Papular dermatitis of pregnancy

Approach to the management of pregnancy in patients with pseudoxanthoma elasticum: a review

Management of pregnancy in patients with rare diseases is often guided by incomplete knowledge because of a lack of high-quality case control studies or single-centre experience. Pseudoxanthoma elasticum (PXE) is an autosomal recessive metabolic disorder that results in calcification of elastic fibres of the skin, retina, and arteries, leading to skin lesions, eventual central visual loss, and potential arterial insufficiency in most patients. It is due to mutations in ABCC6, which encodes the eponymous membrane transport protein. We review the literature on pregnancy in PXE, including the effects of the diseases on pregnancy and its complications, the effect of PXE on the foetus, and the effects of pregnancy on PXE, and conclude that in the majority of pregnancies in women with PXE, the outcome for mother, baby, and the disease is uneventful. We also provide recommendations for managing pregnancy in PXE.

A thick placenta: a predictor of adverse pregnancy outcomes

Purpose

The aim of this study is to evaluate the efficacy of an ultrasonographic measurement of placental thickness and the correlation of a thick placenta with adverse perinatal outcome.

Methods

Placental thickness was measured in single gravidas, 16 to 40 weeks of gestation, between 2005 and 2009. Placentas were considered to be thick if their measured thickness were above the 95th percentile for gestational age.

Results

The incidence of thick placentas was 4.3% (138/3,183). Perinatal morbidity and neonatal conditions were worse in cases with thick placenta rather than without thick placenta.

Conclusions

Ultrasonographic measurement of placental thickness is a simple method to estimate placental size. Thick placenta may be a useful predictor of adverse pregnancy outcomes.

Evaluation of placental maturity by the sonographic textures

PURPOSE

Routine ultrasound screening to predict gestational age is important for risk assessment of pregnancy complications among pregnant women. We explored a quantitative method for sonographic analysis of placental texture, with the objective of reproducible measurement.

METHODS

We studied 151 pregnant women; the gestational ages of their fetuses ranged from 10 to 38 weeks. Three experienced sonographers delineated the placental contour to define the region of interest (ROI). From these sonograms, 72 texture features were derived from the spatial gray-level dependence matrices and gray-level difference matrices. We used these as input variables in a multiple linear regression analysis.

RESULTS

A significant positive correlation (P < 0.01) was found between the multiple linear regression results and the corresponding gestation ages by the three assessors (r (A) = 0.755, r (B) = 0.851, and r (C) = 0.832). We also found good agreement between multiple linear regression results for the three observers. Their κ statistic values were 0.685 between assessors A and B, 0.679 between A and C, and 0.804 between B and C.

CONCLUSION

Quantitative sonography using texture analysis of the placenta was useful in practice to determine gestational age.

Less well-defined dermatoses of pregnancy

Over the past several decades, many specific and nonspecific dermatoses of pregnancy have been described. The lack of a well-defined clinical and histological features as well as reproducibility in some of these entities has led to confusing reports in the literature. In this review article, an account of these nonspecific dermatoses of pregnancy will be presented in an attempt to shed light on their nosology and to better categorize them in view of the recent literature findings.

Sonographic, stereological and Doppler flow velocimetric assessments of placental maturity

OBJECTIVE

To determine whether sonographic assessments of increasing placental maturity are associated with changes in the theoretical diffusing capacity of the organ and with changes in vascular resistance.

DESIGN

Placental maturity was assessed sonographically in 10 organs: five were classified as completely immature and five as completely mature. Doppler flow velocimetric recordings were obtained shortly before delivery performed by elective caesarean section. Placental biopsies taken immediately after delivery were analysed stereologically.

RESULTS

No differences were observed in either placental weight or volume, but the morphometric diffusing capacity of the villous membrane was 40% higher in the mature than in the immature placentas. Doppler indices did not alter with increasing placental maturity.

CONCLUSIONS

Normal term placentas differ significantly in their diffusion characteristics, even when organ weight and volume remain constant. Umbilical vascular resistance may be heavily influenced by the number of parallel circulatory units offered by the placental lobules.

The value of ultrasonic placental grading: no correlation with intrauterine growth retardation or with maternal smoking

In a prospective study the usefulness of placental grading in detecting IUGR has been evaluated. Those who were echoscopically examined within one week before delivery were taken into the study (n = 137). Changes in placental tissue increased clearly as pregnancy progressed and in 42% (57/137) the placentae reached Grade III. Increasing placental grading is associated with normal maturation of the placenta. Post partum examination of the placenta correlated well with the echoscopic picture (accuracy = 80.5%). No relationship was found in an unselected group between Grade III and IUGR at term. When a Grade III placenta was first seen before 36 weeks, in three out of five cases a growth retarded neonate was born. The effects of maternal smoking habits during pregnancy on birth weight and placenta were examined. There were no significant differences in mean placental weight, placental ratio and placental grading as the amount of cigarettes increased. The mean birth weight and birth weight percentile decreased significantly when the mother smoked more than 10 cigarettes per day.

Manifestations of pseudoxanthoma elasticum during pregnancy: a case report and review of the literature

A 30-year-old white woman with pseudoxanthoma elasticum (PXE) was followed throughout her pregnancy with several fetal ultrasonographic examinations and other diagnostic studies; these showed normal development up to the 26th wk and then a marked deceleration of fetal growth. The ultrasonographic appearance of the placenta was abnormal at all times probably related to the microscopic changes. The baby, born at 36 wk, showed severe intrauterine growth retardation as a probable consequence of the abnormal placenta detected by ultrasound and corroborated at birth. The cotyledons were small and more numerous than normal. One third of the placenta was hypoplastic or atrophic, with focal calcification in septa, stroma, villi, and decidua, and increased deposition of fibrin around villi. The most striking change was the increased number of septa and the abnormal elastic tissue.

Pruritic urticarial papules and plaques of pregnancy (PUPPP). A clinicopathologic study

Pruritic urticarial papules and plaques of pregnancy (PUPPP) was recently defined as an intensely pruritic cutaneous eruption occurring in the third trimester. We are reporting fifteen additional cases of this distinctive eruption. The lesions began in the third trimester in all but two patients. The rash consisted of a symmetric eruption of papules, urticarial lesions, and some erythema multiforme-like target lesions. Histologic examination showed a mild nonspecific lymphohistiocytic perivasculitis. Moderate or intense pruritus was present in all but one case. The abdomen and proximal extremities were most commonly involved, but two patients had lesions only on the lower legs. Clearing occurred prior to delivery (five cases), within 1 week of delivery (nine cases), and at 6 weeks postpartum (one case). The pruritus was decreased with topical corticosteroids and diphenhydramine in all cases except one. Fetal wastage did not occur. Subsequent pregnancies were uneventful in two patients. PUPPP is a benign dermatosis of pregnancy which resolves spontaneously or with delivery.