Abnormal Placenta Research Articles

Transvaginal sonographic screening of abnormal intra-amniotic structure around internal cervical os at 18-21+6 weeks of gestation.

To detect an abnormal intra-amniotic structure around the internal cervical os using transvaginal sonography at 18-21+6 weeks of gestation. In this cohort study, during a 12-month period from July 2022 to June 2023, 395 transvaginal scans were performed for second-trimester cervical-length screening in singleton pregnancies at 18-21+6 weeks of gestation. Nine abnormal intra-amniotic structures (AIAS), 87 low-lying placentas (LLP, second-trimester placenta previa or placental margin within 2 cm from internal cervical os), and 299 controls (not LLP and no abnormal finding around internal cervical os) were diagnosed. Sonographic features of AIAS and delivery outcomes in the three groups were compared. Sonographic features of nine AIAS cases were: two single bands, one single broad band, one multiple bands, one single tubular, and one multiple tubulars. Blood flow was noted in seven cases. Seven AIAS had disappeared by 26 weeks, one was resolved at 34 weeks, and one (vasa previa and parachute placenta) remained until delivery. Incidences of emergency cesarean section, abnormal placenta and umbilical cord, and abnormal deliveries in AIAS were significantly higher than those in LLP and control groups (P = 0.031). Blood losses during delivery in AIAS and LLP groups were significantly greater than in the control group (P = 0.004), but there was no significant difference in blood loss between AIAS and LLP groups. The incidence of AIAS around the internal cervical os in the second trimester was 2.28% (9/395 fetuses). Mid-second-trimester transvaginal sonographic screening for the detection of AIAS around the internal cervical os including vasa previa may be essential to reduce perinatal morbidity.

Uterine layers hypervascularization in atypical placentation: the comparison of magnetic resonance imaging with vascular pathomorphology

Rationale: One in five women worldwide delivers through cesarean section, which is associated to a high rate of placenta previa and abnormal placenta attachment to the uterine wall. The grade of placenta accreta spectrum (PAS) correlates with blood loss volume, which could be related to vascularization characteristics. Up to now, there have been no studies on the diagnostic value of magnetic resonance criteria for hypervascularization of the uterine wall and their correlation with an assumed grade of PAS according to the International Federation of Gynecology and Obstetrics (FIGO) classification. Also, abnormal vessels location and their wall structure have not been studied with state-of-the-art pathomorphological methods. Aim: To develop a classification for various types of the uterine wall hypervascularization depending on the depth of placental invasion assessed by magnetic resonance imaging (MRI). Methods: We retrospectively analyzed medical files of 66 patients aged 18 to 45 years, who were assumed to have PAS based on their sonography results. To clarify the extent and localization of the placental invasion, all patients had MRI performed at 24 to 32 weeks of gestation. In all patients, the PAS grade was verified pathologically; in 30 of them (45,5%), a detailed pathological examination was additionally performed. The PAS grades were classified according to Morbidly Adherent Placenta Imaging Reporting and Data System (MAPI-RADS). The MRI data were correlated with the PAS (FIGO) grade estimated from intraoperative data and with intraoperative blood loss. At the final study step, the MRI data was correlated with abnormal pathomorphology, with the assessment of the degree of vascularization and the visual picture of abnormal uteroplacental vasculature. Results: We have proposed a classification of MRI signs of hypervascularization in the lower uterine segment correlating with the depth of placenta accreta. Type 1. Single small vessels in the myometrium, medium caliber arteries in the projection of the uterine serosa (normal variation for the 3rd trimester of gestation). Type 2. Numerous small confluent vessels, mainly in the uteroplacental region, and retroplacental hematomas (typical for placenta accreta, or FIGO PAS 1). Type 3. Intrauterine hypervascularization with a deficient myometrium thickness, predominantly vessels of the middle layer (typical for placenta increta, or FIGO PAS 2). Type 4. Thinning of the lower uterine segment due to significant bulging of the placenta in the presence of curved anastomosing vessels of vast caliber over 4 mm (typical for placenta increta – FIGO PAS 2, as well as placenta percreta – FIGO PAS 3a). Type 5. Hypervascularization outside the uterus, over its surface and in the parametrial tissues: at the border with the bladder, uterine isthmus, including signs of fibrosis and growing into the posterior bladder wall (typical for various grades of placenta percreta – FIGO PAS 3b, 3c). Conclusion: The proposed classification of uterine wall hypervascularization in accordance with the grades of placenta accreta spectrum (FIGO PAS) could be useful for its practical implementation by radiologists.

Risk factors and birth outcomes of preterm birth subtypes: a case-control study of singleton natural pregnancy

ObjectiveThe objective of the study was to identify the risk factors correlated with spontaneous preterm birth (SPTB) and iatrogenic preterm birth (IPTB), as well as to compare the pregnancy outcomes...

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.

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. Multicenter case series of women undergoing routine and extended prenatal ultrasound and perinatal obstetric care. Prenatal ultrasound findings, perinatal care, and pathology documentation in cases of placental pathology are presented. 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.

Maternal exposure to beta-Cypermethrin disrupts placental development by dysfunction of trophoblast cells from oxidative stress

As a broad-spectrum and efficient insecticide, beta-Cypermethrin (β-CYP) poses a health risk to pregnancy. It matters the mechanisms of maternal exposure to β-CYP for impacting reproductive health. The placenta, a transient organ pivotal for maternal-fetal communication during pregnancy, plays a crucial role in embryonic development. The effect of β-CYP exposure on the placenta and its underlying molecular mechanisms remain obscure. The objective of this study was to investigate the effect of β-CYP exposure on placental development and the function of trophoblast, as well as the underlying mechanisms through CD-1 mouse model (1, 10, 20 mg/kg.bw) and in vitro HTR-8/SVneo cell model (12.5, 25, 50, 100 μM). We found slower weight gain and reduced uterine wet weight in pregnant mice with maternal exposure to β-CYP during pregnancy, as well as adverse pregnancy outcomes such as uterine bleeding and embryo resorption. The abnormal placental development in response to β-CYP was noticed, including imbalanced placental structure and disrupted labyrinthine vascular development. Trophoblasts, pivotal in placental development and vascular remodeling, displayed abnormal differentiation under β-CYP exposure. This aberration was characterized by thickened trophoblast layers in the labyrinthine zone, accompanied by mitochondrial and endoplasmic reticulum swelling within trophoblasts. Further researches on human chorionic trophoblast cell lines revealed that β-CYP exposure induced apoptosis in HTR-8/SVneo cells. This induction resulted in a notable decrease in migration and invasion abilities, coupled with oxidative stress and the inhibition of the Notch signaling pathway. N-acetylcysteine (an antioxidant) partially restored the impaired Notch signaling pathway in HTR-8/SVneo cells, and mitigated cellular functional damage attributed to β-CYP exposure. Collectively, exposure to β-CYP induced oxidative stress and then led to inhibition of the Notch signaling pathway and dysfunction of trophoblast cells, ultimately resulted in abnormal placenta and pregnancy. These findings indicate Reactive Oxygen Species as potential intervention targets to mitigate β-CYP toxicity. The comprehensive elucidation contributes to our understanding of β-CYP biosafety and offers an experimental basis for preventing and managing its reproductive toxicity.

Correlation Between Ultrasonographic Placental Thickness and Adverse Fetal and Neonatal Outcomes.

Introduction The placenta is often overlooked in the routine evaluation of normal gestations, receiving attention only when abnormalities are detected. Placental thickness can serve as a good predictor of fetal growth and birth weight, especially in the second trimester.In this prospective study, we measured placental thickness in the second and third trimesters of singleton pregnancies and identified an association between placental thickness and adverse outcomes such as congenital anomalies, fetal growth restriction (FGR), prematurity, low birth weight, stillbirth, and hydrops fetalis. Methodology A total of 298 patients aged 20 to 33 yearswith a singleton pregnancy and regular cycles, who were sure of the date of their last menstrual period, were observed. Placental thickness was measured by ultrasound at 18-20 and 30-32 weeks, and patients were divided into three groups. Group A consisted of patients with normal placental thickness. Group B included patients with a thin placenta (below the 10th percentile). Group C consisted of patients with a thick placenta (above the 95th percentile). The correlation between placental thickness andthe fetal and neonatal outcome was observed. Results Out of 298 patients, 82 (27.5%) were primigravida and 216 (72.4%) were multigravida. At 18-20 weeks, premature birth was observed in one patient (7.69%) in Group C and six patients (20%) in Group B, compared with eight patients (3.14%) in Group A. At 30-32 weeks, premature birth was seen in two patients (16.67%) in Group C and 11 patients (36.67%) in Group B, compared with two patients (0.78%) in Group A. At 18-20 weeks of gestation, low birth weight was observed for three patients (23.08%) in Group C and 16 patients (53.33%) in Group B, compared with 15 patients (5.88%) in Group A. At 30-32 weeks, low birth weight was observed for four patients (33.33%) in Group C and 19 patients (63.33%) in Group B compared with 11 patients (4.30%) in Group A. A significant association was found between a thin placenta and low birth weight and prematurity at both 18-20 and 30-32 weeks of gestation. Two patients (13.33%) had major congenital abnormalities and a thick placenta at 18-20 weeks. In Group C, hydrops were observed in two patients (15.38%) at 18-20 weeks and two patients (16.67%) at 30-32 weeks. A significant association was found between a thick placenta and hydrops. At 30-32 weeks, 13 patients (43.33%) in Group B had developed FGR compared with six patients (2.34%) with a normal placenta. A significant association was found between a thin placenta and FGR. One patient (7.69%) with a thick placenta had a stillbirth, indicating a nonsignificant association. Conclusions A positive correlation was observed between congenital anomalies and hydrops and a thick placenta, whereas FGR, preterm labor, prematurity, and low birth weight were associated with a thin placenta. Subnormal placental thickness for a particular gestational age may be the earliest sign of FGR. A sonographically identified abnormal placenta should alert clinicians to the possibility of a compromised perinatal outcome and the need for evaluation and close follow-up.

Deep Learning Radiomic Analysis of MRI Combined with Clinical Characteristics Diagnoses Placenta Accreta Spectrum and its Subtypes.

Different placenta accreta spectrum (PAS) subtypes pose varying surgical risks to the parturient. Machine learning model has the potential to diagnose PAS disorder. To develop a cascaded deep semantic-radiomic-clinical (DRC) model for diagnosing PAS and its subtypes based on T2-weighted MRI. Retrospective. 361 pregnant women (mean age: 33.10 ± 4.37 years), suspected of PAS, divided into segment training cohort (N = 40), internal training cohort (N = 139), internal testing cohort (N = 60), and external testing cohort (N = 122). Coronal T2-weighted sequence at 1.5 T and 3.0 T. Clinical characteristics such as history of uterine surgery and the presence of placenta previa, complete placenta previa and dangerous placenta previa were extracted from clinical records. The DRC model (incorporating radiomics, deep semantic features, and clinical characteristics), a cumulative radiological score method performed by radiologists, and other models (including a radiomics and clinical, the clinical, radiomics and deep learning models) were developed for PAS disorder diagnosing (existence of PAS and its subtypes). AUC, ACC, Student's t-test, the Mann-Whitney U test, chi-squared test, dice coefficient, intraclass correlation coefficients, least absolute shrinkage and selection operator regression, receiver operating characteristic curve, calibration curve with the Hosmer-Lemeshow test, decision curve analysis, DeLong test, and McNemar test. P < 0.05 indicated a significant difference. In PAS diagnosis, the DRC-1 outperformed than other models (AUC = 0.850 and 0.841 in internal and external testing cohorts, respectively). In PAS subtype classification (abnormal adherent placenta and abnormal invasive placenta), DRC-2 model performed similarly with radiologists (P = 0.773 and 0.579 in the internal testing cohort and P = 0.429 and 0.874 in the external testing cohort, respectively). The DRC model offers efficiency and high diagnostic sensitivity in diagnosis, aiding in surgical planning. 3 TECHNICAL EFFICACY: Stage 2.

A case of circumvallate placenta causing preterm premature rupture of membranes post-amniocentesis

We report a case of circumvallate placenta which led to preterm premature rupture of membranes (PPROM) and leakage in a mother at 17 weeks of gestation. The mother underwent amniocentesis after the triple marker test showed an increased risk for trisomy 21. We encountered difficulty in aspirating amniotic fluid due to the abnormal placental structure, which was not known at the time of the invasive procedure. The mother experienced leaking 7 days post-procedure, followed by miscarriage. Autopsy examination revealed that the placenta was circumvallate, which not only caused difficulty in aspirating the amniotic fluid but also could be the cause of PPROM, a well-known complication of the circumvallate placenta. We emphasize that examining the placenta is very important to identify the cause of events in certain situations; circumvallate placenta or abnormal placenta can be suspected in cases where hindrance is encountered (not able to aspirate amniotic fluid even if the needle is visible in the amniotic sac) during amniocentesis.

Proteomic Biomarkers of Intrahepatic Cholestasis of Pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disease, which can lead to adverse fetal outcomes, including preterm labor and intrauterine death. The pathogenesis of ICP is still unclear. We hypothesized that pathological index leads to abnormal placenta changes in ICP. Investigation of these differences in protein expression in parallel profiling is essential to understand the comprehensive pathophysiological mechanism underlying ICP. The present study screened differentially expressed proteins (DEPs) as novel diagnostic markers for ICP. Proteomic profiles of placental tissues from 32 ICP patients and 24 healthy volunteers (controls) were analyzed. Our founding was valid by following western blotting and immunohistochemistry staining, respectively. The association of the key protein expression with clinicopathological features of ICP was further analyzed. A total of 178 DEPs were identified between the ICP and control groups. Functional enrichment analysis showed these proteins were significantly enriched in the PPAR singling pathway by KEGG and PPARα/RXRα activation by IPA. Apolipoprotein A2 (APOA2) was the only upregulated protein, which uniquely identified in ICP groups and related to both pathways. Validation of western blotting and immunohistochemical staining analysis showed significantly higher APOA2 expression in the ICP group than in the control group. Furthermore, the expression of APOA2 is associated with clinicopathological features in ICP groups. Receiver operating characteristic (ROC) curve analyses showed that the AUC of APOA2 was 0.8984 (95% confidence interval (CI): 0.772–1.000). This study has identified up-regulated APOA2 associated with PPAR singling pathway and PPARα/RXRα activation in ICP. Thus, APOA2 may be involved in ICP pathogenesis, serving as a novel biomarker for its diagnosis.

Analysis of risk factors and changes in myocardial biomarker levels in 122 cases of early neonatal anemia.

Anemia in the first week after birth, which could affect growth, development, and organ function, should be an important warning sign to clinicians. The aim of this study was to assess the related risk factors of early neonatal anemia and to analyze the effect of anemia on the expression levels of myocardial markers in newborns. Clinical data from 122 confirmed cases of anemic newborns and 108 nonanemic newborns were collected to analyze the independent risk factors for early anemia using logistic regression analyses. Blood samples were collected from both groups for the detection of myocardial markers, including the protein marker cardiac troponin T (cTnT), as well as enzyme markers creatine kinase isoenzyme MB (CK-MB) and lactate dehydrogenase (LDH). Multivariate logistic regression analysis revealed that preterm birth (OR: 3.589 [1.119-11.506], p < 0.05), multiple pregnancy (OR: 4.117 [1.021-16.611], p < 0.05), and abnormal placenta (OR: 4.712 [1.077-20.625], p < 0.05) were independent risk factors for early neonatal anemia. The levels of myocardial markers, including cTnT (303.1 ± 244.7 vs. 44.2 ± 55.41 ng/L), CK-MB (6.803 ± 8.971 vs. 2.5326 ± 2.927 μkat/L), and LDH (32.42 ± 35.26 vs. 19.73 ± 17.13 μkat/L), were significantly higher in the anemic group than in the nonanemic group. Multiple pregnancy, preterm birth, and abnormal placenta were identified as risk factors for early neonatal anemia. The occurrence of early neonatal anemia was associated with increased levels of myocardial markers.

Prenatal diagnosis and postnatal outcome of Type-III vasa previa: systematic review of literature.

Type-III vasa previa (VP) is a rare form of VP, not necessarily associated with other placental or vascular anomalies, in which aberrant vessels run from the placenta to the amniotic membranes, near the internal cervical os, before returning to the placenta. Early diagnosis of Type-III VP is important but technically challenging. The objective of this study was to gather the current available evidence on the perinatal diagnosis and outcome of Type-III VP. A systematic review of the literature on the perinatal diagnosis of atypical Type-III VP was carried out in PubMed, MEDLINE and EMBASE accordingto PRISMA guidelines from inception to March 2023. Data extraction and tabulation were performed by two operators and checked by a third senior author. The quality of the included studies was evaluated using the National Institutes of Health tool for the quality assessment of case-series studies. Our local ultrasound database was searched for previously unreported recent cases. Characteristics of prenatally and postnatally diagnosed Type-III VP, including clinical features and perinatal outcomes, were summarized using descriptive statistics. Eighteen cases of Type-III VP were included, of which 16 were diagnosed prenatally (14 cases were retrieved from 10 publications and two were unpublished cases from our center) and two were diagnosed postnatally (retrieved from two publications). All prenatal cases were diagnosed on transvaginal ultrasound at a mean gestational age of 29 weeks (median, 31 weeks; range, 19-38 weeks). Conception was achieved with in-vitro fertilization in 4/16 (25.0%) cases. There were no prenatal symptoms in 15/18 (83.3%) cases, while in two (11.1%) cases there was vaginal bleeding and in one (5.6%) preterm labor occurred. In 15/18 (83.3%) cases, at least one placental abnormality was observed, including low-lying insertion (9/17), succenturiate or accessory lobe (1/17), velamentous cord insertion (3/18) and marginal insertion (9/18). All prenatally diagnosed cases were liveborn and were delivered by Cesarean section before rupture of membranes at a median gestational age of 35 weeks (range, 32-38 weeks) without neonatal complications. Emergency Cesarean section was performed in 2/16 (12.5%) cases with a prenatal diagnosis and 1/2 (50.0%) cases with a postnatal diagnosis (P = 0.179). Among those with data available, an Apgar score of ≤ 7 was observed in the prenatally vs postnatally diagnosed group in 5/13 vs 1/1 cases, respectively, at the 1-min evaluation and 3/13 vs 1/1 cases, respectively, at the 5-min evaluation. The prenatal diagnosis of Type-III VP is challenging, with few cases reported in the literature; however, it is crucial for minimizing the risk of adverse outcome by enabling early-term elective Cesarean delivery prior to rupture of membranes. Given that clinical manifestations and risk factors are non-specific, and that Type-III VP cannot be excluded when there is a normal cord insertion or a singular placental mass, systematic screening by transvaginal ultrasound in the general pregnant population is recommended, particularly in those with a low-lying or morphologically abnormal placenta and those who conceived using assisted reproductive technology. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Impact of spontaneous abortion history and induced abortion history on perinatal outcomes of singleton pregnancies

BackgroundAt present, there are several studies on abortion history and perinatal outcomes, but there is no unified conclusion whether the history of abortion and different types of abortion are related to perinatal complications of subsequent pregnancy. We aim to study the impact of different types of abortion history on perinatal outcomes of singleton pregnancies.MethodsThis was a retrospective study from a maternity and infant hospital in Shanghai, China from 2016 to 2020. Pregnant women who gave birth to live singleton infant were included (n = 75,773). We classified abortion into spontaneous abortion (SAB) and induced abortion (IA). We compared the perinatal outcomes of singleton pregnancies with different abortion histories and used Logistic regression analysis to evaluate the associations between pre-pregnancy abortion history with perinatal outcomes.ResultsWe observed that pregnant women with a history of abortion were more likely to have a premature delivery (0.99% VS 0.45%), gestational diabetes mellitus (GDM) (13.40% VS 10.29%), placenta abnormality (8.16% VS 5.06%), placenta previa (5.65% VS 3.75%), placenta accreta (0.18% VS 0.04%), and placenta adhesion (2.79% VS 1.03%) than those who obtained singleton pregnancies without a history of abortion. When confounding factors were adjusted, differences in placenta abnormality still existed (excluding placenta abruption). The odds ratios and 95% confidence interval of placenta previa, placenta accreta, and placenta adhesion in pregnant women with only SAB history, only IA history, and both abortion history were 1.294(1.174–1.427), 1.272(1.159–1.396), and 1.390(1.188–1.625), 2.688(1.344–5.374), 2.549(1.268–5.125), and 5.041(2.232–11.386), 2.170(1.872–2.515), 2.028(1.738–2.366), and 3.580(2.917–4.395), respectively.ConclusionsOur research showed that pregnant women who have a history of abortion before pregnancy were more likely to have premature birth, GDM, placenta previa, placenta accreta, and placenta adhesion. After adjusting for confounding factors, we found that the history of SAB, IA, and both SAB and IA history were related to the increased risk of placenta previa, placenta accreta, and placenta adhesion.

Analysis of risk factors and pregnancy outcomes in pregnant women with subchorionic hematoma.

Subchorionic hemorrhage (SCH) or hematoma is one of the abnormal ultrasonic manifestations. At present, there are few studies on the pathogenesis of SCH, and its underlying mechanism is still unclear. It may be related to abnormal placenta formation and implantation, autoimmune dysfunction, and coagulation dysfunction. As a unique complication of pregnancy, SCH has a controversial effect on pregnancy outcome. The aim of the present study was to explore the possible etiology of SCH, especially its association with autoimmune dysfunctions, as well as the pregnancy outcomes of SCH patients. This retrospective cohort study was conducted at the Third Affiliated Hospital of Zhengzhou University. Patients with a singleton pregnancy of ≤14 weeks gestation from June 2021 to June 2022 were included. Patients with SCH detected by ultrasound were selected as the study group, while patients without SCH during the same period were chosen as the control group. Immunological indicators and pregnancy outcomes were primarily compared between the 2 groups. The decrease in protein S activity and antithrombin-III levels, the increase in homocysteine levels, and the presence of autoantibodies (such as lupus anticoagulant, anticardiolipin antibody, and antinuclear antibody spectrum) were found to be risk factors for SCH. SCH in the first trimester was associated with higher rates of premature rupture of membranes (13.5% vs 3.8%) and miscarriage (14.4% vs 6.4%). However, there were no significant differences in the rates of placental abruption, fetal distress, cesarean section, neonatal birth weight, and gestational age. The incidence of miscarriage was also significantly higher in patients with subchorionic hematoma (SCH) who tested positive for autoantibodies (28.2% vs 7.6%). There were no significant differences in other clinical characteristics and pregnancy outcomes between patients with SCH who had positive autoantibodies and those who did not. The occurrence of SCH may be related to maternal immune abnormalities. SCH may increase the risk of premature rupture of membranes and abortion. However, there is no correlation between the presence or absence of SCH and neonatal outcomes.

Features of pregnancy course in patients with thrombophilia and abnormal placenta location

Aim: to identify inherited and acquired thrombophilia as well as features of pregnancy course in women with abnormal placenta location.Materials and Methods. Within the framework of a prospective controlled cohort non-randomized, interventional study there was analyzed pregnancy course in 135 women with abnormal placenta location: group I – 42 patients with abnormal placenta location in history; group II – 61 women with placenta previa detected during ongoing pregnancy; group III – 32 patients with placenta previa detected both in ongoing and previous pregnancy. The control group consisted of 120 pregnant women with normal placenta location without a previous complicated obstetric history. All patients underwent clinical examination of pregnancy course assessing fetus intrauterine growth retardation (IUGR) and fetal biophysical profile; inherited and acquired thrombophilia were identified – analyzing circulating antiphospholipid antibodies (APAs) by ELISA, inherited thrombophilia by polymerase chain reaction to identify mutations in genes encoding 5,10methylenetetrahydrofolate reductase (MTHFR), G20210A mutations in prothrombin gene, V Leiden mutation, polymorphismin fibrinogen and plasminogen activator inhibitor 1 (PAI-1) genes.Results. Inherited thrombophilia was detected in 101 (74.81 %) pregnant woman with abnormal placenta location: group I – in 31 (73.8 %) patients, group II and group III – in 44 (72.1 %) and 26 (81.3 %) patients, respectively. Inherited forms of thrombophilia were detected in 29 (24.2 %) women from control group. Multigenic forms of thrombophilia peaked in group III (14/43.8 %), followed by group I (16/38.1 %) and group II (23/37.7 %). In the control group, multigenic thrombophilia was detected in 16 (13.3 %) women. Selective inherited thrombophilia and АРАs circulation were detected in 30 (22.22 %) women with abnormal placenta location: group I – in 8 (19.0 %) patients, group II – in 13 (21.3 %), and group III – in 9 (28.1 %) cases. In the control group, there were only 8 (6.7 %) such patients. Patients with IUGR signs were identified in all study groups: 4 (9.52 %) in group I, 6 (9.84 %) in group II, 6 (18.75 %) in group III as well as in control group in 6 (6.67 %) women.Conclusion. Pregnancy management in patients with thrombophilia and placental abnormalities should be accompanied by an proper fetal assessment (biophysical profile) and, in some cases, anticoagulant or antiplatelet therapy. However, insufficient number of cases requires to conduct further investigations to assess a relation between thrombophilia, placenta previa and a risk of obstetric complications particularly IUGR.

Hsa_circ_0002348 regulates trophoblast proliferation and apoptosis through miR-126-3p/BAK1 axis in preeclampsia

BackgroundPreeclampsia is a common pregnancy complication characterized by high blood pressure and damage to organs. Abnormal placenta and vascular function can lead to preeclampsia. Accumulating evidence has suggested a potential link between circular RNAs (circRNAs) and preeclampsia. As a placenta and endothelial-expressed circRNA, hsa_circ_0002348, may be promising to be the novel molecular target for preeclampsia. However, the function and mechanism of hsa_circ_0002348 in preeclampsia has not been elucidated.Materials and methodsAn overlap analysis of two circRNA profiles from placenta and endothelial cells was used to identify a functionally unknown circRNA, hsa_circ_0002348. Quantitative real-time PCR (qRT-PCR) and in situ hybridization (ISH) were used to detect its expression in the trophoblast cells and placental tissues. The mouse model of lipopolysaccharide (LPS)-induced preeclampsia was established to determine the in vivo role of hsa_circ_0002348. RNA immunoprecipitation (RIP), Luciferase reporter assay, qRT-PCR, western blot, gain- and loss-of-function and rescue experiments were conducted to uncover the role of hsa_circ_0002348 and its interaction with miR-126-3p and BAK1 in regulating trophoblast proliferation and apoptosis. Fluorescence in situ hybridization (FISH) and Immunohistochemistry (IHC) were performed to examine the expression of miR-126-3p and BAK1 in mice and human placentas, respectively.ResultsHsa_circ_0002348 was significantly increased in the preeclampsia placentas, and positively correlated with the severity of preeclampsia patients’ clinical manifestations. Its overexpression exacerbated preeclampsia-like features in the mouse model of LPS-induced preeclampsia. Functionally, hsa_circ_0002348 was found to inhibit trophoblast proliferation and promote trophoblast apoptosis. Mechanistically, hsa_circ_0002348, as an endogenous miR-126-3p sponge, upregulated the expression of BAK1. Additionally, both hsa_circ_0002348 knockdown and miR-126-3p overexpression enhanced the mammalian target of rapamycin (mTOR) and ERK1/2 signaling pathway.ConclusionsHsa_circ_0002348 might be a novel regulator of trophoblast proliferation and apoptosis through miR-126-3p/BAK1 axis in preeclampsia, which may serve as a potential target for detecting and treating preeclampsia.

Comparison of Adverse Maternal Outcome in Early Onset Versus Delayed Onset Preeclampsia

Aim: To determine the association of adverse maternal outcome with early onset preeclampsia than delayed onset preeclampsia. Study Design: Cohort study. Place and Duration of Study: Department of Obstetrics &amp; Gynecology Unit-II, DHQ Hospital, Mirpur, AJK from 30th December 2020 to 29th June 2021. Methodology: A total of 60 (30 early onset pre-eclampsia and 30 delayed onset pre-eclampsia) females of age 18-40 years with parity &lt;5, presenting at gestational age &gt;24 weeks were included. Patients with chronic or gestational diabetes (BSR&gt;186mg/dl), chronic hypertension (BP≥140/90mmHg), cardiac disease (on medical record), multiple gestation (on ultrasound), abnormal placenta (abruption, previa, accrete, increta, percreta on ultrasound) were excluded. Females were evaluated for eclampsia (BP&gt;160/100mmHg along with convulsions), DIC, HELLP syndrome and avascular tubular necrosis by using blood samples and ultrasound findings. Results: The adverse maternal outcome i.e. eclampsia was recorded in 11 (36.67%) in exposed group (early onset pre-eclampsia) versus 04 (13.33%) in unexposed group (delayed onset pre-eclampsia) (p= 0.053; relative risk = 2.75), acute tubular necrosis was recorded in 05 (16.67%) in exposed group (early onset pre-eclampsia) while 00 (0.0%) in unexposed group (delayed onset pre-eclampsia) (p = 0.099; relative risk = 11.00), DIC was recorded in 03 (10.0%) versus 00 (0.0%) respectively (p= 0.192; relative risk = 7.00) and HELLP syndrome in 06 (20.0%) versus 00 (0.0%) respectively (p = 0.076; relative risk = 13.0). Practical Implication: We recommend that a proper protocol should be designed in these high risk patients for antenatal monitoring and proper management plans in order to reduce the morbidity and mortality of the mother and fetus. Conclusion: This study concluded that adverse maternal outcome is higher in early onset preeclampsia as compared to delayed onset preeclampsia. Keywords: Preeclampsia, Adverse Maternal Outcome, Eclampsia.

Relationship between Abnormal Placenta and Obstetric Outcomes: A Meta-Analysis.

The placenta has several crucial physiological functions that help maintain a normal pregnancy. Although approximately 2-4% of pregnancies are complicated by abnormal placentas, obstetric outcomes remain understudied. This study aimed to determine the outcomes and prevalence of patients with abnormal placentas by conducting a systematic review of 48 studies published between 1974 and 2022. The cumulative prevalence of circumvallate placenta, succenturiate placenta, multilobed placenta, and placenta membranacea were 1.2%, 1.0%, 0.2%, and 0.004%, respectively. Pregnancies with a circumvallate placenta were associated with an increased rate of emergent cesarean delivery, preterm birth (PTB), and placental abruption compared to those without a circumvallate placenta. The succenturiate lobe of the placenta was associated with a higher rate of emergent cesarean delivery, whereas comparative results were observed in terms of PTB, placental abruption, and placenta previa in comparison to those without a succenturiate lobe of the placenta. A comparator study that examined the outcomes of multilobed placentas found that this data is usually unavailable. Patient-level analysis (n = 15) showed high-rates of abortion (40%), placenta accreta spectrum (40%), and a low term delivery rate (13.3%) in women with placenta membranacea. Although the current evidence is insufficient to draw a robust conclusion, abnormal placentas should be recognized as a high-risk factor for adverse outcomes during pregnancy.

Pregnancy, childbirth and neonatal outcomes associated with adolescent pregnancy

ObjectiveTo assess the obstetric and neonatal outcomes associated with adolescent pregnancy in Iran. MethodsWe retrospectively assessed women who gave birth between January 1st, 2020, and January 1st, 2022. These pregnant women were separated into two groups: (1) women aged 19 and younger; (2) women aged 20–34 years. Main outcome measures include preterm birth, maternal comorbidities, preeclampsia, eclampsia, low birth weight (LBW), intrauterine growth restriction (IUGR), placenta abnormalities, placenta abruption, chorioamnionitis, meconium fluid, fetal distress, methods of delivery, rate of cesarean section (CS), perineal lacerations, postpartum hemorrhage, childbirth trauma, shoulder dystocia, congenital malformation, and unfavorable maternal and neonatal outcome. Logistic regression models were used to determine the influence of teenage pregnancy on adverse pregnancy and childbirth outcomes. ResultsOf 7033 deliveries, 92.4% of women were adults, and 7.6% were adolescents. Adolescents residing in rural districts were more common than adults (42.3% vs. 33.7%). However, access to prenatal facility care was the same as the majority of women had 6-10 prenatal care visits during their pregnancy. There was no difference in the risk of preeclampsia, placenta abruption, placenta previa, fetal distress, preterm labor, shoulder dystocia, perineal lacerations, childbirth trauma, congenital malformation, postpartum hemorrhage, intensive care unit admission, maternal death, and unfavorable neonatal outcome including stillbirth, neonatal intensive care unit admission, neonatal death in adolescent pregnancies compared to adults. Adolescents had a significantly higher risk of LBW (OR: 1.47, 95%CI: 1.01–2.73), IUGR (OR: 1.96, 95%CI: 1.31–2.45), and meconium fluid (OR: 1.74, 95%CI: 1.41–2.32), however, there was no statistically significant difference after adjusting the confounding factors. Compared with adults, adolescents had a significantly lower risk of CS (aRR: 0.67, 95%CI: 0.51–0.77) and a lower risk of gestational diabetes (aRR: 0.78, 95%CI: 0.51–0.95). ConclusionsAlthough we found no serious consequences of adolescent pregnancy, more research is needed to reach a more accurate conclusion about teenage pregnancy.

Placenta accreta spectrum with severe morbidity: fibrosis associated with cervical-trigonal invasion

Objective Describe the clinical-surgical results of patients with PAS in the low-posterior cervical-trigonal space associated with fibrosis (PAS type 4) compared with PAS types in other locations (Types 1, upper bladder, 2 in upper parametrium) and in particular with PAS type 3, corresponding to dissectible cervical-trigonal invasion. The clinical-surgical results of using a standard hysterectomy were analyzed with a modified subtotal hysterectomy (MSTH) in patients with PAS type 4. Material and methods A descriptive, retrospective, multicenter study included 337 patients of PAS; thirty-two corresponding to PAS type 4, from three PAS reference hospitals, CEMIC, Buenos Aires, Argentina, Fundación Valle de Lili, Cali, Colombia, and Dr. Soetomo General Hospital, Surabaya, Indonesia, between January 2015 and December 2020. PAS was diagnosed by abdominal and transvaginal ultrasound and topographically characterized by ultrafast T2 weighted MRI. In persistent macroscopic hematuria after MSTH, the surgeon performs an intentional cystotomy and uses a square compression suture to achieve the hemostasis inside the bladder wall. According to a PAS topographical classification, the patients with low-vesical cervical involvement compared with PAS located in relation with the upper blader (type1), upper parametrium (type 2 upper), and also with PAS situated in the lower vesical-trigon space (type 3). PAS 3 and 4 are located in identical area, but in type 3, group A, the vesicouterine space was dissectible, and in type 4, group B, significant fibrosis made surgical dissection extremely challenging. Furthermore, group B was divided into patients treated with total hysterectomy (HT) and those treated with a modified subtotal hysterectomy (MSTH). The surgical requirements to perform an MSHT included the availability of proximal vascular control at the aortic level (internal manual aortic compression, aortic endovascular balloon, aortic loop, or aortic cross-clamping). Then surgeon performed an upper segmental hysterotomy, avoiding the abnormal placenta invasion area; after that, the fetus was delivered, and the umbilical cord was ligated. After uterine exteriorization, the surgeon applies a continuous circular suture with number 2 polyglactin 910, taking some portions of the myometrium -to avoid unintentional slipping- around the lower uterine segment and a 3–4 cm proximal to the abnormal adhesion of the placenta. After tightening hard the circular suture, the uterine segment was circumferentially cut, three centimeters proximal to the circular hemostatic sutures. Next, the surgery follows the upper steps of conventional hysterectomy without changes. Additionally, the histological presence of fibrosis was examined in all samples. Results Modified subtotal hysterectomy in patients with PAS type 4 (cervical-trigonal fibrosis) resulted in a significant clínico-surgical improvement over total hysterectomy. The median operative time and intraoperative bleeding were 140 min (IQR 90–-240) and 1895 mL (IQR 1300–2500) in patients undergoing modified subtotal hysterectomy, and 260 min (IQR 210–287) and 2900 mL (IQR 2150–5500) in patients treated with total hysterectomy, respectively. The complication rate was 20% for MSHT and 82.3% for patients with a total hysterectomy. Conclusions PAS in the cervical trigonal area associated with fibrosis implies a greater risk of complications due to uncontrollable bleeding and organ damage. MSTH is associated with lower morbidity and difficulties in PAS type 4. Prenatal or intrasurgical diagnosis is essential to plan surgical alternatives to improve the results.

Race Differences in Transfusion Thresholds in Patients Undergoing Cesarean Delivery [ID: 1377655

INTRODUCTION: Transfusion is a major contributor to severe maternal morbidity (SMM) and is influenced by the presence of anemia on admission for delivery. As rates of SMM vary by race, we sought to describe transfusion thresholds by race and hemoglobin on admission for delivery. METHODS: This was an IRB-approved retrospective cohort analysis of deliveries in a single health care network from 2015 to 2020. Multivariable binomial regression models assessed the relationship between transfusion, hemoglobin on admission for delivery, and race. Patients with hemorrhage, abruption, or placenta abnormalities were excluded to control for events associated with transfusion. Models were adjusted for age, parity, insurance, marital status, and tobacco use and evaluated by mode of delivery. Anemia was defined as hemoglobin less than 11.0 mg/dL. RESULTS: Eighty-one thousand six hundred thirteen delivery admissions were included. People of Black race diagnosed with anemia had 1.4 times the odds of transfusion compared to White race (95% CI 1.1–1.8). In anemic patients undergoing cesarean, people of Black race had two times the odds of transfusion than people of White race (95% CI 1.4–2.7). For example, people of Black race undergoing cesarean with starting hemoglobin of 6.0 mg/dL had a 76% (95% CI 64–88%) predicted probability of transfusion compared to 27% (95% CI 17–37%) for people of White race at the same starting hemoglobin undergoing cesarean. CONCLUSION: Transfusion was more likely in people of Black race compared to White race regardless of starting hemoglobin value or underlying risk factors. This was most pronounced in patients undergoing cesarean. Exploration of specific factors contributing to this finding in the context of structural racism and inequitable care are warranted.