An excess of rare placental pathologies occur with abnormally invasive placenta (AIP).

Abstract

s / Placenta 35 (2014) A1eA112 A15 Objectives: To analyze unusual amniotic features encountered in routine placenta. Methods and result: A 38-year-old caucasian woman at 21 weeks (amenorrhea) of a spontaneous twin pregnancy, gravida 3, para 0110, presented to emergency department with epigastric pain and hypertension. Pre-eclampsia was suspected. Ultrasonography showed 19 weeks male dichorionic-diamniotic separate twin fetuses. After urgent laboratory tests HELLP syndrome was diagnosed. The patient underwent caesarean section. Fetuses and placentas were examinated. Fetus A weighted 100 g., fetus B weighted 180 g. Post-mortem examination showed hypoxic features and no malformation. Placenta A weighted 50 g. and measured cm 6 x 6 x1,3. The cut surface showed an old infarct less than 1 cm and pale parenchyma. The extra placental membrane were opaque. The cord contained three vessels. Placenta B weighted 80 g. and measured cm 7 x7 x1,5. The cut surface showed pale parenchyma. The extra placental membrane were translucent. The cord contained three vessels. Histology showed areas of dysmorphic and dysmature villi in both placenta. The amnion of placenta A was mostly detached from chorion and showed areas of stratified squamous epitheliumwith keratinisation andmany very tiny keratin cyst in its thickness. In other areas ballooning degeneration was seen. Discussion: These features did not met neither the criteria for amnion nodosum nor for the usual squamous metaplasia and both amnion nodosum and amnion squamous metaplasia are usually encountered later in pregnancy. Squamous plaques, keratin cyst are rather regular features of the amnion of manymammals as artiodactyls, perissodactyls, cetacean, chiropters and, much less, carnivores. Here there was neither amniotic sac inflammation nor oligohydramnios. Keratinic areas were wide and were present only in one placenta. This pregnancy had poor out-came because of HELLP syndrome, but it is not clear if these amniotic features may be related as well to an abnormal placentation. P1.15-N. AN EXCESS OF RARE PLACENTAL PATHOLOGIES OCCUR WITH ABNORMALLY INVASIVE PLACENTA (AIP). Alma Dfzafic , Vivek Gupta , Christopher Koenig , Ciaran Mannion , Abdulla Al-Khan , Nicholas P. Illsley , Stacy Zamudio b,d a St. Georges University School of Medicine, St Georges, Grenada; Hackensack University Medical Center, Division of Maternal-etal Medicine and Surgery, Hackensack, NJ, USA; Hackensack University Medical School Dept. of Pathology, Hackensack, NJ, USA; Hackensack University Center for Abnormal Placentation, Hackensack, NJ, USA Introduction: The primary risk factor for AIP is scarring in the lower uterine segment combined with a low lying placenta or placenta previa. We noticed that rare placental pathologies, those occurring in 5% placental area) infarctions (30%). The incidence of Infarctions increased with greater severity of AIP disease (p 75%, p<0.001). There were 10 velamentous cord insertions, 3 succenturiate lobes, 3 hyper-twisted cords, 2 circumvallate placentas, 1 two-vessel cord, and a placenta membranacea. These rare complications were present in 44%, 27% and 25% of accreta, increta and percreta cases, respectively (p1⁄40.34). 7/10 of the IVF pregnancies were among the accretas (28% of all accretas) versus 2/10 among incretas (9.5%) and 1/10 (4%) among percretas (p1⁄40.06). However, placentae from IVF pregnancies did not account for a disproportionate number of the pathologies: there were 3 velamentous cord insertions (all in twins) and one membranacea amounting to 28% of the IVF placentae (p 1⁄4 0.94 versus the remainder of the series. Conclusion: Rare placental pathologies are common in AIP, but this is not due to the IVF pregnancies in our series. P1.16. VASCULAR ALTERATIONS ARE KEY FOR DEVELOPMENTAL PROBLEMS IN THE PREAND POSTNATAL PHASES OF CLONED BOVINES Paulo Maiorka , Phelipe Favaron , Andrea Mess , Caio dos Santos , Flavio Meirelles , Maria Angelica Miglino b Department of Pathology, School of Veterinary Medicine, University of S~ ao Paulo, Sao Paulo, SP, Brazil; Department of Surgery, School of Veterinary Medicine, University of S~ ao Paulo, Sao Paulo, SP, Brazil; c Faculty of Animal Sciences and Food Engineering, University of S~ ao Paulo, Sao Paulo, SP, Brazil Assisted reproductive techniques were commonly applied in humans and animals, but are still associated with major developmental and survival problems. Objectives: In order to learn more about problems associated with cloning or nuclear transfer as the most invasive of these methods, we studied pathological alterations in the bovine model. Methods: We necropsied 13 newborn individuals that died soon after birth and included data on embryos and fetuses from terminated NT pregnancies. Results: Embryos showed several individual differences especially in relation to the stage of development. The most pronounced problems were related to the development of the liver, lung, and heart. The clones that survived until the neonatal period differed quantitatively and qualitatively from what was known for in-vivo breeds. Alterations in body weight were found in 92.3% of the newborns that survived between 1 to 20 days after successful pregnancy. Body weight was not related to the survival time after birth or to the severity of malformations. Mostly, alterations resulted as gigantism with a maximum of 62 kg, whereas most animals were between 45 and 55 kg. In contrast, one animal with 3 days of age was very small with only 13 kg and was born with nearly similar weight. Conclusion: Pathological modifications in cloned bovines affected a variety of organs including heart, lung and liver, but seemed to be associated with disturbances of the vascular system that hark back to developmental problems during the intrauterine phase. Thus, vascular developmental problems resulted as the primary or key alterations that may be caused by epigenetic modifications of the cloning process. Financial support: FAPESP (05/60606-3), CNPq (477740/2008-1), CAPES (Process: 335/2013), INCTC, and NETCEM. P1.17. DECREASED PLACENTAL WEIGHT CENTILE AND INCREASED BIRTHWEIGHT:PLACENTAL WEIGHT RATIOS IN STILLBIRTHS SUGGESTS PLACENTAL INSUFFICIENCY EVEN IN STILLBIRTHS OF “UNKNOWN” CAUSE Stephanie Worton , Alexander Heazell a,b Maternal and Fetal Health Research Centre, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK; b St. Mary’s Hospital, Central Manchester University Hospital NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK Introduction: Various abnormalities of placental structure and function are thought to contribute significantly to stillbirth; especially stillbirths associated with fetal growth restriction (FGR). Modern systems to classify