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Fridman Kogan Z, Nahum Fridland S, Ganer Herman H, Miremberg H, Bustan M, Schreiber L, Kovo M. Postpartum antihypertensive treatment: Is there a correlation to placental lesions? Arch Gynecol Obstet 2023:10.1007/s00404-023-07263-7. [PMID: 37902838 DOI: 10.1007/s00404-023-07263-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 10/09/2023] [Indexed: 11/01/2023]
Abstract
OBJECTIVE We aimed to examine the association of clinical risk factors and placental lesions, in gestations complicated with preeclampsia, with the need for antihypertensive treatment in the early postpartum period. METHODS The computerized files and placental reports of all singleton deliveries at 24.0-42.0 weeks complicated by preeclampsia were reviewed between January 2013 and October 2020. Obstetric characteristics and placental lesions were compared between patients who required antihypertensive treatment in the early postpartum period and those who did not (control group). Placentas were classified into maternal and fetal malperfusion lesions and inflammatory responses. RESULTS As compared to controls (n = 200), the anti-hypertensive treatment group (n = 95) was characterized by increased rates of preterm birth, preeclampsia with severe features, and cesarean delivery (p < 0.001 for all). More placental hematomas (p = 0.01) and placental maternal vascular lesions (p = 0.03) were observed in the antihypertensive treatment group as compared to controls. In adjusted logistic regression analysis, gestational age (OR 0.86, 95% CI 0.79-0.93, p = 0.001) and preeclampsia with severe features (OR 8.89, 95% CI 3.18-14.93 p < 0.001) were found to be independently associated with the need for postpartum antihypertensive treatment. CONCLUSION Placental vascular lesions are more common in preeclamptic patients who need postpartum antihypertensive treatment, yet only early onset of preeclampsia with severe features was found to be independently associated with antihypertensive treatment in the early postpartum period.
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Affiliation(s)
- Zviya Fridman Kogan
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shir Nahum Fridland
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadas Ganer Herman
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadas Miremberg
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mor Bustan
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Letizia Schreiber
- Department of Pathology, Edith Wolfson Medical Center, Holon, Israel, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar-Saba, Israel.
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Cersonsky TEK, Cersonsky RK, Saade GR, Silver RM, Reddy UM, Goldenberg RL, Dudley DJ, Pinar H. Placental lesions associated with stillbirth by gestational age, according to feature importance: Results from the stillbirth collaborative research network. Placenta 2023; 137:59-64. [PMID: 37080046 DOI: 10.1016/j.placenta.2023.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/22/2023]
Abstract
INTRODUCTION Previous studies have identified lesions commonly found in placentas associated with stillbirth but have not distinguished across a range of gestational ages (GAs). The objective of this study was to identify lesions associated with stillbirths at different GAs by adapting methods from the chemical machine learning field to assign lesion importance based on correlation with GA. METHODS Placentas from the Stillbirth Collaborative Research Network were examined according to standard protocols. GAs at stillbirth were categorized as: <28 weeks (extreme preterm stillbirth [PTSB]), 28-33'6 weeks (early PTSB), 34-36'6 weeks (late PTSB), ≥37 weeks (term stillbirth). We identified and ranked the most discriminating placental features, as well as those that were similar across GA ranges, using Kernel Principal Covariates Regression (KPCovR). RESULTS These analyses included 210 (47.2%) extreme PTSB, 85 (19.1%) early PTSB, 62 (13.9%) late PTSB, and 88 (19.8%) term stillbirths. When we compute the KPCovR, the first principal covariate indicates that there are four lesions (acute funisitis & nucleated fetal red blood cells found in extreme PTSB; multifocal reactive amniocytes & multifocal meconium found in term stillbirth) that distinguish GA ranges among all stillbirths. DISCUSSION There are distinct placental lesions present across GA ranges in stillbirths; these lesions are identifiable using sophisticated feature selection. Further investigation may identify histologic changes across gestations that relate to fetal mortality.
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Affiliation(s)
- Tess E K Cersonsky
- Warren Alpert Medical School of Brown University, 222 Richmond St, Providence, RI, 02903, USA.
| | - Rose K Cersonsky
- Department of Chemical and Biological Engineering, University of Wisconsin, Engineering Hall, 1415 Engineering Dr, Madison, WI, 53706, USA
| | - George R Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, 250 Blossom St, 3rd Floor, Webster, TX, 77598, USA
| | - Robert M Silver
- Department of Obstetrics & Gynecology, University of Utah School of Medicine, 30 N 1900 E # 2B200 SOM, Salt Lake City, UT, 84132, USA
| | - Uma M Reddy
- Department of Obstetrics & Gynecology, Columbia University School of Medicine, 622 West 168th Street, New York, NY, 10032, USA
| | - Robert L Goldenberg
- Department of Obstetrics & Gynecology, Columbia University School of Medicine, 622 West 168th Street, New York, NY, 10032, USA
| | - Donald J Dudley
- Department of Obstetrics & Gynecology, University of Virginia School of Medicine, 200 Jeanette Lancaster Way, Charlottesville, VA, 22903, USA
| | - Halit Pinar
- Warren Alpert Medical School of Brown University, 222 Richmond St, Providence, RI, 02903, USA; Department of Pathology, Women and Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University, 101 Dudley St, Providence, RI, 02905, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Labuschagne H, Burns C, Martinez S, Carrillo M, Waggoner M, Schwanninger I, Maher J, Hampton M, Flores-Guardado J, Schlabritz-Loutsevitch NE. Coccidioidomycosis in pregnancy: Case report and literature review of associated placental lesions. Case Rep Womens Health 2016; 12:5-10. [PMID: 29629302 PMCID: PMC5886004 DOI: 10.1016/j.crwh.2016.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 10/19/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Coccidioidomycosis is an endemic fungal infection found most commonly in the Southwestern United States, Northwestern Mexico, and parts of Central and South America. Although infection is relatively uncommon during pregnancy, it is imperative to have an index of suspicion in order to diagnose and begin timely treatment to prevent dissemination and dire consequences. CASE REPORT A 33-year-old Hispanic female was evaluated after she was involved in an automobile accident. Radiographic evaluation showed a 3.2 × 3.2 cm cavitary thick-walled lesion. A biopsy was negative for malignancy. Evaluation was positive for coccidioidomycosis by complement fixation reaction. Four months later, the patient presented 7 weeks into a pregnancy with massive hemoptysis. Bronchoscopy revealed bleeding from the right upper lobe and emergency embolization was performed. The patient had a spontaneous abortion 9 days after admission. The right upper and middle lobes of the lung were resected due to continuous bleeding. A subsequent pregnancy was un-eventful. Coccidioidomycosis titers remained negative throughout the second pregnancy. DISCUSSION This case demonstrates the potential for severe pulmonary coccidioidomycosis and vascular strain of pregnancy-associated vascular expansion in the first trimester of pregnancy and the possibility of a favorable pregnancy outcome in subsequent pregnancies after appropriate treatment. The route of feto-maternal transmission and placental lesions in coccidioidomycosis are discussed.
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Affiliation(s)
- Heloise Labuschagne
- Department of Internal Medicine, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - C. Burns
- Department of Pathology, Medical Center Hospital, Odessa, TX, USA
| | - Stacy Martinez
- Department of Academic Affairs, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Maira Carrillo
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Melissa Waggoner
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Irene Schwanninger
- Department of Academic Affairs, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - James Maher
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Moss Hampton
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - Javier Flores-Guardado
- Department of Internal Medicine, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
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Triunfo S, Lobmaier S, Parra-Saavedra M, Crovetto F, Peguero A, Nadal A, Gratacos E, Figueras F. Angiogenic factors at diagnosis of late-onset small-for-gestational age and histological placental underperfusion. Placenta 2014; 35:398-403. [PMID: 24746262 DOI: 10.1016/j.placenta.2014.03.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/24/2014] [Accepted: 03/26/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study was designed to explore the association between angiogenic factors levels at diagnosis of small-for-gestational age (SGA) and placental underperfusion (PUP). METHODS In a cohort of SGA singleton pregnancies, each delivered at >34 weeks, uterine (UtA), umbilical (UA), and middle cerebral (MCA) arteries were evaluated by Doppler upon diagnosis of SGA status. In addition, maternal circulating concentrations of placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) were assayed by ELISA, and each placenta was evaluated for histologic signs of PUP using a hierarchical and standardized classification system. Logistic regression was applied to analyze independent relationships (at diagnosis) between angiogenic factors and Doppler parameters. RESULTS A total of 122 suspected SGA pregnancies were studied, 70 (57.4%) of which ultimately met PUP criteria. In this group, 85 placental findings qualified as PUP. Both mean UtA pulsatility index z-values (1.26 vs. 0.84; p = 0.038) and PlGF multiples of normal median (0.21 vs. 0.55; p = 0.002) differed significantly in pregnancies with and without PUP, respectively. By logistic regression, PlGF alone was independently predictive of PUP (OR = 0.11 [95% CI 0.025-0.57]; p = 0.008). DISCUSSION Histologic placental abnormalities in term SGA neonates reflect latent insufficiency in uteroplacental blood supply. The heightened risk of adverse perinatal outcomes in this context underscores a need for new Doppler or biochemical prenatal markers of placental disease. Angiogenic factors may be pivotal identifying SGA neonates. CONCLUSIONS Diminished circulating levels of placental growth factor, determined upon discovery of SGA status, are associated with histologic evidence of PUP.
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Affiliation(s)
- S Triunfo
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain; Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | - S Lobmaier
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain; Frauenklinik und Poliklinik, Technische Universität München, Munich, Germany
| | - M Parra-Saavedra
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain; Maternal-Fetal Unit, CEDIFETAL, Centro de Diagnóstico de Ultrasonido e Imágenes, CEDIUL, Colombia
| | - F Crovetto
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain; Ca' Granda, Ospedale Maggiore Policlinico, Dipartimento Ostetricia e Ginecologia, Università degli Studi di Milano, Milan, Italy
| | - A Peguero
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - A Nadal
- Department of Pathology, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - E Gratacos
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - F Figueras
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
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Parra-Saavedra M, Crovetto F, Triunfo S, Savchev S, Peguero A, Nadal A, Parra G, Gratacos E, Figueras F. Placental findings in late-onset SGA births without Doppler signs of placental insufficiency. Placenta 2013; 34:1136-41. [PMID: 24138874 DOI: 10.1016/j.placenta.2013.09.018] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 09/25/2013] [Accepted: 09/25/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To describe placental pathological findings in late-onset small-for-gestational age (SGA) births for which Doppler signs of placental insufficiency are lacking. METHODS A series of placentas were evaluated from singleton pregnancies of SGA births (birth weight below the 10th percentile) delivered after 34 weeks with normal umbilical artery Doppler (pulsatility index below the 95th percentile), that were matched by gestational age with adequate-for-gestational age (AGA) controls. Using a hierarchical and standardized system, placental lesions were classified histologically as consequence of maternal underperfusion, fetal underperfusion or inflammation. RESULTS A total of 284 placentas were evaluated (142 SGA and 142 AGA). In the SGA group, 54.2% (77/142) of the placentas had weights below the 3rd percentile for GA while it was a 9.9% (14/142) in the AGA group (p < 0.001). Only 21.8% (31/142) of SGA placentas were free of histological abnormalities, while it was 74.6% (106/142) in the AGA group (p < 0.001). In the abnormal SGA placentas (111/142) there were a total of 161 lesions, attributable to MUP in 64% (103/161), FUP in 15.5% (25/161), and inflammation in 20.5% (33/161). DISCUSSION In most placentas of term SGA neonates with normal UA Doppler histological abnormalities secondary to maternal underperfusion prevail, reflecting latent insufficiency in uteroplacental blood supply. This is consistent with the higher risk of adverse perinatal outcome reported in this population and underscores a need for new markers of placental disease. CONCLUSIONS A significant proportion of late-onset SGA births with normal umbilical artery Doppler may still be explained by placental insufficiency.
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Affiliation(s)
- M Parra-Saavedra
- Department of Maternal-Fetal Medicine, Institute Clínic of Gynecology, Obstetrics and Neonatology (ICGON), Hospital Clinic-IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain; Maternal-Fetal Unit, CEDIFETAL, Centro de Diagnóstico de Ultrasonido e Imágenes, CEDIUL, Barranquilla, Colombia
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