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Hauptman I, Gill KS, Lim T, Mack WJ, Wilson ML. Prediction of neonatal outcomes using gestational age vs ACOG definitions of maternal disease severity in hypertensive disorders of pregnancy. Arch Gynecol Obstet 2024:10.1007/s00404-024-07684-y. [PMID: 39152282 DOI: 10.1007/s00404-024-07684-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 08/01/2024] [Indexed: 08/19/2024]
Abstract
PURPOSE Hypertensive disorders of pregnancy cause significant neonatal complications. Disease severity is often used to predict neonatal outcomes, however gestational age (GA) at delivery may be a better predictor. We aimed to assess whether disease severity or GA was more predictive of adverse neonatal outcomes. METHODS We included 165 participants with confirmed HELLP syndrome or severe preeclampsia (sPE). Two predictive models were constructed to assess the ability of disease severity compared to GA to predict a composite adverse neonatal outcome. The composite outcome included low birth weight, SGA, IUGR, Apgar score, and neonatal death. RESULTS Using severity as a predictor of binary neonatal outcome had an AUC of 0.73 (0.65-0.81), with a sensitivity (SE) of 70.3% and a specificity (SP) of 64.4%. For GA, we observed an AUC of 0.82 (0.75-0.89), with a SE of 75.7% and a SP of 76.7%. CONCLUSION For the composite neonatal outcome, GA was a better predictor than ACOG diagnosis (severity). This observation underscores the need for further research to validate these findings in larger cohorts and to determine their applicability to maternal outcomes.
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Affiliation(s)
- Isabella Hauptman
- Keck School of Medicine, Department of Population and Public Health Sciences, University of Southern California, Los Angeles, USA
| | - Kevin S Gill
- Keck School of Medicine, Department of Population and Public Health Sciences, University of Southern California, Los Angeles, USA
| | - Tiffany Lim
- Keck School of Medicine, Department of Population and Public Health Sciences, University of Southern California, Los Angeles, USA
| | - Wendy J Mack
- Keck School of Medicine, Department of Population and Public Health Sciences, University of Southern California, Los Angeles, USA
| | - Melissa L Wilson
- Keck School of Medicine, Department of Population and Public Health Sciences, University of Southern California, Los Angeles, USA.
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2
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Feldstein O, Dekalo A, Mor L, Levin M, Schreiber L, Paz YG, Israeli E, Barda G, Weiner E. Placental Histopathological Lesions and Adverse Neonatal Outcomes in Patients with Inflammatory Bowel Diseases- A retrospective Cohort Study. Reprod Sci 2024:10.1007/s43032-024-01571-2. [PMID: 38664358 DOI: 10.1007/s43032-024-01571-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 04/18/2024] [Indexed: 05/04/2024]
Abstract
Inflammatory bowel diseases (IBD) are significantly associated with adverse pregnancy and neonatal outcomes, though the pathomechanism is yet unknown. To investigate the relationship between IBD and adverse pregnancy outcomes by comparing neonatal outcomes and placental histopathology in two matched groups of patients with and without IBD. In this retrospective study, data of all patients who gave birth between 2008-2021 and were diagnosed with IBD were reviewed and compared to a control group matching two control cases for every IBD case. Neonatal outcomes and placental pathology were compared between the groups. Compared to the control group (n=76), the placentas of patients with IBD (n=36) were characterized by significantly lower placental weight (p < 0.001), and higher rates of maternal vascular malperfusion lesions (MVM, p < 0.001) and maternal and fetal inflammatory response lesions (p < 0.001). Neonates of patients with IBD were more frequently small for gestational age (SGA) (p=0.01), with increased rates of need for phototherapy (p = 0.03), respiratory morbidity and NICU admission (p < 0.001 for both outcomes). Multivariate logistic regression analyses adjusting for possible confounders (including maternal age, gestational age, chronic hypertension, smoking, and thrombophilia) confirmed the independent association between IBD and composite MVM lesions (aOR 4.31, p < 0.001), maternal inflammatory responses (aOR 40.22, p < 0.001) and SGA infants (aOR 4.31, p = 0.013). IBD is associated with increased rates of placental histopathological lesions and adverse pregnancy outcomes, including SGA infants. These novel findings imply the role of placental malperfusion and inflammatory processes in pregnancy complications of IBD patients, which should be followed accordingly. Approval of local ethics committee # WOMC-0219-20.
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Affiliation(s)
- Ohad Feldstein
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel
| | - Ann Dekalo
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel
| | - Liat Mor
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel.
| | - Meital Levin
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel
| | - Letizia Schreiber
- Department of Pathology, The Edith Wolfson Medical Center, Holon, Israel
- Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Ganor Paz
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel
- Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Israeli
- Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Gastroenterology and Liver Diseases, The Edith Wolfson Medical Center, Holon, Israel
| | - Giulia Barda
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel
- Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Weiner
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel
- Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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3
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Frimat M, Gnemmi V, Stichelbout M, Provôt F, Fakhouri F. Pregnancy as a susceptible state for thrombotic microangiopathies. Front Med (Lausanne) 2024; 11:1343060. [PMID: 38476448 PMCID: PMC10927739 DOI: 10.3389/fmed.2024.1343060] [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] [Received: 11/22/2023] [Accepted: 02/12/2024] [Indexed: 03/14/2024] Open
Abstract
Pregnancy and the postpartum period represent phases of heightened vulnerability to thrombotic microangiopathies (TMAs), as evidenced by distinct patterns of pregnancy-specific TMAs (e.g., preeclampsia, HELLP syndrome), as well as a higher incidence of nonspecific TMAs, such as thrombotic thrombocytopenic purpura or hemolytic uremic syndrome, during pregnancy. Significant strides have been taken in understanding the underlying mechanisms of these disorders in the past 40 years. This progress has involved the identification of pivotal factors contributing to TMAs, such as the complement system, ADAMTS13, and the soluble VEGF receptor Flt1. Regardless of the specific causal factor (which is not generally unique in relation to the usual multifactorial origin of TMAs), the endothelial cell stands as a central player in the pathophysiology of TMAs. Pregnancy has a major impact on the physiology of the endothelium. Besides to the development of placenta and its vascular consequences, pregnancy modifies the characteristics of the women's microvascular endothelium and tends to render it more prone to thrombosis. This review aims to delineate the distinct features of pregnancy-related TMAs and explore the contributing mechanisms that lead to this increased susceptibility, particularly influenced by the "gravid endothelium." Furthermore, we will discuss the potential contribution of histopathological studies in facilitating the etiological diagnosis of pregnancy-related TMAs.
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Affiliation(s)
- Marie Frimat
- CHU Lille, Nephrology Department, Univ. Lille, Lille, France
- Inserm, Institut Pasteur de Lille, Univ. Lille, Lille, France
| | | | | | - François Provôt
- CHU Lille, Nephrology Department, Univ. Lille, Lille, France
| | - Fadi Fakhouri
- Service of Nephrology and Hypertension, CHUV and University of Lausanne, Lausanne, Switzerland
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Amirlatifi S, Kooshari Z, Salmani K, Fallah Ziyarani M, Azizi S, Ghotbi E, Zolali B. Evaluation of long noncoding RNA (LncRNA) in pathogenesis of HELLP syndrome: diagnostic and future approach. J OBSTET GYNAECOL 2023; 43:2174836. [PMID: 36795605 DOI: 10.1080/01443615.2023.2174836] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
HELLP syndrome is a disorder during pregnancy which is defined by elevation of liver enzymes, haemolysis, and low platelet count. This syndrome is a multifactorial one and both genetic and environmental components can have a crucial role in this syndrome's pathogenesis. Long noncoding RNAs (lncRNAs), are defined as long non-protein coding molecules (more than 200 nucleotides), which are functional units in most cellular processes such as cell cycle, differentiation, metabolism and some diseases progression. As these markers discovered, there has been some evidence that they have an important role in the function of some organs, such as placenta; therefore, alteration and dysregulation of these RNAs can develop or alleviate HELLP disorder. Although the role of lncRNAs has been shown in HELLP syndrome, the process is still unclear. In this review, our purpose is to evaluate the association between molecular mechanisms of lncRNAs and HELLP syndrome pathogenicity to elicit some novel approaches for HELLP diagnosis and treatment.
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Affiliation(s)
- Shahrzad Amirlatifi
- Clinical Research Development unit (SHACRDU), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Kooshari
- Clinical Research Development unit (SHACRDU), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Kiana Salmani
- Department of Genetics, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Maryam Fallah Ziyarani
- Department of Genetics, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Sepideh Azizi
- Clinical Research Development unit (SHACRDU), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Elena Ghotbi
- Preventative Gynecology Research Center, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Bita Zolali
- Clinical Research Development unit (SHACRDU), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Jiao Y, Liu Y, Li H, Song Z, Wang S, Zhang J, Li J, Liu J, Wang P, Chen Y. Value of proteinuria in evaluating the severity of HELLP and its maternal and neonatal outcomes. BMC Pregnancy Childbirth 2023; 23:591. [PMID: 37596554 PMCID: PMC10436574 DOI: 10.1186/s12884-023-05862-5] [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: 01/17/2023] [Accepted: 07/20/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND HELLP syndrome refers to a group of clinical syndromes characterized by hemolysis, elevated liver enzymes and low platelet, and the evidence on the association between proteinuria and the severity of HELLP and its maternal and neonatal outcomes is rare. METHODS 106 pregnant women were assigned to the proteinuric group (24-hUPro ≥ 0.3 g, 79 cases) and the non-proteinuric group (24-hUPro < 0.3 g, 27 cases). The proteinuric group was further divided into three subgroups: mild group (24-hUPro:0.3-2.0 g, 33 cases), moderate group (24-hUPro:2.0-5.0 g, 21 cases) and severe group (24-hUPro: ≥5.0 g, 25 cases). The general clinical data, laboratory indexes, complications and pregnancy outcome and adverse neonatal outcomes of HELLP with or without proteinuric were analyzed. RESULTS Compared with proteinuric group, the non-albuminuric group or in the three proteinuric subgroups of HELLP pregnant women's, increased proteinuria was associated with earlier onset gestations, higher incidence of abdominal pain, skin jaundice, headache, blurred vision (p < 0.05 respectively), and also the higher levels of ALT, AST, LDH, Fib, APTT, ATII, proportions of tubular urine and lower levels of ALB, PLT (p < 0.05 respectively). In the three subgroups of the proteinuric group, the ratio of fetal growth restriction, cesarean section and postpartum hemorrhage were compared, and the difference was statistically significant (p < 0.05 respectively). Compared with the proteinuric group, the non-proteinuric group had higher birth weight, birth length, and lower SGA, admission rate in NICU (p < 0.05 respectively). In the three subgroups of the proteinuric group, significant differences were identified in the adverse outcomes of newborns (p < 0.05 respectively), and the incidence of adverse outcomes in neonates tended to be higher. Significant differences were identified in birth weight, birth length, and lower SGA and NICU occupancy rate among the three subgroups (p < 0.05 respectively). CONCLUSIONS HELLP syndrome is a severe complication of pregnancy, involving multiple systems of the whole body. It has posed a great challenge to obstetricians for its acute onset, dangerous condition, rapid progress, and great harm. Thus, insights into HELLP syndrome should be gained, and early diagnosis, early treatment and timely termination of pregnancy should be conducted to reduce the incidence of maternal and fetal adverse outcomes and improve maternal and fetal prognosis.
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Affiliation(s)
- Yan Jiao
- Department of obstetrics and gynecology of Xuzhou Central Hospital, No.199, Jiefang South Road, Xuzhou, Jiangsu, 221009, People's Republic of China
| | - Yan Liu
- Department of Clinical Laboratory, Xuzhou Central Hospital, No.199, Jiefang South Road, Xuzhou, Jiangsu, 221009, People's Republic of China
| | - Hongyuan Li
- Department of neurology, Xuzhou Central Hospital, No.199, Jiefang South Road, Xuzhou, Jiangsu, 221009, People's Republic of China
| | - Zimeng Song
- School of medical technology, Xuzhou Medical University, Xuzhou No.209, Tong Shan Road, Xuzhou, 221000, Jiangsu, People's Republic of China
| | - Shiliang Wang
- Department of obstetrics and gynecology of Xuzhou Central Hospital, No.199, Jiefang South Road, Xuzhou, Jiangsu, 221009, People's Republic of China
| | - Jiao Zhang
- Department of Clinical Laboratory, Xuzhou Central Hospital, No.199, Jiefang South Road, Xuzhou, Jiangsu, 221009, People's Republic of China
| | - Jian Li
- Department of Clinical Laboratory, Xuzhou Central Hospital, No.199, Jiefang South Road, Xuzhou, Jiangsu, 221009, People's Republic of China
| | - Jia Liu
- Department of Clinical Laboratory, Xuzhou Central Hospital, No.199, Jiefang South Road, Xuzhou, Jiangsu, 221009, People's Republic of China
| | - Peng Wang
- Department of Clinical Laboratory, Xuzhou Central Hospital, No.199, Jiefang South Road, Xuzhou, Jiangsu, 221009, People's Republic of China.
| | - Yanhong Chen
- Department of Clinical Laboratory, Xuzhou Central Hospital, No.199, Jiefang South Road, Xuzhou, Jiangsu, 221009, People's Republic of China.
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Arts N, Schiffer V, Severens-Rijvers C, Bons J, Spaanderman M, Al-Nasiry S. Cumulative effect of maternal vascular malperfusion types in the placenta on adverse pregnancy outcomes. Placenta 2022; 129:43-50. [PMID: 36215782 DOI: 10.1016/j.placenta.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/22/2022] [Accepted: 09/13/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Placental vascular disease, characterized by Maternal Vascular Malperfusion (MVM) lesions, is considered to be the underlying cause of pregnancy complications. Aim is to evaluate the relationship between the cumulative number of MVM lesion types, and adverse pregnancy- and neonatal outcomes. METHODS This retrospective cohort study included 272 women with singleton gestations who gave birth at a Dutch tertiary hospital between 2017 and 2018 with available placental histopathology reports. Analyzed according to the Amsterdam Placental Workshop Group Consensus Statement, placentas were divided into groups based on the cumulative number of MVM lesions: no lesions (n = 124), 1-2 types (n = 124) and 3-5 types of lesions (n = 24). RESULTS The proportion of placenta syndrome (PS) was highest (95.8%) in the 3-5 MVM lesions group (p < 0.001). The presence of MVM lesions was highly associated with PS during pregnancy (aOR 6.81, 95% CI 3.76-12.33). Furthermore, every additional type of MVM lesion corresponded with a threefold increased odds for the occurrence of PS (aOR 3.00, 95% CI 2.10-4.29). The group with 3-5 types of MVM lesions showed the highest incidence of adverse neonatal outcomes, lower mean birth weight, prolonged hospitalization, NICU admissions and neonatal deaths (aOR 6.47, 95% CI 0.33-127.68), corresponding with a fourfold increased odds for the occurrence of neonatal death for every additional MVM lesion (aOR 4.19, 95% CI 1.39-12.68). DISCUSSION A higher number of MVM lesion types is strongly associated with an increased incidence of adverse pregnancy- and neonatal outcomes, indicating that guidelines should focus also on the amount of MVM lesion types for the monitoring/management of subsequent pregnancies.
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Affiliation(s)
- Nadi Arts
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Netherlands.
| | - Veronique Schiffer
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Netherlands; GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre, Netherlands
| | | | - Judith Bons
- Central Diagnostic Laboratory, Maastricht University Medical Centre, Netherlands
| | - Marc Spaanderman
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Netherlands
| | - Salwan Al-Nasiry
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Netherlands
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Ashwal E, Ferreira F, Mei-Dan E, Aviram A, Sherman C, Zaltz A, Kingdom J, Melamed N. The accuracy of Fetoplacental Doppler in distinguishing between growth restricted and constitutionally small fetuses. Placenta 2022; 120:40-48. [DOI: 10.1016/j.placenta.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/17/2021] [Accepted: 02/07/2022] [Indexed: 01/05/2023]
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Nichols L, Bree Harper K, Callins KR. Educational Case: Hemolysis elevated liver enzymes and low platelets (HELLP syndrome). Acad Pathol 2022; 9:100055. [PMID: 36177063 PMCID: PMC9512840 DOI: 10.1016/j.acpath.2022.100055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 07/12/2022] [Accepted: 08/15/2022] [Indexed: 11/24/2022] Open
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Tjandraprawira KD, Kusumah AY, Kamilah AY, Putri DI, Ananta MR, Sari SP, Djuwantono T, Petrie A. Management and perinatal outcomes of hypertensive disorders of pregnancy in a low-resource setting in Indonesia. SAGE Open Med 2021; 9:20503121211060194. [PMID: 34888051 PMCID: PMC8649090 DOI: 10.1177/20503121211060194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/28/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives: To provide up-to-date data concerning hypertensive disorders of pregnancy on maternal and neonatal profiles in Indonesia. Methods: Retrospective clinical audit on all pregnancy-associated hypertensive women between 1 January 2020 and 31 March 2020 at Cianjur General District Hospital. Results: Preeclampsia accounts for 66.8% (235/352) of hypertensive disorders of pregnancy, gestational hypertension 29% (102/352) and chronic hypertension 4.3% (15/352). Compared to other pregnant women, those with preeclampsia, on average, had higher systolic and diastolic blood pressures and poorer kidney (ureum and creatinine) and liver function (aspartate transaminase enzyme and alanine transaminase enzyme) profiles (p < 0.001, < 0.001, < 0.001, 0.003, 0.033 and 0.002, respectively), and required more intensive care admission. Neonates from women with severe forms of preeclampsia (eclampsia and HELLP syndrome (haemolysis, elevated liver enzymes, low platelets)) had, on average, lower birthweight (p = 0.015 and 0.048, respectively) and birth length (p = 0.021, 0.017). Neonates from eclamptic mothers had poorer APGAR (appearance, pulse, grimace, activity and respiration) scores (p = 0.006 and 0.005, respectively). Conclusion: Hypertensive disorders of pregnancy exerts adverse maternal and neonatal outcomes, particularly among eclampsia and HELLP-syndrome neonates. Various challenges remain for optimal management.
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Affiliation(s)
- Kevin Dominique Tjandraprawira
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.,Department of Obstetrics and Gynaecology, Cianjur General District Hospital, Cianjur, Indonesia
| | - Aria Yusti Kusumah
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.,Department of Obstetrics and Gynaecology, Cianjur General District Hospital, Cianjur, Indonesia
| | - Azka Yumna Kamilah
- Department of Obstetrics and Gynaecology, Cianjur General District Hospital, Cianjur, Indonesia
| | - Dhini Isti Putri
- Department of Obstetrics and Gynaecology, Cianjur General District Hospital, Cianjur, Indonesia
| | - Mayang Rizky Ananta
- Department of Obstetrics and Gynaecology, Cianjur General District Hospital, Cianjur, Indonesia
| | - Selvi Puspa Sari
- Department of Obstetrics and Gynaecology, Cianjur General District Hospital, Cianjur, Indonesia
| | - Tono Djuwantono
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Aviva Petrie
- UCL Eastman Dental Institute, University College London, London, UK
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Genest DS, Dal Soglio D, Girard S, Rey E. Association between proteinuria and placental pathology in preeclampsia: A retrospective study. SAGE Open Med 2021; 9:20503121211058053. [PMID: 34925835 PMCID: PMC8673865 DOI: 10.1177/20503121211058053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: Preeclampsia develops due to placental insufficiency and systemic proinflammatory and antiangiogenic mediator release, with ensuing systemic endothelial dysfunction. Nephrotic-range proteinuria appears to be associated with worse pregnancy outcomes. The relationship between differing degrees of proteinuria and the severity of placental alterations has not been studied. Methods: This is a single-centre retrospective comparison of 150 singleton pregnancies complicated by preeclampsia and varying degrees of proteinuria. Maternal demographic, obstetrical and fetal outcome data were obtained from chart review. The placental histologic evaluations were performed by a placental pathologist blinded to all other clinical information. Results: Preeclamptic women with massive proteinuria had evidence of more severe maternal vascular malperfusion lesions. The severity of the lesions was progressive through mild, moderate and massive proteinuria. Women with massive proteinuria had a higher incidence of renal dysfunction and severe hypertension, and had earlier preterm deliveries compared to preeclamptic women with mild and moderate proteinuria (p < 0.05). Conclusion: Preeclampsia with more severe proteinuria is associated with a higher prevalence of placental maternal vascular malperfusion.
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Affiliation(s)
| | - Dorothée Dal Soglio
- Department of Pathology and Clinical Laboratory Medicine, CHU Sainte-Justine, Montreal, QC, Canada
| | - Sylvie Girard
- Department of Obstetrics and Gynecology, Université de Montréal, Centre de Recherche, CHU Sainte-Justine, Montreal, QC, Canada
| | - Evelyne Rey
- Department of Obstetrics and Gynecology, Université de Montréal, Centre de Recherche, CHU Sainte-Justine, Montreal, QC, Canada
- Division of Obstetric Medicine, Department of Medicine, University of Montreal, CHU Sainte-Justine, Montreal, QC, Canada
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Ramdin S, Naicker T, Pillay V, Singh SD, Baijnath S, Mkhwanazi BN, Govender N. Physiological characterization of an arginine vasopressin rat model of preeclampsia. Syst Biol Reprod Med 2021; 68:55-69. [PMID: 34743622 DOI: 10.1080/19396368.2021.1981486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Rodent models have contributed greatly to our understanding of preeclampsia (PE) progression in humans, however to-date no model has been able to effectively replicate the clinical presentation of the disease. This study aimed to provide a thorough physiological characterization of the arginine vasopressin (AVP)-induced rat model of PE to determine its applicability in studying the pathophysiology of PE. Female Sprague Dawley rats (n = 24) were separated into four groups (n = 6 per group) viz., pregnant AVP, pregnant saline, non-pregnant AVP, and non-pregnant saline. All animals received a continuous dose of either AVP (150 ng/h) or saline via subcutaneous mini osmotic pumps for 18 days. Full physiological characterization of the model included measuring systolic and diastolic blood pressure, and collecting urine and blood samples for biochemical analysis. AVP infusion significantly increased blood pressure and urinary protein levels in the pregnant rats (p < 0.05). Biochemical markers measured, differed significantly in the AVP-treated vs the pregnant saline groups (p < 0.05). Placental and individual pup weight decreased significantly in the pregnant AVP vs pregnant saline group (p < 0.05). The physiological and hematological data confirm the usefulness of this rat model in the study of PE, since AVP-induced vasoconstriction increases peripheral resistance and successfully mimics the pathological changes associated with PE development in humans.Abbreviations: PE: preeclampsia; AVP: arginine vasopressin; ISSHP: International Society for the Study of Hypertension in Pregnancy; ACOG: American College of Obstetricians and Gynecologists; RUPP: reduced uterine perfusion pressure; sFlt-1: soluble fms-like tyrosine kinase; VEGF: vascular endothelial growth factor; PlGF: placental growth factor; AVP: arginine vasopressin; PAVP: pregnant AVP-treated; PS: pregnant saline; GD: gestational day; ALT: alanine transaminase; NAVP: non-pregnant AVP-treated; NS: non-pregnant saline; AST: aspartate aminotransferase; HDL: high-density lipoprotein; RBC: red blood cell; RAAS: renin-angiotensin aldosterone system; HELLP: hemolysis, elevated liver enzymes, low platelet.
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Affiliation(s)
- Sapna Ramdin
- Department of Basic Medical Sciences, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Thajasvarie Naicker
- Optics and Imaging Centre, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Virushka Pillay
- Department of Basic Medical Sciences, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Sanil D Singh
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Sooraj Baijnath
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Blessing N Mkhwanazi
- Discipline of Dietetics and Nutrition, College of Agriculture, University of KwaZulu-Natal, Durban, South Africa
| | - Nalini Govender
- Department of Basic Medical Sciences, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
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Habib YH, Gowayed MA, Abdelhady SA, El-Deeb NM, Darwish IE, El-Mas MM. Modulation by antenatal therapies of cardiovascular and renal programming in male and female offspring of preeclamptic rats. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2021; 394:2273-2287. [PMID: 34468816 DOI: 10.1007/s00210-021-02146-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/26/2021] [Indexed: 11/28/2022]
Abstract
Morbidity and mortality risks are enhanced in preeclamptic (PE) mothers and their offspring. Here, we asked if sexual dimorphism exists in (i) cardiovascular and renal damage evolved in offspring of PE mothers, and (ii) offspring responsiveness to antenatal therapies. PE was induced by administering NG-nitro-L-arginine methyl ester (L-NAME, 50 mg/kg/day, oral gavage) to pregnant rats for 7 days starting from gestational day 14. Three therapies were co-administered orally with L-NAME, atrasentan (endothelin ETA receptor antagonist), terutroban (thromboxane A2 receptor antagonist, TXA2), or α-methyldopa (α-MD, central sympatholytic drug). Cardiovascular and renal profiles were assessed in 3-month-old offspring. Compared with offspring of non-PE rats, PE offspring exhibited elevated systolic blood pressure and proteinuria and reduced heart rate and creatinine clearance (CrCl). Apart from a greater bradycardia in male offspring, similar PE effects were noted in male and female offspring. While terutroban, atrasentan, or α-MD partially and similarly blunted the PE-evoked changes in CrCl and proteinuria, terutroban was the only drug that virtually abolished PE hypertension. Rises in cardiorenal inflammatory (tumor necrosis factor alpha, TNFα) and oxidative (isoprostane) markers were mostly and equally eliminated by all therapies in the two sexes, except for a greater dampening action of atrasentan, compared with α-MD, on tissue TNFα in female offspring only. Histopathologically, antenatal terutroban or atrasentan was more effective than α-MD in rectifying cardiac structural damage, myofiber separation, and cytoplasmic alterations, in PE offspring. The repair by antenatal terutroban or atrasentan of cardiovascular and renal anomalies in PE offspring is mostly sex-independent and surpasses the protection offered by α-MD, the conventional PE therapy.
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Affiliation(s)
- Yasser H Habib
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Pharos University in Alexandria, Alexandria, Egypt
| | - Mennatallah A Gowayed
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Pharos University in Alexandria, Alexandria, Egypt
| | - Sherien A Abdelhady
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Pharos University in Alexandria, Alexandria, Egypt
| | - Nevine M El-Deeb
- Department of Clinical Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Inas E Darwish
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Pharos University in Alexandria, Alexandria, Egypt
- Department of Clinical Pharmacology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mahmoud M El-Mas
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt.
- Department of Pharmacology and Toxicology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.
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Penn AA, Wintermark P, Chalak LF, Armstrong J, Redline R, Scher MS, Nelson KB. Placental contribution to neonatal encephalopathy. Semin Fetal Neonatal Med 2021; 26:101276. [PMID: 34420894 DOI: 10.1016/j.siny.2021.101276] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Placental assessment, although currently underused, can inform our understanding of the etiology and timing of Neonatal Encephalopathy (NE). We review our current understanding of the links between placental dysfunction and NE and how this information may inform clinical decisions, now and in the future, emphasizing the four major placental lesions associated with NE. In addition, we discuss maternal and fetal factors that are hypothesized to contribute to specific placental pathologies, especially innate or acquired thrombophilias. We outline the importance of assessing placenta across trimesters and after delivery. As this field continues to evolve, currently available placental histopathological examination methods may need to be combined with advanced prenatal molecular and imaging assessments of placenta and be applied in well-designed studies in large representative populations to better define the links between placental dysfunction and NE.
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Affiliation(s)
- A A Penn
- Division of Neonatology, Department of Pediatrics, Columbia University, New York, NY, USA.
| | - P Wintermark
- Division of Newborn Medicine, Montreal Children's Hospital, Montreal, Canada
| | - L F Chalak
- Neonatal-Perinatal Medicine, Department of Pediatrics, UT Southwestern Medical Center, Dallas, USA
| | - J Armstrong
- Department of Pediatrics (Section of Child Neurology, Neurology, and OB/GYN), University of Colorado Anschutz Medical Campus, Hemophilia and Thrombosis Center, Aurora, CO, USA
| | - R Redline
- Department of Pathology, UH Cleveland Medical Center, Cleveland, OH, USA
| | - M S Scher
- Case Western Reserve University School of Medicine, Department of Pediatrics, Department of Neurology, Rainbow Babies and Children's Hospital/MacDonald Hospital for Women, UH Cleveland Medical Center, Cleveland, OH, USA
| | - K B Nelson
- National Institutes of Health, National Institute of Neurological Diseases and Stroke, Bethesda, MD, USA
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Gong L, Zhao H, Cui Y, Li X. Transcriptome analysis of placentae reveals HELLP syndrome exhibits a greater extent of placental metabolic dysfunction than preeclampsia. Hypertens Pregnancy 2021; 40:134-143. [PMID: 33818250 DOI: 10.1080/10641955.2021.1908348] [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: 12/13/2022]
Abstract
Objective: The association between HELLP syndrome and preeclampsia has been investigated with conflicting conclusions. This study is to investigate the pathogenesis underlying these two diseases by analyzing placental transcriptome.Methods: The gene expression profile downloaded from Gene Expression Omnibus database was analyzed by R language.Results: A total of 573 differentially expressed genes in HELLP syndrome and 358 in preeclampsia were identified, among which 295 were unique to HELLP syndrome. Some metabolism-associated pathways were uniquely enriched in HELLP syndrome.Conclusions: HELLP syndrome exhibits a greater extent of placental metabolic dysfunction than preeclampsia, although these two diseases might share partial pathogenesis.
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Affiliation(s)
- Lili Gong
- Department of Obstetrics, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics, The Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Huanqiang Zhao
- Department of Obstetrics, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics, The Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Yutong Cui
- Department of Obstetrics, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics, The Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Xiaotian Li
- Department of Obstetrics, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Obstetrics, The Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China.,Department of Obstetrics, The Shanghai Key Laboratory of Birth Defects, Shanghai, China.,Department of Obstetrics, Institutes of Biochemical Sciences, Fudan University, Shanghai, China
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15
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Levy M, Gonen N, Kovo M, Schreiber L, Marom O, Barda G, Volpert E, Bar J, Weiner E. Does macroscopic estimation of the extent of placental abruption correlate with pregnancy outcomes? Eur J Obstet Gynecol Reprod Biol 2020; 254:188-194. [PMID: 33007579 DOI: 10.1016/j.ejogrb.2020.09.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION We aimed to study the correlation between the extent of placental abruption (PA), as grossly estimated immediately after delivery, and pregnancy outcomes, in correlation with placental histopathology. MATERIALS AND METHODS Pregnancy and placental reports of all pregnancies complicated by PA (clinically diagnosed) between 11/2008-12/2018 were reviewed. We compared maternal background, pregnancy outcomes, and placental histopathology between cases of PA divided into three groups according to the extent of abruption: Group 1-<30 %, Group 2-30-49 %, and Group 3->50 % of placental surface. Placental lesions were classified according to the current "Amsterdam" criteria. The primary outcome was defined as a composite of severe neonatal morbidity and included ≥ 1 of the following complications: seizures, intraventricular hemorrhage, hypoxic-ischemic encephalopathy, periventricular leukomalacia, blood transfusion, necrotizing enterocolitis, intrauterine fetal demise, or neonatal death. RESULTS A total of 260 PA cases were included: 111 (42.7 %) in Group 1, 94 (36.2 %) in Group 2, and 55 (21.1 %) in Group 3. The rate of the primary outcome (7.2 % vs. 11.7 % vs. 27.3 %, p = 0.02) was associated with the degree of PA as well as maternal heavy smoking (p = 0.04), DIC (p = 0.03), umbilical artery Ph <7.1 (p = 0.02), 5-minute Apgar scores <7 (p = 0.03), NICU admissions, placental maternal vascular malperfusion lesions (p = 0.04), and neonatal weights <5th percentile (0.04). In multivariable analysis severe adverse neonatal outcome was independently associated with the percentage of PA (aOR = 1.4, 95 % CI = 1.3-3.9). CONCLUSION The extent of placental abruption, as estimated by the examiner, correlated with DIC and severe neonatal outcomes and may serve as an early alarming sign in deliveries complicated by PA.
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Affiliation(s)
- Michal Levy
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel; Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Noa Gonen
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel; Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel; Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Letizia Schreiber
- Department of Pathology, The Edith Wolfson Medical Center, Holon, Israel; Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Or Marom
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel; Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Giulia Barda
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel; Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eldar Volpert
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel; Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel; Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Weiner
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel; Affiliated With Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Placental Histopathology and Pregnancy Outcomes in "Early" vs. "Late" Placental Abruption. Reprod Sci 2020; 28:351-360. [PMID: 32809128 DOI: 10.1007/s43032-020-00287-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
Placenta-associated pregnancy complications (fetal growth restriction and preeclampsia) are traditionally classified as "early" and "late" due to their different pathophysiology, histopathology, and pregnancy outcomes. As placental abruption (PA) represents another placenta-associated complication, we aimed to study if this categorization can be applied to PA as well. Pregnancy and placental reports of all pregnancies complicated by PA between November 2008 and January 2019 were reviewed. Maternal background, pregnancy outcomes, and placental histopathology were compared between cases of PA < 34 weeks (early PA group) vs. > 34 weeks (late PA group). Placental lesions were classified according to the "Amsterdam" criteria. The primary outcome was severe neonatal morbidity (≥ 1 severe neonatal complications: seizures, IVH, HIE, PVL, blood transfusion, NEC, or death). Included were 305 cases of PA, 71 (23.3%) in the early group and 234 (76.7%) in the late group. The early PA group was characterized by higher rates of vaginal bleeding upon presentation (p = 0.003), DIC (p = 0.018), and severe neonatal morbidity (p < 0.001). The late PA group was characterized by a higher rate of urgent Cesarean deliveries (p < 0.001). The early PA group was characterized by higher rates of placental maternal vascular malperfusion (MVM) lesions (p < 0.001), maternal inflammatory response (MIR) lesions (p < 0.001), placental hemorrhage (p < 0.001), and a lower feto-placental ratio (p < 0.001). Using regression analysis, we found that severe neonatal morbidity was independently associated with early abruption (aOR = 5.3, 95% CI = 3.9-7.6), placental MVM (aOR = 1.5, 95% CI = 1.2-1.9), placental MIR (aOR = 1.9, 95% CI = 1.4-2.3), and inversely associated with antenatal corticosteroids (aOR = 0.9, 95% CI = 0.6-0.98). "Early" and "late" PA significantly differ in their presentation, placental pathology, and pregnancy outcomes.
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17
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Maternal use of selective serotonin reuptake inhibitors (SSRI) during pregnancy-neonatal outcomes in correlation with placental histopathology. J Perinatol 2020; 40:1017-1024. [PMID: 31988450 DOI: 10.1038/s41372-020-0598-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/08/2020] [Accepted: 01/16/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE We investigated the association between prenatal selective serotonin reuptake inhibitors (SSRI) exposure and pregnancy-outcomes with correlation to placental-histopathology. STUDY DESIGN Included were pregnancies with maternal SSRI use throughout pregnancy (SSRI-group) and the control group was matched with pregnancies unexposed to SSRI. Placental lesions were classified according to the "Amsterdam" criteria. Adverse neonatal outcome was defined as ≥1 early neonatal-complications. RESULTS SSRI group had lower birthweights (p < 0.001), higher rates of meconium (p = 0.009), NICU admissions (p < 0.001), and adverse neonatal-outcome (p < 0.001). SSRI placentas had lower birthweight-to-placental-weight ratio (p = 0.02) and higher rates of fetal vascular malperfusion (FVM) lesions (p = 0.03). Using multivariable analyses: GA < 37 weeks (aOR = 2.1, 95%CI 1.7-4.6) and SSRI (aOR = 1.7, 95%CI 1.3-3.9) were independently associated with adverse neonatal outcome while GA < 37 weeks (aOR = 1.6, 95%CI 1.2-3.4), SSRI (aOR = 1.3, 95%CI 1.1-2.6), and smoking (aOR = 1.2, 95%CI 1.1-4.0) were independently associated with FVM lesions. CONCLUSION SSRI use during pregnancy was independently associated with adverse neonatal outcome and placental FVM.
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Bustan-Nahumson M, Bornstein S, Feldstein O, Levy M, Schreiber L, Bar J, Kovo M, Weiner E. Preeclampsia in Different Maternal Age Groups-Is There an Association with Pregnancy Outcomes and Placental Pathology? Reprod Sci 2020; 27:1879-1887. [PMID: 32562243 DOI: 10.1007/s43032-020-00207-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 04/23/2020] [Indexed: 11/27/2022]
Abstract
We aimed to compare maternal characteristics, pregnancy outcomes, and placental pathology in pregnancies complicated by preeclampsia at three different maternal age groups. Medical records and pathological reports of patients diagnosed with preeclampsia and delivered between 2008 and 2018 in a single tertiary center, were reviewed. Preeclampsia was diagnosed according to the current ACOG guidelines. Study population was divided into 3 groups of maternal age: group 1-< 27 years; group 2-27-35 years; and group 3-> 35 years (advanced maternal age = AMA). Data regarding maternal characteristics, neonatal outcomes, and placental histopathological lesions were compared between the groups. Composite adverse neonatal outcome was defined as ≥ 1 early neonatal complication. The AMA group (n = 145) was associated with a higher BMI, and higher rates of diabetes mellitus (DM), chronic hypertension (CHTN), and Cesarean deliveries compared with group 1 (n = 107) and group 2 (n = 255). The AMA group also had lower neonatal birthweights and a higher rate of composite adverse neonatal outcome compared with the other age groups. None of the placental lesions differed between the groups. By multivariable analysis, we found that maternal age (aOR 1.36, 95% CI 1.17-3.93), GA at delivery (aOR 0.80, 95% CI 0.61-0.90), DM (aOR 1.19, 95% CI 1.07-3.05), and CHTN (aOR 1.23, 95% CI 1.08-2.01) were independently associated with composite adverse neonatal outcome. Pregnancies at AMA were associated with higher complication rates, but without any differences in placental pathology, suggesting that the worse outcomes associated with AMA in preeclampsia are attributed to maternal chronic morbidities and not to differences observed in placental pathology.
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Affiliation(s)
- Mor Bustan-Nahumson
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Sandy Bornstein
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Feldstein
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Levy
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Letizia Schreiber
- Department of Pathology, The Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Weiner
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Levy M, Alberti D, Kovo M, Schreiber L, Volpert E, Koren L, Bar J, Weiner E. Placental pathology in pregnancies complicated by fetal growth restriction: recurrence vs. new onset. Arch Gynecol Obstet 2020; 301:1397-1404. [PMID: 32333099 DOI: 10.1007/s00404-020-05546-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 04/11/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE In an attempt to shed new light on the pathogenesis of fetal growth restriction (FGR), we aimed to study pregnancy characteristics, neonatal outcomes, and placental histopathological lesions of FGR pregnancies in two different subgroups: when developed after appropriate for gestational age (AGA) pregnancy and when developed after previous pregnancy with FGR. STUDY DESIGN Pregnancy and placental reports of all singleton pregnancies complicated by FGR (defined as actual birthweight below the 10th percentile according to local birthweight nomograms) between 2008 and 2018 were reviewed. Included were only cases with previous delivery. Maternal background, neonatal outcomes, and placental histopathology were compared between FGR that occurred after FGR (recurrent FGR group) and FGR that occurred after an AGA pregnancy (FGR after AGA group). Placental lesions were classified according to the current "Amsterdam" criteria. Continuous variables were compared using the Student's t test or the Mann-Whitney test as appropriate. Categorical variables were compared using Chi-square or Fisher's exact test as appropriate. RESULTS A total of 334 FGR cases with a previous delivery were included in the study. Of them, 111 cases constituted the recurrent FGR group and 223 constituted the FGR after AGA group. The recurrent FGR group was characterized by higher rates of maternal diabetes during pregnancy and hypertensive diseases (9% versus 2.7%, p = 0.01 and 19.8% versus 11.6%, p = 0.04). The FGR after AGA group was characterized by a higher rate of fetal vascular malperfusion (FVM) lesions (29.6% versus 18.0%, p = 0.02), and by lower mean birthweight (1842 ± 424.9 versus 1977.4 ± 412.2, p = 0.005), as compared to the recurrent FGR group. CONCLUSION Recurrent FGR was associated with maternal background morbidities during pregnancy which represents a chronic repeated insult, while "new" FGR cases (those followed an AGA pregnancy) were characterized by a higher rate of FVM lesions and lower birthweight which probably represent an "accident" in placentation. These findings may suggest that different mechanisms of placental dysfunction exist in the two subgroups of FGR.
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Affiliation(s)
- Michal Levy
- Departments of Obstetrics and Gynecology, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, The Edith Wolfson Medical Center, PO Box 5, 58100, Holon, Israel.
| | | | - Michal Kovo
- Departments of Obstetrics and Gynecology, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, The Edith Wolfson Medical Center, PO Box 5, 58100, Holon, Israel
| | - Letizia Schreiber
- Department of Pathology, Affiliated with Sackler Faculty of Medicine, Tel Aviv University The Edith Wolfson Medical Center, Holon, Israel
| | - Eldar Volpert
- Departments of Obstetrics and Gynecology, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, The Edith Wolfson Medical Center, PO Box 5, 58100, Holon, Israel
| | - Liron Koren
- Departments of Obstetrics and Gynecology, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, The Edith Wolfson Medical Center, PO Box 5, 58100, Holon, Israel
| | - Jacob Bar
- Departments of Obstetrics and Gynecology, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, The Edith Wolfson Medical Center, PO Box 5, 58100, Holon, Israel
| | - Eran Weiner
- Departments of Obstetrics and Gynecology, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, The Edith Wolfson Medical Center, PO Box 5, 58100, Holon, Israel
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Stojanovska V, Zenclussen AC. Innate and Adaptive Immune Responses in HELLP Syndrome. Front Immunol 2020; 11:667. [PMID: 32351511 PMCID: PMC7174768 DOI: 10.3389/fimmu.2020.00667] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/24/2020] [Indexed: 12/11/2022] Open
Abstract
Innate and adaptive immune involvement in hemolysis, elevated liver enzymes and low platelet (HELLP) syndrome is an understudied field, although it is of high clinical importance. This syndrome implies a risk of serious morbidity and mortality to both the mother and the fetus during pregnancy. It was proposed that HELLP syndrome occurs in a circulatory inflammatory milieu, that might in turn participate in a complex interplay between the secreted inflammatory immunomodulators and immune cell surface receptors. Meanwhile, reported immune cell attenuation during HELLP may consequently lead to a prolonged immunoactivation and tissue damage. In this regard, learning more about the immune components of this syndrome should widen the understanding of the HELLP pathophysiology and eventually enable development of novel immune-based therapeutics. This review aims to summarize and discuss the recent and previous findings of the innate and adaptive immune responses during HELLP in order to update the current knowledge of the immune involvement in HELLP pathogenesis.
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Affiliation(s)
- Violeta Stojanovska
- Experimental Obstetrics and Gynecology, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Ana Claudia Zenclussen
- Experimental Obstetrics and Gynecology, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany
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Tamayev L, Schreiber L, Marciano A, Bar J, Kovo M. Are there gender-specific differences in pregnancy outcome and placental abnormalities of pregnancies complicated with small for gestational age? Arch Gynecol Obstet 2020; 301:1147-1151. [PMID: 32239281 DOI: 10.1007/s00404-020-05514-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/12/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Adaptations to pathological intrauterine environment might differ in relation to fetal gender. We aimed to study sex-specific differences in placental pathology of pregnancies complicated by small for gestational age (SGA). METHODS The medical records and placental histology reports of all neonates with a birth-weight ≤ 10th percentile, born between 24 and 42 weeks of gestation, during 2010-2018, were reviewed. Composite neonatal outcome was defined as one or more of early following complications: neonatal sepsis, blood transfusion, phototherapy, respiratory morbidity, cerebral morbidity, necrotizing enterocolitis, or death. Results were compared between the male and female groups of neonates. Placental lesions were classified into maternal and fetal vascular malperfusion (MVM and FVM) lesions, maternal and fetal inflammatory responses (MIR and FIR), and villitis of unknown etiology (VUE). RESULTS The male SGA group (n = 380) and the female SGA group (n = 363) did not differ in regard to maternal age, BMI, smoking, associated pregnancy complications, gestational age, and mode of delivery. Neonates in the SGA male group had increased birth-weight and increased respiratory morbidity as compared to the female SGA group (p = 0.007, p = 0.005, respectively). There was no between-group differences in the rate of placental lesions. By multivariate logistic regression analysis, male gender (aOR 1.55, 95% CI 1.05-2.30, p = 0.025), FIR (aOR 4.83, 95% CI 1.07-13.66, p = 0.003), and VUE (aOR 1.89, 95% CI 1.03-3.47, p = 0.04), were found to be independently associated with adverse composite neonatal outcome. DISCUSSION Male gender as well as placental FIR and VUE are independently associated with adverse neonatal outcome in SGA neonates.
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Affiliation(s)
- Liliya Tamayev
- Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 5, 58100, Holon, Israel.
| | - Letizia Schreiber
- Departments of Pathology, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Adi Marciano
- Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 5, 58100, Holon, Israel
| | - Jacob Bar
- Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 5, 58100, Holon, Israel
| | - Michal Kovo
- Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, P.O. Box 5, 58100, Holon, Israel
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Histologic chorioamnionitis concomitant placental abruption and its effects on pregnancy outcome. Placenta 2020; 94:39-43. [PMID: 32421533 DOI: 10.1016/j.placenta.2020.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Two possible causative pathways have been suggested to participate in the development of placental abruption (PA), an acute inflammatory pathway and placental vascular derived, a chronic pathway. We aimed to study the impact of the inflammatory pathway on maternal and neonatal outcome. METHODS The computerized medical files and placental reports of all pregnancies diagnosed with PA, between 11/2008-1/2019, at 24-42 weeks, were reviewed. Placental lesions were classified according to "Amsterdam" criteria into maternal and fetal vascular malperfusion lesions, acute inflammatory responses and chronic villitis. Composite neonatal morbidity included ≥1 of the following: seizures, intra-ventricular hemorrhage (IVH), hypoxic-ischemic encephalopathy, periventricular leukomalacia (PVL), blood transfusion, necrotizing enterocolitis (NEC), neonatal sepsis, respiratory distress syndrome, or neonatal death. Maternal and neonatal outcome were compared between PA with and without histologic chorioamnionitis (HC). RESULTS As compared to the PA without HC group (n = 267), the PA with HC group (n = 77) was characterized by lower gestational age (GA) at delivery (32.9 ± 5.5 vs. 35.6 ± 4.1 weeks, p < 0.001), higher rates of oligohydramnios (p < 0.001), bloody amniotic fluid at labor (p < 0.001), maternal postpartum fever (p < 0.001), longer maternal hospitalization (<0.001), and increased composite adverse neonatal morbidity (41.6% vs. 22.8%, p = 0.002). By multivariate analysis, GA and HC were found to be independently associated with adverse neonatal outcome, aOR 0.63 95% CI 0.43-0.78, p < 0.001, and aOR1.12, 95% CI 1.02-3.87, p = 0.04, respectively. DISCUSSION The involvement of the inflammatory causative pathway in the development of placental abruption, is associated with increased maternal and neonatal morbidity.
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Grinstein E, Schreiber L, Gluck O, Torem M, Izaik Y, Bar J, Kovo M. Placental abnormalities differ in small for gestational age neonates in relation to their prenatal sonographic abdominal circumference measurements. J Matern Fetal Neonatal Med 2020; 35:759-764. [PMID: 32106737 DOI: 10.1080/14767058.2020.1731463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Antenatal detection of abdominal circumference (AC) <10th percentile, among small for gestational age (SGA) neonates, probably reflects the severity of their growth restriction. We aimed to study neonatal outcome and placental pathology among SGA neonates in correlation to their AC measurements.Methods: Maternal and neonatal computerized medical records and placental histopathology reports of all SGA neonates, (neonatal birth-weight ≤10th percentile), born between 24 and 42 weeks, during 2015-2018 were reviewed. Included cases with fetal biometric measurements conducted up to 7 days prior labor. Results were compared between cases with sonographic antenatal AC <10th percentile and neonates with sonographic antenatal AC ≥10th percentile. Placental lesions were classified according to "Amsterdam" Placental workshop criteria.Results: The AC <10th percentile group (n = 148) was characterized by higher rate of nulliparity (p = .003), and induction of labor (p = .009), as compared to the AC ≥10th percentile group (n = 41). There were no between groups differences in the rate of maternal BMI (kg/m2), hypertensive disorders, diabetes or smoking. Neonatal hypoglycemia was more common in the AC <10th percentile group as compared to the AC ≥10th percentile group (p = .04). Placentas from the AC <10th percentile group were smaller (p < .001), with more MVM lesions (p = .02) and chronic villitis (p = .04). By multivariate regression analysis, AC <10th percentile and maternal hypertensive disorders, were found to be independently associated with placental MVM lesions, aOR = 2.43 (95% CI 1.04, 5.88) and aOR = 3.15 (95% CI 1.06, 9.31), respectively.Conclusions: Higher rate of placental maternal malperfusion lesions, chronic villitis, and more neonatal hypoglycemia characterize SGA neonates with AC <10th percentile, pointing to the importance of AC measurement as an indicator for placental insufficiency.
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Affiliation(s)
- Ehud Grinstein
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Letizia Schreiber
- Department of Pathology, Edith Wolfson Medical Center, Holon, Israel; Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Gluck
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maya Torem
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yakira Izaik
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Weiner E, Feldstein O, Schreiber L, Grinstein E, Barber E, Dekalo A, Mizrachi Y, Bar J, Kovo M. None, One, or Both Placentas Involved with Malperfusion Lesions in Twin Pregnancies Complicated by Preeclampsia-Does It Matter? Reprod Sci 2020; 27:845-852. [PMID: 32046401 DOI: 10.1007/s43032-019-00087-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/18/2019] [Indexed: 10/25/2022]
Abstract
We aimed to study the association between the number of placentas with vascular malperfusion lesions in dichorionic twin pregnancies complicated by preeclampsia and the severity of the disease and pregnancy outcomes. Dichorionic twin pregnancies with preeclampsia (n = 125), from January 2007-June 2018, were reviewed. Affected placenta was defined as the presence of maternal/fetal vascular malperfusion lesions. Maternal demographics, pregnancy characteristics, and neonatal outcomes were compared between three groups: no pathological placentas, one pathological placenta, and two pathological placentas. Composite adverse neonatal outcome was defined as ≥ 1 early neonatal complication. Regression analysis models were used to recognize independent associations with the number of involved placentas. The two pathological placenta group (n = 57 pregnancies), the one pathological placenta group (n = 40 pregnancies), and the no pathological placenta group (n = 28 pregnancies) differed in terms of gestational age (GA) at delivery (p < 0.001, p = 0.008) and the rates of severe features (p = 0.028, p = 0.047). Neonates born to the two pathological placenta group (n = 114), the one pathological placenta group (n = 80), and the no pathological placenta group (n = 56) were characterized by lower birth weights (p < 0.001, p = 0.031), higher rates of small for gestational age (SGA) (p = 0.017, p = 0.748), neonatal intensive care unit admission (p = 0.004, p = 0.013), and composite adverse neonatal outcome (p < 0.001, p = 0.025). By regression analyses, the presence of two pathological placentas was found to be independently associated with severe features (aOR = 5.1), GA at delivery < 32 weeks (aOR = 2.0), SGA (aOR = 2.5), and composite adverse neonatal outcome (aOR = 2.7). In dichorionic twin pregnancies, there is an association between the presences of placental vascular malperfusion lesions in none, one, or both placentas and the development of early and severe preeclampsia, as well as with SGA and adverse neonatal outcome.
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Affiliation(s)
- Eran Weiner
- Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 58100, Holon, Tel Aviv, Israel.
| | - Ohad Feldstein
- Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 58100, Holon, Tel Aviv, Israel
| | - Letizia Schreiber
- Department of Pathology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 58100, Holon, Tel Aviv, Israel
| | - Ehud Grinstein
- Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 58100, Holon, Tel Aviv, Israel
| | - Elad Barber
- Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 58100, Holon, Tel Aviv, Israel
| | - Ann Dekalo
- Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 58100, Holon, Tel Aviv, Israel
| | - Yossi Mizrachi
- Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 58100, Holon, Tel Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 58100, Holon, Tel Aviv, Israel
| | - Michal Kovo
- Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 58100, Holon, Tel Aviv, Israel
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The association between isolated oligohydramnios at term and placental pathology in correlation with pregnancy outcomes. Placenta 2019; 90:37-41. [PMID: 32056549 DOI: 10.1016/j.placenta.2019.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/22/2019] [Accepted: 12/03/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Isolated term oligohydramnios (ITO) is an obstetrical complication of which the etiology, management, and clinical importance are controversial. In attempt to deepen our understanding, we aimed to study placental pathology and pregnancy outcomes in pregnancies complicated by ITO. MATERIALS AND METHODS - Maternal demographics, neonatal outcomes, and placental histopathology reports of all pregnancies complicated by ITO at 370/7 to 410/7 weeks were reviewed. Excluded were cases complicated by hypertensive disorders, intrauterine fetal growth restriction, placental abruption, and deliveries of undiagnosed small for gestational age neonates. Results were compared between the ITO group and a control group matched for gestational age and mode of delivery. Placental lesions were classified according to the current "Amsterdam" criteria. Composite adverse neonatal outcome was defined as one or more of the following early complications: neonatal intensive care unit admission, sepsis, blood transfusion, phototherapy, respiratory morbidity, cerebral morbidity, necrotizing enterocolitis, or death. RESULTS The study group included 108 patients with ITO that were compared to matched controls. Placentas from the ITO group were characterized by higher rates of placental weights <10th centile (p < 0.001), abnormal cord insertion (p < 0.001), and maternal vascular malperfusion (MVM) lesions (p < 0.001). Neonates from the ITO group had lower birth weights (p < 0.002), and worse composite adverse neonatal outcome (p = 0.028) compared to controls. CONCLUSION - The current study demonstrates higher rates of placental MVM lesions, and worse neonatal outcome in pregnancies complicated by ITO. These novel findings suggest that ITO should be seen as part of the "placental insufficiency" spectrum.
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Trottmann F, Baumann M, Amylidi-Mohr S, Surbek D, Risch L, Mosimann B, Raio L. Angiogenic profiling in HELLP syndrome cases with or without hypertension and proteinuria. Eur J Obstet Gynecol Reprod Biol 2019; 243:93-96. [PMID: 31678761 DOI: 10.1016/j.ejogrb.2019.10.021] [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] [Received: 06/12/2019] [Revised: 10/14/2019] [Accepted: 10/17/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Angiogenic profiling with the use of sFlt-1/PlGF ratio (soluble fms-like tyrosine kinase-1/placental growth factor) can be helpful to characterize women with signs of impending preeclampsia (PE). However, little is known about the angiogenic profile of pregnancies complicated by HELLP syndrome. The aim of this study was to examine the relationship of angiogenic profiles in cases of HELLP syndrome with and without classical signs of preeclampsia. STUDY DESIGN The angiogenic profile of pregnant women with singleton gestation and isolated PE (group 1), PE associated with HELLP syndrome (group 2), and isolated HELLP syndrome (group 3) from 01/2011 to 03/2018, were compared. To overcome gestational age dependent angiogenic behavior, cases (group 3) were matched 1:2 with cases from group 1 and 2. Matching criteria was gestational age (±1 week). PE and HELLP syndrome were defined according to the international Society for the Study of Hypertension in Pregnancy (ISSHP) statement 2014. RESULTS During the observational period, 244 women could be included in the study. Of those, 237 (97.1%) were diagnosed with PE. In 42 cases (17.2%) PE was associated with HELLP syndrome while 7 (2.9%) patients were diagnosed with isolated HELLP syndrome. Angiogenic profiles in terms of sFlt-1/PlGF ratios differed significantly between the three groups, showing highest levels in group 2 (PE/HELLP) while cases with isolated HELLP demonstrated the lowest ratios and sFlt-1 values (p = 0.01). CONCLUSION We conclude that isolated HELLP syndrome is rare and seems to be a particular entity expressing a different angiogenic behaviour compared to classical PE or PE associated with HELLP syndrome.
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Affiliation(s)
- Fabienne Trottmann
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Marc Baumann
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Sofia Amylidi-Mohr
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Daniel Surbek
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Lorenz Risch
- Division of Clinical Chemistry, Labormedizinisches Zentrum Dr. Risch, Bern, Switzerland
| | - Beatrice Mosimann
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Luigi Raio
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
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Amniotic fluid transitioning from clear to meconium stained during labor-prevalence and association with adverse maternal and neonatal outcomes. J Perinatol 2019; 39:1349-1355. [PMID: 31320720 DOI: 10.1038/s41372-019-0436-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/11/2019] [Accepted: 05/28/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this study is to compare pregnancy outcomes in deliveries complicated by primary meconium-stained amniotic fluid (MSAF, present at membrane rupture) and secondary MSAF (transitioned from clear to MSAF during labor). METHODS The medical records and neonatal charts of all deliveries ≥ 370/7 weeks between October 2008 and July 2018 were reviewed. The primary outcome was composite adverse neonatal outcome that included early neonatal complications. RESULTS Of 30,215 deliveries during the study period, 4302 (14.2 %) were included: 3845 (89.4%) in the primary MSAF group and 457 (10.6%) in the secondary MSAF group. The rate of the primary outcome was higher in the secondary MSAF group (p = 0.006). This association remained significant after controlling for background confounders. The secondary MSAF group had higher rate of cesarean deliveries (CDs) and assisted vaginal deliveries. There was a higher rate of composite adverse neonatal outcome when secondary MSAF was diagnosed < 3 vs. >3 h before delivery (p = 0.004). CONCLUSION Secondary MSAF was associated with higher rates of adverse neonatal outcome, CDs, and assisted vaginal deliveries, compared with primary MSAF.
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Levy M, Kovo M, Schreiber L, Kleiner I, Koren L, Barda G, Volpert E, Bar J, Weiner E. Pregnancy outcomes in correlation with placental histopathology in subsequent pregnancies complicated by preeclampsia. Pregnancy Hypertens 2019; 18:163-168. [DOI: 10.1016/j.preghy.2019.09.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 08/19/2019] [Accepted: 09/28/2019] [Indexed: 02/06/2023]
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Feldstein O, Kovo M, Tal O, Braunstein M, Grinstein E, Schreiber L, Bar J, Weiner E. The association between abnormal coagulation testing in preeclampsia, adverse pregnancy outcomes, and placental histopathology. Hypertens Pregnancy 2019; 38:176-183. [DOI: 10.1080/10641955.2019.1638396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Ohad Feldstein
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel
| | - Michal Kovo
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel
| | - Ori Tal
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel
| | - Michal Braunstein
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel
| | - Ehud Grinstein
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel
| | - Letizia Schreiber
- Departments of Pathology, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel
| | - Eran Weiner
- Departments of Obstetrics & Gynecology, the Edith Wolfson Medical Center, Holon, Israel
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Gluck O, Kovo M, Tairy D, Barda G, Bar J, Weiner E. Bloody amniotic fluid during labor - Prevalence, and association with placental abruption, neonatal morbidity, and adverse pregnancy outcomes. Eur J Obstet Gynecol Reprod Biol 2019; 234:103-107. [PMID: 30682598 DOI: 10.1016/j.ejogrb.2019.01.011] [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: 11/06/2018] [Revised: 01/04/2019] [Accepted: 01/08/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To study the association between bloody amniotic fluid (BAF) during labor and adverse pregnancy outcomes. STUDY DESIGN In the last 10 years we have implemented an institutional protocol that mandates obstetricians/midwives to report their subjective impression of the color of amniotic fluid (clear, meconium stained, bloody) during labor. The medical records, and neonatal charts of all singleton deliveries ≥ 370/7 weeks between 2008-2018 were reviewed. The cohort was divided into two groups: clear AF (Clear group) and BAF (BAF group). Cases with meconium stained AF were excluded. The primary outcome was a composite of the following complications: umbilical Ph ≤ 7.1, seizures, hypoxic-ischemic encephalopathy, intra-ventricular hemorrhage, periventricular leukomalacia, hypoglycemia, hypothermia, mechanical ventilation, meconium aspiration syndrome, RDS, NEC, phototherapy, sepsis, or transfusion. RESULTS Overall, 21,300 deliveries were reviewed, 20,983 (98.5%) in the Clear group and 317 (1.5%) in the BAF group. The rate of the primary outcome did not differ between the BAF (2.2%) and the Clear (2.1%) groups. The rate of placental abruption (both clinically and hystopathologically) did not differ between the groups (3.2% vs. 1.9% and 1.6% vs. 0.6%, respectively). BAF was associated with higher rates of labor induction (p = 0.002), assisted vaginal deliveries (p = 0.04), cesarean deliveries (p = 0.03), and lower birth weights (p = 0.03). CONCLUSION BAF observed in labor was not associated with composite adverse neonatal outcome, nor with placental abruption. BAF was associated with higher rates of labor induction, assisted vaginal deliveries, cesarean deliveries, and lower birth weights. These findings may assist obstetricians and neonatologists in the interpretation of BAF observed in labor.
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Affiliation(s)
- Ohad Gluck
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Tairy
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Giulia Barda
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Weiner
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Farladansky-Gershnabel S, Gal H, Kidron D, Krizhanovsky V, Amiel A, Sukenik-Halevy R, Biron-Shental T. Telomere Homeostasis and Senescence Markers Are Differently Expressed in Placentas From Pregnancies With Early- Versus Late-Onset Preeclampsia. Reprod Sci 2018; 26:1203-1209. [PMID: 30474505 DOI: 10.1177/1933719118811644] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Early-onset preeclampsia (EOPE; <34 weeks' gestation) usually has more severe morbidity for the mother and fetus compared to late-onset preeclampsia (LOPE). Telomere homeostasis is disrupted in preeclampsia (PE) and senescence markers are increased. The pathophysiologic differences between early and LOPE are not fully unraveled yet. METHODS We studied placental biopsies from 7 pregnancies with EOPE, 6 pregnancies with LOPE, and 13 healthy gestational age-matched controls. Telomere length and aggregate formation were assessed using qualitative fluorescence in situ hybridization and electronic quantitative methods. Senescence markers were evaluated including senescence-associated heterochromatin foci, β-galactosidase (SAβ-Gal), and P16 staining, as was the expression of P16 complementary DNA (cDNA) using real-time quantitative polymerase chain reaction (RT-qPCR). RESULTS There were no differences in maternal age, gravidity, parity, body mass index, and mode of conception between the study and the control groups. The percentage of trophoblasts with short telomeres was higher in placental samples from EOPE (52.61% [12.27%]) versus LOPE (28.72% [10.14%]); both were higher compared to controls (7.53% [5.14%], P = .03). Aggregate formation was enhanced in EOPE (8.72% [2.49%]) compared to LOPE (4.54% [1.45%]); both were higher than in healthy controls (2.72% [1.08%], P = .03). Trophoblasts from EOPE versus LOPE were more likely to stain positive for SAβ-Gal and P16 compared to controls (P < .001). P16 cDNA expression assayed by RT-qPCR was 7.51 times higher in EOPE compared to controls and 5.86 times higher than in LOPE. CONCLUSIONS Impaired telomere homeostasis and senescence markers are more prominent in EOPE versus LOPE. These findings may contribute to our understanding of the pathophysiology and explain their different clinical presentations and outcomes.
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Affiliation(s)
- Sivan Farladansky-Gershnabel
- 1 Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,2 Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hilah Gal
- 3 Department of Molecular Cell Biology, The Weizmann Institute of Science, Rehovot, Israel
| | - Debora Kidron
- 2 Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,4 Department of Pathology, Meir Medical Center, Kfar Saba, Israel
| | - Valery Krizhanovsky
- 3 Department of Molecular Cell Biology, The Weizmann Institute of Science, Rehovot, Israel
| | - Aliza Amiel
- 5 Genetics Institute, Meir Medical Center, Kfar Saba, Israel
| | - Rivka Sukenik-Halevy
- 1 Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,2 Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,5 Genetics Institute, Meir Medical Center, Kfar Saba, Israel
| | - Tal Biron-Shental
- 1 Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,2 Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Aviram A, Sherman C, Kingdom J, Zaltz A, Barrett J, Melamed N. Defining early vs late fetal growth restriction by placental pathology. Acta Obstet Gynecol Scand 2018; 98:365-373. [PMID: 30372519 DOI: 10.1111/aogs.13499] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 10/21/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Although early and late fetal growth restriction have been suggested to be distinct entities, the optimal gestational age cut-off that differentiates the two conditions is currently unclear and has been arbitrarily set in previous studies between 32 and 37 weeks. We aimed to use placental pathology findings to determine that optimal gestational age cut-off between early and late fetal growth restriction. MATERIAL AND METHODS A retrospective cohort study of all women with singleton gestation who gave birth to a neonate diagnosed as small-for-gestational age (small-for-gestational age, defined as birthweight <10th percentile for gestational age) at a tertiary referral center between January 2001 and December 2015, and for whom placental pathology was available. Placental abnormalities were classified into lesions associated with maternal vascular malperfusion (MVM), fetal vascular malperfusion, placental hemorrhage and chronic villitis. Placental findings were analyzed as a function of gestational age at birth. The analysis was repeated in the subgroups of women without hypertensive complications of pregnancy (to reflect changes associated with isolated small-for-gestational age) and of neonates with severe small-for-gestational age (defined as birthweight <5th percentile), which are more likely to represent true fetal growth restriction. RESULTS A total of 895 women met the inclusion criteria. The only histological finding that changed with gestational age was MVM pathology, which decreased in frequency with increasing gestational age. We identified a considerable drop in the rate of MVM lesions at 33 weeks of gestation. The rate of MVM pathology in placentas of infants born before 330/7 weeks was significantly higher than that observed in placentas of infants born at 330/7 weeks or longer: 71.6% vs 27.4%, P < 0.001 for ≥2 MVM lesions, and 35.5% vs 3.5%, P < 0.001 for ≥3 MVM lesions. These findings persisted in the subgroups of women without hypertensive complications of pregnancy (n = 662) and of neonates with severe small-for-gestational age (n = 464). CONCLUSIONS Using placental pathology as a direct measure of the mechanisms underlying fetal growth restriction, the optimal gestational age at birth cut-off which differentiates early from late fetal growth restriction appears to be 330/7 weeks.
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Affiliation(s)
- Amir Aviram
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Christopher Sherman
- Division of Anatomic Pathology, Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Center , University of Toronto, Toronto, Ontario, Canada
| | - John Kingdom
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Arthur Zaltz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Jon Barrett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Nir Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
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The role of placental malperfusion in the pathogenesis of preeclampsia in dichorionic twin and singleton pregnancies. Placenta 2018; 70:41-49. [PMID: 30316326 DOI: 10.1016/j.placenta.2018.09.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 08/10/2018] [Accepted: 09/05/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION In singletons, the pathogenesis of hypertensive disorders of pregnancy (HDP) is attributed to abnormal placentation, characterized by maternal vascular malperfusion (MVM) lesions. Whether MVM plays a similar role in twin pregnancies is unclear. The purpose of the study was to compared placental pathology findings between dichorionic-twin and singleton pregnancies complicated by HDP. METHODS Retrospective cohort study of women with dichorionic-twin or singleton pregnancies complicated by HDP who gave birth in a single tertiary center between 2001 and 2015. Placental abnormalities were classified into lesions associated with MVM, fetal vascular malperfusion, placental hemorrhage and chronic villitis. Placental findings and neonatal outcomes were compared between twin and singleton pregnancies. RESULTS A total of 144 women with twins and 768 women with a singleton pregnancy met the inclusion criteria. Compared with HDP singletons, twins with HDP had higher mean birth weights, were less likely to be small for gestational age and be born at <34 and at <32 weeks. Twins had lower odds for placental weight below <10th percentile (aOR 0.49, 95%CI 0.33-0.71), for MVM pathology (aOR 0.28, 95%CI 0.20-0.39) and for fetal vascular malperfusion pathology (aOR 0.65, 95%CI 0.45-0.93). These finding remained significant in the subpopulation of early onset HDP (<34 weeks) and small for gestational newborn. DISCUSSION Our findings support the hypothesis that MVM are less relevant to the pathogenesis of HDP in twin pregnancies and suggest that other placental or non-placental factors are responsible for the increased risk of HDP in twin pregnancies.
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Ernst LM. Maternal vascular malperfusion of the placental bed. APMIS 2018; 126:551-560. [DOI: 10.1111/apm.12833] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/28/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Linda M. Ernst
- Department of Pathology and Laboratory Medicine; NorthShore University HealthSystem; Evanston Hospital; Evanston IL USA
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Weiner E, Feldstein O, Tamayev L, Grinstein E, Barber E, Bar J, Schreiber L, Kovo M. Placental histopathological lesions in correlation with neonatal outcome in preeclampsia with and without severe features. Pregnancy Hypertens 2018; 12:6-10. [PMID: 29674201 DOI: 10.1016/j.preghy.2018.02.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 01/19/2018] [Accepted: 02/06/2018] [Indexed: 12/09/2022]
Abstract
OBJECTIVE We aimed to compare pregnancy outcome and placental histopathology in women with preeclampsia (PE) with and without severe features. METHODS The medical records and placental pathology reports of all pregnancies complicated by PE during 2008-2016, were reviewed. Results were compared between those with and without severe features (severe PE vs. mild PE groups), according to current ACOG guidelines. Placental lesions were classified to maternal/fetal vascular supply lesions, and maternal/fetal inflammatory responses. Small for gestational age (SGA) was defined as neonatal birth-weight ≤10th%. Composite adverse neonatal outcome was defined as one or more of the following: sepsis, transfusion, phototherapy, respiratory morbidity, cerebral morbidity, NEC, or death. RESULTS The severe PE group (n = 284) was characterized by lower gestational age at delivery (p < 0.001), and higher rates of antenatal corticosteroid use (p = 0.003), and cesarean deliveries (p < 0.001) as compared to the mild PE group (n = 151). More placentas <10th% and more composite maternal vascular malperfusion (MVM) lesions were observed in the severe PE group as compared to the mild PE group (p < 0.001 for both). In multivariate analysis, composite placental MVM lesions were independently associated with severe PE (aOR = 1.75, 95%CI 1.4-4.9). Higher rates of SGA (p = 0.016), and composite adverse neonatal outcome (p = 0.002) characterized the severe PE group. In multivariate analysis, adverse neonatal outcome was independently associated with gestational age (aOR = 0.54, 95%CI 0.49-0.68), SGA (aOR = 1.75, 95%CI = 1.15-3.59), severe PE (aOR = 1.8, 95%CI = 1.13-3.54) and placental MVM lesions (aOR = 2.13, 95%CI = 1.05-4.39). CONCLUSION More pronounced placental pathology and higher rate of adverse neonatal outcome characterize preeclampsia with severe features as compared with the milder form of the disease.
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Affiliation(s)
- Eran Weiner
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ohad Feldstein
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liliya Tamayev
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Grinstein
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Barber
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Letizia Schreiber
- Department of Pathology, The Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Weiner E, Barber E, Feldstein O, Schreiber L, Dekalo A, Mizrachi Y, Bar J, Kovo M. The placental component and neonatal outcome in singleton vs. twin pregnancies complicated by gestational diabetes mellitus. Placenta 2018; 63:39-44. [PMID: 29486855 DOI: 10.1016/j.placenta.2018.01.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 01/18/2018] [Accepted: 01/23/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE We aimed to compare placental histopathological lesions and neonatal outcome in singleton vs. twin pregnancies complicated by gestational diabetes mellitus (GDM). METHODS Maternal characteristics, neonatal outcomes, and placental histopathology reports of pregnancies complicated by GDM, between 1/2008-10/2016, were reviewed. Results were compared between singletons (singleton group) and dichorionic-diamniotic twins (twin group). Placental lesions were classified as placental weight abnormalities, maternal and fetal vascular malperfusion lesions (MVM, FVM), inflammatory lesions, and lesions associated with chronic villitis. LGA was defined as birth-weight ≥90th percentile. Composite adverse neonatal outcome was defined as one or more early neonatal complications. RESULTS Compared with the twin group (n = 57), the singleton group (n = 228) was characterized by higher gestational-age (38.6 ± 0.9 vs. 35.1 ± 1.8 weeks, p < 0.001) and a higher rate of insulin treatment (32.9% vs. 17.5%, p = 0.023). Placentas from the singleton group were characterized by higher rates of MVM lesions (54.4% vs. 30.7%, p < 0.001), villitis of unknown etiology (VUE, 5.7% vs. 0.9%, p = 0.040), villous immaturity (10.1% vs. 0.9%, p = 0.001), and placental weight <10th percentile (16.7% vs. 8.8%, respectively, p = 0.049). Using multivariable regression analysis, MVM (aOR = 2.2, 95% CI = 1.6-4.1), VUE (aOR = 1.2, 95% CI = 1.1-2.1), villous immaturity (aOR = 2.3, 95% CI 1.8-7.6), and placental weight <10th percentile (aOR = 1.1, 95% CI = 1.02-1.6), were the only lesions associated with singleton pregnancies. Composite adverse neonatal outcome was more common in the twin group (54.3% vs. 14.0%, p < 0.001) and it was associated only with lower GA (aOR = 3.7, 95% CI 2.1-7.3). CONCLUSION Higher rate of placental weight <10th percentile, MVM lesions, villous immaturity, and VUE characterize GDM singleton pregnancy as compared to twins GDM gestation, suggesting different placental alterations in the diabetic environment.
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Affiliation(s)
- Eran Weiner
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Elad Barber
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Feldstein
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Letizia Schreiber
- Department of Pathology, The Edith Wolfson Medical Center, Holon, Israel Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ann Dekalo
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Mizrachi
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Department of Obstetrics & Gynecology, The Edith Wolfson Medical Center, Holon, Israel Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Héneau A, Guimiot F, Mohamed D, Rideau Batista Novais A, Alberti C, Baud O. Placental Findings and Effect of Prophylactic Hydrocortisone in Extremely Preterm Infants. Pediatrics 2018; 141:peds.2017-1788. [PMID: 29348196 DOI: 10.1542/peds.2017-1788] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To investigate the relationship between histologic findings of the placenta and response to early postnatal hydrocortisone treatment used to prevent bronchopulmonary dysplasia (BPD) in extremely preterm infants. METHODS In an exploratory analysis of the Early Low-Dose Hydrocortisone to Improve Survival Without Bronchopulmonary Dysplasia in Extremely Preterm Infants (PREMILOC) trial, detailed placental analyses were performed on the basis of standardized macroscopic and histologic examinations. Placental histology, categorized into 3 groups, was correlated to neonatal outcomes and response to hydrocortisone treatment. RESULTS Of 523 randomly assigned patients, 457 placentas were analyzed. In total, 125 out of 457 (27%) placentas were classified as normal, 236 out of 457 (52%) placentas were classified as inflammatory, and 96 out of 457 (21%) placentas were classified as vascular. Placental inflammation was associated with a significant, increased rate of BPD-free survival at 36 weeks' postmenstrual age, independent of gestational age, treatment group, and sex (adjusted odds ratio: 1.72, 95% confidence interval [CI]: 1.05 to 2.82, P = .03). Regarding the response to treatment, the strongest benefit of hydrocortisone compared with placebo was found in infants born after placental vascular disease, with significantly more patients extubated at day 10 (risk difference: 0.32, 95% CI: 0.08 to 0.56, P = .004) and similar positive direction on survival without BPD (risk difference: 0.23, 95% CI: 0.00 to 0.46, P = .06). Adjusted to gestational age and treatment groups, placental inflammation was associated with significantly fewer patent ductus arteriosus ligation (adjusted hazard ratio: 0.58, 95% CI: 0.36 to 0.95, P = .03). Placental histology was not found to be associated with other adverse events related to preterm birth. CONCLUSIONS With these findings, we confirm that early low-dose hydrocortisone confers benefits in extremely preterm infants overall and we suggest there is a higher treatment effect in those born after placental vascular disease.
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Affiliation(s)
| | | | - Damir Mohamed
- Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Robert Debré and University Paris Diderot, Sorbonne Paris-Cité, Paris, France.,Inserm U1123 and Centre d'Investigation Clinique-Épidémiologie Clinique 1426, Paris, France; and
| | | | - Corinne Alberti
- Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Robert Debré and University Paris Diderot, Sorbonne Paris-Cité, Paris, France.,Inserm U1123 and Centre d'Investigation Clinique-Épidémiologie Clinique 1426, Paris, France; and
| | - Olivier Baud
- NICU, .,Division of Neonatology and PICU, University Hospitals Geneva, Geneva, Switzerland
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Can Placental Histopathology Lesions Predict Recurrence of Small for Gestational Age Neonates? Reprod Sci 2018; 25:1485-1491. [DOI: 10.1177/1933719117749757] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Gluck O, Schreiber L, Marciano A, Mizrachi Y, Bar J, Kovo M. Pregnancy outcome and placental pathology in small for gestational age neonates in relation to the severity of their growth restriction. J Matern Fetal Neonatal Med 2017; 32:1468-1473. [DOI: 10.1080/14767058.2017.1408070] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ohad Gluck
- Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Letizia Schreiber
- Department of Pathology, E. Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Marciano
- Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Mizrachi
- Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Impairment of BKca channels in human placental chorionic plate arteries is potentially relevant to the development of preeclampsia. Hypertens Res 2017; 41:126-134. [DOI: 10.1038/hr.2017.99] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 06/05/2017] [Accepted: 07/18/2017] [Indexed: 01/02/2023]
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Weiner E, Barber E, Feldstein O, Dekalo A, Schreiber L, Bar J, Kovo M. Placental Histopathology Differences and Neonatal Outcome in Dichorionic-Diamniotic as Compared to Monochorionic-Diamniotic Twin Pregnancies. Reprod Sci 2017; 25:1067-1072. [PMID: 28969512 DOI: 10.1177/1933719117732163] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE We aimed to compare the differences in placental histopathology lesions and pregnancy outcome in dichorionic-diamniotic (DCDA) versus uncomplicated monochorionic-diamniotic (MCDA) twin gestations. STUDY DESIGN Maternal characteristics, neonatal outcome, and placental histopathology reports of all twin deliveries between 24 and 41 weeks were reviewed. Excluded were pregnancies complicated by twin-to-twin transfusion syndrome, twin anemia-polycythemia sequence, selective intrauterine growth restriction, placenta previa, intrauterine fetal death, and malformation. Placental lesions were classified to maternal/fetal vascular malperfusion lesions. Umbilical cord abnormalities included hypo-/hypercoiling and abnormal insertion. Composite adverse neonatal outcome was defined as 1 or more early complications. Small for gestational age (SGA) was defined as birth weight ≤10th percentile. RESULTS The DCDA group (n = 362) was characterized by higher rates of assisted reproductive techniques ( P < .001) and nulliparity ( P = .03) as compared to the MCDA group (n = 65). Gestational age at delivery was similar between groups. Placental maternal vascular malperfusion lesions were more common in placentas from DCDA group (38.2% vs 23.1%; P = .016), while fetal vascular malperfusion lesions and abnormal cord insertion were more common in placentas from MCDA group ( P = .027; P< .001). The SGA and composite adverse neonatal outcome were more common in the MCDA group ( P = .031 and P = .038, respectively). By multivariate regression analysis, composite adverse neonatal outcome was found to be independently associated with the MCDA group, adjusted odds ratio (aOR) = 1.2, 95% confidence interval (CI) = 1.04 to 1.89, P = .041, and with placental fetal malperfusion lesions aOR = 1.3, 95% CI = 1.1 to 2.09, P = .038. CONCLUSION Placental pathology differs between MCDA and DCDA twin pregnancies. Adverse neonatal outcome in uncomplicated MCDA twins, as compared to DCDA twins, could be related to increased placental fetal malperfusion lesions and abnormal cord insertion.
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Affiliation(s)
- Eran Weiner
- 1 Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Barber
- 1 Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Feldstein
- 1 Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ann Dekalo
- 1 Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Letizia Schreiber
- 2 Department of Pathology, The Edith Wolfson Medical Center, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- 1 Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- 1 Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Weiner E, Dekalo A, Feldstein O, Barber E, Schreiber L, Bar J, Kovo M. The placental factor in spontaneous preterm birth in twin vs. singleton pregnancies. Eur J Obstet Gynecol Reprod Biol 2017; 214:1-5. [DOI: 10.1016/j.ejogrb.2017.04.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/08/2017] [Accepted: 04/18/2017] [Indexed: 11/16/2022]
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Mechanistic Insight into Long Noncoding RNAs and the Placenta. Int J Mol Sci 2017; 18:ijms18071371. [PMID: 28653993 PMCID: PMC5535864 DOI: 10.3390/ijms18071371] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/19/2017] [Accepted: 06/21/2017] [Indexed: 02/07/2023] Open
Abstract
Long non-coding RNAs (lncRNAs) are classified as RNAs greater than 200 nucleotides in length that do not produce a protein product. lncRNAs are expressed with cellular and temporal specificity and have been shown to play a role in many cellular events, including the regulation of gene expression, post-transcriptional modifications and epigenetic modifications. Since lncRNAs were first discovered, there has been increasing evidence that they play important roles in the development and function of most organs, including the placenta. The placenta is an essential transient organ that facilitates communication and nutrient exchange between the mother and foetus. The placenta is of foetal origin and begins to form shortly after the embryo implants into the uterine wall. The placenta relies heavily on the successful differentiation and function of trophoblast cells, including invasion as well as the formation of the maternal/foetal interface. Here, we review the current literature surrounding the involvement of lncRNAs in the development and function of trophoblasts and the human placenta.
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