Placental Pathology Research Articles

Assessment of serum survivin in women with placenta previa and accreta spectrum: a cross-sectional study

This study aimed to examine the relationship between maternal serum survivin levels and placental disorders by comparing these levels across cases of normal placentation, placenta previa, and placenta accreta spectrum (PAS). In this prospective cross-sectional study, we enrolled 84 pregnant women categorized into control (n = 42), placenta previa (n = 24), and PAS (n = 28) groups. Serum survivin levels were quantitatively determined using ELISA, and statistical analyses were performed using ANOVA and post-hoc tests. Serum survivin levels were significantly elevated in the placenta previa (348.3 pg/mL, range: 173.0-776.4) and PAS groups (785 pg/mL, range: 324.50–1122) compared to controls (177.9 pg/mL, range: 87.3–242.0) (p < 0.05), suggesting an association between survivin expression and abnormal placental adherence and invasion. Our findings demonstrate significant associations between elevated serum survivin levels and placental disorders, specifically placenta previa and PAS. These associations suggest a potential role for survivin in the pathogenesis of placental complications and warrant further investigation through longitudinal studies.

Analysis of prenatal diagnosis and pregnancy outcomes for rare autosomal trisomies detected by non-invasive prenatal testing in 33,079 cases

BackgroundNon-invasive prenatal testing is widely used for screening common fetal aneuploidy disorders such as trisomy 21, trisomy 18, and trisomy 13. However, its ability to detect rare autosomal trisomies has introduced a new layer of complexity and clinical uncertainty.MethodsA retrospective analysis was conducted on the prenatal diagnostic results and pregnancy outcomes of cases identified as high-risk for rare autosomal trisomies through non-invasive prenatal testing at the reproductive medicine center, Renmin hospital, Hubei university of medicine, from 2015 to 2023.Results66 cases identified as high-risk for rare autosomeal trisomies, yielding a detection rate of 0.20% (66/33,079). 7 declined amniocentesis, while the others underwent the procedure. Prenatal diagnostic procedures did not confirm the presence of the corresponding rare autosomal trisomy in any of these cases. Among the 66 cases of rare autosomal trisomies (RATs), 5 cases were lost to follow-up, and 1 case underwent termination of pregnancy (TOP) for personal reasons, leaving 60 cases with valid pregnancy outcomes. Of these 60 valid outcomes, 50 (83.33%) resulted in full-term births, while 10 (16.67%) experienced adverse pregnancy outcomes.ConclusionPrenatal diagnosis for high-risk rare autosomal trisomies typically reveals a normal karyotype with no detectable chromosomal abnormalities, and most cases can achieve full-term pregnancy outcomes. However, adverse pregnancy outcomes such as preterm birth, fetal demise, placental abnormalities, and intrauterine growth restriction are common and should be given clinical attention and consideration.

Exploring The Differentiation Potential of EomesPOS Mouse Trophoblast Cells in Mid-Gestation.

Mouse trophoblast stem (mTS) cells can be derived from the blastocyst or extraembryonic ectoderm as late as embryonic day (E) 6.5and when cultured in vitro, can differentiate to all trophoblast subtypes of the mature placenta. Expression of the T-box transcription factor, Eomes, is required for the maintenance of, and used to identify mTS cells. During development, Eomes is restricted to the ExE and, by E7.5, to the chorion, after which its expression declines. The placental junctional zone and labyrinth layers are thought to develop exclusively from the ectoplacental cone and chorion, respectively. While it is well established that mTS cells express Eomes in vitro, it is unknown if Eomes-positive (EomesPOS) trophoblast that reside in the chorion after E6.5 are restricted in their developmental potential to the labyrinth layer in vivo. This study utilized a lineage tracing technique to evaluate the in vivo differentiation of EomesPOS trophoblast. Using an Ai6 reporter mouse crossed with a tamoxifen-inducible Eomes-Cre-ERT2 mouse, Cre was activated from E7.5 to E9.5, permanently marking all EomesPOS trophoblast and daughter cells with the ZsGreen fluorescent protein. This approach was complemented with immunofluorescence staining to assess how the EomesPOS trophoblast had contributed to the differentiated trophoblast population within the placenta by E17.5. Importantly, the results show that daughter cells of EomesPOS trophoblast in which Cre was activated, contributed to both placental layers; specifically, spongiotrophoblast and glycogen trophoblast within the junctional zone and syncytiotrophoblast and sinusoidal trophoblast giant cells within the labyrinth. This confirms that EomesPOS trophoblast maintain the capacity to contribute to both placental layers in vivo and do so after E7.5. This study expands our understanding of trophoblast differentiation in vivo and may prove useful in assessing how EomesPOS trophoblast contribute placental development later in gestation and in the context of placental pathology, where Eomes expression has been reported.

CD56-Positive NK Cells and CD138-Positive Plasma Cells in Basal Decidua of Term Placentas in Singleton Pregnancies After Assisted Reproductive Technology Treatment of Endometriosis-Related Infertility

A eutopic endometrium in endometriosis shows altered immune responses, including abnormalities of NK cells and expression of plasma cells, related to reproductive issues. This study investigated the counts of CD56-positive NK cells and CD138-positive plasma cells in the basal decidua of term placentas in singleton pregnancies after endometriosis-related infertility conceived by assisted reproductive technology (ART). This single-center, case-control study involved immunohistochemical analysis of CD56-positive NK cells and CD138-positive plasma cells in basal decidua using primary monoclonal mouse antibodies, followed by secondary antibodies using a standardized protocol. CD56 and CD138 immunohistochemically positive cells were reported as the total cell count for each studied antibody expressed per 1 mm2 of basal decidua (Olympus BX46 and Olympus Image Analyzer). Placental samples containing basal decidua from 36 participants with endometriosis-related infertility who conceived by ART, 31 participants with male factor infertility who conceived by ART and 40 healthy controls were included. Endometriosis decidua showed the lowest median count of CD56-positive NK cells (11.5 / mm2, p = 0.039) in BD compared to male factor group (25 / mm2) and healthy controls (24.5 / mm2). No differences were found for CD138-positive plasma cells counts between study groups. Basal decidua in pregnancies after endometriosis-related infertility showed reduced total count of CD56-positive NK cells, without differences in the CD138-positive plasma cell counts compared to control groups. Future studies should investigate how changes in NK cells throughout pregnancy affect the development of perinatal complications and placental pathologies in women with endometriosis, which could uncover potential diagnostic and therapeutic targets.

Placental Microvascular Architecture Imaging in Normal and Congenital Heart Disease Pregnancies.

To evaluate the placental vascular architecture using MV Flow™ imaging for analyzing vascular distribution per region of biological tissue in isolated congenital heart diseases (CHD), CHD associated with extracardiac malformations (EXM) and normal pregnancies, and to explore the relationship of fetal Doppler flow parameters and growth to placental perfusion in these conditions. Placental microvascular structure was assessed using MV-Flow™ in a total of 227 normal fetuses and 139 with CHD; fetuses with gestational age ranging from 11 to 41 weeks were included. Placental vascular indices (VIMV %) was acquired at three different segments of each placenta (upper, middle, and lower regions). Doppler pulsatility indices of fetal umbilical artery (UA), middle cerebral artery (MCA), ductus venosus (DV), uterine artery (UtA), and cerebroplacental ratio were measured in both normal and CHD groups. The CHD group was divided into two subgroup based on whether it is associated with EXM. Compared to the control group, the CHD with EXM group exhibited a significantly lower VIMV % for the upper, middle, and lower regions of the placenta (P = .005; P = .018; P = .039, respectively). In the total CHD group, VIMV % decreased in the middle segment of placenta in the 2nd trimester compared to the control group. But the VIMV % of upper and middle segments decreased in the 3rd trimester. Both subgroups, EXM and isolated CHD, showed similar distribution of gestational weeks. Doppler vascular indices were significantly different compared to normal in the total CHD group for UA-pulse index (PI), DV-PI, right UtA-PI, and left UtA-PI, with similar differences from normal for the CHD with EXM group. DV-PI was the only significantly different Doppler vascular parameter for the isolated CHD group compared to normal. For the first time, MV-Flow™ imaging demonstrated reduced placental vascularity in fetuses with CHD and ECM and in fetuses with isolated CHD in the 3rd trimester of pregnancy. Application of MV-Flow™ as part of serial fetal echocardiographic surveillance in cases of CHD may allow for better understanding of the development of placental abnormalities.

Congenital Heart Disease Fetuses Have Decreased Mid-Gestational Placental Flow, Placental Malperfusion Defects, andImpaired Growth.

Placental health may impact the development and outcomes of congenital heart disease (CHD). CHD fetuses have been shown retrospectively to have decreased placental blood flow. The purpose of this study was to determine if CHD fetuses with decreased placental blood flow have placental pathology at birth and if there is a relationship between placental blood flow, placental pathology, and outcomes. We performed a prospective case-control study of 38 CHD fetuses, including 28 with single ventricle physiology and 36 controls. Demographic, clinical, and postnatal biometric data were collected. Umbilical venous volume flow (UVVF) was measured from 2nd trimester fetal echocardiograms. Placentas underwent standardized pathological analysis. Standard descriptive statistics and regression analyses were performed to analyze the relationship between UVVF, placental defects, and outcomes. CHD fetuses had a 15% decrease in mid-gestational UVVF indexed to fetal weight (P<0.01), and a 27% reduction in UVVF as a proportion of fetal cardiac output (P<0.01) compared to controls. CHD fetuses had increased placental maternal vascular malperfusion (MVM) lesions (44% vs 18%, P<0.05), especially high-grade MVM (39% vs 9.1%, P=0.05), and a trend toward increased placental fetal vascular malperfusion lesions (42% vs 23%, P=0.10). Placental MVM but not fetal vascular malperfusion lesions were associated with decreased birth weight in CHD fetuses (P<0.001). There was no association between UVVF and placental pathologic findings or fetal growth. CHD (particularly single ventricle) fetuses have decreased mid-gestational placental blood flow, increased placental malperfusion defects, and impaired fetal growth. Placental MVM may influence impaired fetal growth in CHD.

Placental inflammatory response and association with the severity of neonatal hypoxic ischemic encephalopathy.

Placental lesions are associated with worse neonatal outcomes, but their association with neonatal hypoxic-ischemic encephalopathy (HIE), including the full range of severity from mild to severe HIE, has not been well described. To determine the association of acute and chronic placental lesions with mild versus moderate to severe HIE; secondarily, to assess the impact of multiple placental lesions on severity of HIE. This retrospective study of prospectively collected data included neonates born at ≥36weeks, with a birth weight of >1800g, diagnosed with HIE between January 2012 and November 2022. The cohort was divided into those with mild versus moderate to severe HIE, based on the modified Sarnat staging. Placental histologic diagnoses were made according to the Amsterdam Placental Workshop Group Consensus Statement. Placental pathologic lesions were classified into acute inflammation with attention to stages and grades of maternal and fetal inflammatory responses (MIR and FIR, respectively), maternal vascular malperfusion, fetal vascular malperfusion, villitis of unknown etiology, and other lesions. Chi-square and Fisher's exact test were used to compare rates of placental pathologies between mild and moderate to severe HIE groups. Of 394 neonates ≥36weeks' gestation diagnosed with HIE, 172 had mild HIE and received supportive care, while 180 had moderate to severe HIE and underwent therapeutic hypothermia. 42 patients were excluded due to lack of placental pathology reports. FIR was significantly associated with moderate to severe HIE vs. mild HIE (53% vs. 38%, P<0.01). Higher grade and stage of FIR was also associated with worse severity of HIE (moderate to severe HIE showed FIR stage ≥2 in 81% and grade 2 in 15% vs. 34% and 3% in those with mild HIE, respectively). MIR was diagnosed in more placentas from the moderate to severe HIE group (58% vs. 47%, P=0.04) with higher stage and grade MIR in patients with moderate to severe HIE (86% with MIR stage ≥2 and 19% with MIR grade 2). High-grade (patchy/diffuse) chronic villitis was more prevalent in the moderate to severe HIE group vs. mild HIE group (18% vs. 8%, P<0.01). There is a higher prevalence of placental inflammatory lesions in neonates with moderate to severe HIE compared to those with mild HIE.

Effects of Assisted Reproductive Technology on Genetics, Obstetrics, and Neonatal Outcomes.

The prevalence of infertility has increased in the United States over the past decade with 1 in 5 reproductive-aged women suffering from this diagnosis. The use of assisted reproductive technology (ART) to achieve pregnancy has correspondingly steadily increased. After examining the outcomes of ART births, clear trends of increased preterm birth rate, higher-order multiples, and imprinting disorders have been established among ART-related outcomes. However, the relationship between ART and birth defects, abnormal placentation, and stillbirth require further investigation. This review aims to highlight current literature surrounding ART and its relationship with key obstetrical outcomes, neonatal outcomes, and medical genetics.

Vaginal bleeding during pregnancy: a retrospective cohort study assessing maternal and perinatal outcomes.

Vaginal bleeding is a relatively common problem during pregnancy, with up to 25% of women experiencing some level of bleeding or spotting during pregnancy. Although not always a concern, pregnancy-related vaginal bleeding may detrimentally impact maternal and fetal health, and can arise at any stage during the pregnancy, usually linked with preterm labor, miscarriage, placental abnormalities, or implantation bleeding. As vaginal bleeding may compromise newborn health outcomes, for example, leading to low birth weight and neonatal intensive care unit (NICU) hospitalizations, it is imperative to understand the etiology of the bleed and effectively manage the patient's condition. Thus, the aim of this study was to evaluate the prognostic value of vaginal bleeding as an indicator for at-risk pregnancies, aiming to elucidate its association with perinatal outcomes and pregnancy complications. Consecutive pregnant female patients, aged 16-47 years, were included in this retrospective cohort study, and categorized into those with or without pregnancy-associated bleeding. Between-group differences and correlations in pregnancy complications and perinatal outcomes were statistically analyzed. Among a total of 441 patients, the incidence of vaginal bleeding was 74.4%, predominantly occurring in the first trimester (67.1%). No significant association was found between bleeding and maternal age, parity, abortion history, or total number of pregnancies. Educational level varied, with 64.9% of moderate education level experiencing bleeding. Pre-pregnancy comorbidities, such as diabetes, hypertension, and hypothyroidism, were not significantly correlated with bleeding. However, a history of infertility and progesterone treatment during pregnancy was significantly associated with bleeding episodes. An increased risk for NICU admissions and conditions such as respiratory distress in neonates was found, alongside a significant association with post-delivery bleeding and premature labor in the later trimesters. Vaginal bleeding during pregnancy was not found to be significantly associated with maternal age, parity, abortion history, or total pregnancies. Nonetheless, the findings suggest a significant relationship between bleeding episodes and a history of infertility or progesterone treatment during pregnancy. Additionally, pre-pregnancy comorbidities, including diabetes, hypertension, and hypothyroidism were not associated with pregnancy bleeding. However, the latter was associated with increased risk of post-delivery bleeding, premature labor, and neonatal complications, such as respiratory distress and NICU admissions.

Pharmacological treatment of pregnancy complications in adults: An overview of phase IV clinical trials.

The aim of this review was to provide a review of the pharmacological treatments for pregnancy complications in adults. This review analyzed medications used for pregnancy complications in phase IV clinical trials based on the ClinicalTrials.gov database. The search included completed trials only. As of September 1, 2023, a total of 29,654 phase IV clinical trials were identified, of which 298 were related to pregnancy complications. Of these, 24 clinical trials met the inclusion criteria for the current study. In the 24 included clinical trials, we found 9 trials for overactive bladder with 5005 participants in total, 236 of which had adverse effects from the drugs used. Six trials for preeclampsia were conducted on 663 participants, with only 1 adverse drug effect reported. Three trials each were conducted on urinary tract infections and gestational diabetes mellitus (115 and 656 participants, respectively) without any adverse drug effects reported. One trial each focused on anemia, dystocia, and placentation disorders (80, 1003, and 14 participants, respectively) without any adverse drug effects reported. The trials reported minimal adverse drug effects, suggesting potential effectiveness and safety in managing these complications. While the trials mentioned minimal adverse effects, close monitoring and individualized patient care are essential, as are evaluating the risk-benefit ratio and the specific circumstances of each patient.

Comparisons among radiologist, MR findings and radiomics-clinical models in predicting placenta accreta spectrum disorders: a multicenter study.

To assess and compare the diagnostic accuracy of radiologist, MR findings, and radiomics-clinical models in the diagnosis of placental implantation disorders. Retrospective collection of MR images from patients suspected of having placenta accreta spectrum (PAS) was conducted across three institutions: Institution I (n = 505), Institution II (n = 67), and Institution III (n = 58). Data from Institution I were utilized to form a training set, while data from Institutions II and III served as an external test set. Radiologist diagnosis was performed by radiologists of varying levels of experience. The interpretation of MR findings was conducted by two radiologists with 10-15years of experience in pelvic MR diagnosis, following the guidelines for diagnosis. Radiomics analysis extracted features from sagittal T2-weighted images and combined them with prenatal clinical features to construct predictive models. These models were then evaluated for discrimination and calibration to assess their performance. As measured by the area under the receiver operating characteristic curve (AUC), the diagnostic efficacy was 0.587 (0.542-0.630) for junior radiologists from Institution I, 0.568 (0.441-0.689) from Institution II, and 0.507 (0.373-0.641) from Institution III. The AUC was 0.623 (0.580-0.666) for senior radiologists from Institution I, 0.635 (0.508-0.749) from Institution II, and 0.632 (0.495-0.755) from Institution III. The diagnostic efficacy of MR findings was 0.648 (0.601-0.695) for Institution I, 0.569 (0.429-0.709) for Institution II, and 0.588 (0.442-0.735) for Institution III. The diagnostic efficacy of the radiomics-clinical model was significantly higher, with an AUC of 0.794 (0.754-0.833) for Institution I, 0.783 (0.664-0.903) for Institution II, and 0.816 (0.704-0.927) for Institution III. The diagnostic efficacy of the Fusion model was significantly higher, with an AUC of 0.867 (0.836-0.899) for Institution I, 0.849 (0.753-0.944) for Institution II, and 0.823 (0.708-0.939) for Institution III. The fusion models demonstrated superior diagnostic efficacy compared to radiologists, MR findings, and the radiomics-clinical models. Furthermore, the diagnostic accuracy of PAS was notably higher when utilizing the radiomics-clinical models than when relying solely on radiologist diagnosis or MR findings. Radiomics analysis substantially augments the diagnostic precision in PAS, providing a significant enhancement over conventional radiologist and MRI findings. The diagnostic efficacy of the fusion model is notably superior to that of individual diagnostic modalities.

Addition of Lay Language Comments in Placental Pathology Reports Increases Provider Understanding and Comfort.

Placental pathology reports may contain terminology that obstetric providers do not feel comfortable discussing with their patients. To determine if lay language comments appended to the placental pathology report increase provider comfort and understanding of the report. We drafted a priori lay language comments explaining the major pathologic findings in the placenta. To test the acceptability and value of the comments, we designed an anonymous and randomized provider survey aimed to assess understanding of the terminology in the pathology report and comfort with explaining the report to their patients. Survey respondents were randomly assigned to receive 2 hypothetical placental pathology reports, one with and one without lay language comments. Respondents were asked to rate their understanding and comfort level explaining the report to their patients on a scale of 1 to 4. Within-provider differences in understanding and comfort by report type and pathology type were assessed by using repeated measures analysis of variance. Thirty-one providers responded to the survey. Providers reported greater complete understanding of the report when reading the report with lay language comments as compared to the report without the comments (mean comfort of 3.5 for lay language versus 2.97 for original report, P < .001), as well as greater comfort with the report (mean comfort of 3.29 for lay language versus 2.81 for original report, P = .002). There was no difference in provider understanding or comfort by the pathology findings represented (P = .66). Our survey results indicate that the inclusion of lay language comments in the placental pathology report can improve provider understanding of the placental findings and therefore improve their comfort when discussing the findings with a patient and considering future treatment options.

Artificial Intelligence in Fetal Growth Restriction Management: A Narrative Review.

This narrative review examines the integration of Artificial Intelligence (AI) in prenatal care, particularly in managing pregnancies complicated by Fetal Growth Restriction (FGR). AI provides a transformative approach to diagnosing and monitoring FGR by leveraging advanced machine-learning algorithms and extensive data analysis. Automated fetal biometry using AI has demonstrated significant precision in identifying fetal structures, while predictive models analyzing Doppler indices and maternal characteristics improve the reliability of adverse outcome predictions. AI has enabled early detection and stratification of FGR risk, facilitating targeted monitoring strategies and individualized delivery plans, potentially improving neonatal outcomes. For instance, studies have shown enhancements in detecting placental insufficiency-related abnormalities when AI tools are integrated with traditional ultrasound techniques. This review also explores challenges such as algorithm bias, ethical considerations, and data standardization, underscoring the importance of global accessibility and regulatory frameworks to ensure equitable implementation. The potential of AI to revolutionize prenatal care highlights the urgent need for further clinical validation and interdisciplinary collaboration.

The Relationship between Soluble Endoglin Levels, Endothelial Nitric Oxide Synthase Levels, and Thrombocyte Count and the Onset of Preeclampsia

Background Early-onset preeclampsia, or EOP, depicts clear placental abnormalities (placental factor), whereas late-onset preeclampsia, or LOP, does not. However, previous studies found varying results on the role of proangiogenic and antiangiogenic factors, including soluble endoglin (sEng), endothelial nitric oxide synthase (eNOS), and thrombocytes in both types of preeclampsia. Objective This study aimed to determine the relationship between sEng levels, eNOS levels, and thrombocyte count with the onset of preeclampsia. Methods A cross-sectional study was conducted on subjects diagnosed with severe preeclampsia receiving treatment at Dr. M. Djamil Hospital Padang from December, 2023, until March, 2024. After meeting the inclusion and exclusion criteria, maternal plasma concentrations of sEng and eNOS were determined by ELISA, while thrombocytes were measured by a complete blood count. Results A total of 40 women with EOP and 40 with LOP participated in this study. This study found no difference between the two groups in eNOS (p = 0.303) and sEng (p = 0.468). However, thrombocyte count differed between early and late-onset PE (p = 0.001). Spearman correlation analysis found a significant correlation between eNOS and sEng (p = 0.033), eNOS and thrombocyte count (p = 0.026), and thrombocyte count and sEng (p = 0.032). Conclusion This study found no difference in proangiogenic and antiangiogenic factors between EOP and LOP, which suggests that a subset of patients with LOP also has an imbalance in the concentrations of proangiogenic and antiangiogenic factors in maternal plasma. However, lower thrombocyte counts in EOP reflect a more severe disease course. This study also found a correlation between eNOS and sEng, eNOS and thrombocyte count, and thrombocyte count and sEng in preeclampsia.

Modulation of placental angiogenesis by metformin in a rat model of gestational diabetes.

Gestational diabetes mellitus (GDM) significantly disrupts placental structure and function, leading to complications such as intrauterine growth restriction (IUGR) and preeclampsia. This study aimed to investigate the effects of GDM on placental histology, angiogenesis, and oxidative stress, as well as evaluate metformin's protective role in mitigating these changes. A total of 60 pregnant Sprague-Dawley rats were divided into four groups: control, metformin-treated, GDM, and GDM with metformin. GDM was induced using streptozotocin (STZ) at 40mg/kg, and metformin was administered at 200mg/kg from gestational day (GD) 4 to GD17. Blood glucose and insulin levels were assessed, and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was calculated. Placentae were weighed and subjected to histological, immunohistochemical, and molecular analyses, focusing on key angiogenesis markers (VEGF, VEGFR, CD31, KLF2) and oxidative stress indicators (MDA, eNOS). GDM increased placental weight, angiogenesis (elevated VEGF, VEGFR, CD31), and oxidative stress (elevated MDA, eNOS). Histopathological changes included villous edema, membrane rupture, and hemosiderin deposition. Metformin treatment reduced placental weight; normalized VEGF, KLF2, and PlGF expression; and improved placental architecture. Additionally, oxidative stress was significantly reduced in metformin-treated GDM rats. In conclusion, GDM induces placental abnormalities, promoting excessive angiogenesis and oxidative stress, potentially leading to IUGR and other complications. Metformin showed protective effects by reducing placental overgrowth and restoring vascular and oxidative balance. These findings suggest that metformin may play a therapeutic role in improving placental health in GDM pregnancies, warranting further investigation into its long-term effects on fetal development and maternal health.

Quantitative evaluation of placental microvascular blood flow and microstructure in fetal growth restriction with IVIM MRI.

Intravoxel incoherent motion (IVIM) MRI uses diffusion-weighted (DW) MRI acquisitions to evaluate the microvascular and cellular environments of tissue. Due to these properties, IVIM has been increasingly utilized to evaluate abnormal placentation. Our primary objective was to compare IVIM parameters in the placenta of patients with fetal growth restriction and appropriate for gestational age controls across gestational ages. Our secondary aim was to quantify IVIM parameters in fetal versus maternal placental aspects to evaluate microvascular and parenchymal differences. With IRB approval, pregnant individuals with a diagnosis of fetal growth restriction (n=24) and controls (n=22) were retrospectively analyzed. DW-MRI data were collected at 1.5 T with nine b-values (range, 0 s/mm2 to 1,000 s/mm2). Data were processed by one non-blinded reader to obtain mean perfusion fraction (f), pseudo-diffusion coefficient (D*), their product fD*, and diffusion coefficient (D) in maternal and fetal aspects of the placenta, defined by bisecting the thickness of the placenta. Repeated measures of two-way ANOVAs were used to compare IVIM parameters in fetal and maternal placental aspects between participant groups. Correlations between IVIM parameters and gestational age were also evaluated in both groups. The average gestational age at MRI was 27±4 weeks for both groups. The percentile estimated fetal weight was 5.4±5.9% for the fetal growth restriction group and 42.8±28.5% for controls (P<0.001). The parameters D* and fD*, related to microvascular blood flow and tissue perfusion, were significantly lower in participants with fetal growth restriction compared to controls (D*, 40.5 vs. 52.4×10-3 mm2/s, P=0.043; fD*, 14.7 vs. 21.0×10-3 mm2/s, P=0.019). No other differences were observed, nor associations between gestational age and IVIM parameters in either group. Our results suggest reduced microvascular flow in placentas of patients with fetal growth restriction compared to controls.

Cumulative effects of extreme ambient temperatures on placental perfusion and function markers in early pregnancy: analysis from a birth cohort study.

Exposure to suboptimal temperatures during pregnancy has been associated with adverse pregnancy and birth outcomes related to placental development disorders. No prior studies have examined the potential impacts of temperature on placental markers. We conducted an investigation into the cumulative impact of daily ambient temperature on critical clinical placental perfusion and function markers during the placentation period, utilizing data from a prospective birth cohort in Nanjing, China. We collected UtA-PI data and blood samples during the first follow-up (11-13.5 weeks of gestation) and measured PlGF and PAPP-A concentrations in plasma. We estimated individual daily temperature exposure over the 30 days preceding the follow-up and applied a Distributed Lag Nonlinear Model to evaluate its associations with UtA-PI, PlGF, and PAPP-A levels. We included 3403, 3407, and 3427 women in the UtA-PI, PlGF, and PAPP-A analyses, respectively. Cold exposure was associated with higher UtA-PI measurements, with the strongest estimated percent change being 14.80% (95% CI: 3.32, 27.55). Both cold and heat exposures were associated with decreased PlGF concentrations, with the strongest estimated percent changes being -44.23% (95% CI: -63.28, -15.30) and -48.27% (95% CI: -64.33, -24.98), respectively. Temperature effects on UtA-PI were immediate, whereas changes in PlGF concentrations manifested after a cumulative lag of 24 days. Both cold and heat exposures were associated with changes in placental markers, providing new insights into the potential mechanisms connecting ambient temperature to adverse pregnancy and birth outcomes through disorders of placental development.

Singleton term pregnancies resulting from frozen-thawed embryo transfer in hormone replacement cycles increase the risk of aberrant placentation, including velamentous umbilical cord insertion.

The number of frozen-thawed embryo transfers (FETs) has recently increased, and FET must be completed in the ovulatory (NC-FET) or programmed hormone replacement cycle (HRC-FET). However, the relationship between FET and abnormal placentation is unclear. This study aimed to determine whether the two distinct endometrial preparation protocols affect the incidence of several pathologic conditions caused by abnormal placentation, such as placenta with velamentous umbilical cord insertion (VCI), hypertensive disorders of pregnancy (HDP), and placenta accreta spectrum (PAS). For this retrospective cohort study, the medical records of 1,161 singleton term FET-conceived and -delivered cases were reviewed from January 2016 to July 2024. The study population was categorized into HRC-FET (Group A: n = 846) and NC-FET (Group B: n = 315) cases. After adjusting for confounding factors, the odds ratios (ORs) of the investigated targeted variables in Group A compared to Group B were calculated using multivariate logistic regression. The incidence of VCI and PAS in Groups A and B was 7.0% and 2.5% for VCI and 5.1% and 1.0% for PAS, respectively, with a significant difference (P < 0.01). The adjusted ORs for VCI, PAS, and HDP in Group A compared to those in Group B were 3.07 (P < 0.01), 5.73 (P < 0.01), and 1.24 (P = 0.42), respectively. Pregnancies achieved through HRC-FET have higher risks of developing abnormal placentation (i.e., VCI and PAS) than those achieved through NC-FET. These pregnancies are high risk and should be managed carefully for a healthy perinatal course.

Factors of early neonatal maladaptation of late preterm infants

Late preterm infants are more susceptible to various unfavorable factors than preterm infants. The leading place in the structure of morbidity, as well as the formation of long-term unfavorable outcomes in this group of children is occupied by respiratory disorders, impaired or delayed neurodevelopment. In order to study in detail the pathological conditions leading to adaptation disorders, we retrospectively analyzed the data of developmental histories of late premature infants and delivery histories. The relationship between placental abnormalities, including fetal growth and developmental delays, fetal conception, history of pregnancy termination, low birth weight, age of the woman in labor and increased need for respiratory support, as well as clinical manifestations of cerebral ischemia in newborns at 34 0/7–36 6/7 weeks gestation was revealed

Predictive Model for Histological Chorioamnionitis Risk in Parturients with Intrapartum Fever.

This study aimed to analyze the causative factors of histological chorioamnionitis (HCA) in parturients with intrapartum fever, assess the implications for maternal and neonatal outcomes, and develop a predictive model to enhance clinical decision-making. A retrospective analysis was performed on 408 parturients with intrapartum fever at Fujian Provincial Maternal and Child Health Hospital from January 2022 to June 2023. Based on post-delivery placental pathology, the data were categorized into HCA (249 cases) and non-HCA groups (159 cases). Variables were first screened using univariate analysis, followed by multivariate logistic regression to identify high-risk factors and develop a predictive model. The model's accuracy was validated using Bootstrap resampling and receiver operating characteristic (ROC) curve analysis. Significant differences were found between the HCA and non-HCA groups in terms of duration of premature rupture of membranes (≥24 hours), peak body temperature during labor (≥38°C), and levels of white blood cell count and C-reactive protein (CRP) at the onset of fever (p < 0.05). The predictive model showed strong accuracy, with an ROC area under the curve of 0.715. Intrapartum fever linked with HCA markedly exacerbates maternal and neonatal outcomes. Key risk factors for HCA include a peak labor temperature ≥38°C, CRP levels at fever onset, and grade III contamination of amniotic fluid. The developed model accurately predicts the HCA risk, enabling enhanced clinical interventions.