Utrecht, The Netherlands
| | - J A Bruijn
- Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - H J Baelde
- Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - M L P van der Hoorn
- Department of Obstetrics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - R J Turner
- Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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16
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Nowak C, Joubert M, Jossic F, Masseau A, Hamidou M, Philippe HJ, Le Vaillant C. Perinatal prognosis of pregnancies complicated by placental chronic villitis or intervillositis of unknown etiology and combined lesions: About a series of 178 cases. Placenta 2016; 44:104-8. [PMID: 27452445 DOI: 10.1016/j.placenta.2016.04.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 04/18/2016] [Accepted: 04/20/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The objective of this work was to evaluate and compare perinatal outcomes of pregnancies complicated by placental chronic intervillositis (CIUE) or villitis (CVUE) of unknown etiology and combined lesions. METHODS Retrospective study of all cases of significant CVUE and CIUE occurring during a 12-year period in a university tertiary hospital center. Multiple pregnancies, infectious and medical termination of pregnancies (TOP) without intra-uterine growth restriction (IUGR) were excluded. RESULTS 178 placentas were affected (78 cases of CVUE, 24 cases of CIUE and 76 cases of combined lesions involving both villitis and intervillositis) including 12 cases of recurrence. A disorder of fetal growth was found in 73% of cases and we noted 9.5% of cases of abortion. The rate of IUGR appeared to be significantly higher in case of CIUE with a fetal death risk five times higher. These complications seems to be related to more diffuse inflammatory infiltrates (p < 0.05). CVUE was associated with a significant morbidity with 42% of severe IUGR and severe alterations of umbilical artery Doppler in nearly one third of cases. Caesarean section was important (54.8%). Sixty-one percent of newborns were hospitalized and 11.4% in neonatal reanimation. In case of combined lesions, fetal outcomes appeared relatively close to those of CVUE. CVUE could recur in more severe forms or as CIUE with an increased risk for the fetus. Clinicoanatomic correlations were noted. DISCUSSION Observation of recurrence of CVUE on CIUE or combined lesions and similar phenotypic characteristics of the infiltrates suggest that they could be two different stages of a same disease. CVUE remains a disease to be considered as serious. Association of small lesions of intervillositis does not change the prognosis. The severity of histological lesions and the initial obstetrical accident could be discriminatory to identify patients at risk of serious recurrence. Harmonized classification will be required. CONCLUSIONS This study confirms the higher morbidity of CIUE compared to CVUE but shows the necessity of monitoring pregnancies following an episode of CVUE, which are still at risk of serious and recurrent complications.
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Affiliation(s)
- Christel Nowak
- Department of Obstetrics and Gynecology, Hôpital Mère-Enfant, Centre Hospitalier universitaire, Nantes, France.
| | - Madeleine Joubert
- Department of Pathology, Hôpital Mère Enfant, Centre Hospitalier Universitaire, Nantes, France
| | - Frederique Jossic
- Department of Pathology, Hôpital Mère Enfant, Centre Hospitalier Universitaire, Nantes, France
| | - Agathe Masseau
- Internal Medicine Department, Hôtel Dieu, Centre Hospitalier universitaire, Nantes, France
| | - Mohamed Hamidou
- Internal Medicine Department, Hôtel Dieu, Centre Hospitalier universitaire, Nantes, France
| | - Henri-Jean Philippe
- Department of Obstetrics and Gynecology, Hôpital Mère-Enfant, Centre Hospitalier universitaire, Nantes, France
| | - Claudine Le Vaillant
- Department of Obstetrics and Gynecology, Hôpital Mère-Enfant, Centre Hospitalier universitaire, Nantes, France
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