Placental Histological Findings Research Articles

Placental histological findings in COVID-19 term, preterm and metabolic disorders pregnancy

Placental histological findings in COVID-19 term, preterm and metabolic disorders pregnancy

Fetal growth restriction and a single umbilical artery are independent predictors of hypospadias during pregnancy

IntroductionLittle is known about the association between hypospadias and small fetuses, as well as the pathological implications of fetal growth restriction (FGR). Thus, we aimed to investigate the association between hypospadias and small fetuses using a database of fetal ultrasound and obstetric events. MethodsA cohort of male singleton infants delivered after 22 weeks of gestation at Keio University Hospital between 2013 and 2019 was retrospectively reviewed. FGR was defined according to the Delphi criteria. Logistic regression analysis was performed to identify the significant predictors of hypospadias. Placental pathology was reviewed in cases with hypospadias. ResultsOf the 2,040 male infants included in the present study, 23 had hypospadias. The prevalences of a single umbilical artery (SUA), small for gestational age, maternal hypertensive disorders of pregnancy, and a small placenta, were significantly higher in infants with hypospadias. Multiple logistic regression analysis revealed that FGR (odds ratio [OR] = 9.39; 95% confidence interval [CI], 2.50–35.3) and the presence of a SUA (OR = 33.4; 95% CI, 8.00–139.5) were independently and significantly associated with hypospadias. When FGR was stratified by the time of onset, its association with hypospadias was significant regardless of the time of onset. Moreover, placental histological findings suggested that fetal vascular malperfusion might play a role in hypospadias. DiscussionFGR and SUAs are independent prenatal predictors of the development of hypospadias, and fetal vascular malperfusion of the placenta may be involved in the etiology of hypospadias.

The key role of examining the placenta in establishing a probable cause for stillbirth

IntroductionAutopsy is regarded as the “gold standard” to determine probable causes of stillbirths. However, autopsy is expensive and not readily available in low- and middle-income countries. Therefore, we assessed how the clinical cause of death is modified by adding placental histology and autopsy findings. MethodData from the Safe Passage Study was used where 7060 pregnant women were followed prospectively. Following a stillbirth, each case was discussed and classified at weekly perinatal mortality meetings. This classification was later adapted to the WHO ICD PM system. Clinical information was presented first, and a possible cause of death decided upon and noted. The placental histology was then presented and, again, a possible cause of death, using the placental and clinical information, was decided upon and noted, followed by autopsy information. Diagnoses were then compared to determine how often the additional information changed the initial clinical findings. ResultsClinical information, placental histology, and autopsy results were available in 47 stillbirths. There were major amendments from the clinical only diagnoses when placental histology was added. Forty cases were classified as due to M1: complications of placenta, cord, and membranes, when placental histology was added compared to 7 cases with clinical classification only, and M5: No maternal condition identified decreased from 30 cases to 3 cases. Autopsy findings confirmed the clinical and placental histology findings. DiscussionClinical information together with examination of the placenta revealed sufficient information to diagnose the most probable cause of death in 40 of 47 cases of stillbirth (85%).

Placental histology following assisted hatching in fresh transfer cycles.

To assess placental histological findings following assisted hatching in fresh transfer in vitro fertilization cycles. Evaluation of a historic cohort of live singleton deliveries after fresh embryo transfer (ET) at a single university medical center between 2009 and 2017. We compared perinatal outcomes and placental histology in cases where assisted hatching was performed prior to ET (AH group) and cases with no AH (no AH group). Overall, 166 deliveries following AH were compared to 494 deliveries with no AH. Patients' demographics were similar between the groups. Median antral follicle count was significantly lower in the AH group, median 11 (range 1-50) vs. 16 (range 1-80), p < 0.001, and the primary indication for infertility treatment significantly more often diminished ovarian reserve (p < 0.001). Cycle characteristics in the AH group included a higher gonadotropin dose employed, and a lower rate of single and blastocyte transfer. Pregnancies following AH were associated with less low-lying placentas, 0.6% vs. 6.2%, p = 0.001, and comparable for other perinatal outcomes. After adjusting for confounders, the rate of bilobated placentas was higher following AH, aOR 7.10, 95% CI 1.50-33.51. The rate of perivillous depositions was higher with AH, aOR, 95% CI 3.18, 1.46-6.93, and the rate of chorangiosis lower in this group, aOR, 95% CI 0.32, 0.11-0.93. The overall rate of vascular lesions was similar between the groups. Pregnancies following AH are notable for a lower rate of placenta previa, yet a higher rate of bilobated placentas and perivillous depositions and less chorangiosis, warranting further investigation.

Perinatal outcomes and placental histology in small-for-gestational-age pregnancies-A comparison of population-based and universal growth charts.

To assess obstetric, perinatal, and placental histologic findings in small-for-gestational-age (SGA) neonates according to different growth charts. A retrospective cohort of singleton deliveries from 2008 to 2019 were divided into SGA neonates according to the local population-based chart, SGA according to universal standard growth charts (but appropriate for gestational age [AGA] according to local charts) and AGA deliveries according to both charts. A total of 626 local population SGA deliveries, 132 universal SGA and 468 AGA deliveries were compared. The local population SGA group had a significantly higher rate of preterm and cesarean deliveries. An adverse neonatal outcome occurred in 27.2% of the local population SGA group, 9.8% of the universal SGA group and 6.7% of the AGA group (P< 0.001). In the local population SGA group, placental weight was lower, birth weight to placental weight ratio was highest, and the rate of maternal malperfusion lesions was highest-55.4% versus 45.4% in the universal SGA group and 39.1% in the AGA group (P< 0.001). Villitis of unknown etiology was significantly more common and histologic chorioamnionitis was significantly less common in the local population SGA group. Our findings support the use of a local population-based growth chart for the diagnosis of fetal growth restriction.

Pregnancy Complications, Correlation With Placental Pathology and Neonatal Outcomes.

We aimed to clarify and contribute to a better comprehension of associations and correlations between placental histological findings, pregnancy evolution, and neonatal outcomes. This is a longitudinal and prospective observational study, performed between May 2015 and May 2019, on 506 pregnant women. Clinical data related to pregnancy outcome, neonatal health status, and placental histology were primarily collected. Twin pregnancies or malformed newborns were excluded and therefore the study was conducted on 439 cases. These cases have been then subdivided into the following study groups: (a) 282 placentas from pathological pregnancies; and, (b) a control group of 157 pregnancies over 33 weeks of gestational age, defined as physiological or normal pregnancies due to the absence of maternal, fetal, and early neonatal pathologies, most of which had undergone elective cesarean section for maternal or fetal indication. A normal placenta was present in 57.5% of normal pregnancies and in 42.5% of pathological pregnancies. In contrast, placental pathology was present in 26.2% of normal pregnancies and 73.8% of pathological pregnancies. Comparison of the neonatal health status with the pregnancy outcome showed that, among the 191 newborns classified as normal, 98 (51.3%) were born from a normal pregnancy, while 93 (48.7%) were born from mothers with a pathological pregnancy. Among the 248 pathological infants, 59 (23.8%) were born from a mother with a normal pregnancy, while 189 (76.2%) were born from pregnancies defined as pathological. Placental histology must be better understood in the context of natural history of disease. Retrospective awareness of placental damage is useful in prevention in successive pregnancy, but their early identification in the evolving pregnancy could help in association with biological markers or more sophisticated instruments for early diagnosis.

Gestational diabetes mellitus in in-vitro fertilization pregnancies – Clinical and placental histological characteristics

We aimed to investigate obstetric and neonatal outcomes and placental histological findings in in vitro fertilization (IVF) pregnancies complicated by gestational diabetes mellitus (GDM) as compared to unassisted pregnancies. This was a retrospective cohort of deliveries at a single university affiliated center between 12/2008 and 01/2020. Included were singleton pregnancies complicated by GDM, for which placental histopathological examination was performed. Obstetric, neonatal and placental outcomes were compared between pregnancies following IVF and unassisted pregnancies. Placental lesions were categorized according to the "Amsterdam" criteria. Included were 688 deliveries with a diagnosis of GDM with placental examination - 69 IVF pregnancies (IVF group) and 619 unassisted pregnancies (control group). The IVF group was characterized by a significantly higher maternal age and higher rate of nulliparous women - 60.8% vs. 32.9%, p<0.001. There were no differences in GDM type between the study groups - about two thirds of cases were GDMA1 and on third GDMA2. A higher incidence of preeclampsia was noted in the IVF group - 17.3% vs. 9.3%, p=0.03, with no difference in cesarean deliveries and birthweight. IVF deliveries were characterized by a significantly higher rate of adverse neonatal outcomes - 18.8% vs. 8.8%, p=0.008, although this did not attain significance after adjustment to gestational age. No differences were noted in placental histology between the groups. GDM in IVF is associated with a significantly higher rate of adverse neonatal outcomes, as compared with non-assisted pregnancies complicated by GDM. Placental histology does not shed light on these clinical associations.

Sex of the Fetus can be Associated with Placental Pathologies in Premature Deliveries

Background: There are many pregnancy complications that are significantly associated with the gender of the fetus; one of them is preterm labour, which is an important obstetric problem that may lead to many perinatal morbidity and mortality. Objective: To find out whether there is a relation between the findings of placental pathology of premature deliveries and gender difference. Patients and Methods: Fifty deliveries before a 32 week gestational age. Obstetrical, and placental histological findings have been compared among all males (n=25), and females (n=25) premature neonates. Results: The male premature fetus had distribution rate in maternal age, gestation age at the time of delivery, placental weight, and feto-placental weight-ratio in females, but a higher birth-weight centile ([55.09±11.3] versus [43.09±8.2]). Histopathology of the placenta found no significant association of fetal-sex with acute inflammatory lesions (p=0.09), intra-placental vascular pathological findings, or utero-placental vascular pathology. However, the chronic inflammatory lesion showed a higher pathological score in male fetuses than in the females (p=0.01). Conclusion: Premature deliveries with less than thirty-two weeks, the male fetal-sex had higher placental pathological lesions, suggesting maternal immunological responses towards the invading trophoblasts. The immunological background of these pathological lesions needs further studies. Keywords: Male fetal sex, placental pathology, premature delivery

Factors associated with poor fetal outcome in placental abruption.

We aimed at describing placental abruption in our county and at evaluating factors associated with poor fetal outcome. In this case-control study, women with placental abruption were identified from two databases of Brest University Hospital between January 2013 and December 2018. Placental histological findings, course of pregnancies, maternal and fetal characteristics were described and compared between cases (placental abruption with stillbirth or neonatal death) and controls. We identified 135 placental abruption, of whom 24.4% were complicated with stillbirth and 6.5% with neonatal death. Forty percent of women were smokers and 14.1% had a history of vasculoplacental disorder. Pregnancies were complicated with 42.2% of pre-eclampsia and 43% of intrauterine growth restriction. Cases were associated with more autoimmune diseases in mother (20.0% versus 3.2%, P=0.003), more aspirin or heparin use during pregnancy (20.0% versus 6.3%, P=0.03), less pre-eclampsia (25.0% versus 49.5%, P=0.01) and more deliveries≤34weeks of gestation (80.0% versus 43.2%, P=0.0001) than controls. Placentas from cases showed more placental indentation≥30% (42.5% versus 5.3%, P<0.0001) and less histological chronic inflammation, especially less chronic chorioamniotitis (2.5% versus 24.2%, P=0.002) than controls. In multivariate analysis, factors negatively associated with poor fetal outcome were placental histological chronic inflammation (P=0.01) and macroscopic infarcts (P=0.01). Poor fetal outcome is negatively associated with certain placental histological chronic lesions, but not with pre-eclampsia, what suggests various pathophysiological processes among placental abruption.

Are we over-diagnosing vasa praevia? The experience and lessons learned in a tertiary centre.

Vasa praevia (VP) is a rare obstetric condition in which unprotected fetal vessels transverse the cervix, are vulnerable to rupture during labour and may result in rapid exsanguination of the fetus. Antenatal diagnosis of VP has resulted in excellent outcomes. However, there are little data available on the false positive rates for the antenatal diagnosis of VP. Improving accuracy of the diagnosis of VP can potentially improve outcomes and reduce unnecessary intervention. To assess our accuracy in the diagnosis of VP, examine our false positive diagnoses of VP and suggest strategies during antenatal ultrasound to aid in the antenatal diagnosis of VP. We conducted a retrospective descriptive study of women diagnosed with VP antenatally over 11years at a single tertiary hospital and eligible patients were identified from obstetric databases. All medical records, including ultrasound reports, were reviewed and compared with the placental histological findings and both operative and midwifery documentation of the cord insertion. Twenty-three women (25 babies) were diagnosed with VP and underwent a caesarean section delivery at a mean gestational age of 36weeks. The false positive rate in our series was 17% (4/23). Our study highlights the importance of postnatal confirmation of the diagnosis of VP and careful documentation of intraoperative findings of the placenta and cord insertion. We suggest strategies to aid in the accurate diagnosis of VP, thereby improving clinical decision-making and reducing unnecessary intervention.

Isolated Leukocytosis to Predict Chorioamnionitis in Preterm Prelabor Rupture of Membranes Between 24 and 33 Weeks [21K

INTRODUCTION: During Prelabor Premature Rupture of Membranes (PPROM), Chorioamnionitis is an indication for delivery; hence prompt diagnosis is of major relevance for maternal and neonatal outcome. Chorioamnionitis can affect about 40-70% of preterm births with premature rupture of membranes. The objective of this study is to assess the relevance of isolated leukocytosis in predicting Chorioamnionitis during PPROM between 24 and 33 weeks. METHODS: In this retrospective study performed at our institution from 2014 to 2017, 161 pregnancies with PPROM where selected. The last white blood cell count (WBC) obtained before delivery was used as an indicator for Chorioamnionitis, which was diagnosed by placental histologic findings. Patients were classified as PPROM without Chorioamnionitis and with Chorioamnionitis with and without Leukocytosis (&gt;15,000 cells/ml). Time of when Celestone was given in relation to the last WBC obtained, indication for delivery and presence of other signs of infection including fever were documented. RESULTS: 81 patients had PPROM without Chorioamnionitis; only 9 (11%) had leukocytosis. From the patients with Chorioamnionitis, 50 (62.2%) had leukocytosis (Average WBC 17,500) and 30 (37.8%) did not (Average WBC 9,900). 85% of the patients with leukocytosis had Chorioamnionitis. Only 2.5% of patients with Chorioamnionitis had fever and 20% of the patients with Chorioamnionitis were delivered due to suspected infection. Sensitivity for Leukocytosis was 62.5% with specificity of 88.8%. Receiver operating characteristic AUC was 0.723 (p value&lt;0.001, 95% confidence interval 0.6396 to 0.8066). CONCLUSION: Isolated leukocytosis can become a strong predictor for Chorioamnionitis if repeated periodically during PPROM between 24 and 33 weeks.

Association of late second trimester miscarriages with placental histology and autopsy findings

ObjectivesTo describe the placental histology and autopsy findings in pregnancies where fetal demise occurred before a gestational age of 22 weeks. Study designThis study was a subset of a larger study where the effect of alcohol exposure during pregnancy on stillbirths was studied. In a prospective cohort, 7,010 singleton pregnancies were followed from the first antenatal visit until infant one year of age visit. Gestational age was assessed by ultrasound, preferably at the first antenatal visit. All pregnancy losses were identified and when the fetuses delivered at or after a gestation of 20 weeks, the mother or parents were approached for consent for autopsy. This study describes the placental pathology and findings at autopsy in losses before 22 weeks gestation (late second trimester miscarriages). ResultsFourteen cases were identified in which 13 had an autopsy and 12 had a histological examination of the placenta. The most prevalent histological abnormality was placental abruption which was seen in 6 miscarriages, occasionally on its own, or in combination with maternal vascular malperfusion or acute chorioamnionitis. The second most frequent finding was maternal vascular malperfusion, as found in five placentas, alone or in combination with other pathology. The third most frequent pathology was acute chorioamnionitis, found in four placentas, in combination or alone. Other causes were diffuse chronic villitis due to cytomegalovirus infection and early amnion rupture with anhydramnios and cord obstruction. ConclusionsCauses of fetal demise at the end of the second trimester differ little from causes of stillbirth. There is value in using placental histology in late second trimester miscarriages to try to identify the cause of demise.

The Contribution of an Infectious Workup in Understanding Stillbirth.

This study was aimed to assess the utility of diagnostic tests of maternal and fetal infection in the evaluation of stillbirth. A single-center retrospective study from January 2011 to December 2016 of all women presenting to the hospital with intrauterine fetal death at or after 20 weeks of gestation. Standard evaluation included review of medical records, clinical and laboratory inflammatory workup, maternal serologies, fetal autopsy, placental pathology, and fetal and placental cultures. A suspected infectious etiology was defined as meeting at least two diagnostic criteria, and only after exclusion of any other identifiable stillbirth cause. During the 7-year study period, 228 cases of stillbirth were diagnosed at our center. An infectious etiology was the suspected cause of stillbirth in 35 cases (15.3%). The mean gestational age of infection-related stillbirth was 28 1/7 (range: 22-37) weeks, while for a noninfectious etiology, it was 34 0/7 (range: 25-38) weeks (p = 0.005). Placental histological findings diagnostic of overt chorioamnionitis and funisitis were observed in 31 (88.5%) cases. In 16 (45.7%) cases the placental and fetal cultures were positive for the same pathogen. Serology of acute infection was positive in three (8.5%) of the cases. Maternal and fetal infectious workup is valuable in the investigation of stillbirth, particularly before 30 weeks of gestation and should be considered a part of standard evaluation.

Placental Findings in Postpartum Preeclampsia: A Comparative Retrospective Study.

Preeclampsia is a multifactorial placental disease that can occur after delivery. The pathophysiology of postpartum preeclampsia remains unknown. The objective was to describe placental findings in postpartum preeclampsia. This is a case-control study, comparing the placental histologic findings in four groups of 30 patients with postpartum preeclampsia, early-onset preeclampsia, late-onset preeclampsia, and normotensive controls. Placentas of postpartum preeclampsia had a mean placental weight not different from that of late-onset preeclampsia at a similar gestational age (479.0 ± 152.7 vs. 521.3 ± 144.1 g, p = 0.07); they showed a higher rate of acute deciduitis of 42.4% than early preeclampsia (5.7%, p < 0.01) or in controls (3.2%, p < 0.01); 18.2% had decidual arteriolopathy, with no significant difference with other groups. These placentas had fewer villous infarcts as compared with early preeclampsia (9.1 vs. 62.9%, p < 0.01) and less accelerated maturation of villi (24.2 vs. 74.3%, p < 0.01). There were no significant differences for decidual arteriolopathy and villous infarcts among postpartum preeclampsia, late-onset preeclampsia, and the controls. This suggests that postpartum preeclampsia is more of a maternal disease in which the placenta may act as a priming effect in predisposed mothers and becomes clinically apparent after delivery.

Preterm birth subtypes, placental pathology findings, and risk of neurodevelopmental disabilities during childhood

IntroductionPreterm birth (PTB) and in-utero inflammation are recognized risk factors of neurodevelopmental disabilities (NDDs); however, their combined role in NDDs is unknown. We examined the independent and joint association of PTB and placental histological findings with the childhood risk of NDDs (overall and by subgroups including autism spectrum disorder (ASD) and ADHD). MethodsWe analyzed data from the Boston Birth Cohort, where mother-infant pairs were enrolled at birth and followed from birth onwards. Birth outcomes, placental pathology and NDDs were obtained from electronic medical records. Placental pathology was categorized using a standardized classification system proposed by the Amsterdam Placental Workshop Group. ResultsPTB (all, including spontaneous, medically indicated) was an independent risk factor for NDDs. Placental histological chorioamnionitis (CA) and PTB additively increased the odds of NDDs (aOR: 2.16, 95% CI: 1.37, 3.39), as well as ADHD (aOR: 2.75, 95% CI: 1.55, 4.90), other developmental disabilities (aOR: 1.96, 95% CI: 1.18, 3.25) and possibly ASD (aOR: 2.31, 95% CI: 0.99, 5.39). The above associations were more pronounced in spontaneous than medically indicated PTB. PTB alone in the absence of CA only had a moderate association with ASD and ADHD. Placental maternal vascular malperfusion alone or in combination with PTB was not associated with the risk of NDDs. DiscussionOur study provided new insights on PTB and NDDs by further considering preterm subtypes and placental histology. We revealed that children of spontaneous PTB along with histological CA were at the highest risk for a spectrum of NDDs.

239: The contribution of an infectious workup to understanding stillbirth

Stillbirth remains unexplained in a significant proportion of fetuses, even after a thorough evaluation. Despite the known contribution of infectious etiologies to this devastating pregnancy outcome, the yield such a workup is of unproven benefit. We aimed to assess the utility of diagnostic tests of maternal and fetal infection in the evaluation of stillbirth. A single center retrospective study from 1/2011-3/2017 of all women presenting to the hospital with intra-uterine fetal death at or after 20 weeks of gestation. Standard evaluation included a maternal interview, review of medical records, clinical and laboratory inflammatory workup, serology testing (for syphilis, Parvovirus B19, Rubella, CMV, Listeria, Toxoplasmosis, Hepatitis B and C) fetal autopsy, placental pathology and fetal and placental cultures. Additional standard stillbirth workup, including Kleinhauer-Betke, blood for group and screen and HbA1C, was obtained. An infectious etiology was considered the underlying cause of stillbirth if it was supported by at least two diagnostic tests (concordant pathogenic maternal and fetal cultures, histological chorioamnionitis, maternal symptoms of infection or positive serologies) and there was no other probable cause. During the 7-year study period, 228 cases of stillbirth occurred. Placental histological findings diagnostic of overt chorioamnionitis were observed in 69 (30.3%) cases. Serologies of acute infection were positive in 11 (4.8%) of the cases. In 39 cases the placental and abortus cultures were positive for the same pathogen. An infectious etiology was the probable cause of stillbirth, supported by at least two diagnostic tests, in 35 cases (15.3%). The mean gestational age of stillbirth caused by an infection was 29 weeks, while for a non-infectious etiology it was 32 weeks (p=0.005). Diagnostic tests of maternal and fetal infection are valuable in the investigation of stillbirth, particularly before 30 weeks of gestation and should be considered a part of standard evaluation.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

152. Placental pathology and neonatal outcome in relation to uterine artery Doppler velocimetry in pregnancies complicated by placenta syndrome

Objectives High resistance utero-placental circulation leads to placenta insufficiency related complications for both mother and fetus. The objective of this study was to evaluate the relationship between abnormal uterine artery pulsatility index (UtAPI) Doppler measurements, neonatal outcome and placental histological findings in placenta syndrome (PS) pregnancies. Methods A retrospective pilot study was performed on singleton pregnancies complicated by PS (pre-eclampsia and/or foetal growth restriction). UtA, umbilical (UmbA) and middle cerebral artery (MCA) Doppler measurements were collected within the last two weeks prior to delivery. Patients were divided into two groups according to UtAPI values, in which UtAPI > p95 was considered abnormal. Histological lesions were classified according to the criteria of the Society for Pediatric Pathology. Statistical analysis was performed using independent T-, Mann-Whitney U- and Fisher’s exact test. Multivariate analysis was used to correct UtAPI for gestational age (GA) at delivery and parity. Results The UtA-PI > p95 group (n = 25) showed a higher rate of premature delivery (p = 0,025), caesarean section (p = 0,007) and NICU-admission (p = 0,001) compared to the UtA-PIp95 group showed a significantly higher UmbA-PI (p = 0,004) with absent or reversed flow (p = 0,002), a lower MCA-PI (p = 0,010) and cerebro-placental ratio (p Conclusions In pregnancies complicated by PS, UtA-PI > p95 showed a moderate predictive ability for placental underperfusion independently of GA at delivery and parity. Furthermore, neonatal outcome and Doppler measurements were poorer.

Perinatal outcome and placental apoptosis in patients withlate-onset pre-eclampsia and abnormal uterine artery Doppler at diagnosis.

To determine the rate of placental apoptosis and adverse perinatal outcome in patients with late-onset pre-eclampsia (PE) and abnormal uterine artery (UtA) Doppler at diagnosis. This was a prospective cohort study of women with singleton pregnancy diagnosed with late PE, performed between August 2011 and January 2014 at the Maternal-Fetal Medicine Unit of Hospital Carlos Van Buren. Patients were stratified according to UtA Doppler status at diagnosis (pulsatility index (PI) ≤ or > 95th percentile). Logistic regression analysis was performed to identify associations between abnormal UtA Doppler and adverse maternal and perinatal outcomes. In a subset of this cohort for whom placental samples were available, immunohistochemical analysis of the placenta was performed to identify the rate of apoptosis and its association with UtA Doppler by comparing samples from those with normal and those with abnormal UtA Doppler and normotensive controls. Non-parametric linear trend analysis was performed for assessment of the apoptotic index. Eighty-six patients were included in the final analysis. Of these, UtA-PI was above the 95th percentile in 33 (38.4%) patients. Gestational age at diagnosis and delivery were significantly lower in this group compared with patients with normal UtA Doppler. Abnormal UtA Doppler was associated with increased risk of severe PE (odds ratio (OR) = 7.5; 95% CI, 2.76-20.46; P < 0.001), late preterm delivery (OR = 13.7; 95% CI, 4.53-41.46; P < 0.001), small-for-gestational age at birth (OR = 12.3; 95% CI, 3.17-47.57; P < 0.001) and admission to the neonatal intensive care unit (OR = 12.8; 95% CI, 2.61-62.36; P = 0.002). Moreover, UtA Z-score demonstrated a significant inverse correlation with birth-weight Z-score (r = -0.34; P = 0.0013). Mean placental apoptotic index demonstrated an ascending linear trend according to UtA Doppler status (P = 0.04). In patients with late PE, UtA Doppler was useful for clinical classification and as an indicator of placental histological findings. Correlation between UtA Doppler and the apoptotic index provides new evidence of a subgroup of late PE with a placental origin. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

989: Obstetric outcomes and placental findings in gestational diabetes patients according to pre-gestational weight and weight gain

We aimed to assess clinical outcomes and placental lesions among gestational diabetes patients according to pre-gestational weight and weight gain during pregnancy. This was a cohort of all GDM deliveries at our institution during 2009-2015. We defined two groups: high BMI group - pre-gestational BMI >30 and or gestational weight gain>20 kg, and normal BMI group. Placentas were examined by a single pathologist and described according to new Redline classification. Placental weight (PW) was noted, as were additional histopathological findings. 685 deliveries with a diagnosis of GDM were reviewed (3.2% of all deliveries). BMI status was available for 429 patients, of which 221 (51.5%) had a high BMI and 208 (48.3%) had a normal BMI. Pathological reports were available for 144 of these patients. Similar age, gravidity and parity were noted in both groups, but high BMI patients displayed a higher rate of GDMA2 (41.6% vs. 30.2%, p=0.01). Despite similar gestational age at delivery, high BMI patients’ birth weight was significantly higher (3475 ± 508 gr vs. 3242 ± 503 gr, p<0.001) with more large for gestational age neonates (33.1% vs. 13.9%, p<0.001), and a trend for more cesarean deliveries (CD), 49.3% vs. 40.8%, p=0.07. By logistic regression, past CD and high BMI were independently associated with CD, while GDM type and birth weight were non-significant. Placental weight was increased among high BMI patients. However, this did not retain significance after adjustment for birth weight, and GDM type. No differences were demonstrated in other placental histological findings. GDM pregnancies accompanied by increased weight gain or elevated pre-gestational BMI are associated with adverse obstetric outcomes, despite similar placental findings. Patient should be advised regarding these outcomes, as gestational weight gain may determine delivery mode.

Placental development and function in women with a history of placenta-related complications: a systematic review.

Women with a history of placenta-related pregnancy complications, such as preeclampsia, intrauterine growth restriction or preterm delivery, have an increased risk for recurrence of such complications. This recurrence is likely the result of underlying endothelial dysfunction that leads to abnormal placentation, especially in complications with an early onset. This study provides an overview of biomarkers of placental development and function in pregnancies from women with a history of placenta-related complications. A systematic literature search was conducted limited to human studies and including keywords related to a history of placenta-related complications and markers of placental development and function. Two independent reviewers assessed eligibility and quality of 1553 retrieved unique articles. Five articles reporting on placental development and function in women with an obstetric history of preeclampsia (n=3), intrauterine growth restriction (n=1) and preterm delivery (n=2) were eligible for quality assessment. We identified associations between a history of preeclampsia and abnormal placental histological findings at term in the current pregnancy, but found contradictory results regarding presence of uterine artery notching. In women with a history of very preterm delivery (<32weeks), one study showed associations with abnormal placental histology. Literature on the association between a history of placenta-related complications and placental development and function in subsequent pregnancies is scarce and studies are heterogeneous. However, literature shows that placenta-related pregnancy complications are associated with subsequent placental histology.