Lower Placental Weight Research Articles

The causal effects of placental weight on atherosclerotic cardiovascular disease: a Mendelian randomization and mediation analysis

IntroductionPrevious studies have linked placental weight (PW) to cardiovascular diseases, but the causality and potential mediators underlying this relationship are still unknown.Material and methodsWe conducted Mendelian randomization (MR) analysis via summary statistics from genome-wide association studies (GWAS), including PW adjusted for sex, 21 candidate mediators and atherosclerotic cardiovascular disease (ASCVD), which includes coronary heart disease (CHD) and ischemic stroke (IS).Two-step MR was employed to identify and assess the mediation proportion of potential mediators in the association between PW and ASCVD. Additionally, we conducted a repeated analysis using PW adjusted for gestational age and sex.ResultsUnivariable MR (UVMR) analysis revealed that for each 1-SD decrease in fetal genotype-determined PW adjusted for sex only, the risk of CHD increased by 24% (95% CI: 1.05–1.46) and the risk of large artery stroke (LAS) increased by 46% (95% CI: 1.13–1.89). Similar results were obtained in repeated analyses. The mediation MR analysis revealed that the causal relationship between fetal genotype-determined PW and CHD risk was primarily mediated by birthweight, type 2 diabetes, and education, each mediating 3.66% to 40.80% of the total effect. The causal relationship between fetal genotype-determined PW and LAS risk was mediated mainly by type 2 diabetes, which accounted for 22.11% of the total effect.ConclusionsThis study elucidated a unidirectional causal relationship between lower PW and a greater ASCVD risk, with factors such as birthweight, type 2 diabetes, and education mediating the association between PW and ASCVD.

Placental chronic inflammatory histopathology and fetal growth in a cohort with universal placental examination

IntroductionChronic placental inflammation is a routinely diagnosed group of placental lesions that reflect immunologic dysfunction of the mother, fetus, or both. MethodsComplete placental pathology examinations were performed for all term births at New York Presbyterian- Brooklyn Methodist Hospital from January 2010–August 2016. Diagnoses were blinded except to gestational age. CPI lesions were marked as chronic choriodeciduitis, decidual plasma cells, chronic inflammation of basal plate with anchoring villitis, and chronic villitis. ResultsIn this cohort of term pregnancies, 257 (11.6 %) males and 218 (9.8 %) females had ≥1 CPI lesions. Chronic villitis was the most common (319 or 14 %), with chronic choriodeciduitis, decidual plasma cells, and chronic inflammation of basal plate with anchoring villitis in 94 (4 %), 69 (3 %) and 170 (8 %), respectively. In males, chronic villitis was associated with lower gestational adjusted birthweight and had no association with placental weight. In females, chronic villitis was associated with lower gestational adjusted birthweight, but the effect became nonsignificant after adjustment for placental weight. DiscussionIn summary, CPI lesions’ incidence and association with birth weight vary by sex. Chronic villitis is associated with lower birthweight in females; this effect is completely mediated by placental weight. Chronic villitis showed a weak direct association of chronic villitis in males, but no association with lower placental weight in males. We suggest that differences between our results and previous publications reflect effects of sampling bias.

Maternal affective symptoms and sleep quality have sex-specific associations with placental topography

BackgroundThe impacts of prenatal maternal affective symptoms on the placental structure are not well-established. Employing Geographic Information System (GIS) spatial autocorrelation, Moran's I, can help characterize placental thickness uniformity/variability and evaluate the impacts of maternal distress on placental topography. MethodsThis study (N = 126) utilized cohort data on prenatal maternal affective symptoms and placental 2D and 3D morphology. Prenatal maternal depression, stress, anxiety and sleep quality were scored for each trimester using the Edinburgh Postnatal Depression Scale (EPDS), Stressful Life Event Scale (SLE), Penn State Worry Questionnaire (PSWQ), and Pittsburgh Sleep Quality Index (PSQI), respectively. Placental shape was divided into Voronoi cells and thickness variability among these cells was computed using Moran's I for 4-nearest neighbors and neighbors within a 10 cm radius. Sex-stratified Spearman correlations and linear regression were used to study associations between mean placental thickness, placental GIS variables, placental weight and the average score of each maternal variable. ResultsFor mothers carrying boys, poor sleep was associated with higher mean thickness (r = 0.308,p = 0.035) and lower placental thickness uniformity (r = −0.36,p = 0.012). Lower placental weight (r = 0.395,p = 0.003), higher maternal depression (r = −0.318,p = 0.019) and worry/anxiety (r = −0.362,p = 0.007) were associated with lower placental thickness uniformity for mothers carrying girls. LimitationsThe study is exploratory and not all GIS models were developed. Excluding high-risk pregnancies prevented investigating pregnancy complications related hypotheses. A larger sample size is needed for greater confidence for clinical application. ConclusionsPlacental topography can be studied using GIS theory and has shown that prenatal maternal affective symptoms and sleep have sex-specific associations with placental thickness.

Prevalence of Risk Factors Associated with Placental Malaria in Observational Study in Kator Primary Health Center South Sudan

Introduction: Civil unrest, public health system fragility and community mass relocation had played major roles in development of Placental Malaria Parasitization. This study aimed to measure and identifies risk factors associated with placental malaria infections in Kator primary health center. Methods and Materials: 115 enrolled pregnant women in cross-section survey after signing consent form using observational technique tools in one year period. ABO, peripheral blood antigen detection for malaria parasites using RDT kits and quantitative questionnaire information were obtained at recruitment phase while second peripheral blood for placental malaria parasites species applying RDT, placental weight and baby weight were measured after delivery as phase two. SPSS version 26 was applied with 0.005% P-value and CI 95%. Results: Out of 115 recruited pregnant women only (86.0%) 99 reached delivery room. With 29 primigravidae, 23 secundigravidae and 47 multigravidae; primigravida OR 95%CI 2.4 (1.73-5.64) P-vale 0.00013 and secundigravida with OR 95% CI1.8 (1.23-2.93) P-value 0.00072 and multigravida with OR 95% CI 1.5 (0.91-3.45) P-value 0.83. untreated bed net with OR 95% CI 1.4 (1.12-3.08) P-value 0.00053 and shared bed net at night with OR 95% CI 7.4(5.18-17.32) P-value 0.00027. Low birth weight, low placental weight and blood group O were not associated with placental malaria. Overall Placental Malaria prevalent was 26.3%. Conclusion: in this study, elevated placental malaria was recorded in Kator area of South Sudan. Doubling efforts to reduce placental malaria infections and its adverse clinical complications a new strategy to control the syndromic effects of the disease is required.

Outcome-Based Risk Stratification Model for the Diagnosis of Placental Maternal Vascular Malperfusion

The Amsterdam Consensus Statement introduced the term maternal vascular malperfusion (MVM) to group a constellation of findings associated with impaired maternal–placental circulation. In isolation, these findings are relatively common in placentas from normal gestations, and there is uncertainty on how many, and which, are required. We aimed to determine the criteria essential for MVM diagnosis in correlation with obstetrical outcomes. A total of 200 placentas (100 with a reported diagnosis of MVM and 100 controls matched by maternal age and gravida-para-abortus status) were reviewed to document MVM features. Obstetrical outcomes in the current pregnancy were recorded including hypertension, pre-eclampsia with or without severe features, gestational diabetes, prematurity, fetal growth restriction, and intrauterine fetal demise. On univariate logistic regression analysis, adverse outcome was associated with low placental weight (LPW, <10% percentile for gestational age), accelerated villous maturation (AVM), decidual arteriopathy (DA), infarcts (presence and volume), distal villous hypoplasia, and excess multinucleated trophoblast in basal plate ≥2 mm (all P < .01) but not with retroplacental hemorrhage. In a multivariable model DA, infarcts and AVM were significantly associated with adverse outcomes, whereas LPW showed a trend toward significance. A receiver–operating characteristic curve including these 4 parameters showed good predictive ability (area under the curve [AUC], 0.8256). Based on the probability of an adverse outcome, we recommend consistent reporting of DA, AVM, infarcts, and LPW, summarizing them as “diagnostic of MVM” (DA or AVM plus any other feature, yielding a probability of 65%–97% for adverse obstetrical outcomes) or “suggestive of MVM” (if only 1 feature is present, or only 2 features are infarcts plus LPW, yielding a probability of up to 52%). Other features such as distal villous hypoplasia, excess (≥2 mm) multinucleated trophoblast, and retroplacental hemorrhage can also be reported, and their role in MVM diagnosis should be further studied.

Clinical and Histological Associations of Chronic Inflammatory Lesions in Preterm Placentas: Uncovering the Hidden Dangers.

Chronic placental inflammatory lesions (CPIL) include chronic deciduitis (CD), villitis of unknown etiology (VUE), and chronic chorioamnionitis (CCA). The frequency of these lesions and their relationship with various clinicopathological parameters in preterm birth (PTB) is presented. Preterm placentas from April 2018 to December 2020 were reviewed for presence of CPIL. PTB was classified as spontaneous, indicated, or mixed phenotype. The association of CPIL with clinical parameters like gestational age, birth weight, obstetric complications, and placental parameters like placental dimensions, weight, vascular malperfusion, acute inflammatory lesions, and basal plate myometrial fibers were analyzed. The study included 538 preterm placentas with 54.3% from indicated PTB. CD was more common (28.4%) than VUE (17.8%) and CCA (12.6%). CD showed significant association with VUE and CCA (both P = .0001) and VUE with CCA (P = .0001). CD was more common in indicated PTB (33.8%, P = .002) and associated with lower birth weight (1591 g vs 1705 g, P = .003), lower placental weight (270.7 g vs 296.9 g, P = .004), length (14.2 cm vs 14.8 cm, P = .006), breadth (11.7 cm vs 12.2 cm, P = .007), maternal vascular malperfusion (P = .004), and basal plate myometrial fibers (P = .02). High-grade and multifocal low-grade VUE was associated with reduced placental length (13.9 cm vs 14.6 cm, P = .02)and breadth (11.5 cm vs 12.1 cm, P = .01). CCA did not show any other association. CPIL are common in PTB and their coexistence suggested a common pathogenic mechanism. Placental examination is the only definite way to identify as they lack clinical signs and symptoms. The smaller placental size associated with these lesions may suggest alter mechanisms for adverse pregnancy outcomes.

Low placental weight may be involved in the etiology of congenital cryptorchidism in neonatal boys

IntroductionSeveral factors have been reported to be associated with the etiology of cryptorchidism; however, clear evidence regarding the risk factors for cryptorchidism is elusive. In the present study, we evaluated the clinical characteristics of cryptorchidism using the common neonatal intensive-care unit (NICU) database of the National Hospital Organization and explored one of possible factors associated with the development of cryptorchidism. MethodsA total of 7882 male neonates were included in this study. We separated them into two groups: those without cryptorchidism (n = 7852) and those with cryptorchidism (n = 30) at the time of discharge from the NICU. Cryptorchidism was defined as a condition in which the testis was located out of the scrotum on the route of descent at the time of NICU discharge.The associations between cryptorchidism and the maternal, placental, and neonatal information were analyzed. Analyses were performed statistically to compare nominal variables between the groups using Fisher's direct establishment calculation method and logistic regression analyses. ResultsUnivariate analyses showed the placental weight <10% tile (odds ratio 3.31, 95% confidence interval [CI] 1.18–8.64), birth height <−2 standard deviations (SD) (odds ratio 3.65, 95% CI 0.92–10.6), birth weight <−2SD (odds ratio 4.06, 95% CI 1.55–9.51), and small for gestational age (odds ratio 3.82, 95% CI 1.46–8.97) were significantly associated with the development of cryptorchidism. Multivariate analyses showed that placental weight <10th percentile (odds ratio 2.86, 95% CI 1.11–7.44) was significantly associated with the development of cryptorchidism. DiscussionAlthough, this study population was limited to infants admitted to the ICU, the data indicated a possible association between low placental weight and the development of cryptorchidism in neonatal boys.

Associations between placental pathology and poor intrauterine growth among a cohort of mother-infant singleton pairs in Leyte, the Philippines.

Poor intrauterine growth has negative impacts for child growth and development and disproportionately affects children living in low-resource settings. In the present study, we investigated relationships between placental pathologies and indicators of poor intrauterine growth. We enrolled a longitudinal cohort of 279 mother-infant pairs from Leyte, the Philippines. Placental measures included characteristics, pathological findings, and immunohistochemistry. At birth, intrauterine growth was assessed using anthropometric measures, weight-for-gestational age, and the clinical assessment of nutritional status score (CANSCORE) for determining fetal malnutrition. Multivariate linear regression and log-binomial regression models were applied, controlling for potential confounding factors. Maternal vascular malperfusion (MVM) was related to reduced birthweight (P < 0.0001), birth length (P = 0.002), head circumference (P = 0.001), and weight-to-length ratio (P = 0.016). MVM increased the risk for preterm delivery (P = 0.0005) and small for gestational age (SGA) (P = 0.016). Acute chorioamnionitis (P = 0.013) and MVM (P = 0.021) both led to an increased risk for fetal malnutrition defined by CANSORE<25. Villous tissue activated caspase-3 was associated with lower birth length (P = 0.0006), higher weight-to-length ratio (P = 0.004), reduced risks for SGA (P = 0.011) and low weight-to-length ratio for gestational age (P = 0.004). The present study applied comprehensive measures for intrauterine growth and demonstrates that low placental weight and placental pathology, chiefly MVM, contribute to poor intrauterine growth. A better understanding of the mechanistic role of specific placental pathologies on adverse newborn outcomes will provide opportunities for reducing incidence of poor intrauterine growth and associated long-term morbidities.

Association between maternal cholesterol level during pregnancy and placental weight and birthweight ratio: data from the Japan Environment and Children’s Study

BackgroundPlacental weight to birthweight ratio (PW/BW ratio), or its inverse, is used as an indicator of placental efficiency. Past studies have shown an association between an abnormal PW/BW ratio and adverse intrauterine environment, however, no previous studies have examined the effect of abnormal lipid levels during pregnancy on PW/BW ratio. We aimed to evaluate the association between maternal cholesterol levels during pregnancy and placental weight to birthweight ratio (PW/BW ratio).MethodsThis study was a secondary analysis using the data from the Japan Environment and Children’s Study (JECS). 81 781 singletons and their mothers were included in the analysis. Maternal serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) levels during pregnancy were obtained from participants. Associations between maternal lipid levels and placental weight and PW/BW ratio were assessed by regression analysis using restricted cubic splines.ResultsDose–response relationships were observed between maternal lipid level during pregnancy and placental weight and PW/BW ratio. High TC and LDL-C levels were associated with heavy placental weight and high PW/BW ratio, i.e., inappropriately heavy placenta for birthweight. Low HDL-C level was also associated with inappropriately heavy placenta. Low TC and LDL-C levels were associated with low placental weight and low PW/BW ratio, i.e., inappropriately light placenta for birthweight. High HDL-C was not associated with PW/BW ratio. These findings were independent of pre-pregnancy body mass index and gestational weight gain.ConclusionsAbnormal lipid levels such as elevated TC and LDL-C, and low HDL-C level, during pregnancy were associated with inappropriately heavy placental weight.

Placenta previa in in vitro fertilization and unassisted pregnancies–is there a difference in perinatal outcomes and placental histology?

Introduction In-vitro-fertilization (IVF) is an independent risk factor for placenta previa (PP). Our aim was to study this link by comparing the clinical characteristics and placental histology of pregnancies complicated by PP in IVF versus unassisted pregnancies. Methods A retrospective-cohort study of deliveries with PP between 2008 and 2021. Placental histology, obstetric and neonatal outcomes were compared between IVF and unassisted pregnancies. Included, were singleton deliveries complicated by PP at gestational weeks (GA) >24. Results A total of 182 pregnancies were included − 23 IVF pregnancies (IVF group) and 159 unassisted pregnancies (Control group). The control group was characterized by higher gravidity (p = .007) and parity (p < .001) and a trend of more past cesarean deliveries, whereas the IVF group- by a higher rate of nulliparity (p < .001) and diabetes mellitus (p = .04). The control group was characterized by a higher rate of placental weight below the 10th percentile (47.8 versus 13.9%, p = .001) and by a trend of a lower overall placental weight. No differences were noted in maternal and fetal vascular lesions. Discussion While PP in non-assisted pregnancies is probably associated with previous CDs, in IVF it is more “sporadic,” and may complicate any index pregnancy. A lower placental weight was more prevalent in the control group, supporting the concept that pregnancies complicated by PP following IVF can be attributed to initial abnormal location of placentation, rather than an underlying pathological uterine segment of implantation. Nevertheless, IVF and unassisted pregnancies entail similar perinatal outcomes in cases of PP.

The impact of HIV and ART exposure during pregnancy on fetal growth: a prospective study in a South African cohort

BackgroundIn utero exposure to human immunodeficiency virus (HIV) and antiretroviral (ART) is associated with adverse birth outcomes, which are often attributed to alterations in placental morphology. This study used structural equation models (SEMs) to examine the impact of HIV and ART exposure on fetal growth outcomes and whether these associations are mediated by placental morphology in urban-dwelling Black South African women.MethodsThis prospective cohort study included pregnant women living with HIV (WLWH, n = 122) and not living with HIV (WNLWH, n = 250) that underwent repeated ultrasonography during pregnancy, and at delivery, to determine fetal growth parameters in Soweto, South Africa. The size and the velocity of fetal growth measures (i.e., head and abdominal circumference, biparietal diameter, and femur length) were calculated using the Superimposition by Translation and Rotation. Placenta digital photographs taken at delivery were used to estimate morphometric parameters and trimmed placental weight was measured. All WLWH were receiving ART for the prevention of vertical transmission of HIV.ResultsA trend towards a lower placental weight and significantly shorter umbilical cord length was reported in WLWH compared to their counterparts. After sex stratification, umbilical cord length was significantly shorter in males born to WLWH than in male fetuses born to WNLWH (27.3 (21.6–32.8) vs. 31.4 (25.0–37.0) cm, p = 0.015). In contrast, female fetuses born to WLWH had lower placental weight, birth weight (2.9 (2.3–3.1) vs. 3.0 (2.7–3.2) kg), and head circumference (33 (32–34) vs. 34 (33–35) cm) than their counterparts (all p ≤ 0.05). The SEM models showed an inverse association between HIV and head circumference size and velocity in female fetuses. In contrast, HIV and ART exposure was positively associated with femur length growth (both size and velocity) and abdominal circumference velocity in male fetuses. None of these associations appeared to be mediated via placental morphology.ConclusionOur findings suggest that HIV and ART exposure directly affects head circumference growth in females and abdominal circumference velocity in male fetuses; but may improve femur length growth in male fetuses only.

Effect of Tinospora cordifolia on gestational diabetes mellitus and its complications

ABSTRACT Ayurvedic system of medicine uses giloy or guduchi, also known as Tinospora cordifolia (TC), to treat diabetes and related diseases like hyperglycemia and hyperlipididemia. However, its usage in gestational diabetes mellitus (GDM) is not well studied. The primary objective of the study was to examine the effects of water extract of TC called satva, essential oil, and hydroalcoholic (HA) extract on GDM and its complications and to explore their mechanism of action using mice model. We used streptozotocin-induced diabetes in pregnant mice as murine model and tested TC preparations for anti-GDM activities. Blood glucose, insulin, litter size, and placental weight were assessed. ELISA method was used to measure plasma insulin level to compute homeostatic model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), and homeostatic model assessment for assessing beta cell function (HOMA-Beta) levels to estimate insulin resistance, insulin sensitivity, and beta cell function respectively. TC-treated groups had significantly higher serum insulin levels, QUICKI, average litter size, and lower placental weight (p < .001). TC oil and HA extract increased pancreatic beta cell activity according to the level of HOMA-Beta. TC lowered placenta weight and increased litter size significantly compared to control group. Our findings suggest that TC preparations preserve pancreatic beta cells, increase insulin production, decrease insulin resistance, and improve beta cell function, hence preventing GDM. TC preparations also reduced placental weight and increased litter size in mice. Based on these results, we recommend the clinical trial and testing of TC preparations for management of GDM and associated complications. Refer graphical abstract (Figure S1).

Placental morphological features of small for gestational age preterm neonates born to mothers with pregnancy-induced hypertension.

Small for gestational age (SGA) neonates are often born to mothers with pregnancy-induced hypertension (PIH). Here, we aimed to explore the morphometric characteristics of the placenta during the perinatal period associated with SGA risk in mothers with PIH and identify the risk factors related to SGA. The medical records of 134 neonates born between 28- and 32-weeks' gestation to PIH mothers were retrospectively analyzed. Placental morphology and umbilical cord (UC) length were compared between the SGA and appropriate for gestational age (AGA) groups. The placenta of the SGA group had a shorter major (15.00 vs. 18.00 cm; z = -6.04, p < 0.01) and minor placenta axes (13.00 vs. 15.00 cm; z = -4.59, p < 0.01), lower weight (300.00 vs. 420.00 g; z = -7.21, p < 0.01), smaller volume (282.00 vs. 396.00 cm3; z = -5.00, p < 0.01), and smaller area (141.00 vs. 212.00 cm2; z = -5.96, p < 0.01) than the AGA group. The UC was significantly shorter (39.00 vs. 44.00 cm; z = -3.68, p < 0.01). Short placental major axis [p = 0.03; odds ratio (OR): 2.16; 95% confidence interval (CI): 1.84 - 2.63] and low placental weight (p < 0.01; OR: 2.68; 95% CI: 2.66 - 2.70) were independent risk factors for SGA in premature newborns of PIH mothers. A major axis shorter than 15.5 cm or placental weight lower than 347.50 g at birth was related to a greater risk of SGA infants born to PIH mothers. As a predictor in prenatal ultrasound, the major axis is more helpful for precise prenatal pre-evaluation of vulnerable SGA preterm neonates with PIH mothers.

The Relationship Between the Weight of the Placenta and Birth Weight of the Neonate

INTRODUCTION Weight of placenta has long been associated with fetal growth and perinatal well-being. Low placental weight (standardized for sex and gestational age) is more common among stillbirths whereas high placental weight is associated with neonatal death, serious neonatal morbidity, low 5-min Apgar score, and respiratory morbidity. Low placental weight is believed to reflect an inadequate placental surface area for nutrient and gas exchange, leading to fetal compromise. However, it has also been proposed that the increased risk associated with high placental weight is the result of villous oedema, which may compress blood vessels and reduce transfer of gas and nutrients to the fetus. MATERIAL AND METHODS A descriptive cross-sectional study of the total, 798 subjects met the inclusive criteria. After consent, age, sex, prepregnancy weight, weight of mother at the time of delivery, neonatal weight and trimmed placental weight were recorded. RESULTS The mean birth weight was 2818±447.19 gm while the placental weight was 489.29±59 gm with mean placental-fetal weight ratio of 17.63. The mean birthweight of male was 2823.97±451.12 gm whereas female was 2811.69±442.93 gm. Similarly, mean placental weight of male was 490.37±57.7 gm and female was 487.98±60.58 gm. As gestational age increases placental and birth weight also increases whereas placental-birth weight ratio decreases. CONCLUSION There is a positive relation between placental weight and weight of the neonate at the time of birth. However, the ratio of the placental and neonatal birth weights at term decreases with advancing gestational age. Thus, prolongation of pregnancy at term may adversely affect the fetus.

Clinical features at the time of non-hysteroscopic myomectomy before pregnancy, which affect adverse pregnancy outcomes: a retrospective cohort study

BackgroundTo investigate the association of clinical characteristics at the time of non-hysteroscopic myomectomy before pregnancy and adverse obstetric outcomes in the next pregnancy.MethodsIn this retrospective cohort study, we identified 248 women who underwent abdominal or laparoscopic myomectomy for intramural (IM) and/or subserosal (SS) uterine myomas in Bundang CHA Medical Center before pregnancy and delivered at the same hospital between 2010 and 2020. The association between clinical characteristics at the time of myomectomy and subsequent obstetric outcomes was analyzed using the Chi-square test, the Student t-test or one-way ANOVA, and multivariable analysis.ResultsThere was one case of uterine rupture. The gestational age at delivery was 37.7 ± 2.4 weeks. There were 2 (0.8%) cases of fetal loss before 23 weeks, but there were no cases of perinatal death. The risk of transfusion during or after delivery was higher in the group in which multiple myomas were removed compared to the group in which only one was removed (aOR = 2.41, 95% CI [1.20–4.86], p = 0.014). The risk of neonatal composite morbidity was higher in the group in which myomas including the IM type were removed, than in the group in which only SS myomas were removed (aOR = 14.29, 95% CI [1.82–99.57], p = 0.012). Although not statistically significant, the group in which the sum of the diameters of the three largest myomas was greater than 15 cm showed a higher frequency of preterm birth (19.3% vs. 10.1%, p = 0.001) and lower birth weight (2901 ± 625 g vs. 3063 ± 576 g, p = 0.001) compared to the group with diameters less than 15 cm. Placenta accreta/increta (7.9% vs. 3.8%, p = 0.043) and lower placental weight (646 ± 170 g vs. 750 ± 232 g, p = 0.034) were more common in patients with an interval between myomectomy and pregnancy of less than 12 months compared to more than 12 months.ConclusionsTo our knowledge, this is the first study to investigate the association between clinical features at the time of myomectomy before pregnancy and various adverse obstetric and perinatal outcomes. If the removed myomas are multiple, IM, large, or the interval between myomectomy and pregnancy is short, the risk of obstetric and neonatal complications may increase.

Stereological and histopathological assessment of intrauterine growth restriction placenta from Saudi women

BackgroundPlacental insufficiency causes fetal adaptation, leading to fetal programming of chronic diseases. Placentas with intrauterine growth restriction (IUGR) are smaller than average and may contribute to low birth weight of the newborn. The number of patients with IUGR in the Saudi population is increasing; however, little is known about their placentas. The aim of this study was to assess morphometric and histopathological placental changes in Saudi patients with IUGR. MethodsOverall, 20 healthy pregnant Saudi women (control group) and 20 pregnant Saudi women with IUGR were enrolled. Maternal and fetal morphometric measurements were recorded. The placentas from both groups were processed for histopathological examination using stereological techniques. ResultsThe IUGR group had lower placental weight, volume, length, breadth, and surface area than the control group. The total volume of villi and surface area of the terminal villi were significantly reduced in the IUGR placentas. IUGR group had a reduction in birth weight; length; and circumference of the head, chest, abdomen, and thigh compared to control group. ConclusionThe reduction in placental mass, specifically the reduction in the volume and surface area of villi, the functional units, may have reduced the capacity for nutrient transport. This led to a significant reduction in neonatal measurements. The fetus rearranged nutrient distribution in favor of the brain and other essential organs; however, at the expense of thigh development and growth. This fetal trade-off strategy increases the risk of developing chronic diseases in adulthood. Therefore, IUGR infants may require more clinical attention.

Placental dysfunction in congenital heart disease: Insights from anatomical pathology

Women with congenital heart disease are at increased risk of obstetric and fetal complications during pregnancy. Placental dysfunction seems to emerge among the different etiological hypotheses. However, studies supporting this pathway are scarce, especially histopathological studies. The objectives of this study were to describe the placental lesions observed in pregnant women with CHD and to compare these findings with placentas from a control group of healthy women. In this single-center prospective study, we reported the results of 69 histopathological analyses (43 placentas from CHD and 26 from healthy women). Pathological findings were classified according to the Amsterdam Placental Workshop Group Consensus. In the control group, patients with comorbidities or risk factors for pre-eclampsia or fetal growth restriction were excluded. Patients were matched for age and BMI. Median gestational age at delivery was 38 [36–38.5] weeks for CHD group vs. 39.4 [38.5–40] weeks for control group ( P < 0.001). Pathologies were identified in 84% of CHD placentas vs. 42% of healthy placentas ( P < 0.001). Among the CHD group, there was 49% of anatomic pathologies, the main one being low placental weight for gestational age (95%). There was also 46% of vascular, 16% of infectious and 9% of inflammatory pathologies. The rate of small placentas for gestational age was significantly higher in the CHD group (46% vs. 15%, P = 0.009). As vascular pathologies, maternal vascular malperfusion (MVM) was significantly more frequent in CHD placentas (28% vs. 8%, P = 0.043). There was no significant difference between groups for infectious, inflammatory and other lesions: choriomanionitis, chorangiosis and villitis ( Fig. 1 ). Pregnant women with CHD had significantly more placental histopathologic abnormalities than healthy women. The most common placental pathologies were anatomic and vascular abnormalities. Small placenta for gestational age and MVM were significantly more present in CHD placentas. These results support the hypothesis of placental dysfunction in CHD women.

LITERATURE REVIEW: PLACENTAL MORPHOLOGY OF PREGNANT WOMAN WITH THE COVID-19

Placental disruption is an essential factor contributing to intrauterine fetal growth. Pregnant women who have been infected with Covid-19 will experience complications. One of the consequences of pregnant women have been infected with Covid-19 will cause delays in neural development in babies from the time they are in the womb. Delayed neural development in utero is associated with placental disorders. This study aims to review the literature on the placental product in pregnant women with Covid-19. The research was conducted by searching for journals on scientific sites using Covid-19 and Placenta. The study used articles published from 2018 to 2022. The results were 32 articles that stated that pregnant women with confirmed Covid-19 would have lower placental weight, dark placental color, and abnormal umbilical cord insertion. In conclusion, abnormal placentas were found in pregnant women with Covid19, but the Placenta also resembled the Placenta in women with diabetes and hypertension. More extensive studies are needed to elucidate the contribution of impaired placentation to delayed neurodevelopment in Covid-19 cases. Keywords: Covid-19, Pregnant mother, Placenta

Fetal sex impacts birth to placental weight ratio and umbilical cord oxygen values with implications for regulatory mechanisms

BackgroundWe determined the effect of fetal sex on birth/placental weight and umbilical vein and artery oxygen values with implications for placental efficiency and regulatory mechanisms underlying fetal–placental growth differences.MethodsA hospital database was used to obtain birth/placental weight, cord PO2 and other information on patients delivering between Jan 1, 1990 and Jun 15, 2011 with GA > 34 weeks (N = 69,836). Oxygen saturation was calculated from the cord PO2 and pH data, while fractional O2 extraction was calculated from the oxygen saturation data. The effect of fetal sex on birth/placental weight, cord PO2, O2 saturation, and fractional O2 extraction was examined in all patients adjusting for pregnancy and labor/delivery covariates, and in a subset of low-risk patients.ResultsBirth/placental weights were lower in females indicating decreased placental efficiency. Umbilical vein oxygen values were higher in females attributed to increased uterine blood flow, while artery oxygen values were lower in females attributed to decreased hemoglobin and umbilical blood flow, and increased oxygen consumption. Fetal O2 extraction was increased in females confirming increased O2 consumption relative to delivery.ConclusionsSex-related differences in uterine/umbilical blood flows, placental development, and fetal O2 consumption can be linked to the differences observed in cord oxygen. The lower umbilical artery oxygen in females as a measure of systemic oxygenation signaling growth could account for their decreased birth weights, while slower development in female placentae could account for their lower placental weights, which could be differentially effected contributing to their lower birth/placental weights.

Association of Placental Parameters with Low Birth Weight Among Neonates Born in the Public Hospitals of Hadiya Zone, Southern Ethiopia: An Institution-Based Cross-Sectional Study.

IntroductionPlacenta indices are the significant determinants of perinatal outcome and neonatal mortality. A clinician can predict neonatal status based on the findings from the placental indices. However, there are limited studies on the relationship between placental parameters and neonatal birth weight in Ethiopia. Hence, this study aimed to assess placental parameters and their association with birth weight among neonates born at public hospitals in southern Ethiopia.MethodsA facility-based cross-sectional study was conducted on 249 systematically selected placentae with the attached umbilical cord from normal singleton live birth with known gestational age. A weighing scale, long needle, and standard non-elastic tape were used to measure placental parameters. Maternal and neonatal characteristics were obtained from the medical charts. Bivariable and multivariable logistic regressions analyses were done to assess the association between placental indices with neonatal birth weight. Finally, an adjusted odds ratio with the corresponding 95% CI was used to declare the statistical significance.ResultsIn this study, the mean placental weight, diameter, and thickness were 475.9gm, 17.73cm, and 4.43cm, respectively, and the prevalence of low birth weight was 10% (95% CI: 6–14%). Low placental weight (AOR: 6.57; 95% CI: 2.47–17.48), low placental thickness (AOR: 4.94; 95% CI: 1.42–17.22), and gestational age (AOR: 4.73; 95% CI: 1.49–14.99) were associated with low birth weight.ConclusionThis study revealed that placental parameters, particularly weight and thickness, and gestational age have a significant influence on low birth weight. Therefore, proper examination of the placenta should be performed routinely following delivery for better newborn care.