Decidual Research Articles

Abruptio placenta, Couvelaire uterus following severe early-onset preeclampsia: A case report

Background: Abruptio placenta refers to premature placental detachment from the uterus. Couvelaireuterus is a rare complication of abruptio placenta marked by blood infiltration of the myometrium followinghemorrhage into the decidua basalis. This is a case of severe early-onset preeclampsia with rapiddeterioration.Case presentation: A 35-year-old primigravida presented at 26 weeks 4 days with frontal headache andelevated blood pressure. On admission, with severe preeclampsia and type 1 fetal growth restriction, thepatient received labetalol, nifedipine, magnesium sulfate, and antenatal steroids. After two days ofhospitalization, she was discharged home to be closely monitored as an outpatient. She was readmittedwith severe hypertension and developed abruptio placenta with fetal death. Following labor induction, thepatient had significant antepartum hemorrhage necessitating an emergency hysterotomy.Intraoperatively, she had postpartum hemorrhage refractory to uterotonics with a Couvelaire uterus.Hemostasis was achieved using B-Lynch brace sutures. She developed hemolysis, elevated liverenzyme and low platelet count (HELLP) syndrome and acute kidney injury. She was transfused withpacked red cells, fresh frozen plasma, and platelets. Hemodynamically unstable, she was admitted to thecritical care unit and later stepped down to ward status and allowed home.Conclusion: Abruptio placenta is a clinical diagnosis, and a high index of suspicion is required becauseprompt action may be lifesaving. Complications such as Couvelaire uterus pose a significant challenge inmanagement and may lead to hysterectomy. However, in select cases, the uterus can be preserved byapplying B-lynch brace sutures.

Near miss cases during cesarean hysterectomy due to morbid adherence of placenta at Al-Yarmouk Teaching Hospital

Background: Placental adhesion disorder, or placenta accreta, is caused by a decidua basalis shortage that leads to the chorionic villi penetrating the myometrium. Different types of placental adhesion disorders are classified according to the degree of uterine adhesion. Cesarean Hysterectomy is indicated in cases of morbid adherence of the placenta in various age groups during childbearing age. Objectives: Evaluation of the influence of placental adhesion on hysterectomy at the time of cesarean in near-missed pregnant women and assessment of factors that increase its incidence among Iraqi women. Methods: This research encompassed a case-control study involving 64 pregnant women, with the participants selected from Al-Yarmouk Teaching Hospital. The pregnant patients were divided into two groups. The first group consisted of thirty-two pregnant women with emergency cesarean hysterectomy due to placental adhesion. The second group was made up of thirty-two pregnant women with elective cesarean hysterectomy due to placental adhesion. Results: In the present study, it has been found that there are no significant differences in the age of patients who undergo elective cesarean hysterectomy as compared to emergency cesarean hysterectomy (p > 0.05). Also, according to the gestational age, most elective surgery patients are full-term pregnancies; meanwhile, the emergency cases are mostly preterm. Elective patient parity was higher than emergency cases at three parity 13 vs 9. The patients with emergency cesarean hysterectomy showed that the presence of two or more scars in the uterus was accreta in about 72% of patients. Meanwhile, the elective patients with placental adherence showed a higher frequency of two or more scars, the same as observed in emergency cases. Still, there were more emergency cases than elective cases. Conclusion: There are elevations in the incidences of placental adhesion, reflecting the increase in cesarean hysterectomy surgeries and near-miss cases.

Subchorionic hematoma: Research status and pathogenesis (Review).

Subchorionic hematoma (SCH) is a hematoma in which blood accumulates between the chorion and decidua basalis due to the separation of the chorion and decidua basalis. It is common in patients with threatened abortion in early pregnancy and is mainly detected by ultrasound. SCH mainly manifests as an hypoechoic or anechoic crescent-shaped fluid dark area on ultrasound images. Although there are numerous studies on SCH, its pathogenesis and etiology remain unclear, and its influence on pregnancy outcomes is also controversial; there are also no uniform clinical treatment guidelines. Current studies suggest that the occurrence of SCH may be related to several factors, such as abnormal coagulation function, autoimmune factors of pregnant women, assisted reproduction, drug use during pregnancy and reproductive tract infection; however, its exact etiology remains unclear. Some studies suggest that SCH is associated with adverse pregnancy outcomes such as miscarriage, preterm birth, preeclampsia and fetal growth restriction, although other studies have found that SCH does not increase the risk of adverse pregnancy outcomes. Therefore, the present review mainly discusses the pathogenesis, etiology and treatment of SCH in an aim to provide a reference for the clinical treatment of this condition in pregnant women.

Visual identification of three kinds of human decidual tissues from elective termination of pregnancy

IntroductionThe decidua can be classified into the decidua basalis, decidua capsularis and decidua parietalis. This study aimed to visually identify these three kinds of decidual tissues from fresh samples obtained in early pregnancy based on their macroscopic appearances, which can be discerned visually. MethodsDecidual samples were collected from 15 pregnant women between 6 and 8 weeks of gestation after elective termination of pregnancy. We identified the three different kinds of fresh decidual tissues in early pregnancy according to their different macroscopic appearances by only the naked eye. H&E staining, in situ immunofluorescence and flow cytometry were performed to confirm the accuracy of this method. ResultsWe developed a method to discern the three different kinds of decidual tissues according to their individual macroscopic features. We found that the decidua parietalis was a thick tissue with less blood, with one side being intact epidermis and the other side being rough tissue. The decidua basalis had rough surfaces, a dense texture and high blood content. The decidua capsularis was a thin membrane tissue with or without blood clots. CK+/HLA-G+ extravillous trophoblast cells (EVTs) and heme oxygenase-1+ (HMOX1+) decidual macrophages were present in large quantities in the decidua basalis and decidua capsularis but were nearly undetectable in the decidua parietalis. We also found a wide distribution of endovascular extravillous trophoblast cells (enEVTs), which participate in spiral artery remodelling in the decidua basalis. DiscussionWe successfully identified three kinds of human decidual tissues from early pregnancy with the naked eye for the first time. This breakthrough method will greatly assist studies related to decidua during early pregnancy.

Pregnancy-related factors induce immune tolerance through regulation of sCD83 release.

A well-balanced maternal immune system is crucial to maintain fetal tolerance in case of infections during pregnancy. Immune adaptations include an increased secretion of soluble mediators to protect the semi-allogeneic fetus from excessive pro-inflammatory response. B lymphocytes acquire a higher capacity to express CD83 and secrete soluble CD83 (sCD83) upon exposure to bacteria-derived components such as LPS. CD83 possesses immune modulatory functions and shows a promising therapeutic potential against inflammatory conditions. The administration of sCD83 to pregnant mice reduces LPS-induced abortion rates. The increased CD83 expression by endometrial B cells as compared to peripheral blood B cells suggests its modulatory role in the fetal tolerance, especially in the context of infection. We postulate that in pregnancy, CD83 expression and release is controlled by pregnancy-related hormones. The intra- and extracellular expression of CD83 in leukocytes from peripheral blood or decidua basalis and parietalis at term were analyzed by flow cytometry. After treatment with pregnancy-related hormones and LPS, ELISA and qPCR were performed to study sCD83 release and CD83 gene expression, respectively. Cleavage prediction analysis was used to find potential proteases targeting CD83. Expression of selected proteases was analyzed by ELISA. Higher levels of CD83 were found in CD11c+ dendritic cells, CD3+ T cells and CD19+ B cells from decidua basalis and decidua parietalis after LPS-stimulation in vitro. An increase of intracellular expression of CD83 was also detected in CD19+ B cells from both compartments. Stimulated B cells displayed significantly higher percentages of CD83+ cells than dendritic cells and T cells from decidua basalis and peripheral blood. Treatment of B lymphocytes with pregnancy-related molecules (E2, P4, TGF-β1 and hCG) enhanced the LPS-mediated increase of CD83 expression, while dexamethasone led to a reduction. Similarly, the release of sCD83 was increased under TGF-β1 treatment but decreased upon dexamethasone stimulation. Finally, we found that the hormonal regulation of CD83 expression is likely a result from a balance between gene transcription from CD83 and the modulation of the metalloproteinase MMP-7. Thus, data supports and complements our previous murine studies on hormonal regulation of CD83 expression, reinforcing its immunomodulatory relevance in anti-bacterial responses during pregnancy.

Isolation and Immunophenotyping of Leukocytes from the Human Maternal-Fetal Interface.

During human pregnancy, leukocytes that infiltrate the maternal-fetal interface play a major role in establishing a delicate balance between immune tolerance and functional response and setting the inflammatory process that leads to labor. Here we describe two methods for isolating immune cells from the chorioamniotic membranes (decidua parietalis) and placental blood (decidua basalis) that combine gentle enzymatic digestion, magnetic cell sorting, and density gradient. Isolated leukocytes can be immunophenotypified by flow cytometry, and both isolation methods are compatible with downstream cellular and molecular applications, such as cell culture, transcriptome, and proteome analyses.

Chimerization of human ESC-derived extraembryonic cells with the mouse blastocyst.

It has been reported that human embryonic stem cells (hESCs) treated with BMP4 and inhibitors of TGFβ signaling (A83-01) and FGF signaling (PD173074), called BAP, can efficiently differentiate to extraembryonic (ExE) cells in vitro. Due to restricted access to human embryos, it is ethically impossible to test the developmental potential of ExE cells in vivo. Here, we demonstrate that most ExE cells expressed molecular markers for both trophoblasts (TBs) and amniotic cells (ACs). Following intra-uterine transplantation, ExE cells contributed to the mouse placenta. More interestingly, ExE cells could chimerize with the mouse blastocyst as, after injection into the blastocyst, they penetrated its trophectoderm. After implantation of the injected blastocysts into surrogate mice, human cells were found at E14 in placental labyrinth, junction zones, and even near the uterine decidua, expressed placental markers, and secreted human chorionic gonadotropin. Surprisingly, ExE cells also contributed to cartilages of the chimeric embryo with some expressing the chondrogenic marker SOX9, consistent with the mesodermal potential of TBs and ACs in the placenta. Deleting MSX2, a mesodermal determinant, restricted the contribution of ExE cells to the placenta. Thus, we conclude that hESC-derived ExE cells can chimerize with the mouse blastocyst and contribute to both the placenta and cartilages of the chimera consistent with their heteogenious nature. Intra-uterus and intra-blastocyst injections are novel and sensitive methods to study the developmental potential of ExE cells.

337 Acute inflammation is associated with reduced basal decidua progesterone receptor density in spontaneous preterm birth

337 Acute inflammation is associated with reduced basal decidua progesterone receptor density in spontaneous preterm birth

Морфологические особенности эндометрия у пациенток с ожирением и ранними репродуктивными потерями

Aim. To clarify and summarize current data on the relationship between morphological features of gravid transformation of the endometrium and early reproductive losses in women with obesity. Key points. The growing prevalence of obesity worldwide is of serious concern not only due to numerous metabolic complications associated with excess visceral adipose tissue, but also due to reproductive dysfunction in women. Obesity is considered a key factor that increases several times the likelihood of pregnancy complications such as spontaneous abortion, non-viable pregnancy, stillbirth, gestational diabetes mellitus, and preeclampsia. The development of adverse events in the context of maternal obesity may be based on the interaction of biological processes associated with pregnancy and chronic inflammation caused by obesity. However, the causal relationship between BMI and spontaneous abortion is not fully understood, possibly due to the multifactorial effects of excess body weight on pregnancy progression. In addition, BMI as an isolated variable may not reflect other important health risk factors such as nutrition, physical activity, and insulin resistance. Conclusion. Female obesity is associated with worse natural and assisted conception outcomes, including an increased risk of spontaneous abortion. Low-grade inflammation affecting arterial remodeling, placentation, and uterine immune cell composition and activity in maternal obesity contributes to a high incidence of pregnancy complications. The development of a unified morphological panel that takes into account the main indicators of endometrial transformation processes with an assessment of its receptor profile and diagnostically significant immunological factors will allow verification of endometrial pathology at the molecular level and justification of pathogenetic therapy in the risk group of early reproductive losses in women with obesity. Keywords: gravid endometrium, obesity, reproductive function, reproductive losses, miscarriage.

Placenta accreta on non-scarred uterus: About a case

Placenta accreta is an abnormally adherent placenta (abnormal adhesion of the placenta to the myometrium), due to the localized or diffuse absence of the decidua basalis. Its incidence increases with increasing cesarean section rates. Placenta accreta in a non-scarred uterus is very rare but remains possible due to other risk factors which are age, smoking, placenta preavia and finally invasive endouterine procedures. Among its consequences, we first note the hemorrhage of delivery which can be associated with significant maternal morbidity and mortality, uterine rupture and also the invasion of adjacent organs by the placental trophoblast. We report an interesting case of placenta accreta on a non-scarred uterus discovered during a planned cesarean section for placenta previa. This is a 41-year-old patient with no history of scarred uterus, 5th procedure, 3rd parity, with history of spontaneous miscarriage cured at 2 months, pregnant at 39 weeks, unmonitored pregnancy, admitted to the maternity emergency room for two days before for delivery method where the parturient benefited from a clinical examination and an obstetric ultrasound showing a completely covering anterior placenta, amniotic fluid of normal quantity and an estimate of the fetal weight at 2800g, then scheduled for a cesarean section. The diagnosis of placenta accreta is made during cesarean section. We opted for radical treatment. Placenta accreta is a pathology at risk of serious hemorrhagic complications during pregnancy and the postpartum period. This should encourage us to systematically search for ultrasound criteria for placenta accreta. The ultrasound report, in these patients, must explicitly mention this. Adequate care in the presence of a multidisciplinary team makes it possible to limit the mortality and morbidity associated with this pathology.

Pregnancy prediction via ultrasound-detected endometrial blood for hormone replacement therapy-frozen embryo transfer: a prospective observational study

BackgroundThis study aimed to assess the predictive value of endometrial blood flow branches on pregnancy outcomes after hormone replacement therapy-frozen embryo transfer (HRT-FET).MethodsThis prospective observational study involved 292 reproductive-aged women who underwent endometrial receptivity assessment in a tertiary care academic medical center in southwest China using power Doppler ultrasonography during HRT-FET. Three-dimensional power Doppler ultrasound was performed on the day of endometrial transformation and the day before embryo transfer. The endometrial blood flow branches of the endometrial and subendometrial regions were compared in the non-pregnant and pregnant groups at the two time points mentioned above.ResultsThe endometrial blood flow branches were higher in pregnant patients than in non-pregnant patients on the day of endometrial transformation (P = 0.009) and the day before embryo transfer (P = 0.001). Changes in endometrial blood flow pattern and endometrial blood flow branches at the two time points did not differ among the pregnancy outcome samples. After adjusting for age, antral follicles, and embryos transferred, the endometrial blood flow branches on the day before embryo transfer was the independent factor influencing the chance of clinical pregnancy, with an odds ratio of 3.001 (95% confidence interval: 1.448 − 6.219, P = 0.003).ConclusionsEndometrial blood flow perfusion during the peri-transplantation period of the HRT-FET cycle is a good indicator of pregnancy outcomes, suggesting that valuation of endometrial branches via power Doppler ultrasound is a simple and effective approach for achieving indicator measurements.

Impact of endometrial compaction on reproductive outcomes after cryotransfer of euploid embryos in a modified natural cycle: protocol for a prospective cohort study.

Embryo implantation is a complex and poorly understood process. Most studies to date have focused on the analysis of the endometrium at the end of the estrogenic phase, while the available data on its importance after secretory transformation are limited and inconsistent. Current evidence does not allow for a conclusive interpretation of the changes observed in the pre-implantation endometrium, whether in the natural or replacement cycle, and their relevance in the development of a pregnancy or the implications for clinical practice. Multicenter prospective observational cohort study. Based on our sample size calculation, the study group will consist of 206 women (exposed or "compaction" group: 103 women with a decrease of ≥ 5% in endometrial thickness between the estrogenic phase and the day of embryo transfer; non-exposed "non-compaction" group: 103 women with similar or greater endometrial thickness between these time points). The main objective of this study is to compare the ongoing pregnancy rates in natural cycles for euploid embryo transfer in patients who present endometrial compaction at the time of transfer versus those who with a stable or greater endometrial thickness with respect to the estrogenic phase. The estimated duration of the study is 30 months. Inclusion criteria are: 18 to 50 years of age, with primary or secondary infertility, subjected to endometrial preparation in a modified natural cycle for transfer of a genetically euploid blastocyst, from their own oocyte or oocyte donation, with a normal uterine cavity. Exclusion criteria are: uterine or endometrial disease (e.g., multiple myomatosis, severe adenomyosis, Asherman syndrome, refractory endometrium), conditions that prevent correct ultrasound assessment (tilted uterus), or a history of recurrent implantation failure or repeated miscarriages. The findings from this study will provide valuable insights into the potential influence of the "endometrial compaction" phenomenon on reproductive outcomes during natural cycle endometrial preparation. By examining this aspect, we aim to contribute to a better understanding of the factors that may impact successful outcomes in fertility treatments.

Morbidly Adherent Placenta at Upper Segment of Uterus- A Case Report

Background: Morbidly adherent placenta (MAP) is a spectrum of disorder which describes adherence of all or part of the placenta to the uterine wall or surrounding organs. It is one of the most devastating complication of pregnancy. It occurs when there is abnormally firm attachment of placental villi to the uterine wall with the absence of normal intervening decidua basalis and nitabuch’s layer. MAP is often asymptomatic antenatally and the diagnosis is only established after unsuccessful attempt to remove of the placenta at delivery. A majority of morbidly adherent placenta are diagnosed during the third stage of labour or during caesarean section which results in adverse consequences including exsanguinating haemorrhage . It is one of the most common cause of obstetric hysterectomy. Accurate prenatal diagnosis is critical to reduce the risk of maternal morbidity and mortality.
 Aim: To report the case of a morbid adherent placenta at upper segment of uterus with conservation of uterus following reconstructive surgery.
 Case Presentation: A 24 years old 3rd gravid women with morbid adherent placenta at upper segment was treated by segmental resection and reconstructive surgery. Her post- operative period was uneventful.
 Conclusion: Antenatal diagnosis of morbidly adherent placenta, multi-disciplinary team with surgical expertise and facilities for blood transfusion can reduce maternal mortality and morbidity. This rare morbid attachment of placenta at upper segment is one of the example.
 Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 157-161

FRI375 Validation Of A Novel Mouse Placenta Explant Protocol For Screening Of Drugs Modulating Circadian Rhythms

Abstract Disclosure: J.S. Lee: None. H.M. Hoffmann: None. Introduction Pre-eclampsia is one of the leading causes of maternal, fetal, and neonatal morbidity and mortality, complicating about 4% of pregnancies. Recent work has identified PERIOD3 (PER3), a gene regulating 24-hour circadian rhythms, to be downregulated in the preeclamptic placenta. The role of circadian rhythms in the placenta largely remains unknown. Our goal is to establish an organotypic placental preparation to allow screening of drugs that regulate circadian rhythms. These studies are a first step towards understanding how circadian rhythm changes are caused in the placenta and will be the basis for future studies to understand how circadian rhythm disruption in the placenta cause pregnancy complications, such as preeclampsia. Methods We established a novel organotypic placenta preparation allowing to study circadian rhythms in a LumiCycle using gestation day (GD) 14 and GD18 placental explants from the validated circadian reporter mouse Per2::Luciferase. Using H&E we validated the explants to be >80% enriched in either decidua (DC) which is strictly of maternal origin, labyrinth (LB) which is strictly of fetal origin, and the junctional zone (JZ) which consists of binucleated cells fused of maternal and fetal cells. Results Through H&E staining, we validated by distinct morphology that the DC is enriched with neutrophils; the JZ contains spongiotrophoblasts and glycogen trophoblasts; whereas the LB has anucleated red blood cells. We next established a protocol to record Per2::Luciferase circadian rhythms for <6 days. We found that the Per2::Luciferase circadian rhythm shortens with increased gestational age, where the period in DC, LZ and LB in the GD14 placenta is ∼4h longer than in the GD18 placenta, showing an unexpected plasticity in circadian timekeeping in the placenta. Because PER3 is downregulated in the pre-eclamptic placenta, we asked if the explants would be useful for pharmacologically screenings. We applied PF670462 (1μM), which stabilizes PER1/2/3, or epidermal growth factor (EGF, 30ng/mL), a growth factor important in placental function and a PER2 enhancer. PF670462 lengthened Per2::Luciferase period in the DC and JZ, confirming the expected circadian rhythm stabilizing effect of PF670462. Surprisingly, EGF only modulated circadian rhythms in the GD14 placental, where EGF shortened Per2::Luciferase period in DC, and lengthen the period in the JZ and LB zones in the GD14 placenta. This data suggests EGF has gestational age and placenta zone specific effects. Conclusion We validated a novel ex vivo placental preparation to study circadian rhythms at GD14 and GD18. We identified a placenta zone and gestation age specific effect of EGF, an effect future studies will further expand on. This model will be useful to complete pharmacological screenings of drugs that can restore circadian rhythms in the preeclamptic placenta. Presentation: Friday, June 16, 2023

THU633 Atonal BHLH Transcription Factor 8 (ATOH8) Functions In Decidualization

Abstract Disclosure: R. Thapa: None. B. Bany: None. ATOH8 is a member of the vast basic helix-loop-helix (bHLH) protein family that is widely known to play a role in various physiological and pathological processes. However, the functional significance of ATOH8 expression in the endometrium during implantation and in the first trimester of pregnancy in women is still lacking. In the mid to late secretory phase of the menstrual cycle, elongated fibroblast-like mesenchymal cells in the uterine endometrium begin to trans-differentiate into polygonal epithelioid-like (decidual) cells. During pregnancy, this process continues more broadly and supports successful embryo implantation and early placental development. We employed an established in vitro model using uterine fibroblast (HuF) cells derived from the decidua parietalis of term patients to investigate the function of ATOH8 during in vitro decidualization. All experiments were carried out using cells isolated from at least six independent patients (N=6). We measured the expression of classical decidualization marker genes and the characteristic shape change from small fibroblast-like cells to large epitheloid-like decidual cells to assess decidualization. Treating cells with steroids plus a membrane-permeable cAMP analog (EPC) for 48h caused in vitro decidualization of these cells, while treatment with vehicle alone had no effect. We discovered that ATOH8 expression was dramatically upregulated during this decidualization at both the mRNA and protein levels, with the protein primarily localized to the nucleus. The functional role of ATOH8 during decidualization was investigated using lentivirus-mediated shRNA knockdown or overexpression of ATOH8. When ATOH8 expression was silenced, we discovered that the ability of the cells to undergo decidualization was greatly and significantly diminished. On the other hand, overexpression of ATOH8 enhanced some aspects of decidualization. The addition of recombinant BMP2 alone had little effect on ATOH8 expression. However, in the presence of EPC it significantly enhanced ATOH8 expression. This effect of BMP2 on ATOH8 expression was inhibited by preincubating the cells with 500 nM DMH-1 (an ALK2/3 inhibitor) for one hr prior to inducing decidualization. Steroids alone did not affect ATOH8 or BMP2 expression. However, the addition of cAMP alone represented the major effect of EPC on ATOH8 expression while having a slight impact on BMP2 expression. A robust increase in BMP2 expression required the presence of both steroids and cAMP together. Our results indicate that ATOH8 plays a crucial role in human endometrial stromal cell decidualization. Further, our results suggest that ALK2/3 receptors are most likely involved in mediating the effect of BMP2 on increasing ATOH8 expression. Keywords: ATOH8, Decidualization, Embryo Implantation Presentation: Thursday, June 15, 2023

PLACENTA ACCRETA SPECTRUM DISORDERS

Placenta accreta spectrum is a rare pathology, but there is an increase in the incidence of placenta accreta. In the accreta spectrum, abnormal placental adherence to the myometrium stems in part from partial or total absence of the decidua basalis and imperfect development of the fibrinoid or Nitabuch layer. This results in the absence of a physiological line of cleavage, so resulting in failure of separation of the placenta causing significant hemorrhage. This leads to maternal morbidity and mortality. 12 patients of placenta accreta managed at Government Medical College and Rajindra Hospital, Patiala, over 1 year (December 2021–November 2022) were reported. All cases had a histopathologically proven diagnosis of placenta accreta. The major risk factors identified were placenta previa, previous cesarean section, multiparity, advanced maternal age, previous uterine surgeries, or curettage. Ultrasound (USG) color Doppler and magnetic resonance imaging allowed us to strongly suspect the presence of placenta accreta in a pregnant woman with risk factors. Placenta accreta spectrum is associated with life-threatening hemorrhage, urinary bladder injury, intensive care unit admission, massive blood transfusion, and maternal death. The course of action in each and every patient varies according to whether the diagnosis of the placenta is made antenatal or during C-section and the amount of blood loss.

Decreased Fatty Acid Oxidation Gene Expression in Pre-Eclampsia According to the Onset and Presence of Intrauterine Growth Restriction.

Mitochondrial fatty acid oxidation (FAO) is lower in placentas with pre-eclampsia. The aim of our study was to compare the placental mRNA expression of FAO enzymes in healthy pregnancies vs. different subgroups of pre-eclampsia according to the severity, time of onset, and the presence of intrauterine growth restriction (IUGR). By using real-time qPCR, we measured the mRNA levels of long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD), medium-chain acyl-CoA dehydrogenase (MCAD), and carnitine palmitoyltransferases 1A and 2 (CPT1A, CPT2) on the maternal side (anchoring villi in the basal decidua) and on the fetal side (chorionic plate) of the placenta (n = 56). When compared to the controls, LCHAD, MCAD, and CPT2 mRNA had decreased in all pre-eclampsia subgroups globally and on the fetal side. On the maternal side, LCHAD mRNA was also lower in all pre-eclampsia subgroups; however, MCAD and CPT2 mRNA were only reduced in severe and early-onset disease, as well as CPT2 in IUGR (p < 0.05). There were no differences in CPT1A mRNA expression. We conclude that the FAO enzymes mRNA in the placenta was lower in pre-eclampsia, with higher reductions observed in severe, early-onset, and IUGR cases and more striking reductions on the fetal side.

Chorionic bump in ultrasound of the first trimester: Report of a case and bibliographic review

Background: Chorionic bump involves the gestational sac and can be visualized in first trimester ultrasound. It is described as an irregular convexity that protrudes towards the gestational sac and corresponds to the formation of a hematoma on choriodecidual surface.&#x0D; Objective: This is a clinical case reported in a second level hospital. An updated search was carried out on the topic of timely diagnosis of chorionic bump.&#x0D; Case Report: A round echogenic mass protruding from the choriodecidual surface, measuring 17.3 x 16.5 x 19.1mm, was identified during a transvaginal examination at 8 weeks' gestation. Uterine cavity with an irregular Gestational Sac with a mean diameter of 29.9mm with poor decidual reaction, observing the amnion inside without evidence of an embryonic pole and a 2.3mm yolk sac. The pregnancy was not viable.&#x0D; Discussion: Etiopathogenesis remains unclear. This case demonstrates that a chorionic bump can be considered a poor prognostic finding in ecosonogram.&#x0D; Conclusion: "Chorionic Bump" is a phenomenon little investigated in ultrasound. The etiology is still unknown. When it is identified, it can be associated with a poor prognostic finding. The most important task for the sonographer is to know how to identify and differentiate it correctly from an early embryonic death.

Metabolomics analysis of serum metabolites during endometrial transformation: association with recurrent implantation failure in hormonal replacement therapy-frozen embryo transfers cycles.

The purpose of this study was to investigate alterations in serum metabolites during endometrial transformation and possibleassociations with recurrent implantation failure (RIF) in hormonal replacement therapy (HRT)-frozen embryo transfer (FET) cycles. We performed a prospective study involving 100 patients scheduled for HRT-FET cycles during January 2022 to April 2022. Blood serum samples were collected on the day of progesterone administration (dPA) and on the third day of progesterone administration (d3PA). Gas chromatography-mass spectrometry (GC-MS) analysis was performed to identify and quantify serum metabolites. A nested case-control study including 19 RIF patients and 19 matching controls was conducted to explore the predictive value of serum metabolites for RIF. Partial least squares discriminant analysis (PLS-DA) and receiver operating characteristic (ROC) curve analysis were performed to establish prediction models. We identified 105 serum metabolites, with 76 of them exhibiting significant alterations during the initial 3 days of endometrial transformation. Metabolites involved in amino acid metabolism and tricarboxylic acid (TCA) cycle showed lower levels during endometrial transformation. In the nested case-control study, the prediction model based on the ratio of serum metabolites between d3PA and dPA showed the highest area under the ROC curve (AUC), accuracy, and R2 and Q2 values. Eight metabolites, including indol-3-propionic acid, beta-alanine, myristoleic acid, malic acid, indole, DL-isocitric acid, proline, and itaconic acid, exhibited high predictive values for RIF. This study demonstrates alterations in serum metabolites during endometrial transformation, particularly in amino acid metabolism and TCA cycle. The identified metabolites, especially indol-3-propionic acid and malic acid, show potential as predictive markers for RIF. These findings contribute to a better understanding of the metabolic changes associated with endometrial receptivity and provide insights for the development of personalized approaches to improve implantation outcomes in FET cycles.

Ectopic decidual reaction – A diagnostic dilemma

The occurrence of decidualization outside the endometrium, is called as ectopic decidual reaction. It can involve any abdominal organs, such as ovary, fallopian tube, cervix, uterine surface, omentum, etc. and present as grey white nodules. These nodules grossly mimic metastatic disease and granulomas, causing a diagnostic dilemma. Decidual reaction is a benign condition and can regress spontaneously in the postpartum period. Thus, it is important to accurately diagnose these lesions for optimal treatment. Histologic examination followed by immunohistochemistry can be performed on the biopsies sampled during cesarean sections, tubal ligation, appendectomy, etc. to obtain a correct diagnosis. Peritoneal location of ectopic decidua is less frequent and can be an incidental finding. Few patients may present with the symptoms of abdominal pain, hemorrhage or irritable bowel syndrome. We thereby, report a case of peritoneal ectopic decidual reaction and discuss its histopathological features, immunohistochemistry and the differential diagnosis.