Part Of Placenta Research Articles

A SYSTEMATIC REVIEW OF THE CRUCIAL ROLE OF RASA DHATU IN PRODUCING HEALTHY PROGENY.

Each year in India, there are approximately 28 million pregnancies, in which 26 million live births, a million neonatal deaths & congenital deformities is occurring due to malnutrition of mother and fetus. The classics of Ayurveda detail the crucial role of Rasa dhatu in the production of healthy progeny. During gametogenesis, Rasa dhatu is the foremost requirement for normal, healthy sperm and oocytes (Shukra & Artava). Malformed paternal Rasa dhatu leads to malnourished and malformed gametocytes through mitochondrial dysfunction, epigenetics and defects in meiosis cause Bija dosha, which in turn lead to Garbhshrava (miscarriage), deformed Garbha formation or congenital deformities like Suchi Mukh uterus in female fetus and sterile progeny. After fertilization, the ceased Artava (accumulated nutritional substance in the fluid of decidual cells) acts as a storage nutrition for the developing embryo in the embryonic phase. During organogenesis the Artava which is the Upadhatu of Rasa dhatu forms the maternal part of placenta. After formation of placenta & umbilical cord the Maternal Rasa dhatu provides directly nutrition to growing fetus. The malformed Rasa dhatu or the blocked Rasavaha channels of mother may cause different levels of intra uterine growth retardation such as Nagdhadara, Upavistaka, Lina garbha, Garbhashaya or Mritgarbha (IUD).

Machine learning opportunities to predict obstetric haemorrhages

Obstetric hemorrhages (OH) are the main preventable cause of morbidity, mortality and cases of "near miss" among obstetric complications worldwide. Early preventive measures based on the OH prediction allow to profoundly reduce the rate of female mortality and morbidity as well as prevent the economic costs of patient intensive care, blood transfusion, surgical treatment and long-term hospitalization. Postpartum haemorrhage (PPH) is the most frequent obstetric haemorrhage determined by one of the four causes: a uterine tonus disorder, maternal birth trauma, retention of placenta parts and blood-clotting disorder. There is still a need for the continued search for an accurate and reliable prediction method despite multiple attempts to develop an effective system for predicting OH. The solution to this may be reasonably considered an innovative method such as artificial intelligence (AI) including computer technologies capable of obtaining conclusions similar to human thinking. One of the particular AI variants is presented by machine learning (ML), which develops accurate predictive models using computer analysis. Machine learning is based on computer algorithms, the most common among them in medicine are the decision tree (DT), naive Bayes classifier (NBC), random forest (RF), support vector machine (SVM), artificial neural network (ANNs), deep neural network (DNN) or deep learning (DL) and convolutional neural network (CNN). Here, we review the main stages of ML, the principles of algorithms action, and the prospects for using AI to predict OH in real-life clinical practice.

МОРФОЛОГИЯ ПРОВИЗОРНЫХ ОРГАНОВ ЛОШАДИ ВО ВЗАИМОСВЯЗИ С ЖИЗНЕСПОСОБНОСТЬЮ НОВОРОЖДЕННЫХ ЖЕРЕБЯТ

The aim of the study is to identify the morphofunctional features of the fetal part of the equine placenta in relation to prenatal growth and development of newborn foals. The fetal parts of the placentas of the most viable foals of the first subtype have a maximum weight of (8.02 ± 0.24) kg, area of (14287.48 ± 311.72) cm2, length of the umbilical cord of (57.68 ± 0.75) cm, thickness of (3.76 ± 0.07) cm. The diameter of the arteries and veins in the umbilical cord is almost the same – 11–12 mm, their lumen is strongly narrowed, the thickness of the wall of the umbilical arteries and vein is also equal to (5–6 mm). The thickness of the chorion reaches (8.00 ± 0.91) mm, the number of villi per 1 cm2 of the chorion is (41.80 ± 1.56) pcs., the thickness of the allantoamnion is (6.20 ± 0.58) mm, and the diameter of the vessels is from 4 to 6 mm, their number on the allantoamnion section of 100 cm2 is 5–10. The weight of the fetal parts of the placentas of less viable foals of the second subtype is (5.93 ± 0.24) kg, the area is (10854.92 ± 407.67) cm2, the length of the umbilical cord is (60.00 ± 0.84) cm, the diameter is (3.62 ± 0.06) cm. The diameter of the vein in the umbilical cord is slightly larger (12 mm) than the arteries (11 and 8 mm). The thickness of the chorion decreases to 4–6 mm (5.20 ± 0.37) mm, the number of villi per 1 cm2 of the chorion is 38.40 ± 1.17, there are areas in which the height and density of the villi are even smaller. The thickness of the allantoamnion is (4.06 ± 0.45) mm, and the diameter of the vessels is from 4 to 6 mm, from 3 to 7 vessels are found in an area of 100 cm2 of the allantoamnion. The weight of the fetal parts of the placentas of the third subtype of the least viable foals is significantly (by 37.37 %) lower than the first, as is the area, the length of the umbilical cord is (57.20 ± 0.66) cm, the diameter is (3.44 ± 0.05) cm. The diameter of the vein in the umbilical cord is slightly smaller (9 mm) than the arteries (12 and 11 mm). The chorion is unevenly covered with small, slightly branching villi, not shiny, its thickness reaches (2.84 ± 0.07) mm, and the number of villi per 1 cm2 is from 20 to 40. The diameter of the walls of the allantoamnion vessels decreases and is no more than 3.5 mm at most, their number is from 3 to 5 per 100 cm2.

Risk factors for blood transfusion after Cesarean section in patients with partial placenta previa

This study assessed risk factors for blood transfusion after Cesarean section in patients with partial placenta previa. We retrospectively reviewed the medical records of 149 patients who underwent Cesarean sections for partial placenta previa between January 2010 and October 2021. Clinical characteristics were compared between the two groups: the blood transfusion group (n=22), defined as patients who received a blood transfusion during surgery or within 24 hours after surgery, and the non-blood transfusion group (n=127), which included other patients. Multivariable logistic regression analysis identified two risk factors independently associated with blood transfusion: antenatal hemorrhage (adjusted odds ratio [aOR], 16.283; 95% confidence interval [CI], 4.405-60.190; <i>P</i><0.001) and preoperative hemoglobin (g/dL) (aOR, 0.427; 95% CI, 0.246-0.739; <i>P</i>=0.002). Thus, patients who are at risk for these two factors should be carefully managed with sufficient preparation for blood transfusion and anesthetic management.

Emerging Strategies for the Biofabrication of Multilayer Composite Amniotic Membranes for Biomedical Applications.

The amniotic membrane (AM) is the innermost part of the fetal placenta, which surrounds and protects the fetus. Due to its structural components (stem cells, growth factors, and proteins), AMs display unique biological properties and are a widely available and cost-effective tissue. As a result, AMs have been used for a century as a natural biocompatible dressing for healing corneal and skin wounds. To further increase its properties and expand its applications, advanced hybrid materials based on AMs have recently been developed. One existing approach is to combine the AM with a secondary material to create composite membranes. This review highlights the increasing development of new multilayer composite-based AMs in recent years and focuses on the benefits of additive manufacturing technologies and electrospinning, the most commonly used strategy, in expanding their use for tissue engineering and clinical applications. The use of AMs and multilayer composite-based AMs in the context of nerve regeneration is particularly emphasized and other tissue engineering applications are also discussed. This review highlights that these electrospun multilayered composite membranes were mainly created using decellularized or de-epithelialized AMs, with both synthetic and natural polymers used as secondary materials. Finally, some suggestions are provided to further enhance the biological and mechanical properties of these composite membranes.

Pathological changes in aborted fetuses and placental tissue in cows with neosporosis

The failure to obtain offspring due to abortion causes considerable damage to the dairy industry worldwide, costing millions of US dollars. Neospora caninum, a protozoan parasite of the Apicomplexa class, is the causative agent of neosporosis, a disease that leads to abortions or the birth of weak offspring in cows. Therefore, addressing this issue is crucial. The purpose of this study is to describe the pathological changes in aborted fetuses and placental tissue in cows with neosporosis. Macroscopic examination of fetal and placental parts was performed through pathological dissection. The gestation age (days) was determined using the formula: 68 + 2.25×CRL (cm) and/or from historical data. DNA of N. caninum was detected by polymerase chain reaction in all fetuses and/or fetal parts of placentas described in the study. It was found that the majority of abortions occurred at 4-5 months of gestation. External examination revealed isolated instances of skin hyperemia and haemorrhages throughout the body. Some fetuses were mummified. Autolysis of the fetus and placental parts was observed in most cases. Placentitis and oedema of the placental tissue were also noted in some cases. Internal examination of fetuses revealed changes in the brain, skeletal muscles, heart, lungs, liver, spleen, and kidneys, in addition to characteristic autolysis. These changes, including grey foci in the brain with a light grey centre, white foci, and multiple white streaks in skeletal muscles and the tongue, can be attributed to typical pathological changes in aborted fetuses with neosporosis. These changes are rare but can impact the determination of the cause of abortion, narrowing down the factors responsible

Analysis of congenital pneumonia incidence in newborns from high-risk mothers

Objective. To detect the incidence of congenital pneumonia in newborns from mothers with placental insufficiency in combination with premature amniotic fluid discharge
 Materials and methods. A retrospective analysis of 57 stories of newborn infants and their mothers was carried out. The newborns were divided into 3 groups: group 1 37 newborns from mothers with placental insufficiency and premature amniotic fluid discharge, group 2 9 infants from mothers with premature amniotic fluid discharge, group 3 11 infants born from mothers with placental insufficiency. The obstetric and gynecological history, the presence of extragenital pathology, the peculiarities of the course of pregnancy and childbirth, and the outcomes for newborns were analyzed.
 Results. Congenital pneumonia was more common in newborns from mothers with placental insufficiency and premature amniotic fluid discharge. In newborn infants of the first group, severe asphyxia occurred more often, being a risk factor. At the same time, the identification of markers of the systemic inflammatory reaction did not always reflect the presence of infectious-inflammatory pathology in newborns. In addition, in the presence of inflammation of the fetal part of placenta, in a large number of newborns pathological microflora is detected during microbiological examination.
 Conclusions. As a result of the study, the role of maternal pathology on the development of intrauterine infection and implementation of infection in the early neonatal period was revealed. The obtained data justify the need for pregravid preparation and prevention of perinatal complications in women with placental insufficiency.

Finding Out Cause of the Maternal Death Following Vaginal Delivery- A Case of Complete Placenta Previa: An Autopsy Report

Placenta previa occur when the placenta is situated completely or its part into the lower uterine segment. Placentaprevia can give rise to bleeding either during pregnancy, during labour or following delivery. Transvaginalsonography is most accurate method to diagnose placenta previa. Due to the fact that since one part of the placentais partially detached, while the other part of placenta has grown into the uterus, postpartum haemorrhage withlethal outcome may occur, unless the mother is hospitalized. Such complications can be prevented by legalabortions. Placenta previa prevents a safe vaginal delivery and requires the delivery of the neonate to be viacaesarean delivery

Патологічне прикріплення плаценти: діагностика, тактика ведення та розродження

The incidence of placenta previa is 0.2-0.9% but continues to be one of the most serious factors in the development of obstetric’s bleeding and perinatal losses. The situation is aggravated by the fact that placenta previa is combined with various variations of abnormal (deep) attachment of the placenta to the uterus (placenta adhaerens, accreta, increta, percreta). Placenta previa, placenta accreta, and vasa previa cause significant maternal and perinatal morbidity and mortality. With the increasing incidence of both cesarean delivery and pregnancies using assisted reproductive technology, these 3 conditions are becoming more common. Placental accretion remains the main cause of maternal hemorrhage and obstetric hysterectomy, resulting in significantly high maternal morbidity and mortality. Risk factors for placenta previa include prior cesarean delivery, pregnancy termination, intrauterine surgery, smoking, multifetal gestation, increasing parity, and maternal age. Advances in ultrasound have facilitated prenatal diagnosis of abnormal placentation allowing the development of multidisciplinary management plans to achieve the best outcomes for mother and baby. Purpose - to review the literature on abnormal placentation, including an evidence-based approach to diagnosis, management and treatment; to follow the evolution of this obstetric pathology in recent years and the complications that may arise. Identification of risk factors, correct antenatal and preoperative diagnosis, multidisciplinary treatment and counseling will help in the overall management of women with placenta accreta and reduce maternal morbidity. According to the literature, it can be concluded that true placenta previa or placenta percreta, as well as suspected placenta previa (for example, in cases with a history of caesarean section in anamnesis), should be managed and delivered by caesarean section in a tertiary health facility. In no case should the placenta be separated if edematous blood vessels with visible placental blood flow after laparotomy are found in the area of attachment of the placenta to the anterior wall of the uterus, as well as when the diagnosis is placenta percreta or placenta increta. As a tactic, not only primary hysterectomy should be considered, but also conservative therapy or delayed hysterectomy (two-stage hysterectomy). In a situation where placenta accreta or partial placenta accreta cannot be accurately diagnosed, a good understanding of hemostasis with balloon catheter occlusion, various methods of suture hemostasis, and total hysterectomy procedures should be considered. No conflict of interests was declared by the author.

Utility of the Movat pentachrome stain technique in the microanatomical analysis of the human placenta

The efficacy and utility of pentachrome staining has been demonstrated in many studies on diverse human body tissues. Movat pentachrome technique is used for multicolor staining of tissue sections and vascular and stroma visualization. So far, the utility of this method for microanatomical evaluation of placental structures has not been demonstrated. The aim of this study is to evaluate the image of normal placenta and to develop some reference images for future evaluation of pathological tissues based on this technique. Material and method. The study was carried out on 21 paraffin slices taken from seven mature human placenta of single pregnant women without significant pathology and completed with a planned, elective Caesarean section. All paraffin slices were used for preparation of tissue microarrays and then performing a histochemical staining (HE and Movat). Results. On the basis of the collected material, microscopic analysis enabled the identification of normal placental villi - terminal villi,mature intermediate villi and stem villi. Moreover the maternal part of placenta was visualized. It is worth emphasizing that in each case not only the trophoblast but also the stroma structures were visualized. Conclusions. This study proved the effectiveness and usefulness of Movat imaging of placenta especially in visualization of the stroma.

Combined staged surgical hemostasis in a case of Placenta previa and Placenta accreta spectrum disorders

The objective: to develop the optimal delivery algorithm in persons with Placenta previa alone and with partial Placenta accreta, using innovative technologies with the priority of organ-saving operations.Materials and methods. 106 pregnant women with prenatal diagnosis of Placenta previa and the possibility of the safe pregnancy prolongation till 34-36 weeks of gestation were included in the study. To achieve the aim of the study, two groups were formed: the first (control) group – 75 patients were delivered via standard elective cesarean section in terms of 34-36 weeks; the second (main) group – 51 patients delivered in the same terms via our organ-saving method (elective cesarean section using argon-plasma tissue coagulation, agonists of oxytocin and vasopressors; and ligation of main uterine vessels and internal iliac arteries).The following characteristics of cesarean section were taken into account: time of the fetal extraction, duration of the operation, intraoperative blood loss volume and Placenta accreta spectrum disorders (PAS) complications were compared in groups with further statistical data analysis.Results. The mean indices of the cesarean section duration and time from the start of an operation till the fetal extraction were significantly lower (p<0.05) in the second group and amounted 55.7±5.1 min and 195.0±21.0 sec, respectively, versus 74.5±4.3 min and 274.0±17.0 sec in the first group. Intraoperative blood loss volume was also significantly lower in the second group than in the first one – 775.0±60.0 ml versus 970.0±55.0 ml, p<0.05).The part of Placenta previa and PAS combination in one patient amounted to 20.0% in the first group and 17.6% in the second one. Pl. accreta was diagnosed in 17.33% cases in the first group, Pl. increta – in 1.33%, Pl. percreta – in 1.33%. Hysterectomy has been performed in 8.0% cases, all Pl. increta and percreta cases required the hysterectomy and were followed by massive obstetric hemorrhages (MOH). DIC-syndrome developed in 2.67%. In the second group Pl. accreta was diagnosed in 19.61% and Pl. increta – in 3.92%, patients with Pl. increta had hysterectomy. MOH were observed in 38.7% cases in the first group versus 9.7% cases in the second group (p<0.05). Furthermore, in the first group hysterectomy was performed almost four times more frequently than in the second group (24.0% versus 6.5% respectively, p<0.05).Conclusions. The developed delivery algorithm in pregnant women with Placenta previa alone or in a combination with PAS allowed to reduce intraoperative blood loss significantly, prevent the MOH development, therefore to reach secure hemostasis and save the uterus.

Comprehensive transcriptional profiling and functional study of lymphangiogenic growth factor in placentome of early-stage pregnant water buffalo.

The aim of the present study was to evaluate the expression and localization of lymphangiogenic factors (VEGF-C and VEGF-D), their receptor (VEGFR3) and lymphatic endothelial marker (LYVE1) in buffalo placenta during early pregnancy [EP], and to investigate the functional role of lymphangiogenic growth factors in placental lymphangiogenesis. The mRNA and protein expression of VEGF-C, VEGF-D, their receptor VEGFR3 and LYVE1 showed significant expression in EP1 (29-42 days) and EP2 stages (51-82 days) both in caruncle (maternal part) and cotyledon (foetal part) of the buffalo placenta. Immunoreactivity of VEGF-C, VEGF-D and LYVE1 was observed around the endometrial gland, in lymphatics and trophoblast cells, whereas VEGFR3 mainly localized in lymphatics of the caruncle and cotyledons. Cultured trophoblast cells were treated with VEGF-C/VEGF-D (50, 100 and 150 ng/ml) and combined doses of VEGF-C and VEGF-D (150 ng/ml) each for different time durations (24, 48 and 72 h). The mRNA expression of LYVE1 and PCNA was significantly (p < .001) upregulated with VEGF-C and VEGF-D and combined treatment (@150 ng/ml), as well as significantly downregulating Caspase-3 at 48 and 72 h. Thus, the present study provides evidence that lymphangiogenic factors are expressed in buffalo placental compartments and they may play a significant role in the regulation of placental function in water buffaloes.

Pathohistological changes in aborted foetuses of cows due to neosporosis: Evidence from Ukraine

Neosporosis is a parasitic disease characterized by abortions and the birth of weak offspring in cows. The causative agent of Neospora caninum is an obligate, protozoan parasite that belongs to the type Apicomplexa. The relevance of the study is conditioned upon the adverse impact of neosporosis on the economy of Ukraine (loss of productivity, veterinary and diagnostic costs). Furthermore, the issue of neosporosis is understudied. In this regard, the purpose of this study was to establish pathohistological changes in aborted foetuses and the foetal part of placentas and to confirm the involvement of the parasite (Neospora caninum) in cases of abortions recorded in different regions of the country. Two methods were used to investigate this problem: histological and real-time polymerase chain reaction. In aborted foetuses positive for N. caninum, the following pathohistological changes were most often detected: focal gliosis and perivascular mononuclear infiltrates in the brain; focal or diffuse mononuclear infiltration in the heart and skeletal muscles; periportal mononuclear infiltrates in the liver; focal necrosis of the mucous membrane and mononuclear infiltration in the foetal part of the placenta. Changes were less often detected in the lungs – mononuclear infiltration of the interstitium and diffuse lymphocytic alveolitis, and in the kidneys – diffuse interstitial mononuclear infiltration. No changes were found in the spleen. Neospore-like cysts were found in one out of twelve foetuses. Lesions established of foetal organs and placentas are inherent in neosporosis. The results of histological studies substantially complement the data of other authors, confirm the involvement of N. caninum in the occurrence of abortions in cows in certain regions of Ukraine, and also represent practical value for the diagnosis and control of neosporosis in cattle

Experimental study of the antiulcer effect of cryopreserved placenta extract on a model of acetylsalicylic acid-induced ulcerogenesis

Abstract Introduction. The gastrotoxicity of nonsteroidal anti-inflammatory drugs is a leading side effect that significantly limits their clinical use, among other types of their toxicity (nephrotoxicity, hepatotoxicity, cardiotoxicity, etc.). Cryopreserved placenta extract has drawn our attention as a potential modifier of the ulcerogenic action of nonsteroidal anti-inflammatory drugs. Aim. To characterize the cytoprotective properties of cryopreserved placenta extract by the condition of the mucous membrane of the proximal (esophagus and stomach) and distal (small and large intestine) parts of the gastrointestinal (GI) tract on the model of ASA-induced ulcerogenesis. Material and methods. The study was performed using 28 male rats weighing 200-220 g. Subchronic ASA-induced ulcerogenesis of the digestive tract was reproduced by intragastrically administration to rats of ASA in a dose of 150 mg/kg. The effect of the studied drugs on the condition of the mucous membrane of the digestive tract was assessed macroscopically by the following criteria: edema, redness and hemorrhage on the surface of the mucous membrane. The ulcer index for each group of animals was calculated. Results and discussion. Five doses of ASA 150 mg/kg cause damage to the esophagus, stomach, small and large intestines in all of the rats. The use of the proton pump inhibitor esomeprazole has pronounced gastrocytoprotective properties, but does not affect the ulcerogenic effect in the small intestine, and in the colon, it enhances it. This is indicated by ulcerative lesions of the colon in 57.1% of all rats administered ASA and esomeprazole, as well as in the folding of the gastric mucosa. In contrast, mild hyperemia of the gastric mucosa was seen in 28.6% of all rats and moderate hemorrhage in 57.1% of all rats due to the combined use of ASA and cryoextract placenta. Conclusions. The use of cryopreserved placenta extract is statistically significantly (p &lt;0.05) inferior to the antiulcer activity of esomeprazole in the stomach. Thus, the ulcer index on the background of the use of ASA and cryopreserved placenta extract was 0.97, and on the background of the use of ASA and esomeprazole – 0.39. In the distal parts of the GI tract cryoextract placenta showed cytoprotective properties against the background of induced ASA ulcerogenesis, in contrast to esomeprazole.

Influence of the farrowing process and different sow and piglet traits on uterine involution in a free farrowing system

An inadequate uterine involution can lead to postpartal disorders in sows and thereby negatively affects the reproductive cycle and performance of the animals. Therefore, the aim of the study was to evaluate the influence of the farrowing process and different sow and piglet traits on the uterine involution in a free farrowing system. In total three data sets of 48 crossbred sows (Large White x Landrace) from the peripartal period were synthesised and analysed. The uterine diameter of three uterine horns per sow was measured daily during the first two weeks postpartum using ultrasonography and then the uterine regression was calculated. Furthermore, the following sow and piglet traits before and during parturition were assessed: parity, body condition score, backfat thickness, gestation length, number of live born piglets, number of stillborn piglets, farrowing duration, duration of placenta expulsion, litter weight, placenta weight, number of placenta parts, faecal score, and birth induction. In addition, the following parameters were recorded five days after farrowing: body temperature, severity and amount of vaginal discharge, pathological colour of vaginal discharge, and lack of appetite. Spearman's correlation test was used to examine the association between the parameters within the group and uterine regression. In addition, a linear multiple regression was used to model the relationship between the uterine involution and explanatory variables from the peripartal period. The mean diameter of the uterus decreased from 32.5 mm on day 2 post-partum to 11.4 mm on day 12 post-partum, which is a relative regression of 66%. In the linear multiple regression model, a significant influence of the body condition score (p = 0.046) and the presence of high body temperature (p = 0.022) on uterine involution was detected. When the BCS increases by one unit (from BCS 3 to 4), the relative regression of the uterine involution decreases by approximately 8% and when fever is present, uterine involution is almost 6% slower. Furthermore, a significant correlation between the gestation length and the uterine involution (r = 0.31; p = 0.035) was identified. However, no correlation between the farrowing process and piglets' traits on the uterine involution was detected. This study showed that the body condition score, the gestation length and fever in the first five days after farrowing had significant effects on uterine involution in sows in a free farrowing system. Therefore, these parameters should be routinely monitored in the farrowing management to assess reproductive health post-partum and warrant early intervention.

Identification of pathogenic variant and preimplantation genetic testing for a Chinese family affected with osteogenesis imperfecta

To identify the pathogenic variant for a husband with osteogenesis imperfecta and provide preimplantation genetic testing (PGT) for the couple. High-throughput sequencing and Sanger sequencing were carried out to identify the pathologic variant in the husband patients. PGT of embryos was performed through direct detection of the mutation site. Meanwhile, chromosome aneuploidy of the blastocysts was screened. Following transplantation, cytogenetic and genetic testing of fetal amniotic fluid sample was carried out during mid-pregnancy. Chromosome copy number variant (CNV) was detected at multiple sites of the placenta after delivery. The husband was found to harbor heterozygous c.544-2A>G variant of the COL1A1 gene. The same variant was not detected in either of his parents. PGT revealed that out of three embryos of the couple, one was wild-type for the c.544-2A site but mosaicism for duplication of 16p13.3.11.2. The other two embryos were both heterozygous for the c.544-2A>G variant. Following adequate genetic counseling, the wild-type embryo was transplanted. Amniotic fluid testing confirmed that the fetus had normal chromosomes and did not carry the c.544-2A>G variant. The copy number of chromosomes at different parts of placenta was normal after birth. For couples affected with monogenic disorders, e.g., osteogenesis imperfecta, direct detection of the mutation site may be used for PGT after identifying the pathogenic variant. After adequate genetic counseling, prenatal diagnosis must be carried out to ensure the result.

Fundal partial placenta percreta complicated with postpartum hemoperitoneum: A case report.

IntroductionThe fundus of the uterus is a rare location for abnormally invasive placenta compared with the common site of abnormally invasive placenta in the lower segment of the uterus.Presentation of caseWe report a case of a 38-year-old multipara woman who had a fundal partial placenta percreta with no prior cesarean sections, which presented as a retained placenta after preterm labor, and complicated with hemorrhagic shock due to postpartum hemoperitoneum, thus it was diagnosed after surgery and managed by subtotal hysterectomy.DiscussionWe discuss the most common risk factors for abnormally invasive placenta and its diagnosis and management. We compare the possibility of leading to invasive placenta resulting from curettage trauma and cesarean delivery scars.ConclusionHistory of uterine surgical procedures without prior cesarean delivery must raise suspicion of abnormally invasive placenta regardless of its localization, especially when associates with preterm labor or retained placenta.

Prediction for Postpartum Hemorrhage of Placenta Previa Patients through MRI Using Self-Adaptive Edge Detection Algorithm.

The study aimed to explore the application value of MRI images based on the optimized self-adaptive edge detection algorithm in the diagnosis of placenta previa and in the prediction of postpartum hemorrhage. Specifically, a self-adaptive edge detection algorithm was constructed based on optimized edge operators, with the nearest scale parameters analyzed. It was then used to process the MRI images of 36 patients with placenta previa. MRI images of different types of placenta previa were analyzed. The results found that the placenta of the complete placenta previa was attached to the lower wall of the uterus and covered the internal cervix in U shape, and the placenta adhered to the anterior and lower wall of the uterus, with widespread placenta accreta noted. With the results of cesarean section as the standard, it was observed that 2 cases of complete placenta previa were diagnosed as partial placenta previa. The diagnostic accuracy rate was 94.44%, which was not notably different from the results of cesarean section (p > 0.05). The postpartum hemorrhage rate and hysterectomy rate of complete placenta previa were higher than partial placenta previa and marginal placenta previa, and the difference was notable (p < 0.05), but no notable differences were noted in placenta adhesion, placenta accreta, neonatal death, and neonatal asphyxia between the three types of placenta previa (p > 0.05). The incidence of thinned myometrium, placenta penetrating the cervix, placenta accreta, and uneven placental signal in patients with postpartum hemorrhage was higher versus those without postpartum hemorrhage, and the difference was notable (p < 0.05). In a word, MRI images based on the self-adaptive edge detection algorithm can clearly show the status of placenta previa and exhibit better diagnosis effects and a higher accuracy rate. The thinned myometrium, the placenta penetrating the cervix, placenta accreta, and uneven placental signal may be the related risk factors for postpartum hemorrhage in patients with placenta previa.

Differential Expression Pattern of Retroviral Envelope Gene in the Equine Placenta.

Endogenous retroviruses (ERVs) are proviral phases of exogenous retroviruses, which have coevolved with vertebrate genomes for millions of years. The conservation of ERV genes throughout evolution suggests their beneficial effects on their hosts' survival. An example of such positive selection is demonstrated by the syncytin gene, which encodes a protein with affinity for various mammalian placentas that is involved in the formation of syncytiotrophoblasts. Although the horse has an epitheliochorial placenta, in which the fetal trophoblasts are simply apposed to the intact uterine epithelium, we have previously demonstrated that the equine ERV (EqERV) env RNA is unexpectedly expressed in placental tissue. In the present study, we investigated the mRNA expression pattern of the EqERV env gene in different parts of the equine placenta, to gain more insight into its putative role in the fetal–maternal relationship. To this end, we used reverse transcription–quantitative PCR (RT–qPCR) and in situ hybridization assays to analyze different target areas of the equine placenta. The retroviral env gene is expressed in the equine placenta, even though there is no syncytium or erosion of the uterine endometrium. The gene is also expressed in all the sampled areas, although with some quantitative differences. We suggest that these differences are attributable to variations in the density, height, and degree of morphological complexity of the chorionic villi forming the microcotyledons. The involvement of the EqERV env gene in different functional pathways affecting the fetus–mother relationship can be hypothesized.

Placenta Previa Accreta Spectrum: Cesarean Hysterectomy.

When cesarean hysterectomy is scheduled in cases of placenta previa accreta/increta/percreta, it is necessary that the departments of obstetrics, anesthesiology, blood transfusion, urology, and radiology hold a preoperative conference to assure full preparation for the surgery. A ureteral stent inserted just before cesarean section serves as a marker. A uterine incision should be made at a site free of placental contact. The presence/absence of bladder invasion by villi, adhesions, and the degree of vascularization greatly influence the amount of bleeding, and bleeding control is a key point. For prevention of massive hemorrhage, methods of blood flow blockage, such as balloon occlusion catheterization of the aorta or common iliac artery, should be considered. Stored autologous blood and Cell Saver should be prepared. When hysterectomy is performed with the placenta left in situ, handling of the elongated cardinal ligament, ureteric injury, and bladder injury are important issues because the lower uterine segment is enlarged with the placenta. If blood flow is not blocked, separation of the bladder at the area of placenta percreta should be performed as the last step, to reduce bleeding (Pelosi's method). At this time, after handling of the cardinal ligament, bladder separation can be performed more safely if the posterior vaginal wall is incised and exposed first.In cases of placenta accreta or partial placenta accreta/increta/percreta, a diagnosis of morbidly adherent placenta may not be obtained until separation of the placenta is performed. If bleeding from the placental separation surface cannot be controlled, total hysterectomy should be performed without hesitation.