Gestational Placenta Research Articles

Effects of co-administration of lamotrigine on valproate transfer across the placenta and its brain entry in developing Genetic Absence Epilepsy Rats from Strasbourg (GAERS).

During development, embryos and foetuses may be exposed to maternally ingested antiseizure medications (ASM), valproate and lamotrigine, essential in some patients to control their epilepsy symptoms. Often, the two drugs are co-administered to reduce required doses of valproate, a known potential teratogen. This study used Genetic Absence Epilepsy Rat from Strasbourg to evaluate transfer of valproate and lamotrigine across late gestation placenta and their entry into cerebrospinal fluid (CSF) and brain of developing rats, in mono- and combination therapies. Animals at embryonic day (E) 19, postnatal day (P) 0, 4 and 21, and adults were administered valproate (30 mg/kg) or lamotrigine (6mg/kg) with their respective [3H]-tracers, either alone or in combination. In chronic experiments, females consumed valproate-containing diet from 2weeks prior to mating until offspring were used at E19 and P0. Drugs were injected 30 min before blood, CSF and brain samples were collected from terminally anaesthetised animals. Radioactivity in samples was measured. In acute monotherapy brain entry of valproate was higher in foetal than postnatal animals, correlating with its plasma protein binding. Brain entry of lamotrigine was not age-dependent. Combination therapy enhanced entry of lamotrigine into the adult brain but had no effects on brain and CSF entry of valproate. Following chronic valproate exposure, placental transfer of valproate decreased in combination therapy; however, foetal brain entry increased. Results suggest that during pregnancy, the use of combination therapy of valproate and lamotrigine may mitigate overall foetal exposure to valproate but potential risks to foetal brain development are less clear.

The clinical value of combining shear wave elastography, VOCAL technique, and T2* MRI of early gestation placenta to predict pre-eclampsia.

To investigate the clinical value of combining shear wave elastography (SWE) with the Volumetric Organ Computer-Aided AnaLysis (VOCAL) technique and T2* magnetic resonance imaging (MRI) to predict pre-eclampsia (PE). From December 2022 to March 2023, we recruited 31 pregnant women diagnosed with PE at our hospital as the observation group and 85 normal pregnant women as the control group. Differences in placental elasticity, vascularization index (VI), flow index (FI), vascularization flow index (VFI), and T2* MRI perfusion fraction (f) were compared between the two groups. Received operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic value of placental elasticity, VI, FI, VFI, f, and their combination for predicting PE. Placental elasticity was higher in the observation group than in the control group, while VI, FI, VFI, and f were lower in the observation group (all p < 0.05). The area under the curve (AUC) for placental elasticity, VI, FI, VFI, f, and their combination for predicting PE were 0.85, 0.77, 0.78, 0.84, 0.65, and 0.94, respectively. The sensitivity was 71%, 55%, 94%, 65%, 55%, and 81%. The specificity was 92%, 91%, 60%, 92%, 79%, and 98%. The combined prediction model had a higher AUC than the individual predictors (p < 0.05). SWE combined with VOCAL technique and T2* MRI has high value for predicting PE and can provide reference information for clinical diagnosis.

Machine learning reveals common transcriptomic signatures across rat brain and placenta following developmental organophosphate ester exposure.

Toxicogenomics is a critical area of inquiry for hazard identification and to identify both mechanisms of action and potential markers of exposure to toxic compounds. However, data generated by these experiments are highly dimensional and present challenges to standard statistical approaches, requiring strict correction for multiple comparisons. This stringency often fails to detect meaningful changes to low expression genes and/or eliminate genes with small but consistent changes particularly in tissues where slight changes in expression can have important functional differences, such as brain. Machine learning offers an alternative analytical approach for "omics" data that effectively sidesteps the challenges of analyzing highly dimensional data. Using 3 rat RNA transcriptome sets, we utilized an ensemble machine learning approach to predict developmental exposure to a mixture of organophosphate esters (OPEs) in brain (newborn cortex and day 10 hippocampus) and late gestation placenta of male and female rats, and identified genes that informed predictor performance. OPE exposure had sex specific effects on hippocampal transcriptome, and significantly impacted genes associated with mitochondrial transcriptional regulation and cation transport in females, including voltage-gated potassium and calcium channels and subunits. To establish if this holds for other tissues, RNAseq data from cortex and placenta, both previously published and analyzed via a more traditional pipeline, were reanalyzed with the ensemble machine learning methodology. Significant enrichment for pathways of oxidative phosphorylation and electron transport chain was found, suggesting a transcriptomic signature of OPE exposure impacting mitochondrial metabolism across tissue types and developmental epoch. Here we show how machine learning can complement more traditional analytical approaches to identify vulnerable "signature" pathways disrupted by chemical exposures and biomarkers of exposure.

The Placenta-A New Source of Bile Acids during Healthy Pregnancy? First Results of a Gene Expression Study in Humans and Mice.

Bile acids (BAs) are natural ligands for several receptors modulating cell activities. BAs are synthesized via the classic (neutral) and alternative (acidic) pathways. The classic pathway is initiated by CYP7A1/Cyp7a1, converting cholesterol to 7α-hydroxycholesterol, while the alternative pathway starts with hydroxylation of the cholesterol side chain, producing an oxysterol. In addition to originating from the liver, BAs are reported to be synthesized in the brain. We aimed at determining if the placenta potentially represents an extrahepatic source of BAs. Therefore, the mRNAs coding for selected enzymes involved in the hepatic BA synthesis machinery were screened in human term and CD1 mouse late gestation placentas from healthy pregnancies. Additionally, data from murine placenta and brain tissue were compared to determine whether the BA synthetic machinery is comparable in these organs. We found that CYP7A1, CYP46A1, and BAAT mRNAs are lacking in the human placenta, while corresponding homologs were detected in the murine placenta. Conversely, Cyp8b1 and Hsd17b1 mRNAs were undetected in the murine placenta, but these enzymes were found in the human placenta. CYP39A1/Cyp39a1 and cholesterol 25-hydroxylase (CH25H/Ch25h) mRNA expression were detected in the placentas of both species. When comparing murine placentas and brains, Cyp8b1 and Hsd17b1 mRNAs were only detected in the brain. We conclude that BA synthesis-related genes are placentally expressed in a species-specific manner. The potential placentally synthesized BAs could serve as endocrine and autocrine stimuli, which may play a role in fetoplacental growth and adaptation.

Activation of the Interferon Pathway in Trophoblast Cells Productively Infected with SARS-CoV-2.

SARS-CoV-2 infection during pregnancy has been associated with poor maternal and neonatal outcomes and placental defects. The placenta, which acts as a physical and immunological barrier at the maternal-fetal interface, is not established until the end of the first trimester. Therefore, localized viral infection of the trophoblast compartment early in gestation could trigger an inflammatory response resulting in altered placental function and consequent suboptimal conditions for fetal growth and development. In this study, we investigated the effect of SARS-CoV-2 infection in early gestation placentae using placenta-derived human trophoblast stem cells (TSCs), a novel in vitro model, and their extravillous trophoblast (EVT) and syncytiotrophoblast (STB) derivatives. SARS-CoV-2 was able to productively replicate in TSC-derived STB and EVT, but not undifferentiated TSCs, which is consistent with the expression of SARS-CoV-2 entry host factors, ACE2 (angiotensin-converting enzyme 2) and TMPRSS2 (transmembrane cellular serine protease) in these cells. In addition, both TSC-derived EVT and STB infected with SARS-CoV-2 elicited an interferon-mediated innate immune response. Combined, these results suggest that placenta-derived TSCs are a robust in vitro model to investigate the effect of SARS-CoV-2 infection in the trophoblast compartment of the early placenta and that SARS-CoV-2 infection in early gestation activates the innate immune response and inflammation pathways. Therefore, placental development could be adversely affected by early SARS-CoV-2 infection by directly infecting the developing differentiated trophoblast compartment, posing a higher risk for poor pregnancy outcomes.

Placental Histopathologic Findings of a Large Cohort of Patients With SARS-CoV-2 Infection During Pregnancy.

Pregnant individuals with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are at a higher risk for adverse pregnancy outcomes. Previous small cohort studies have shown increased frequency of placental lesions associated with maternal vascular malperfusion, fetal vascular malperfusion, and inflammation among patients with SARS-CoV-2, without controlling for cardiometabolic risk factors among many such patients. We aimed to evaluate whether SARS-CoV-2 infection during pregnancy is independently associated with placental abnormalities when controlling for risk factors that could affect placental histopathology. Retrospective cohort study of placentas from singleton pregnancies in Kaiser Permanente Northern California from March to December 2020. Pathologic findings were compared among those with confirmed cases of SARS-CoV-2 during pregnancy and those without. We examined the association between SARS-CoV-2 infection and categorical placental pathologies, controlling for maternal age, gestational age, prepregnancy body mass index, gestational hypertension, preeclampsia/eclampsia, preexisting diabetes, history of thrombosis, and stillbirth. A total of 2,989 singleton gestation placentas were analyzed, 416 (13%) from pregnancies with SARS-CoV-2 infection and 2,573 (86%) from those without infection. Among placentas from pregnancies with SARS-CoV-2, 54.8% had evidence of inflammation, 27.1% maternal malperfusion abnormality, 20.7% massive perivillous fibrin or chronic villitis, 17.3% villous capillary abnormality, and 15.1% fetal malperfusion. After controlling for risks factors and stratifying interval time between SARS-CoV-2 infection and delivery, no association was found between placental abnormalities and SARS-CoV-2 infection during pregnancy. SARS-CoV-2 infection was not associated with an increased risk of placentally mediated adverse outcomes during pregnancy, compared with placentas sent for other indications, in this large diverse cohort.

PS-B05-11: IMPAIRED CELL INTERACTIONS AT THE PRE-ECLAMPTIC MATERNAL-FOETAL INTERFACE

Hypertensive disorders in pregnancy, of which the multisystem syndrome pre-eclampsia is most severe, leading to preterm delivery, maternal mortality and life-long complications1. Pre-eclampsia lacks early screening tools2,3 and causal therapies4,5. To elucidate early disease dynamics, we present the first spatio-temporal study comparing single-nuclei transcriptomes of human preterm pre-eclamptic placentae and healthy controls, contextualising this in a comprehensive study including early and late gestational placentae and implementing spatial multi-omics methods. Here we show trophoblast pre-fusion cells and their developmental trajectory running towards a novel trophoblast cell-state we identify as juvenile syncytiotrophoblast. We found that disturbed trophoblast development, reconstructed by spatial multi-omics and including early dysregulation in differentiation-driving transcription factor p300, likely initiates pre-eclampsia. We suggest pre-eclampsia to be a disease of dysregulated syncytiotrophoblast differentiation: Disease-specific premature differentiation of the maternal-foetal barrier leads to a senescent syncytiotrophoblastic interaction through maternal circulation with maternal vessels. This initiates a disrupted decidual maternal response via LEP, GDF15 and INHBA. Our results highlight a disturbed cellular communication from foetal to maternal side during the development of pre-eclampsia starting with a disturbed trophoblast maturation. We provide new targets for potential early disease prevention in order to protect mother and child from increased gestational mortality and morbidity but also from life-long increased cardiovascular disease risk.

Modeling placental development and disease using human pluripotent stem cells

Our current knowledge of the cellular and molecular mechanisms of placental epithelial cells, trophoblast, primarily came from the use of mouse trophoblast stem cells and tumor-derived or immortalized human trophoblast cell lines. This was mainly due to the difficulties in maintaining primary trophoblast in culture and establishing human trophoblast stem cell (hTSC) lines. However, in-depth characterization of these cellular models and in vivo human trophoblast have revealed significant discrepancies. For the past two decades, multiple groups have shown that human pluripotent stem cells (hPSCs) can be differentiated into trophoblast, and thus could be used as a model for normal and disease trophoblast differentiation. During this time, trophoblast differentiation protocols have evolved, enabling researchers to study cellular characteristics at trophectoderm (TE), trophoblast stem cells (TSC), syncytiotrophoblast (STB), and extravillous trophoblast (EVT) stages. Recently, several groups reported methods to derive hTSC from pre-implantation blastocyst or early gestation placenta, and trophoblast organoids from early gestation placenta, drastically changing the landscape of trophoblast research. These culture conditions have been rapidly applied to generate hPSC-derived TSC and trophoblast organoids. As a result of these technological advancements, the field's capacity to better understand trophoblast differentiation and their involvement in pregnancy related disease has greatly expanded. Here, we present in vitro models of human trophoblast differentiation, describing both primary and hPSC-derived TSC, maintained as monolayers and 3-dimensional trophoblast organoids, as a tool to study early placental development and disease in multiple settings.

Workload Measurement in Subspecialty Placental Pathology in Canada.

Workload measurement is important to help determine optimal staffing and workload distribution for pathology laboratories. The Level 4 Equivalent (L4E) System is the most widely used Anatomical Pathology (AP) workload measurement tool in Canada. However, it was initially not developed with subspecialties in mind. In 2016, a Pan-Canadian Pediatric-Perinatal Pathology Workload Committee (PCPPPWC) was organized to adapt the L4E System to assess Pediatric-Perinatal Pathology workload. Four working groups were formed. The Placental Pathology Working Group was tasked to develop a scheme for fair valuation of placental specimens signed out by subspecialists in the context of the L4E System. Previous experience, informal time and motion studies, a survey of Canadian Pediatric-Perinatal Pathologists, and interviews of Pathologists' Assistants (PA) informed the development of such scheme. A workload measurement scheme with average L4E workload values for examination and reporting of singleton and multiple gestation placentas was proposed. The proposal was approved by the Canadian Association of Pathologist - Association canadienne des pathologistes Workload and Human Resources Committee for adoption into the L4E System. The development of a workload measurement model for placental specimens provides an average and fair valuation of these specimen types, enabling its use for resource planning and workload distribution.

Racial variations of adverse perinatal outcomes: A population-based retrospective cohort study in Ontario, Canada.

IntroductionRacial differences in adverse maternal and birth outcomes have been studied in other countries, however, there are few studies specific to the Canadian population. In this study, we sought to examine the inequities in adverse perinatal outcomes between Black and White pregnant people in Ontario, Canada.MethodsWe conducted a population-based retrospective cohort study that included all Black and White pregnant people who attended prenatal screening and had a singleton birth in any Ontario hospital (April 1st, 2012-March 31st, 2019). Poisson regression with robust error variance models were used to estimate the adjusted relative risks of adverse perinatal outcomes for Black people compared with White people while adjusting for covariates.ResultsAmong 412,120 eligible pregnant people, 10.1% were Black people and 89.9% were White people. Black people were at an increased risk of gestational diabetes mellitus, preeclampsia, placental abruption, preterm birth (<37, <34, <32 weeks), spontaneous preterm birth, all caesarean sections, emergency caesarean section, low birth weight (<2500g, <1500g), small-for-gestational-age (<10th percentile, <3rd percentile) neonates, 5-minute Apgar score <4 and <7, neonatal intensive care unit admission, and hyperbilirubinemia requiring treatment but had lower risks of elective caesarean section, assisted vaginal delivery, episiotomy, 3rd and 4th degree perineal tears, macrosomia, large-for-gestational-age neonates, and arterial cord pH≤7.1, as compared with White people. No difference in risks of gestational hypertension and placenta previa were observed between Black and White people.ConclusionThere are differences in several adverse perinatal outcomes between Black and White people within the Ontario health care system. Findings might have potential clinical and health policy implications, although more studies are needed to further understand the mechanisms.

Pregnancy complications and risk of uterine rupture among women with singleton pregnancies in China

BackgroundThe goal of this study was to investigate whether pregnancy complications are associated with an increased risk of uterine rupture (UR) and how that risk changes with gestational age.MethodsWe obtained all data from China’s National Maternal Near Miss Surveillance System (NMNMSS) between 2012 and 2018. Poisson regression analysis was used to assess the risk of UR with pregnancy complications (preeclampsia, gestational diabetes mellitus, placental abruption, placenta previa and placenta percreta) among 9,454,239 pregnant women. Furthermore, we analysed the risks of UR with pregnancy complications in different gestational age groups.ResultsThe risk of UR was increased 2.0-fold (1.2-fold to 2.7-fold) in women with pregnancy complications (except for preeclampsia). These associations also persisted in women without a previous caesarean delivery. Moreover, an increased risk of UR before term birth was observed among women with gestational diabetes mellitus, placental abruption and placenta percreta. The risk of UR was slightly higher in women with gestational diabetes mellitus who had a large for gestational age (LGA) foetus, especially at 32 to 36 weeks gestation.ConclusionsThe risk of UR is associated with gestational diabetes mellitus, placental abruption, placenta previa and placenta percreta, but varies in different gestational ages.

Distinct Placenta Increta and Percreta in the Setting of Dichorionic Diamniotic Twin Gestation: A Unique Histological Finding

Multiple gestations have been reported as a risk factor for placenta accreta spectrum (PAS) but the evidence is limited. Previous reports showed that PAS degrees (creta, increta, percreta) were similar in multiple gestation placentas. To our knowledge, there have been no reports of PAS in dichorionic placentas with different degrees of invasion. Here, we report dichorionic diamniotic placentas with two different degrees of invasion, one increta and another percreta.

Comparative analysis of miRNA expression profiles in small extracellular vesicles and their originating primary human trophoblast cells from normal and Gestational Diabetes Mellitus placentae

Comparative analysis of miRNA expression profiles in small extracellular vesicles and their originating primary human trophoblast cells from normal and Gestational Diabetes Mellitus placentae

The effect of smoking on the early gestation placenta

The effect of smoking on the early gestation placenta

O-183 Increased Risk Of Hypertensive Disorders Of Pregnancy In Hormone Replacement Therapy Cycle - A Multicenter Cohort Study In Frozen Blastocyst Transfer In Ovulatory Women

Abstract Study question Is hormone replacement therapy cycle (HRT) associated with a higher risk of adverse perinatal outcomes than natural cycle (NC) during frozen embryo transfer (FET)? Summary answer Higher rates of hypertensive disorders of pregnancy (HDPs) and macrosomia were detected in HRT-FET as compared to NC-FET in ovulatory women. What is known already Live-birth rates after HRT-FET and NC-FET are found to be comparable. Recent data showed that pregnancies following HRT-FET are associated with higher risks of HDPs. However, the results might be influenced by selection bias as patients with ovulation disorder were more prone to receive HRT than ovulatory women. As is known, patients with ovulation disorder might have more endocrine disturbances than ovulatory women, which could be associated with adverse obstetrical outcomes. Study design, size, duration Four large reproductive medical centers in Guangdong province, Southeast of China, took part in this multicenter retrospective cohort study. Patients with regular cycles (25-35 days), who underwent either HRT or NC blastocyst FET and delivered after 20 weeks of gestation between January 2017 and December 2019 were analyzed. Preimplantation genetic testing (PGT) cycles, multiple pregnancies and cases with type II diabetes or preconceptional hypertension were excluded. Each patient only contributed one cycle per cohort. Participants/materials, setting, methods Treatment cycles from each patient were linked to their obstetrical medication record and a comprehensive chart review was done to investigate their perinatal outcomes. Maternal and neonatal outcomes were compared between NC-FET and HRT-FET cycles. Multiple logistic regression analyses were performed to adjust the confounding factors including baseline demographics (maternal age, BMI, education level, parity, type of infertility and cause of infertility), as well as IVF characteristics (insemination method and embryo cryopreservation duration). Main results and the role of chance A total of 406 cases from NC-FET and 602 cases from HRT-FET were included. A multiple logistic regression analysis showed that pregnancies after HRT-FET had increased odds of HDPs [adjusted odds ratio (aOR) 2.44, 95% confidence interval (CI), 1.39–4.29] in comparison to pregnancies after NC-FET. Singletons born after HRT-FET were at increased risk of macrosomia compared to NC group (aOR 2.74, 95%CI 1.10–6.87). No significant difference could be seen regarding other obstetrical complications including gestational diabetes, placenta previa, placental abruption and postpartum hemorrhage between HRT-FET and NC-FET. No significant differences were noticed for preterm birth and low birthweight between the different endometrial protocols. Limitations, reasons for caution Our study was retrospective in nature, and some cases were excluded due to missing data. Wider implications of the findings Pregnancies following HRT-FET are associated with higher risks of HDPs and macrosomia in ovulatory women. Physicians should be cautious on the decision of the endometrium preparation for FET, especially for those who can ovulate normally. Trial registration number 2018YFC100310

P–789 Obstetric and perinatal outcomes in poor ovarian responders and normal responders flowing fresh embryo transfer: a prospective, monocentric, observational study

Abstract Study question Whether women pregnant after a poor response in IVF have obstetric and perinatal complications more frequently than women with pregnancies after a normal response in IVF? Summary answer There were no statistically significant differences in obstetric and perinatal complications rate between poor responders and normal responders in Chinese women. What is known already Poor ovarian response usually indicates a reduction in follicular response, resulting in a reduced number of retrieved oocytes. Patients are less likely to conceive and have a higher risk of cycle cancellation and low clinical pregnancy rate. Whether poor ovarian response is associated with obstetric and perinatal complications is however debated. Study design, size, duration Design: Prospective, monocentric, observational study. Size: 1664 women with poor ovarian response and 1061 women with normal ovarian response duration : July 1, 2017 to Aug 15, 2019.Participants/materials, setting, methods: 1664 women with poor ovarian response and 1061 women with normal ovarian response undergoing IVF or ICSI were enrolled in this study. The primary outcome was obstetric and perinatal complications rate. Main results and the role of chance 1664 women with POR and 1061 women with NOR were enrolled in this study.Poor and normal responders did not have significantly different incidences in obstetric and perinatal complications(25.42% vs 25.45%), nor were there a significant difference in preeclampsia, gestational diabetes mellitus, postpartum hemorrhage or abruptio placentae. But POR group have a lower frequency of twin pregnancies(8.47% vs 28.66%,P&amp;lt;0.01),low birth weight(5.08% vs 14.23%,P&amp;lt;0.01)and prematurity (9.32% vs 17.03%,P&amp;lt;0.01). Limitations, reasons for caution Despite its size, an observational study such as this has a number of inherent limitations, and the best way to confirm its findings will be to compare obstetric and perinatal outcomes in different subgroup of pregnancies following ART in an adequately powered randomized, controlled trial. Wider implications of the findings: This prospective, monocentric, observational study suggests that women with poor ovarian response did not have higher perinatal complication rate than women with normal ovarian response. Oocyte quality and quantity may not affect the rate of perinatal complications. Trial registration number Not applicable

Advanced Maternal Age and Pregnancy Outcome at Manipal Teaching Hospital: Cross-sectional Analytical study

Introduction: Advanced and very advanced maternal age are associated with several adverse maternal and fetal outcome. The objective of this study was to find out the possible association between advance maternal age and adverse pregnancy outcomes at Manipal Teaching Hospital.Methods: A cross sectional analytical study conducted at department of Obstetrics and Gynecology, Manipal Teaching Hospital, Pokhara, Nepal. A total of 198 patient who were ≥30 years and &gt;24 weeks pregnant admitted in obstetric ward were selected. These patient were divided into three groups according to their age (30-34, 35-39 and ≥ 40years). We compared the incidence of adverse maternal and perinatal outcome among these groups. We also calculated odds ratio of maternal and perinatal outcomes in 35-39 years and ≥ 40years women, compared with women aged 30-34 years.Results: Comparison of the three age groups revealed that advanced maternal age constitute a predisposing factor for malpresentation, gestational diabetes mellitus, placenta previa, fetal distress and caesarean section. Whereas, risk of non progress of labour, preterm birth, postpartum hemorrhage, perinatal death and congenital anomalies were increased in very advanced maternal age group. From these, statistical significance was reached in case of greater risk of malpresentation (p=0.01,OR=6.66), fetal distress (p=0.04, OR=2.6) and caesarean section(p=0.02,OR=2.06) in advanced age group when compared to the patients aged 30-34. Furthermore, very advanced age group were higher risk of postpartum hemorrhage (p=0.03, OR=2.47) and congenital anomalies, which were statistically significant (p=0.04, OR=29.57) when compared to the 30-34 years.Conclusion: Advanced and very advanced maternal age is associated with several adverse maternal and perinatal outcome. The risk of perinatal complication begin to increase after the age of 35 but significantly increased after 40 years.

Factors Indicating the Accuracy of Fetal Weight Estimation in Preterm Newborns with Normal Amniotic Fluid Volume

OBJECTIVE: To determine the factors indicating the accuracy of fetal weight estimation in the last prenatal ultrasonography before delivery in preterm newborns with normal amniotic fluid volume.STUDY DESIGN: Three hundred and seventy-one singleton pregnancies with normal amniotic fluid volume and delivered at between 24+0 and 37+0 gestational weeks were evaluated in a retrospective study. Any possible associations between the absolute percentage error of fetal weight estimations and the maternal and fetal data were examined.RESULTS: In 135 of the 371 women (36%), the absolute percentage error was greater than 10%. The mean absolute percentage error was 8.7±7.5%. The mean absolute percentage errors were 4.1±2.7% and 16.8±6.4% in the accurate and inaccurate estimation groups, respectively.The rate of women examined during labor was significantly higher in the inaccurate estimation group compared to the accurate estimation group. There were no significant differences in age, body-mass-index, gestational age at delivery, estimated-fetal-weight, actual birth weight, days from the last ultrasound examination to delivery, small for gestational age rate, placenta localization or fetal presentation between the two groups. Examination during labor (β=0.224) was the most important factor for the prediction of the absolute percentage error, followed by gestational age at delivery (β=–0.198), presence of (β=–0.158), and body-mass-index (β=0.142).CONCLUSION: In 36% of our study population, the absolute percentage error was &gt;10%. Examination during labor was the most important factor for the prediction of the absolute percentage error, followed by gestational age at delivery, presence of small for gestational age, and body-mass-index.

A Study on Morphohistometric Changes of Placenta in Gestational Diabetes- A Comparative Analysis

Introduction:The placenta is a complex fetal organ that fulfills pleotrophic roles during fetal growth. Placenta is the most accurate record of the infant’s prenatal experience. Gestational diabetes is much common than preexisting diabetes .i.e. it complicates 2% to 5% of pregnancies. It seems reasonable to expect that biochemical changes occurring in the pregnant women with diabetes should be reflected in the placental structure. Aim &amp; objectives: In the present study an attempt is made to know the morphological changes of placenta in gestational diabetes mellitus.Subjects and Methods:In this study totally 60 placentae were studied, of which 30 were nondiabetic placentae and 30 from Gestational Diabetic mothers were studied macroscopically. Morphologically the shape, site of attachment of umbilical cord, central thickness of placenta was noted. Birth weight of the neonate and the placental ratio were also recorded. By using routine staining techniques and direct microscopy tissues of Gestational Diabetic placenta were studied qualitatively and compared them with normal placenta.Results:Our study demonstrates that there is a significant increase in weight and central thickness of placenta. Neonatal weight and placental ratio were also increased; there was no change in shape and site of attachment of umbilical cord in case of diabetic placenta when compared to normal. Conclusion:On the basis of results of present study it is concluded that diabetic placentae showed increase in weight and central thickness. Neonatal weight and placental ratio were also increased. These findings indicate that control of hyperglycemia only partially prevents the development of placental abnormalities.

Human cytomegalovirus preferentially infects early gestation placental macrophages and evades their antiviral immunogenicity through evasion of the type I IFN response

Abstract Human cytomegalovirus (HCMV) is the leading cause of congenital viral infections. When a pregnant woman develops primary HCMV infection in early gestation, the risk of transplacental infection is ~40%. Studies have documented the presence of HCMV in placental macrophages (Hofbauer cells [HCs]) as a consequence of maternal viremia. However, the interplay between HCMV and placental macrophages (HCs) is poorly defined. With written informed consent, placentae were collected from 12 HIV-1/Hep B/HCMV seronegative women (&amp;gt;18 years). HCs were exposed to human HCMV (TB40/E). qPCR, FACS, ELISA, and Western blot analysis determined the expression of activation markers, cytokines, antiviral genes, and host proteins. Here we found that HCs isolated from early gestation (15–23 weeks) placentae are more susceptible to HCMV infection than HCs isolated from term (&amp;gt;39 weeks) placentae. HCMV infection of early gestation HCs led to a significant upregulation of activation markers, along with elevated secretion of proinflammatory cytokines, compared to HCMV-infected term HCs. In early gestation and term HC, HCMV rapidly induces the type I IFN pathway, leading to secretion of IFNs and strong induction of ISGs. However, HCMV diminishes type I IFN-mediated phosphorylation of STAT2, with early gestation HCs exhibiting the greatest level of inhibition. Our findings show that HCMV can subvert type I IFN signaling to support viral growth at the placenta, particularly during early gestation. Studying mechanisms used by viruses to prevent an immune response is of great importance for the development of new strategies to limit the sequelae of viral infections.