Maternofetal Complications Research Articles

Tu1042 SAFETY OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) IN PREGNANCY: A SYSTEMATIC REVIEW AND META-ANALYSIS

ERCP is a technically challenging procedure rarely associated with serious post-procedure complications. Pregnancy promotes cholelithiasis due to hormonal changes and ERCP may be needed during pregnancy. Limited clinical data are available on the outcomes of ERCP in pregnancy due to the limited number of cases. We performed a systematic review and a meta-analysis to assess the safety of ERCP in pregnancy. A systematic search of PubMed, Medline/Ovid, Web of Science, and Google Scholar through November 20th, 2017 using PRISMA and MOOSE guidelines identified 26 studies that reported the outcomes of ERCP in pregnancy. Random-effects pooled event rate and 95% confidence intervals were estimated. Heterogeneity was measured by I2 and meta-regression analysis was conducted. 26 studies reporting on 1298 pregnant patient who underwent ERCP were identified. Median age was 27.1 years. The pooled event rate for overall non-pregnancy related complications in pregnant patients was 0.122 (95% CI=0.105-0.142; p-value < 0.01). Sub-group analysis showed that the pooled rates of Post ERCP Pancreatitis (PEP) and bleeding were 0.117 (95%CI=0.100-0.137) p-value < 0.01 and 0.046 (95%CI=0.029-0.073) p-value < 0.01 respectively. The pooled event rate for overall pregnancy-related complications was 0.070 (95% CI 0.035-0.134) p-value < 0.01. Substantial heterogeneity was noted in the analysis. ERCP done by experienced endoscopists is a safe procedure during pregnancy with careful selection of cases and limited use of fluoroscopy the maternofetal complications could be reduced.Overall pregnancy-related complications meta-analysis forest plot.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Maternofetal complications of diabetic pregnancy: about 293 cases

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Relationship between Uricemia and Other Biochemical Markers with the Materno-Fetal Complications during Pre-Eclampsia

Goal: Determining the place of Uricemia associated with other biochemical makers in the prediction of fetal-maternal complications during preeclampsia. Material and method: This is a prospective, cross-sectional study of 75 pre-eclamptic women in three maternities in Kinshasa, Democratic Republic of Congo, during the January to December 2013. The values of the following biochemical markers: uricemia, proteinuria and creatinemia were correlated with maternal and fetal prognosis. Results: This study showed that hyper uricemia associated with massive proteinuria and a high creatinine level correlated with an unfavorable pregnancy outcome and the occurrence of major materno-fetal complications such as eclampsia (X-squared = 24.3598, ddl = 2, p-value = 0.000005) and low birth weight (p = 0.001, R2 = 0.08). Conclusion: In view of these results, it appears necessary to ensure these biochemical markers systematically in the monitoring of pre-eclampsia.

Maternal and fetal complications in multiple pregnancies

Objective: To analyze the feto-maternal complications in multiple pregnancy and strategy for its prevention and treatment. Design: Descriptive study Place and Duration of Study: This study was carried out at DHQ Hospital, Faisalabad over a period of one year from December 2004 to December 2005. Methods: There were 60 cases of multiple pregnancies out of a total 3000 pregnant women. Patients with multiple gestations were referred from emergency as well as from outpatient department to labor room and out come and any associated complications were recorded. Result: During one year study period there were 60 cases of multiple pregnancy. Most of multiple pregnancies (91%) were spontaneous. 96% patients were carrying twin pregnancies while 2 cases (3.3%) of triplet pregnancies were recorded. Recorded maternofetal complications of multiple pregnancies were miscarriage (5%), preterm delivery (33.3%), pregnancy induced hypertension, pre-eclampsia, eclampsia (33.3%), intrauterine growth restriction (16.6%), intrauterine death (6.6%) and postpartum haemorrhage (6%). 35% delivered vaginally while 41.6% were delivered by caesarean section. Conclusion: Multiple pregnancies are high risk pregnancies with associated feto-maternal morbidity and mortality due to accompanying complications. Chances of a successful outcome may be improved by appropriate preventive, diagnostic and management strategies, by the availability of specific skill and experience and by a multi-disciplinary approach.

Pregnancy in Sickle Cell Disease Is a Very High-Risk Situation: An Observational Study.

Sickle cell disease is a serious genetic disorder affecting 1/235 births in French Guiana. This study aimed to describe the follow-up of pregnancies among sickle cell disease patients in Cayenne Hospital, in order to highlight the most reported complications. 62 records of pregnancies were analyzed among 44 females with sickle cell disease, between 2007 and 2013. Our results were compared to those of studies conducted in Brazil and Guadeloupe. There were 61 monofetal pregnancies and 2 twin pregnancies, 27 pregnancies among women with SS phenotype, 30 SC pregnancies, and five S-beta pregnancies. The study showed that the follow-up of patients was variable, but no maternal death was found. We also noted that the main maternofetal complications of pregnancies were anemia (36.5%), infection (31.7%), vasoocclusive crisis (20.6%), preeclampsia (17.5%), premature birth (11.1%), intrauterine growth retardation (15.9%), abnormal fetal heart rate (14.3%), and intrauterine fetal death (4.8%). Pregnancies were more at risk among women with SS phenotype. Pregnancy in sickle cell disease patients requires a supported multidisciplinary team including the primary care physician, the obstetrician, and the Integrated Center for Sickle Cell Disease.

Maternofetal Trauma in Craniosynostosis.

Premature cranial suture fusion may prevent neonatal skull malleability during birth, increasing the risk of unplanned cesarean delivery and neonatal birth trauma caused by cephalopelvic disproportion. We sought to determine the incidence of perinatal maternofetal complications in cases of craniosynostosis. Records of children presenting with nonsyndromic craniosynostosis to a tertiary pediatric hospital from 1996 to 2012 were reviewed retrospectively with focus on birth history and birth-related complications. Six hundred eighteen births were reviewed. Rates of cesarean delivery among mothers of children with craniosynostosis [n = 201 (32.5 percent)] exceeded the overall regional rate of 24.5 percent (OR, 1.50; p < 0.0001). Unplanned cesarean delivery occurred in 19.7 percent of births, and were most associated with nulliparous mothers, breech fetal presentations, and lambdoid or multisuture synostosis patterns. Eleven neonates (1.8 percent) exhibited cranial birth trauma, including cephalohematoma and subgaleal hematoma. Neonates with sagittal or multisuture synostosis patterns were more likely to suffer birth trauma and had a higher mean head circumference than those who did not (81st versus 66th percentile, p < 0.05). In the setting of craniosynostosis, birth trauma is increased-for mothers in the form of increased cesarean delivery risk, and for fetuses in the form of subgaleal and subperiosteal perinatal bleeding. Difficult maternal labor may be mediated especially by multisuture or lambdoid synostosis, whereas fetal birth trauma may be mediated to a greater extent by large head size. Prenatal diagnosis of craniosynostosis could influence decision-making in the management of labor. Risk, IV.

PO-0645 Complications Of Prolonged Pregnancy On The Growth Restricted Fetus

Backround Prolonged pregnancy is defined as any pregnancy exceeding 294 days or more. It is now well known that prolonged pregnancy is associated with an increased risk of perinatal mortality and morbidity, both maternal and fetal, particularly in intrauterine growth restricted fetuses. Material and methods We analysed in a retrospective study all births complicated by intrauterine growth restriction of all births in the period 2010–2012. Criteria for inclusion in the study were represented by the diagnosis of intrauterine growth restriction and prolonged pregnancy. Results Rates of transient tachypnea, hypoxia, neonatal apnea, sepsis, thrombocytopenia and hypoglycemia were higher in the postdated growth restricted newborns. An increased frequency of children who needed intensive care after birth, a longer period of hospitalisation and a higher frequency of oligohydramnios were observed in patients who associated both pathologies. Conclusions Chronologically prolonged pregnancies associated with intrauterine growth restriction represent a pathology that requires close monitoring in order to anticipate possible materno-fetal complications.

ATLANTIC-DIP: Excessive Gestational Weight Gain and Pregnancy Outcomes in Women With Gestational or Pregestational Diabetes Mellitus

Women who have diabetes mellitus during pregnancy are at higher risk of adverse outcomes. Excessive gestational weight gain (GWG) is also emerging as a risk factor for maternofetal complications, and in 2009, the Institute of Medicine published recommendations for appropriate GWG. It is unclear whether excessive GWG confers additional risk to women with diabetes in pregnancy and whether Institute of Medicine recommendations are applicable to this population. The objective of this study was to examine whether excessive GWG in pregnancies complicated by diabetes mellitus is associated with higher adverse obstetric outcomes. This was an observational study. The study was conducted at five antenatal centers along the Irish Atlantic seaboard. 802 women with diabetes in pregnancy participated in the study. Maternal outcomes examined included preeclampsia, gestational hypertension, and cesarean delivery. Fetal outcomes included large for gestational age (LGA), macrosomia, and small for gestational age. Excessive GWG was noted in 59% of women. In all women, excessive GWG resulted in higher odds for LGA [adjusted odds ratio (aOR) 2.01, 95% confidence intervals 1.24-3.25 in GDM; aOR 3.97, CI 1.85-8.53 in pregestational diabetes mellitus (PGDM)] and macrosomia (aOR 2.17, CI 1.32-3.55 in GDM; aOR 3.58, CI 1.77-7.24 in PGDM). Excessive GWG was also associated with an increased odds for gestational hypertension (aOR 1.72, CI 1.04-2.85) in women with GDM, and treatment with insulin further increased the odds for LGA (aOR 2.80, CI 1.23-6.38) and macrosomia (aOR 5.63, CI 2.16-14.69) in this group. We show that in the already high-risk settings of both GDM and PGDM, excessive GWG confers an additive risk for LGA birth weight, macrosomia, and gestational hypertension.

Obstetrical Outcome of Young Women with a Past History of Cerebral Venous Thrombosis

Background: This study was designed to review the obstetrical outcome of a consecutive series of cerebral venous thrombosis (CVT) affecting fertile women over a long period of time. Methods: From a computerized database of four hospitals of a French region (Poitou-Charentes), we selected patients admitted to hospital for CVT between January 1995 and February 2012. All the case notes were re-examined by two neurologists to confirm the initial diagnosis of CVT. The criterion of inclusion in our study was the occurrence of CVT in a woman ≤40 years of age. All the patients were recontacted by telephone in September 2012 and could be seen in an outpatient clinic. The data of interest were: occurrence of subsequent pregnancies, outcome of these pregnancies, their possible complications, their management with respect to preventive medication, details on the birth and the neonate. Results: Out of 190 consecutive patients hospitalized for CVT, 62 women aged ≤40 years were included (mean age 27.2 ± 6.7 years at the time of their cerebrovascular event). The mean duration of follow-up was 89.5 ± 60.6 months (median: 76 months). There were 45 pregnancies in 24 of the women. Among these 45 pregnancies, 1 was in progress, 24 were completed resulting in normal children, whereas 20 were terminated (5 voluntary abortions, 14 miscarriages and 1 medical abortion). During the pregnancies recorded, there was one recurrence of CVT and no extra-CVT. Various management strategies were adopted, depending on the identified cause(s) for CVT and the medical history of the patient. Conclusions: Our study confirms that the occurrence of a CVT in young women is not a contraindication for subsequent pregnancy. However, it points to a high incidence of miscarriage. Apart from this fact, there is no increase in materno-fetal complications during pregnancy and childbirth, and the neonates are healthy. The risk of recurrence of a CVT or extra-CVT during subsequent pregnancy is low but most of patients were on preventive antithrombotic medication.

Le diabète gestationnel : diagnostic et prise en charge à court et à long terme

Universal consensus on the diagnosis methods and thresholds has long been lacking. The recently published Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study has been used to confirm the link between hyperglycemia and materno-fetal complications. Consequently, in France, the Société francophone du diabète (SFD) and the Collège national des gynécologues et obstétriciens français (CNGOF) proposed an expert consensus on gestational diabetes mellitus for clinical practice. Fasting blood glucose should be measured at the first visit during early pregnancy for women with risk factors to identify the women with pregestational diabetes. It is proposed a selective screening on risk factors rather than universal screening. Specific treatment of gestational diabetes reduced materno-fetal complications compared to the absence of therapy. Women with a history of gestational diabetes mellitus are characterized by a high risk of type 2 diabetes mellitus.

Évaluation de l’utilisation du sulfate de magnésium dans la prévention secondaire de l’éclampsie : étude rétrospective sur 39 cas

IntroductionThe use of magnesium sulfate (MgSO4) has been advocated since 2000 in France in the management of eclampsia. The aim of this study was to determine the frequency of use of this treatment for eclampsia in a French department. Patients and methodsAll patients obstetrical patients admitted to Critical Care Units of Seine-Maritime for eclampsia over a period of 7 years (2002–2008) were included. Obstetric data, the treatment used for eclampsia and pre-eclampsia and maternofetal complications were collected. The primary outcome parameter was the use of MgSO4 in the secondary prevention of eclampsia. ResultsThirty-nine patients were included. Nineteen patients (48%) had eclampsia in prepartum, three (8%) in per-partum and 17 (44%) in post-partum periods. The use of MgSO4 in the secondary prevention of eclampsia was observed in 92% of cases (36/39). Primary prevention was seen in 8% of cases. The duration of treatment was 2 days (1–7 days). The maternal and perinatal mortality was respectively 2.5 and 11%. ConclusionIn this study, the use of MgSO4 in the secondary prevention is frequent. This result emphasizes the importance of the recommendations of learned societies in the homogenization of the management of rare but serious conditions such as eclampsia.

Effect of Salmonella enteric Serovar Typhimurium in Pregnant Mice: A Biochemical and Histopathological Study

BackgroundFood borne infections caused by Salmonella enterica species are increasing globally and pregnancy poses a significant threat in developing countries, where sanitation facilities are inadequate. Thus, the present study was designed to delineate the effect of Salmonella infection during pregnancy.MethodPregnant, BALB/c mice were challenged orally with Salmonella enterica serovar Typhimurium on gestational day 10 and were monitored for bacterial load, hepatic injury, histopathological alterations vis-a-vis oxidant and antioxidant levels.ResultsPregnant-Salmonella-infected mice had higher bacterial translocation in the liver, spleen as well as liver enzymes mainly aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase compared with Salmonella-infected mice. The levels of lipid peroxidation were significantly higher in all the organs of both pregnant-Salmonella-infected and Salmonella-infected mice compared with control mice. However, the activities of antioxidant enzymes (reduced glutathione, superoxide dismutase and catalase) were lower in the liver, spleen and placenta of pregnant, pregnant-Salmonella-infected and Salmonella-infected mice compared with control mice, but the decrease was more in pregnant-Salmonella-infected mice indicating depression of antioxidant defense system. Histopathologically, pregnant-Salmonella-infected mice had more architectural damage in the liver, spleen and placenta compared with other groups.ConclusionPregnancy makes the host more vulnerable to typhoid fever by affecting the physiology of pivotal organs and highlighting the importance of early and prompts diagnosis so as to avoid the further materno-fetal complications.

Consequences of gestational and pregestational diabetes on placental function and birth weight

Maternal diabetes constitutes an unfavorable environment for embryonic and fetoplacental development. Despite current treatments, pregnant women with pregestational diabetes are at increased risk for congenital malformations, materno-fetal complications, placental abnormalities and intrauterine malprogramming. The complications during pregnancy concern the mother (gravidic hypertension and/or preeclampsia, cesarean section) and the fetus (macrosomia or intrauterine growth restriction, shoulder dystocia, hypoglycemia and respiratory distress). The fetoplacental impairment and intrauterine programming of diseases in the offspring's later life induced by gestational diabetes are similar to those induced by type 1 and type 2 diabetes mellitus. Despite the existence of several developmental and morphological differences in the placenta from rodents and women, there are similarities in the alterations induced by maternal diabetes in the placenta from diabetic patients and diabetic experimental models. From both human and rodent diabetic experimental models, it has been suggested that the placenta is a compromised target that largely suffers the impact of maternal diabetes. Depending on the maternal metabolic and proinflammatory derangements, macrosomia is explained by an excessive availability of nutrients and an increase in fetal insulin release, a phenotype related to the programming of glucose intolerance. The degree of fetal damage and placental dysfunction and the availability and utilisation of fetal substrates can lead to the induction of macrosomia or intrauterine growth restriction. In maternal diabetes, both the maternal environment and the genetic background are important in the complex and multifactorial processes that induce damage to the embryo, the placenta, the fetus and the offspring. Nevertheless, further research is needed to better understand the mechanisms that govern the early embryo development, the induction of congenital anomalies and fetal overgrowth in maternal diabetes.

The Risk of Intellectual Disability in Children Born to Mothers with Preeclampsia or Eclampsia with Partial Mediation by Low Birth Weight

Objective. Preeclampsia and eclampsia (PE) are potentially modifiable risk factors for maternofetal complications. Owing to a paucity of research connecting PE to the risk of intellectual disability (ID) in the offspring, this study examined this relationship. Furthermore, we explored how low birth weight (LBW) mediates the effect of PE on ID. Methods. Data related to South Carolina Medicaid births from 1996 to 2002 were comprised of linked data from maternal Medicaid records, delivery records, birth certificates, Department of Education (DOE), and the Department of Disabilities and Special Needs (DDSNs). After exclusions such as nonidiopathic etiologies of ID, multiple gestations, subsequent siblings in the cohort, pregnancy losses, births under 20 weeks' gestation, and children neither in DOE nor DDSN records, 80,866 maternal–child dyads remained. After adjusting for five covariates of maternal age, race, and education as well as the child's birth year and sex, the effect of PE on ID was examined. Results. The rates of PE and ID were 6.4 and 2.0%, respectively. The rates of ID among children exposed and not exposed to PE were 3.0 and 2.0%, respectively. The crude odds ratio (OR) was 1.549 (95% CI 1.310, 1.832) and the adjusted OR was 1.58 (95% CI 1.334, 1.870). LBW was a significant mediator of the relationship accounting for approximately half of the association. Conclusion. Because of the association of PE, ID, and LBW, additional research is needed to explain mechanisms and to investigate possible impacts of different PE treatment.

Unsuspected, Disseminated Coccidioidomycosis without Maternofetal Morbidity Diagnosed by Placental Examination: Case Report and Review of the Literature

Historically, untreated disseminated coccidioidomycosis during pregnancy was thought to be associated with 100% maternal fatality and 50% fetal mortality and was the leading cause of maternal deaths in areas of endemicity. As recently as 1995, therapeutic abortions and early deliveries were advocated in certain contexts. This report describes an unrecognized case of disseminated coccidioidomycosis diagnosed at the time of placental examination in a woman who completed her pregnancy without significant maternofetal complications. This case suggests that abortion and early delivery may not be necessary, because the possibility of an uncomplicated pregnancy exists. It is likely that other similar cases exist but remain underreported or underdiagnosed because of the mild, nondescript nature of the illness and low clinical suspicion. Although this mother and infant had good clinical outcomes, thorough travel histories and consideration of the associated travel-related diseases are important because of the possibility of serious, potentially avoidable clinical consequences.

La grossesse chez la femme obèse : des conséquences sous-estimées ?

As the prevalence of obesity grows in western countries, maternal obesity is becoming an increasingly frequent high-risk obstetrical situation. Obese women have a higher incidence of pregnancy complications (gestational diabetes, hypertension, toxaemia, etc.) and of adverse fetal outcomes (macrosomia, neural tube defects, perinatal mortality). Cesarean section is more frequent in obese women, resulting in a higher risk of anaesthetic and post-operative complications. Maternofetal complications are proportional to the degree of obesity, and even moderate overweight amplifies the risk. Long-term complications include worsening of maternal obesity, maternal type 2 diabetes, and childhood obesity and metabolic disorders. Before conception, these patients should receive tailored weight-loss advice and be screened for obesity complications. Food intake during pregnancy should be tailored to achieve the minimum maternal weight gain required for normal fetal growth. Long-term follow-up is required to prevent worsening of maternal obesity after delivery, and the child's growth curve should be closely watched

Prise en charge des grossesses à risque chez les femmes drépanocytaires : intérêt d’une stratégie préventive par des transfusions de globules rouges ou des échanges érythrocytaires automatisés

Objective Maternal and fetal risk is often high during pregnancy in sickle cell disease. Our objective was to evaluate the benefits of a transfusion program adapted to each pregnant patient, either by red cell transfusion or by automated red cell exchange, in sickle cell patients with a history of serious obstetrical and/or sickling complications. Study design We managed 18 pregnancies in 14 patients (12 SS, 1 SC, 1 S/b-thalassemia), seven of whom had a history of one or more pregnancies, with severe maternofetal complications in nine out of 10 cases. The other seven patients were pregnant for the first time and were in care because of a history of severe sickling complications. The aim was to achieve a proportion of abnormal hemoglobin (hemoglobin S or S + C) below 50% and a hemoglobin level between 9 and 11 g/dL. The choice between transfusion and red cell exchange was made in the light of the hemoglobin level. Red cell exchange was done using a Fresenius Com. Tec blood cell separator. Patients had red cell exchange in 10 cases, and transfusions in five cases. In three cases, patients had successive transfusions and red cell exchange. Results No serious maternal complication was observed. No fetal or perinatal death occurred. In one case, delivery was induced at 36 weeks of gestation because of fetal distress and hypotrophy. Conclusions Our study suggests that women with severe sickle cell disease, even if they have a serious obstetrical history, can carry their pregnancy to term, without major obstetric complications, through a combination of early management by a multidisciplinary team and a suitable policy of prophylactic transfusion or automated red cell exchange.

Etiología y sensibilidad antimicrobiana en las infecciones urinarias bajas de la embarazada en España

Introduction To improve antibiotic use in the treatment of urinary tract infections during pregnancy, knowledge of the most frequent pathogens and their susceptibilities is required. Methods Between march and july 2004, a prospective multicenter study was conducted in 15 national microbiology laboratories. The laboratories used their standard methods to process the samples. Results Pregnancy or non-pregnancy was recorded in only 1521 women; of these, 150 women were pregnant. The most frequent pathogen in pregnant women was Escherichia coli (54.6%), followed by Streptococcus agalactiae (24.3%). Isolation of gram positive strains (32.2%) was significantly more frequent in pregnant women (p < 0.001). The susceptibility rates of E. coli were 98.8% for fosfomycin, 96.2% for cefixime, and 97.6% for nitrofurantoin; these rates were lower for ampicillin (41.6%). Conclusions E. coli is the main uropathogen during pregnancy, because of the materno-fetal complications of urinary tract infections during pregnancy, alternative antibiotics should be used to reduce the high resistance to antibiotics that are useful in neonatal sepsis.

Mild Carbohydrate Intolerance in Pregnancy

Diagnosis of Gestational Diabetes Mellitus (GDM) requires at least two or more values to be abnormal on the 3 h-100 g oral glucose tolerance test: but how to care for pregnant women with only one abnormal glucose value remains a point of discussion. In fact, although a large number of studies on this argument exist, the clinical significance of "one abnormal value" has yet to be clarified. Our review of previous studies and personal experience on prevalence, metabolic findings and maternal-fetal outcome suggests this pregnancy induced carbohydrate intolerance is a continuum with GDM, associated with an increased incidence of materno-fetal complications. For this reason we believe that it should be diagnosed, monitored and treated.

Hyperexpression of ICAM-1 and CD36 in placentas infected with Plasmodium falciparum: a possible role of these molecules in sequestration of infected red blood cells in placentas.

During pregnancy, Plasmodium falciparum malaria is frequent and associated with maternofetal complications. This could be the consequence of sequestration by several adhesion molecules of parasite-infected red blood cells in syncytiotrophoblast. To investigate the expression of ICAM-1 and CD36, two of the adhesion molecules for Plasmodium falciparum, an immunohistochemical study was carried out in malaria-infected placentas. Thirty-five infected and 35 noninfected samples were chosen randomly. According to the histological classification of Bulmer, the infected placentas were separated in three groups: active, active chronic and past-chronic infection. CD36 was localized in the cytoplasm of stromal cells of terminal villi of infected or noninfected placentas, but not in syncytiotrophoblast. ICAM-1 was detected in the cytoplasm of stromal and endothelial villous cells in both infected and noninfected placentas and in syncytiotrophoblast of eight infected placentas showing more frequently active than active chronic or past-chronic infection (P < 0.001). The percentage of cells immunostained for CD36 or ICAM-1 was evaluated in the terminal villi. The proportion of villous cells, with ICAM-1 and CD36 immunostaining, was significantly higher in infected vs. noninfected placentas (P < 0.0001) and CD36 was detected more in acute inflammatory vs. past-chronic inflammatory placentas (P < 0.05). The higher expression of ICAM-1 in infected placentas and its localization in syncytiotrophoblast particularly during acute infection, suggest ICAM-1 can act directly in the sequestration of parasite-infected red blood cells (IRBCs). On the other hand, the expression of CD36 is influenced by the presence of IRBCs without being directly implicated in sequestration of IRBCs. The hyperexpression of these two molecules could explain the high frequency of malaria during pregnancy.