Histopathological Examination Of Placenta Research Articles

A Rare Case of Chorioangioma / Non Immune Fetal Hydrops

Chorioangioma is a placental hemangioma is a common, non-trophoblastic benign vascular placental tumour of primitive chorionic mesenchyme. The size of the tumour is important. Smaller tumours are clinically insignificant. Giant chorioangioma more than 4 cm has higher risk of maternal and foetal complications. Early diagnosis is done by imaging techniques. Placental lesions detected on sonography necessitate close surveillance of these pregnancies because of the poor outcome ofpregnancy. We present a 32-year primigravida with placental chorioangioma who went in spontaneous labour and delivered a male baby. The baby was referred to higher centre for further evaluation and revealed mild cardiomegaly. The histopathological examination of placenta helped in the diagnosis of placental chorioangioma.

Real-time PCR in the diagnosis of congenital toxoplasmosis.

The diagnosis of congenital toxoplasmosis presents limitations and therefore new options are necessary. The analysis of amniotic fluid by real-time PCR has already proved effective for confirmation of fetal infection. However, its performance in other biological samples is not clear yet. The aim of this study is to better understand the role of real-time PCR in the blood of the mother and newborn as well as in the amniotic fluid and placenta in the diagnosis of congenital toxoplasmosis. This is a descriptive cohort study of pregnant women with toxoplasmosis followed up in Rio de Janeiro, Brazil. Real-time PCR was performed in samples of maternal blood, amniotic fluid, placenta, and blood of newborns. In addition, histopathological examination of placentas was performed, and data collected from babies were collected. 116pregnant women were followed up and 298samples were analyzed. One(0.9%) pregnant woman presented positive PCR in the blood, 3(3.5%) in the amniotic fluid, 1(2.3%) in the placenta and no newborn had positive PCR in the blood. Histopathological study was suggestive of toxoplasmosis infection in24(49%) placentas. Six(5.2%) newborns were diagnosed with congenital toxoplasmosis, and only cases with positive PCR in the amniotic fluid had correlation of the PCR result with the diagnosis of congenital infection. Both maternal and blood samples of newborns and placenta did not prove to be promising in the diagnosis of congenital toxoplasmosis. Further studies are needed to evaluate the real role of molecular diagnosis in other biological materials rather than the amniotic fluid.

Maternal sickle cell disease leading to placental insufficiency and fetal growth restriction: a case report and review of literature

Anemia in pregnancy is a common condition having a significant effect on the outcome of pregnancy. A thorough understanding of epidemiology along with proper clinical history, clinical examination and focussed investigations will help to diagnose the cause of anemia early during pregnancy. We report a case of 22-year-old primigravida who presented at third trimester with anemia complicating pregnancy with fetal growth restriction due to sickle cell disease. The sickle cell disease was suspected with histopathological examination of placenta.

Comparison of Placental Histopathological Findings with Good and Adverse Neonatal Outcomes- A Prospective Observational Study

Introduction: The placenta plays a crucial role in the growth and survival of foetus by performing most of the vital functions for the foetus before delivery. Histopathological examination of placenta can help in investigating the mechanism of placental dysfunction, which can further help in devising more precise intervention strategies and can contribute to more effective therapies in the future. Aim: To compare the placental histopathological findings of patients with adverse neonatal outcomes and good neonatal outcomes. Materials and Methods: This was a prospective observational study conducted on 200 antenatal cases with gestational age >34 weeks were enrolled in the study from IPD of Department of Obstetrics and Gynaecology, Swaroop Rani Hospital, Prayagraj, Uttar Pradesh, India, over a period of 1 year. They were followed- up till delivery and assessed for neonatal outcomes. On the basis of neonatal outcome, patients were divided into two groups- group A with normal neonatal outcomes and group B with adverse neonatal outcomes. A gross and histopathological examination of placenta was performed for each case. The results were compiled and statistically analysed to compare the findings between the groups. The p-value was calculated using Chi-square score and value of <0.05 was considered significant. Results: Out of 200 cases, 143 belonged to group A (with normal neonatal outcomes), in which majority 121 (84%) had normal placental histopathology, 8 (5.5%) had villous infarcts, 9 (6.2%) had syncytial knots and 5 (3.4%) had calcifications. Mean placental weight in group A was 425.88 grams while that in group B was 363.70 grams (p-value <0.0001). Group B (with adverse neonatal outcomes) had 57 cases, 8.8% cases were delivered via vaginal delivery, with low Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score in 53 (26.5%), need for Neonatal Intensive Care Unit (NICU) admission in 57 (28.5%), need for mechanical ventilation in 12 (6%) and death in 6 (3%) cases. Villous infarcts was the placental histopathological feature in all cases with neonatal complications low APGAR score, NICU admission, those requiring mechanical ventilation or neonatal death. Out of these 57 cases, 8 (14%) had normal placental histopathology while 15 (26.3%) had infarcts, 12 (21%) syncytial knots, 9 (15.8%) had calcifications, and 13 (22.8%) had necrosis. Statistically significant difference (p-value <0.05) was found between the two groups in terms of abnormal histopathological findings and mean placental weight. Conclusion: Neonates with adverse outcomes had abnormal placental histopathological findings like villous infarcts, syncytial knots, calcifications, and necrosis.

Placental mesenchymal dysplasia- A case report

Placental mesenchymal dysplasia is a rare disorder mainly characterized by enlarged placenta. Patients on antenatal visits present with normal or slightly raised Beta-HCG, raised Alfa-fetoprotein and cystic structures on USG resembling a molar pregnancy. It has to be differentiated from molar pregnancies to avoid unnecessary termination of pregnancy. This condition is associated with IUGR or IUFD. Mostly the fetus are females. Due to lack of awareness of this condition it remains underreported. Here we present a case report of 20 years old female 37 week pregnant with IUGR with clinical suspicion of molar pregnancy gave birth to alive female fetus and on histopathological examination of placenta was diagnosed with PMD.

Neonatal sepsis: evaluation of risk factors and histopathological examination of placentas after delivery

Neonatal sepsis: evaluation of risk factors and histopathological examination of placentas after delivery

Diagnostic efficacy of inflammatory markers in maternal and umbilical cord blood in histologic chorioamnionitis

Objective To explore the clinical value of maternal and umbilical blood inflammatory markers, interleukin-6 (IL-6), neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP) and pro-calcitonin (PCT), in the diagnosis of histologic chorioamnionitis (HCA). Methods A total of 102 suspected chorioamnionitic cases were enrolled from January 2014 to July 2017. They were assigned into two groups based upon postpartum histopathological examination of placenta: HCA group (48 cases) and control group (54 cases). Maternal and umbilical blood samples were collected for routine blood test and tested for IL-6, NLR, CRP and PCT levels. T, Mann-Whitney U or Chi-square (or Fisher's exact) test was used for data comparison. Meaningful indicators in maternal and umbilical cord blood were analyzed by logistic regression analysis and correlation analysis. At the same time, receiver operating characteristic (ROC) curve was drawn to evaluate their diagnostic values. Results (1) IL-6 level and NLR in maternal blood in HCA group were higher than those in control group [6.95 (2.40-13.50) vs 3.90 (2.30-9.20) pg/ml, Z=-5.147; 5.03 (1.92-9.20) vs 3.94 (1.85-11.17), Z=-3.097; both P<0.05], and the levels of white blood cells, neutrophile granulocytes, CRP and IL-6 as well as NLR in umbilical cord blood were also higher [(9.4±2.0)×109/L vs (8.6±1.4)×109/L, t=-2.522; (6.87±1.62)×109/L vs (5.99±1.26)×109/L, t=-3.071; 12.30 (0.50-89.04) vs 3.18 (0.50-88.93) mg/L, Z=-4.519; (8.78±2.56) vs (4.78±1.45) pg/ml, t=-7.025; (4.45±1.36) vs (3.78±1.22), t=-3.020; all P<0.05]. (2) Logistic regression analysis showed that elevated levels of IL-6 and NLR in maternal blood and CRP and IL-6 in umbilical cord blood were independent risk factors for HCA [OR (95%CI): 1.65 (1.32-2.06), 1.34 (1.02-1.77), 1.05 (1.00-1.11) and 2.39 (1.72-3.32), all P<0.05]. Positive correlations were found between the levels of IL-6 in maternal and umbilical cord blood, and between NLR in maternal blood and CRP level in umbilical cord blood (correlation coefficient: 0.680 and 0.230, both P<0.05). (3) IL-6 level in umbilical blood was of the greatest value in the diagnosis of HCA among all single markers, followed by IL-6 in maternal blood, CRP in umbilical blood and NLR in maternal blood [area under the ROC curve (AUC): 0.904, 0.796, 0.760 and 0.678]. When two indexes were combined, NLR in maternal blood+IL-6 in umbilical cord blood showed the highest diagnostic value, followed by, IL-6 in maternal blood+CRP in umbilical cord blood, IL-6+NLR in maternal blood and NLR in maternal blood+CRP in umbilical cord blood (AUC: 0.917, 0.870, 0.823 and 0.791). When three indexes was used in combination, the diagnostic value of IL-6 in maternal and umbilical cord blood+NLR in maternal blood was higher than that of IL-6 and NLR in maternal blood+CRP in umbilical cord blood (AUC: 0.919 and 0.836). (4) There were 13 cases (27.1%) with neonatal complications in HCA group and two (3.7%) in control group (P<0.05). Conclusions Changes in NLR and IL-6 levels in maternal blood and NLR, IL-6 and CRP levels, and white blood cells and neutrophile granulocytes counts in umbilical cord blood are associated with HCA. The diagnostic efficacy of two indexes combined is superior to that of single index, while the combination of three indexes can significantly improve the diagnostic accuracy and authenticity. Key words: Chorioamnionitis; Interleukin-6; C-reactive protein; Calcitonin; Leukocyte count

Placental Findings in Singleton Stillbirths: A Case-control Study.

This prospective observational study compared placental lesions of stillbirth cases and live birth controls, and aimed to determine the cause of stillbirth. The study enrolled 85 stillbirths and 85 live births at the time of delivery. There was significantly increased incidence of placental abruption (p = 0.005) and gestational diabetes (p = 0.032) in mothers with stillbirths. Histopathological examination of placenta was significantly abnormal in stillbirths compared with live births (p = 0.004). Delayed villous maturation was significantly more in stillbirths (38.82 vs. 16.47%; p = 0.002). Acute (30.59 vs. 16.47%; p = 0.04) and chronic diffuse villitis (16.47 vs. 4.7%; p = 0.02), chorionic plate acute vasculitis (28.235 vs. 14.11%; p = 0.04) were significantly more in stillbirths. Foetal vascular thrombi in the chorionic plate (30.58 vs. 14.12%; p = 0.02) and avascular villi (24.7 vs. 8.23%; p = 0.006) were significantly more in stillbirths. These abnormal placental patterns could provide information about the etiopathogenisis in stillbirths of unknown aetiology.

Teratogenic effect of cisplatin in rats and the protective role of sodium selenate

Eighty pregnant Sprague-Dawley rats were used in this study. They were allotted to four equal groups. The first group served as a control without any treatment while the other groups were given cisplatin, sodium selenate, and cisplatin+sodium selenate, respectively. Cisplatin was injected intraperitoneally in a dose of 5mg/kgbwt. on the 12th day of gestation while sodium selenate was administered orally in a dose of 0.5mg/kgbwt throughout gestation. Animals were sacrificed on the 20th day of gestation for fetal examination. Cisplatin produced significant elevation in the percentages of late resorption sites and dead foetuses compared with the control group. The mean foetal and placental weights were significantly reduced. Dwarf foetuses and subcutaneous (s/c) haemorrhage were also recorded in cisplatin-treated group. Visceral abnormalities were revealed in the form of dilated nares, anophthalmia and/or microphthalmia, dilated brain ventricles, hypertrophy of the heart, hypoplasia of the lung, hepatomegaly and dilated renal pelvis. Skeletal examination showed wide open fontanel, incomplete ossification of parietal and interparietal bones, incomplete ossification of sternum, reduction in the number or even complete absence of phalanges, sacral and/or caudal vertebrae. Histopathological examination of placentas in cisplatin-treated group revealed severe pathological alterations. Administration of sodium selenate significantly alleviated the afore-mentioned adverse effects of cisplatin on the fetuses and their placentas so we conclude that sodium selenate as an antioxidant has an effective protective role in cisplatin teratogenic effects.

Vaginally obtained amniotic fluid samples in the diagnosis of subclinical chorioamnionitis.

Preterm birth is often caused by infection or inflammation. High concentration of lactate dehydrogenase and low concentration of glucose in amniotic fluid obtained by amniocentesis are associated with subclinical chorioamnionitis. We evaluated amniotic fluid lactate dehydrogenase and glucose concentrations in relation to histologic chorioamnionitis in vaginally obtained samples. In a prospective study, vaginally obtained amniotic fluid samples were collected from 53 women with preterm prelabor rupture of membranes at 23(+4) to 34(+5) weeks of gestation at University Hospital, Helsinki, Finland. Amniotic fluid lactate dehydrogenase and amniotic fluid glucose were measured by immunochemiluminometric assays. Histopathologic examination of placenta was performed. The main outcome measure was histologic chorioamnionitis. Median concentration of vaginally obtained amniotic fluid lactate dehydrogenase was higher in women with histologic chorioamnionitis than in women without (1400 IU/L vs. 784.5 IU/L, p = 0.005). By receiver operating characteristics curve the optimal cut-off for amniotic fluid lactate dehydrogenase in relation to histologic chorioamnionitis was 1029 IU/L (sensitivity 65%, specificity 69%, positive predictive value 83% and negative predictive value 46%). Amniotic fluid lactate dehydrogenase concentrations showed striking fluctuation in repeat samples. Amniotic fluid glucose concentrations did not differ among women with or without histologic chorioamnionitis (0 mmol/L vs. 0.65 mmol/L, p = 0.20). Elevated amniotic fluid lactate dehydrogenase was associated with histologic chorioamnionitis, but decreased amniotic fluid glucose was not. However, the clinical value of vaginally obtained amniotic fluid lactate dehydrogenase is limited because of high sample-to-sample variability. Better biomarkers for optimal timing of delivery in women with preterm prelabor rupture of membranes are needed.

Anatomical and Histopathologic Analysis of Placenta in Dilation and Evacuation Specimens

Background: Anatomical and histopathologic examination of placenta in cases of abortion is crucial as to clarify the underlying causes of many adverse pregnancy outcomes. Dilation and evacuation (D&E) is the most common mode of uterine evacuation that commonly examined in pathology sections. The aim of this study is to discuss the various placental pathologies, and to demonstrate the importance of careful pathologic examination of D&E material, also to review the anatomy of placenta and to compare our findings with other publications worldwide. Material and Methods: A retrospective descriptive study for 200 placental tissues was collected in 18 months period and revised for normal anatomy and various placental pathologies. These placentas were obtained by dilation and evacuation (D&E) technique. All cases were undergone for histopathological sections that were stained by Hematoxylin and Eosin (H&E). Results: Placental infarction was observed in 25% of cases, and chorioammnitis was the most common form of placental infection and found in 12.5%. Molar changes were represented a lowered percentage of placental pathologies that found in 9% of specimens. Conclusion: Study and recognition of placental lesions among general surgical pathologists have clinical significance and awareness of deficiency, standardization of diagnostic criteria, and increased knowledge in placental pathology improve the quality of diagnosis in this area.

Placental Mesenchymal Dysplasia: A Case Report

Introduction. A rare case of histologically proven placental mesenchymal dysplasia (PMD) with fetal omphalocele in a 22-year-old patient is reported. Material and Methods. Antenatal ultrasound of this patient showed hydropic placenta with a live fetus of 17 weeks period of gestation associated with omphalocele. Cordocentesis detected the diploid karyotype of the fetus. Patient, when prognosticated, choose to terminate the pregnancy in view of high incidence of fetal and placental anomalies. Subsequent histopathological examination of placenta established the diagnosis to be placental mesenchymal dysplasia. Conclusion. On clinical and ultrasonic grounds, suspicion of P.M.D. arises when hydropic placenta with a live fetus presents in second trimester of pregnancy. Cordocentesis can detect the diploid karyotype of the fetus in such cases. As this condition is prognostically better than triploid partial mole, continuation of pregnancy can sometimes be considered after through antenatal screening and patient counseling. However, a definite diagnosis of P.M.D. is made only on placental histology by absence of trophoblast hyperplasia and trophoblastic inclusions.

Characterization of the Microanatomy and Histopathology of Placentas From Aborted, Stillborn, and Normally Delivered Alpacas (Vicugna pacos) and Llamas (Lama glama)

From 2002 to 2007, 101 camelid abortions and stillbirths were submitted to the Veterinary Diagnostic Laboratory at Oregon State University (84 alpacas [Vicugna pacos], 13 llamas [Lama glama], 4 unknown). For most cases (n = 67), a cause was not determined by routine testing. Eighty-five submissions included placenta for microscopic examination, of which 55 were from abortions to unknown causes (idiopathic). Microscopic features of placentas from abortion/stillbirth were compared with those from 19 camelids delivered normally (6 alpacas, 12 llamas, 1 unknown) and with those from 4 alpaca fetuses of known gestational age collected during the dam's necropsy. The most common microscopic findings in abortion/stillbirth placentas were mineralization (n = 57) and mucinous edema (n = 27) of the chorioallantoic stroma. One or more of these features were also observed in 22 of 23 placentas from normal pregnancies/deliveries and therefore interpreted as incidental findings. The comparison of alpaca placentas after matching for gestational parameters (crown-rump length, weight, days of gestation; n = 41) revealed hypoplasia of placental villi in 5 of 22 idiopathic abortions and in 1 abortion due to umbilical torsion; hypoplasia was further suspected in an additional 6 abortions of unknown cause and 2 abortions of known cause. The identified villous hypoplasia is assumed to have resulted in placental insufficiency. When placental insufficiency is included as cause, idiopathic abortions are reduced from 66.2 to 47.9% of alpaca cases with histopathologic examination of placenta and from 66.3 to 52.5% of alpaca and llama abortions overall. This study also permitted the generation of a linear regression curve correlating alpaca fetal crown-rump length with fetal age.

Association of HIV and Malaria With Mother-to-Child Transmission, Birth Outcomes, and Child Mortality

To assess the impact of HIV and malaria coinfection on mother-to-child HIV transmission (MTCT) and adverse birth outcomes. One hundred nine HIV-positive mother-infant pairs with a malaria diagnosis were identified in a community cohort and followed up postpartum. Maternal malaria was diagnosed by a rapid immunochromatographic test (ICT) on sera and histopathologic examination of placenta. Infant HIV was diagnosed within 6 weeks of birth using polymerase chain reaction (PCR) to capture in-utero and intrapartum HIV transmission. Log binomial models were used to assess the relative risk of MTCT, low birth weight, and preterm birth associated with malaria. Approximately 17.4% of infants were HIV positive at or around birth, and the prevalence of serologic and placental malaria were 31% and 32%, respectively. HIV-positive mothers with serological ICT malaria were significantly more likely to have low-birth-weight infants, and low-birth-weight infants had significantly higher risk of MTCT compared with infants of normal birth weight. Although placental and serologic ICT malaria were significantly associated with MTCT, after adjusting for maternal HIV viral load, the risk of MTCT was significantly increased only for mothers coinfected with placental malaria (relative risk [RR] = 7.9, P = 0.025). Placental malaria increases the risk of MTCT after adjustment for viral load. Programs should focus on enhanced malaria prevention during pregnancy to decrease the risk of adverse birth outcomes and MTCT.

Expression of IGR-IR and VEGF and Trophoblastic Proliferative Activity in Placentas from Pregnancies Complicated by IUGR

Intrauterine growth retardation (IUGR) is recognized as an important cause of low birth weight and elective preterm delivery. IUGR is associated with multiple causative factors, including placental dysfunction. The aim of this prospective study was to investigate the role of trophoblastic proliferative activity and type I insuline-like growth factor receptor (IGF-IR) and vascular endothelial growth factor (VEGF) expressions in the pathogenesis of IUGR. Immunohistochemistry using VEGF, IGF-IR, and Ki-67 antibodies was performed on formalin-fixed placental tissues of third-trimester pregnancies complicated by IUGR (n = 19) and pregnancies with appropriately grown fetuses (n = 27). In addition, histopathological examination of the placentas was performed, and histological findings were categorized into three groups: utero-placental vascular pathologies (UPVP), coagulation-related pathologies, and chronic inflammation. Statistical analysis revealed that villous trophoblastic IGF-IR immunostaining was significantly weaker in placentas with IUGR (p < 0.001), whereas trophoblastic Ki-67 proliferative index and VEGF immunoscoring did not show any significant difference. Histologically, UPVP and chronic inflammation were significant findings in placentas with IUGR (p = 0.04 and p = 0.04, respectively). In addition, placentas were significantly smaller in the IUGR group (p < 0.001). We conclude that villous trophoblastic IGF-IR expression may play a significant role in the pathogenesis of IUGR, and histopathological examination of placentas in pregnancies complicated by IUGR may yield significant findings. In contrast, based on our findings, trophoblastic proliferation and VEGF expression are unlikely to be significant parameters in the pathogenesis of IUGR.