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Tonni G, Lituania M, Cecchi A, Carboni E, Grisolia G, Bonasoni MP, Rizzo G, Ruano R, Júnior EA, Werner H, Sepulveda W. Placental and umbilical cord anomalies detected by ultrasound as clinical risk factors of adverse perinatal outcome: Case series review of selected conditions. Part 1: Placental abnormalities. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024. [PMID: 39165051 DOI: 10.1002/jcu.23773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 08/22/2024]
Abstract
BACKGROUND The aim of this extended review of multicenter case series is to describe the prenatal ultrasound features and pathogenetic mechanisms underlying placental and umbilical cord anomalies and their relationship with adverse perinatal outcome. From an educational point of view, the case series has been divided in three parts; Part 1 is dedicated to placental abnormalities. METHODS Multicenter case series of women undergoing routine and extended prenatal ultrasound and perinatal obstetric care. RESULTS Prenatal ultrasound findings, perinatal care, and pathology documentation in cases of placental pathology are presented. CONCLUSIONS Our case series review and that of the medical literature confirms the ethiopathogenetic role and involvement of placenta abnormalities in a wide variety of obstetrics diseases that may jeopardize the fetal well-being. Some of these specific pathologies are strongly associated with a high risk of poor perinatal outcome.
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Affiliation(s)
- Gabriele Tonni
- Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Mario Lituania
- Preconceptional and Prenatal Pathophysiology, Department of Obstetrics and Gynecology, E.O. Ospedali Galliera, Genoa, Italy
| | - Alessandro Cecchi
- Department of Obstetrics and Gynecology, Regional Prenatal Diagnostic 2 Level Center, ASUR, Loreto Hospital, Loreto, Italy
| | - Elisa Carboni
- Department of Obstetrics and Gynecology, Regional Prenatal Diagnostic 2 Level Center, ASUR, Loreto Hospital, Loreto, Italy
| | - Gianpaolo Grisolia
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, AST, Mantova, Mantua, Italy
| | - Maria Paola Bonasoni
- Department of Pathology, Santa Maria Nuova Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppe Rizzo
- Department of Maternal and Child Health, Urological Sciences, Policlinc Hospital Umberto I, University "La Sapienza", Rome, Italy
| | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine-Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Heron Werner
- Department of Fetal Medicine, Biodesign Laboratory DASA/PUC, Rio de Janeiro, Brazil
| | - Waldo Sepulveda
- FETALMED-Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
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Zaremba L, Kim G. Time to Cut the Cord: A Newly Discovered Placental Mass. Clin Pediatr (Phila) 2023; 62:1599-1602. [PMID: 36964687 DOI: 10.1177/00099228231163697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Affiliation(s)
- Lindsay Zaremba
- Division of Pediatric Hospital Medicine, UH Rainbow Babies & Children's Hospital, Cleveland, OH, USA
| | - Grace Kim
- Division of Pediatric Hospital Medicine, UH Rainbow Babies & Children's Hospital, Cleveland, OH, USA
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Taweevisit M, Nimitpanya P, Thorner PS. Excessive Subchorionic Fibrinoid Deposition as a Component of Massive Perivillous Fibrin Deposition: A Case With Maternal Immune Thrombocytopenia. Pediatr Dev Pathol 2022; 25:466-469. [PMID: 34989279 DOI: 10.1177/10935266211069331] [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: 11/16/2022]
Abstract
Maternal floor infarction (MFI) and massive perivillous fibrin deposition (MPFD) are overlapping placental disorders of unknown etiology, associated with adverse obstetric outcome, and a significant risk of recurrence. We describe a 31-year-old mother with asymptomatic thrombocytopenia throughout pregnancy and a positive lupus anticoagulant. She delivered a normal female neonate at term, whose weight was small for gestational age, with a placenta weighing less than the 10th percentile. Placental examination showed MPFD together with excessive subchorionic fibrinoid deposition. The placenta showed diffuse C4d deposition and an immune-mediated reaction was postulated for the pathogenesis of the placental changes. We suggest that excessive subchorionic fibrinoid deposition may be part of the morphologic spectrum of MFI/MPFD.
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Affiliation(s)
- Mana Taweevisit
- Department of Pathology, Faculty of Medicine, 26683Chulalongkorn University, Pathumwan, Thailand.,King Chulalongkorn Memorial Hospital and Thai Red Cross Society, Pathumwan, Thailand
| | - Panachai Nimitpanya
- King Chulalongkorn Memorial Hospital and Thai Red Cross Society, Pathumwan, Thailand.,Department of Obstetrics and Gynecology, Faculty of Medicine, 26683ChulalongkornUniversity, Pathumwan, Thailand
| | - Paul S Thorner
- Department of Pathology, Faculty of Medicine, 26683Chulalongkorn University, Pathumwan, Thailand.,Department of Laboratory Medicine and Pathobiology, 7938University of Toronto, Toronto, ON, Canada
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Bonasoni MP, Comitini G, Blasi I, Cavazza A, Aguzzoli L. Large Subchorionic Cyst Located at Umbilical Cord Insertion with Vascular Displacing and Intracystic Hemorrhage/Hematoma: A Case Report. Fetal Pediatr Pathol 2022; 41:468-474. [PMID: 33103529 DOI: 10.1080/15513815.2020.1836096] [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: 10/23/2022]
Abstract
Background: Large subchorionic cysts usually arise close to the placental cord insertion site (PCIS) inducing traction on the umbilical cord, impairing blood flow and favoring fetal growth restriction (FGR). Intracystic hemorrhage/hematoma is likely due to the prothrombotic properties of X cells secretion (extravillous trophoblast), which line the cyst wall. Case report: We describe a large subchorionic cyst located exactly at the PCIS, displacing the umbilical cord vessel branches running along the cyst surface. The fetus presented with FGR. At 36 weeks of gestational age, the cyst measured 7.7 cm in maximum dimension showing a partially organized hemorrhage and a peripheral laminated thrombohematoma. The patient underwent elective cesarean section as the cyst and its vessels were at high risk of rupture during labor. Conclusion: Recognition of large subchorionic cysts close to or at the PCIS in a growth restricted fetus with subsequent expedited delivery may avoid a fatal event.
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Affiliation(s)
| | - Giuseppina Comitini
- Unit of Obstetrics & Gynecology, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Immacolata Blasi
- Unit of Obstetrics & Gynecology, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alberto Cavazza
- Pathology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lorenzo Aguzzoli
- Unit of Obstetrics & Gynecology, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Sukhanova M, Mithal LB, Otero S, Azad HA, Miller ES, Jennings LJ, Shanes ED, Goldstein JA. Maternal vs Fetal Origin of Placental Intervillous Thrombi. Am J Clin Pathol 2021; 157:365-373. [PMID: 34546332 PMCID: PMC8500002 DOI: 10.1093/ajcp/aqab139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/22/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To determine maternal vs fetal origin for blood in placental intervillous thrombi (IVTs). METHODS We used comparative analysis of microsatellites (short tandem repeats [STRs]), sex chromosome fluorescence in situ hybridization (FISH), and immunohistochemistry (IHC) for fetal (ɑ-fetoprotein [AFP]) and maternal (immunoglobulin M [IgM]) serum proteins to distinguish the origin of IVTs. Using an informatics approach, we tested the association between IVTs and fetomaternal hemorrhage (FMH). RESULTS In 9 of 10 cases, the preponderance of evidence showed that the thrombus was mostly or entirely maternal in origin. In 1 case, the thrombus was of mixed origins. STR testing was prone to contamination by entrapped fetal villi. FISH was useful but limited only to cases with male fetuses. IgM showed stronger staining than AFP in 9 cases, supporting maternal origin. By informatics, we found no association between IVTs and FMH. CONCLUSIONS Evidence supports a maternal origin for blood in IVTs. IHC for IgM and AFP may be clinically useful in determining maternal vs fetal contribution to IVTs.
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Affiliation(s)
| | - Leena B Mithal
- Pediatrics (Infectious Disease), Chicago, IL, USA,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sebastian Otero
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Hooman A Azad
- Obstetrics and Gynecology (Maternal-Fetal Medicine), Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily S Miller
- Anne and Robert H. Lurie Children’s Hospital, Chicago, IL, USA
| | | | | | - Jeffery A Goldstein
- Departments of Pathology, Chicago, IL, USA,Corresponding author: Jeffery A. Goldstein, MD, PhD;
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Amgalan A, Allen T, Othman M, Ahmadzia HK. Systematic review of viscoelastic testing (TEG/ROTEM) in obstetrics and recommendations from the women's SSC of the ISTH. J Thromb Haemost 2020; 18:1813-1838. [PMID: 32356929 DOI: 10.1111/jth.14882] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/13/2020] [Accepted: 04/24/2020] [Indexed: 12/13/2022]
Abstract
Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) are point-of-care viscoelastic devices that use whole blood samples to assess coagulation and fibrinolysis. These devices have been studied extensively in cardiac surgery, but there is limited robust evidence supporting its use in obstetrics. The hesitancy toward its routine use in obstetrics may be due to the current lack of randomized controlled trials and large observational studies. The study aims to systematically review studies that investigated TEG/ROTEM use in pregnancy or peripartum, and to provide recommendations for future studies to fill current research gaps. We performed a systematic review of studies on viscoelastic testing in obstetrics. Included studies were original research, used TEG or ROTEM during pregnancy or peripartum, and published in English. Ninety-three studies, spanning 31 years from 1989 to 2020 and with a total of 32,817 participants, were included. Sixty-two (66.7%) of the studies used TEG and 31 (33.3%) used ROTEM. To date, there are a total of two randomized controlled trials on TEG/ROTEM use in obstetrics. ROTEM may be used to guide transfusion therapy for postpartum hemorrhage. TEG and ROTEM can detect the hypercoagulable changes associated with pregnancy. Variability between study protocols and results suggests the need for future large prospective high-quality studies with standardized protocols to investigate the utility of TEG/ROTEM in assessing risk for thrombosis and hemorrhage as well as in guiding prophylaxis and treatment in obstetric patients. This review identifies the gaps and provides concrete recommendations for future studies to fill those gaps.
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Affiliation(s)
| | - Terrence Allen
- Department of Anesthesiology, Duke University Hospital, Durham, NC, USA
| | - Maha Othman
- Department of Biomedical and Molecular Sciences, School of Medicine, Queen's University, Kingston, ON, Canada
- School of Baccalaureate Nursing, St. Lawrence College, Kingston, ON, Canada
| | - Homa K Ahmadzia
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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