Abnormal Placenta Research Articles

Placental Mesenchymal Dysplasia Co-existing with High Grade Villitis of Unknown Aetiology (VUE): A Very Rare Case Report and Literature Review

The present case study reports about Placental mesenchymal dysplasia co-existing with high grade villitis of unknown aetiology (VUE). Placental Mesenchymal Dysplasia (PMD) is a rare placental lesion characterized by unusual abnormality of the stem villi of the placenta that could be mistaken for hydatidiform mole due to the presence of both cysts and normal-appearing parenchyma. A 30-year-old G2 P1 (full-term normal delivery) seen in fetal medicine clinic at 20 weeks within view of high risk on combined screening (low PAPP-A and high HCG). An ultrasound scan showed an appropriately grown baby with an abnormal placenta consisting of multiple lacunae more than 50% of the placental mass with increased thickness. A second opinion at tertiary care hospital confirmed the presence of prominent lakes on the placenta. Growth scans also showed IUGR with increasingly abnormal Doppler scans as the pregnancy progressed. At 35 weeks, EFW was < 3rd centile with static growth and patient had Induction of labour at 35 +4 weeks with vaginal delivery of a live male neonate weighing 2325g admitted to the neonatal intensive care unit (NICU) admission due to prematurity. The baby was discharged from NICU at day 5, achieving developmental milestones at the age of 23 weeks post-delivery. On microscopic histological examination, the chorionic plate showed no significant abnormality. The villous architecture was highly abnormal, and some villi were markedly enlarged with myxoid stroma and central degeneration. There were very occasional foci of apparent trophoblastic proliferation with villous architecture abnormalities seen in the form of clusters of large, immature intermediate villi. These features were in keeping with mesenchymal dysplasia. A highly unusual finding in this context was a florid infiltrate of CD3 positive T cells consistent with high-grade villitis of unknown aetiology concluding very rare co-existence of both conditions.

Morphometric and Morphologic Assessment of the Placenta, Birth Weight and Associated Risk Factors in Full Term Neonates in Nigeria

Placenta is a temporary and dynamic organ which is unique in its development and function on which survival, healthy growth and development of fetus in the uterus mostly depends. The study was carried out to determine the morphometry and morphology of placenta, birth weight and associated risk factor of full-term neonates. The study involved 50 placentae (27 from males and 23 from females). Descriptive statistical method of data analysis was used to analyze the mean, standard deviation and z-test to correlate the mean. The mean and standard deviation of neonatal weight, fetoplacental coefficient, weight of placenta, maximum weight of placenta, thickness of placenta and the length of umbilical cord observed were; 3.21±0.4, 6.36±1.92, 0.54±0.16 21.30±1.04, 2.17±0.28 and 54.16±2.11 respectively. Also, the most predominant type of umbilical cord attachment was eccentric with a frequency of 38. The number of cotyledons was found to be 15 and above for 98% of the placentaes excluding one which had 8 cotyledons. The presence of incomplete artery was observed in the study. The result showed that placental weight correlates significantly with neonatal weight and that abnormal placenta results in poor health of the neonate. The examination of the placenta can be useful for the future postnatal life as it is indicative of neonatal birth weight. and resistance to early adulthood diseases of the neonates. It is, therefore, recommended that physicians pay attention to the placenta.

Galectins in Equine Placental Disease

Galectins are proteins that bind to glycans in targeted cells and function in cell-to-cell signaling throughout the body. Galectins have been found to be involved in various reproductive processes, including placental dysfunction, but this has not been investigated in the horse. Therefore, the objective of this study was to assess alterations in galectin expression of the abnormal placenta in pregnant mares. Next-generation RNA sequencing was performed on the postpartum chorioallantois of two placental pathologies following clinical cases of ascending placentitis (n = 7) and focal mucoid placentitis (n = 4), while chorioallantois from healthy postpartum pregnancies (n = 8; 4 control samples per disease group) served as the control. When evaluating ascending placentitis, both galectin-1 (p < 0.001) and galectin-3BP (p = 0.05) increased in the postpartum chorioallantois associated with disease, while galectin-8 (p < 0.0001) and galectin-12 (p < 0.01) decreased in the diseased chorioallantois in comparison with those in the control. In mares with focal mucoid placentitis, numerous galectins increased in the diseased chorioallantois, and this included galectin-1 (p < 0.01), galectin-3BP (p = 0.03), galectin-9 (p = 0.02), and galectin-12 (p = 0.04), in addition to a trend toward increases in galectin-3 (p = 0.08) and galectin-13 (p = 0.09). In contrast, galectin-8 expression decreased (p = 0.04) in the diseased chorioallantois in comparison with that of the controls. In conclusion, galectins alter in abnormal placentae with variations observed among two forms of placental pathologies. These cytokine-like proteins may further our understanding of placental pathophysiology and warrant attention as potential markers of placental inflammation and dysfunction in the horse.

Intrinsic sexual dimorphism in the placenta determines the differential response to benzene exposure

Maternal immune activation (MIA) by environmental challenges is linked to severe developmental complications, such as neurocognitive disorders, autism, and even fetal/maternal death. Benzene is a major toxic compound in air pollution that affects the mother as well as the fetus and has been associated with reproductive complications. Our objective was to elucidate whether benzene exposure during gestation triggers MIA and its impact on fetal development. We report that benzene exposure during pregnancy leads MIA associated with increased fetal resorptions, fetal growth, and abnormal placenta development. Furthermore, we demonstrate the existence of a sexual dimorphic response to benzene exposure in male and female placentas. The sexual dimorphic response is a consequence of inherent differences between male and female placenta. These data provide crucial information on the origins or sexual dimorphism and how exposure to environmental factors can have a differential impact on the development of male and female offspring.

Placenta Accreta Spectrum: We Can Do Better

(Aust N Z J Obstet Gynaecol. 2022;62:376–382) Placenta accreta spectrum (PAS) describes the range of placental disorders. Based on classifications by the International Federation for Gynecology and Obstetrics, Grade 1 PAS indicates an abnormal adherent placenta (accreta), Grade 2 PAS indicates an abnormal invasive placenta into the uterine muscle (increta), and Grade 3 PAS indicates an abnormal placenta that grows into the uterine wall and surrounding organs (percreta). Risk factors for PAS include increased maternal age, multiparity, previous cesarean delivery (CD) or uterine surgery, in vitro fertilization, and placenta previa. The incidence of PAS has been increasing from 0.4 per 1000 births in earlier studies to as high as 3.7 per 1000 births—a trend largely attributed to the worldwide increase in CD. Because PAS is associated with a number of severe pregnancy complications, such as maternal hemorrhage, hysterectomy, and mortality, its accurate diagnosis is important for the appropriate transfer of care and multidisciplinary team (MDT) management. The aim of this study was to determine the rate of antenatal detection of PAS and the impact of MDT management on pregnancy outcomes.

Diagnosis and Management of Gestational Trophoblastic Disease: 2021 Update

(Int J Gynaecol Obstet. 2021;155(suppl 1):86–93) Gestational trophoblastic disease (GTD) is a premalignant disorder that derives from an abnormal placenta. Biomarker hormone human chorionic gonadotropin found in pregnancy and postpartum can help determine disease progression.

Effects of Salvia miltiorrhiza active compounds on placenta-mediated pregnancy complications.

Placenta-mediated pregnancy complications (PMPCs), including preeclampsia (PE), fetal growth restriction (FGR), and recurrent spontaneous abortion (RSA), occur in approximately 5% of pregnancies and are caused by abnormal placenta development. The development of effective therapies for PMPCs is still challenging due to the complicated pathogenesis, such as disrupted vascular homeostasis and subsequent abnormal placentation. Synthetic drugs have been recommended for treating PMPCs; however, they tend to cause adverse reactions in the mother and fetus. Salvia miltiorrhiza (S. miltiorrhiza) has potential effects on PMPCs owing to its advantages in treating cardiovascular disorders. S. miltiorrhiza and its active compounds could attenuate the symptoms of PMPCs through anticoagulation, vasodilation, antioxidation, and endothelial protection. Thus, in this review, we summarize the literature and provide comprehensive insights on S. miltiorrhiza and its phytochemical constituents, pharmacological activities, and on PMPCs, which would be valuable to explore promising drugs.

Hypoxia-sensitive miRNA regulation via CRISPR/dCas9 loaded in hybrid exosomes: A novel strategy to improve embryo implantation and prevent placental insufficiency during pregnancy.

Assisted reproductive techniques as a new regenerative medicine approach have significantly contributed to solving infertility problems that affect approximately 15% of couples worldwide. However, the success rate of an in vitro fertilization (IVF) cycle remains only about 20%-30%, and 75% of these losses are due to implantation failure (the crucial rate-limiting step of gestation). Implantation failure and abnormal placenta formation are mainly caused by defective adhesion, invasion, and angiogenesis. Placental insufficiency endangers both the mother's and the fetus's health. Therefore, we suggested a novel treatment strategy to improve endometrial receptivity and implantation success rate. In this strategy, regulating mir-30d expression as an upstream transcriptomic modifier of the embryo implantation results in modified expression of the involved genes in embryonic adhesion, invasion, and angiogenesis and consequently impedes implantation failure. For this purpose, "scaffold/matrix attachment regions (S/MARs)" are employed as non-viral episomal vectors, transfecting into trophoblasts by exosome-liposome hybrid carriers. These vectors comprise CRISPR/dCas9 with a guide RNA to exclusively induce miR-30d gene expression in hypoxic stress conditions. In order to avoid concerns about the fetus's genetic manipulation, our vector would be transfected specifically into the trophoblast layer of the blastocyst via binding to trophoblast Erb-B4 receptors without entering the inner cell mass. Additionally, S/MAR episomal vectors do not integrate with the original cell DNA. As an on/off regulatory switch, a hypoxia-sensitive promoter (HRE) is localized upstream of dCas9. The miR-30d expression increases before and during the implantation and placental insufficiency conditions and is extinguished after hypoxia elimination. This hypothesis emphasizes that improving the adhesion, invasion, and angiogenesis in the uterine microenvironment during pregnancy will result in increased implantation success and reduced placental insufficiency, as a new insight in translational medicine.

The Multifaceted Clinical Characteristics of Congenital Cytomegalovirus Infection: From Pregnancy to Long-Term Outcomes.

The aim of this study was to capture multifaceted clinical characteristics of congenital cytomegalovirus (CMV) infection from diagnosis to treatment using a multidisciplinary approach including obstetrics, pediatrics, pathology, and otorhinolaryngology-head and neck surgery. This is a retrospective study including 30 consecutive cases of congenital CMV infection that were diagnosed at a single tertiary hospital located in Seoul, Korea from January 2009 to December 2020. Congenital CMV infection was defined as a positive result by polymerase chain reaction from urine, saliva or cerebrospinal fluid or positive CMV IgM from neonatal blood sampled within 3 weeks after birth. All cases were analyzed with respect to whole clinical characteristics from diagnosis to treatment of congenital CMV by a multidisciplinary approach including prenatal sonographic findings, maternal immune status regarding CMV infection, detailed placental pathology, neonatal clinical manifestation, auditory brainstem response test, and antiviral treatment (ganciclovir or valganciclovir). Long-term outcomes including developmental delay and hearing loss were also investigated. The total number of births during the study period in our institution was 19,385, with the prevalence of congenital infection estimated to be 0.15%. Among 30 cases of congenital CMV, the median gestational age at delivery was 32.2 weeks [range, 22.6-40.0] and 66.7% of these infants were delivered preterm at less than 37 weeks. Suspected fetal growth restriction was the most common prenatal ultrasound finding (50%) followed by ventriculomegaly (17.9%) and abnormal placenta (17.9%), defined as thick placenta with calcification. No abnormal findings on ultrasound examination were observed in one-third of births. Maternal CMV serology tests were conducted in only 8 cases, and one case each of positive and equivocal IgM were found. The most common placental pathologic findings were chronic villitis (66.7%) and calcification (63.0%), whereas viral inclusions were identified in only 22.2%. The most common neonatal manifestations were jaundice (58.6%) followed by elevation of aspartate aminotransferase (55.2%) and thrombocytopenia (51.7%). After excluding cases for which long-term outcomes were unavailable due to death (n = 4) or subsequent follow up loss (n = 3), developmental delay was confirmed in 43.5% of infants (10/23), and hearing loss was confirmed in 42.9% (9/21) during the follow-up period. In our cohort, 56.7% (17/30) of neonates were treated for congenital CMV with ganciclovir or valganciclovir. Our data show that prenatal findings including maternal serologic tests and ultrasound have limited ability to detect congenital CMV in Korea. Given that CMV is associated with high rates of developmental delay and hearing loss in infants, there is an urgent need to develop specific strategies for the definite diagnosis of congenital CMV infection during the perinatal period by a multidisciplinary approach to decrease the risks of neurologic impairment and hearing loss through early antiviral treatment.

Invasive Mole With Impending Uterine Rupture : A Case Report

Gestational Trophoblastic Disease (GTD) is an abnormal placenta, composed of a spectrum of premalignant to malignant disorders. In Indonesia, GTD incidence is particularly challenging to estimate, since not all cases will be reported or recognized. It classified into hydatidose mole and gestational trophoblastic neoplasia (GTN). One of those clinicopathological classification of GTN is malignant invasive mole. It is likely to be the cause of increased maternal mortality in Indonesia if the disease is not well diagnosed and treated.We reported the case, a 28 years old woman who had a invasive mole with impending uterine rupture. She had a pervaginam bleeding symptoms since 3 weeks after post curetase due to hydatidose mole indication. She also had multiple abortus history.

Gestational Trophoblastic Disease Metastasized to the Vagina: Case Report

Background: Gestational trophoblastic disease is caused by placenta abnormalities and can metastasize in several places outside the uterus, including the vagina. Its criteria are based on physical examination, laboratory examination, ultrasonography, and histopathology. In addition, the malignancy classification is based on FIGO 2000. Treatment is then carried out according to the malignancy level, and monitoring of results can be carried out based on the β-hCG measurement. Case illustration: A 38-year-old multiparous patient with a gestational age of 12 weeks based on HPHT experienced bleeding in the last three hours before admission to the hospital, originating from a 4 x 4 cm vaginal mass detected in the lower 1/3 of the vagina and active bleeding. Ultrasound examination of the whole abdomen showed that the uterus was enlarged and anteflexed with a uterine size of 18x20 cm according to the gestational age of 20 weeks; a multilocular cystic mass appeared in the adnexa area with the impression of a lutein cyst measuring 3x3 cm; a heterogeneous mass appeared in the uterine cavity with multiple anechoic areas giving a Honeycomb appearance; no gestational sac was seen, and the myometrium was intact. Also, the examination of β-HCG levels was found to be more than 1,000,000 mIU/mL. Based on the presence of a vaginal mass suspected of being metastatic from the uterus, a WHO scoring was performed, and a score of 7 was obtained so that it was included in the high-risk category. Conclusion: Diagnosis and classification of gestational trophoblastic disease help determine appropriate management, thereby increasing patient treatment success.

The Characteristics and Obstetric Outcomes of Type II Vasa Previa: Systematic Review and Meta-Analysis.

Vasa previa is a rare fetal life-threatening obstetric disease classified into types I and II. This study aimed to examine the characteristics and obstetric outcomes of type II vasa previa. A systematic review was performed, and 20 studies (1998-2022) were identified. The results from six studies showed that type II vasa previa accounted for 21.3% of vasa previa cases. The characteristics and obstetric outcomes (rate of assisted reproductive technology (ART), antenatal diagnosis, emergent cesarean delivery, maternal transfusion, gestational age at delivery, and neonatal mortality) were compared between type I and II vasa previa, and all outcomes of interest were similar. The association between ART and abnormal placenta (bilobed placenta or succenturiate lobe) was examined in three studies, and the results were as follows: (i) increased rate of succenturiate lobes (ART versus non-ART pregnancy; OR (odds ratio) 6.97, 95% confidence interval (CI) 2.45-19.78); (ii) similar rate of abnormal placenta (cleavage-stage versus blastocyst embryo transfer); (iii) increased rate of abnormal placenta (frozen versus fresh embryo transfer; OR 2.97, 95%CI 1.10-7.96). Although the outcomes of type II vasa previa appear to be similar to those of type I vasa previa, the current evidence is insufficient for a robust conclusion.

Abnormal placenta implantation. Integration between first- and third-trimester imaging in predicting the severity of Placenta Accreta Spectrum (PAS) disorders.

Placenta accreta spectrum (PAS) disorders are pathological conditions correlated to a high risk of adverse maternal surgical outcomes, especially if not diagnosed. In the last 10 years, the literature interest for prenatal diagnosis of PAS disorders has been noticeably greater. More recently, significant progression in prenatal imaging techniques permitted an increase of early identified cases and a more accurate diagnosis of these anomalies, especially in women with multiple risk factors. The aim of this chapter is to give an overhaul on prenatal diagnosis of PAS disorders throughout gestation and to report whether integration between first- and third-trimester ultrasound can predict the development and severity of these anomalies.

SWAVE 2.0 Imaging of Placental Elasticity and Viscosity: Potential Biomarkers for Placenta-Mediated Disease Detection.

Pregnancy complications such as pre-eclampsia (PE) and intrauterine growth restriction (IUGR) are associated with structural and functional changes in the placenta. Different elastography techniques with an ability to assess the mechanical properties of tissue can identify and monitor the pathological state of the placenta. Currently available elastography techniques have been used with promising results to detect placenta abnormalities; however, limitations include inadequate measurement depth and safety concerns from high negative pressure pulses. Previously, we described a shear wave absolute vibro-elastography (SWAVE) method by applying external low-frequency mechanical vibrations to generate shear waves and studied 61 post-delivery clinically normal placentas to explore the feasibility of SWAVE for placental assessment and establish a measurement baseline. This next phase of the study, namely, SWAVE 2.0, improves the previous system and elasticity reconstruction by incorporating a multi-frequency acquisition system and using a 3-D local frequency estimation (LFE) method. Compared with its 2-D counterpart, the proposed system using 3-D LFE was found to reduce the bias and variance in elasticity measurements in tissue-mimicking phantoms. In the aim of investigating the potential of improved SWAVE 2.0 measurements to identify placental abnormalities, we studied 46 post-delivery placentas, including 26 diseased (16 IUGR and 10 PE) and 20 normal control placentas. By use of a 3.33-MHz motorized curved-array transducer, multi-frequency (80,100 and 120 Hz) elasticity measures were obtained with 3-D LFE, and both IUGR (15.30 ± 2.96 kPa, p=3.35e-5) and PE (12.33 ± 4.88 kPa, p=0.017) placentas were found to be significantly stiffer compared with the control placentas (8.32 ± 3.67 kPa). A linear discriminant analysis (LDA) classifier was able to classify between healthy and diseased placentas with a sensitivity, specificity and accuracy of 87%, 78% and 83% and an area under the receiver operating curve of 0.90 (95% confidence interval: 0.8-0.99). Further, the pregnancy outcome in terms of neonatal intensive care unit admission was predicted with a sensitivity, specificity and accuracy of 70%, 71%, 71%, respectively, and area under the receiver operating curve of 0.78 (confidence interval: 0.62-0.93). A viscoelastic characterization of placentas using a fractional rheological model revealed that the viscosity measures in terms of viscosity parameter n were significantly higher in IUGR (2.3 ± 0.21) and PE (2.11 ± 0.52) placentas than in normal placentas (1.45 ± 0.65). This work illustrates the potential relevance of elasticity and viscosity imaging using SWAVE 2.0 as a non-invasive technology for detection of placental abnormalities and the prediction of pregnancy outcomes.

INNOVATIVE APPROACHES TO PREVENTION OF OBSTETRIC HEMORRHAGE DURING ABDOMINAL DELIVERY IN WOMEN WITH PLACENTATION ABNORMALITIES AND HYPERTENSIVE DISORDERS

Introduction. The leading factor of obstetric haemorrhage is disrupted uterine contractility. Therefore, at a high risk of obstetric haemorrhage, uterotonic drugs and vasoconstrictors are used immediately after deliverу of a baby. However, the use of ergometrine, carbetocin, and terlipressin can lead to rise in blood pressure that should not be contraindicated for women with preeclampsia.&#x0D; The purpose of this study is a search for preventive methods, which ensure the reduction of the frequency of massive obstetric blood loss during caesarean section in women with abnormal placenta ion and hypertensive disorders.&#x0D; Materials and methods. We compared the intraoperative volume of blood loss in 18 women of the main group with abnormal placentation and hypertensive disorders (who received prophylactic devascularization of the uterus) and in 35 women of the comparison group with abnormal placentation, but without hypertension (who received 100 µg of carbetocin intravenously during caesarean section).&#x0D; Results. No significant difference in the volume of blood loss between women of both groups during both urgent and planned childbirth was noted, despite the fact that the risk of massive blood loss in the main group was significantly higher due to the presence of hypertensive conditions in such women. In the patients of the main group (after devascularization of the uterus), already on day 5 of the postoperative period, the blood flow in the uterine arteries restored and did not differ from that in the patients of the comparison group.&#x0D; Conclusion. The technique of devascularization of the uterus in patients with placenta previa and hypertensive conditions can be recommended for the prevention of obstetric haemorrhage.

Advanced maternal age and adverse obstetrical and neonatal outcomes of singleton pregnancies

ObjectiveTo assess the impact of advanced maternal age on pregnancy and childbirth outcomes of singleton pregnancies. Study designWe retrospectively assessed singleton pregnant mothers who gave birth at Khaleej-e-Fars Hospital in Bandar Abbas, Iran, from January 2020 to January 2022. Demographic and obstetrical factors include educational level, medical insurance, residency place, access to prenatal care facilities, number of prenatal care visits, smoking status, gestational age, parity, infertility, maternal comorbidities, preeclampsia, eclampsia, preterm birth, low birth weight (LBW), intrauterine growth restriction (IUGR), macrosomia, placenta abnormalities (previa/acreta), placenta abruption, chorioamnionitis, meconium fluid, fetal distress, methods of delivery, rate of cesarean section (CS), perineal lacerations, postpartum hemorrhage, childbirth injury, shoulder dystocia, congenital malformation, neonatal asphyxia, and unfavorable maternal and neonatal outcome were compared between two groups. The Chi-square test assessed the relationship between categorical factors and maternal age groups. The influence of advanced maternal age on the risk of unfavorable pregnancy outcomes was evaluated using bivariate and multivariate logistic regression. ResultsOf 8354 singleton deliveries, 22.2% belonged to advanced-age mothers. Advanced-age mothers had less education than those aged 20–34 years old. Chronic hypertension, cardiovascular disease, overt diabetes, and thyroid dysfunction were more prevalent among advanced-age mothers. Compared with mothers aged 20–34 years, mothers aged 35 years and higher had a significantly higher risk of gestational diabetes (aOR: 3.18, 95%CI: 1.56–6.95), preeclampsia (aOR: 2.91, 95%CI: 1.35–4.72), placenta abnormalities (aOR: 1.09, 95%CI: 0.77–1.94), CS (aOR: 3.16, 95%CI: 1.51–3.87), postpartum hemorrhage (aOR: 1.94, 95%CI: 1.24–2.61), intensive care unit admission (aOR: 1.36, 95% CI: 1.15–1.99), LBW (aOR: 1.35, 95%CI: 0.97–2.96), preterm birth (aOR: 2.36, 95%CI: 1.65–4.83), stillbirth (aOR: 1.18, 95%CI: 1.01–3.16), and neonatal intensive care admission (aOR: 2.09, 95%CI: 0.73–3.92). According to bivariate regression, the risk of meconium fluid was lower in advanced-age mothers; however, the result of multivariate logistic regression found no correlation between advanced age and the Incidence of meconium fluid. ConclusionAdvanced-age mothers are at increased risk of adverse pregnancy and childbirth outcomes, which persist even after adjusting for several potential confounders.

The Relationship Between Placental Pathology and Neurodevelopmental Outcomes in Complex Congenital Heart Disease.

Complex congenital heart disease (CCHD) is associated with impaired neurodevelopmental outcomes. Peri- and post-operative factors are known contributors while the impact of the prenatal environment is not yet delineated. Variations in fetal circulation, seen in transposition of the great arteries (TGA) and single ventricular physiology (SVP), are associated with placenta abnormalities. These abnormalities may be associated with placental insufficiency, a risk factor for poor neurodevelopmental outcomes. We hypothesized there is a correlation between placental pathology and impaired neurodevelopmental outcomes in patients with CCHD. We performed a single center retrospective cohort study with patients with TGA and SVP from 2010 to 2017 at Children's Wisconsin. Patient variables were obtained from the medical record. Bayley Scales of Infant Development Third Edition standard scores for cognitive, motor, and language performance were collected from neurodevelopmental visits. Placenta pathology reports were reviewed with tabulation of predetermined anatomical and pathological characteristics. We identified 79 patients in our cohort and 61 (77.2%) had abnormal placentas. There was no significant difference between the two groups in any demographic or clinical variables. For cognitive and motor performance, without adjusting for the covariates, infants with placental abnormalities had significantly lower scores compared to infants without (p = 0.026, p = 0.045 respectively). Conversely, there was no significant difference in language scores between the two groups (p = 0.12). Placenta abnormalities are common in patients with CCHD, and placenta abnormalities are associated with impaired neurodevelopmental outcomes. These results underscore the complex causal pathways of neurodevelopmental impairment in infants with CCHD and offer opportunities for targeted postnatal developmental interventions after discharge.

Texture analysis of sonographic image of placenta in pregnancies with normal and adverse outcomes, a pilot study

IntroductionMany maternal and fetal morbidity and mortality from complications of pregnancy have been attributed to placenta abnormality. Placenta assessment in developing countries is mainly through ultrasonography which is subjective and prone to error. Objective assessment of placental abnormalities through texture analysis has been frequently done using magnetic resonance images with little done on ultrasound generated images, thus, the need for this study. The study is aimed at using statistical texture analysis in characterizing placenta tissue into normal and abnormal placenta as well as testing the accuracy of different texture analysis algorithms in differentiating placenta into normal and abnormal placental tissues. MethodsThis longitudinal study involved 500 ultrasound-generated placenta images from patients screened for adverse pregnancy outcomes in a private hospital in Enugu. These images were loaded onto an HP laptop for viewing. Two regions of interest were selected from the placenta tissue where texture features were extracted and were classified into normal and abnormal placentas using MaZda® software version 47 while the accuracy of the classification descriptors was assessed using WEKA classification algorithms. ResultsCo-occurrence matrix, run length matrix and histogram parameters differentiated normal placenta tissue from abnormal placental tissues (p-value <0.05) while variance is the only absolute gradient parameter that can differentiate normal placenta tissue from abnormal placenta tissues. All feature descriptors show high classification accuracy using KNN and ANN algorithms. ConclusionTexture analysis can differentiate normal placenta tissues from abnormal placenta tissue which will reduce the errors associated with subjective assessment of the placenta echogenicity. Implications for practiceIntegrating these computer-aided algorithms into our ultrasound machines will lead to early detection of abnormal placenta tissues as early management results in better pregnancy outcomes.

Risk factors for premature placental abruption: a retrospective observational comparative study

AIM: This study aimed to determine the risk factors for premature placental abruption (PPA). MATERIALS AND METHODS: A retrospective comparative study was conducted at the Republican Perinatal Center of Petrozavodsk. The study group included 106 patients with a confirmed diagnosis of PPA from 2007 to 2017. The control group (comparison) included 106 women without PPA and abnormal placenta. RESULTS: The statistical data analysis revealed the following risk factors of PPA: lack of higher education in the patient (odds ratio [OR]: 0.51, 95% confidence interval [CI]: 0.280.90); smoking (OR: 3.41, 95% CI: 1.298.97); chronic liver disease (OR: 7.29, 95% CI: 1.6033.06); uterine abnormalities (OR: 8.57, 95% CI: 1.0569.79); and pelvic inflammatory disease (OR: 6.12, 95% CI: 2.5614.62). The effect of chronic hypertension, chronic kidney disease, and anemia on the occurrence of PPA in our study was not significant. CONCLUSION: An increased risk of PPA was found in patients who smoke without higher education with chronic liver disease, uterine abnormalities, and pelvic inflammatory diseases.

ТHE METABOLIC ASPECTS OF PREECLAMPSIA DEVELOPMENT

Complications associated with preeclampsia (PE) include fetal growth retardation, premature birth, prenatal and postpartum hemorrhage, perinatal loss, and more. Obese women have an increased risk of developing PE, probably due to impaired placental development due to altered metabolic homeostasis. The aim was to generalize current knowledge about the role of risk factors associated with obesity and hypercholesterolemia in PE with an emphasis on the results of preclinical models. Material and methods. In reviewing the literature, we used Medline systems from PubMed (2011). The search was adapted for Embase (2014-2022) and Scopus (2015-2022). The inclusion criteria were: the effect of obesity on pregnancy; experimental models of the pathogenesis of obesity during pregnancy; the features of predictive diagnosis of obese women at the stage of preconception and during pregnancy; features of antenatal care in obese women. The study was performed at Vinnytsya National Pirogov Memorial Medical University, according to research work № 0121U109141 “Optimization of early diagnosis and preventive treatment of perinatal complications caused by gestational endotheliopathy.” Results. Inflammatory cytokines from maternal adipose tissue and hypercholesterolemia have been associated with systemic inflammation, hypertension, and other adverse effects associated with PE. The main pathways of the negative influence of obesity on the genesis of PE were realized due to the manifested gestational endotheliopathy. Decreases in adipose tissue and associated adipokines were associated with optimization of placental angiogenesis and an overall improvement in the adverse effects associated with PE. Conclusions. Increased maternal adipose tissue mass and cholesterol levels contribute to metabolic disorders and systemic inflammation, which may contribute to the development of gestational endotheliopathy and subsequent abnormal placenta vascularization. Further research will need to further clarify the contribution of pharmacotherapy, as well as some lifestyle adjustments, including preconceptional weight loss and the results of PE in women at high risk of obesity.