Placental Histopathological Changes Research Articles

Correlations of Placental Histopathology, Neonatal Outcome, and Cardiotocogram Baseline Variability and Acceleration Patterns in the Growth Restricted Preterm Population.

To evaluate the possible connections of cardiotocography (CTG) signs with neonatal outcome and placental histopathology between growth restricted preterms. Placental slides, baseline variability, and acceleration patterns of cardiotocograms, and neonatal parameters were studied retrospectively. Placental histopathological changes were diagnosed according to the Amsterdam criteria; percentage of intact terminal villi and capillarization of villi were also studied. 50 cases were analyzed: 24 were early-onset fetal growth restriction (FGR), 26 were late-onset FGR. Reduced baseline variability was related to poor neonatal outcome; lack of accelerations similarly had associations with poor outcomes. Maternal vascular malperfusion, avascular villi, VUE, and chorangiosis were more common in the background of reduced baseline variability and absence of accelerations. Lower percentage of intact terminal villi was significantly associated with lower umbilical artery pH, higher lactate levels, and reduced baseline variability on CTG; absence of accelerations was correlated with decreased capillarization of terminal villi. Baseline variability and absence of accelerations seem to be useful and reliable markers in predicting poor neonatal outcome. Maternal and fetal vascular malperfusion signs, decreased capillarization, and lower percentage of intact villi in placenta could contribute to pathologic CTG signs and poor prognosis.

Effect of Parity on Placental Histopathology Features in Singleton Live Births Following IVF.

The aim of this study was to evaluate the effect of parity (primipara vs multipara) on the histopathology of the placenta in singleton live births following in vitro fertilization. We conducted a retrospective cohort study evaluating data of all IVF resulted live births from one university affiliated hospital during 2009-2017. All patients had the placenta sent for pathological evaluation. Exclusion criteria were history of miscarriage or elective termination of pregnancy, abnormal uterine cavity findings, previous uterine surgery, in vitro maturation cycles, gestational carrier cycles, oocyte recipient cycles, preimplantation genetic diagnosis cycles, and multiple pregnancies. The outcomes measured included anatomical, inflammation, vascular malperfusion, and villous maturation placental features. A multivariate analysis was conducted to adjust the results for factors potentially associated with placental pathology features. A total of 395 live births were included in the final analysis and were allocated to the study groups according to parity: primipara (n = 273) and multipara (n = 122). After adjustment for potential confounding factors, multiparity was found to be significantly associated with delayed villous maturation (OR 4.9; 95% CI 1.2-19.8) and primiparity was significantly associated with maternal vascular malperfusion (OR 0.6; 95% CI 0.3-0.8). We showed that parity has an impact on placental histopathological changes which in turn may affect perinatal outcome.

Body mass index implications in intrahepatic cholestasis of pregnancy and placental histopathological alterations

Introduction and objectivesIntrahepatic cholestasis is a frequent disease during pregnancy. It is unknown if liver function alterations produce specific placental lesions. The aim of this study was to evaluate placental histopathological changes in patients with intrahepatic cholestasis of pregnancy (ICP), and to explore correlations between the placental histopathology and hepatic function alteration or patient comorbidities, and body mass index. Patients and methodsA retrospective cohort study included women with ICP, most of them showing comorbidities such as overweight/obesity, preeclampsia and gestational diabetes. They were attended at the National Institute of Perinatology in Mexico City for three years. Placental histopathological alterations were evaluated according to the Amsterdam Placental Workshop Group Consensus Statement. Data was analyzed using Graph-Pad Prism 5. ResultsThe results indicated that the placenta of ICP patients showed many histopathological alterations; however, no correlations were observed between the increase in bile acids or liver functional parameters and specific placental lesions. The most frequent comorbidities found in ICP patients were obesity, overweight and preeclampsia. Surprisingly, high percentage of ICP patients did not respond to UDCA treatment independently of the BMI group to which they belonged. ConclusionThe data suggest that ICP contribute to placental lesions. In addition, in patients with normal weight, an increase of chorangiosis and a reduced accelerated villous maturation without syncytial knots were observed in comparison with overweight and obese patients. It is necessary to improve the medical strategies in the treatment and liver disfunction surveillance of ICP patients.

Placenta, the Key Witness of COVID-19 Infection in Premature Births.

Adverse perinatal outcomes, such as increased risks of pre-eclampsia, miscarriage, premature birth, and stillbirth have been reported in SARS-CoV-2 infection. For a better understanding of COVID-19 complications in pregnancy, histopathological changes in the placenta, which is the interface between mother and foetus, could be the place to look at. The aim of this study was to determine placental histopathological changes and their role in preterm birth in pregnant women with SARS-CoV-2 infection. We performed a prospective, observational study in a COVID-only hospital, which included 39 pregnant women with SARS-CoV-2 infection and preterm birth compared with a control group of 39 women COVID-19 negative with preterm birth and a placental pathology exam available. The microscopic examination of all placentas revealed placental infarction (64.1% vs. 30.8%), decidual arteriopathy (66.7% vs. 23.1%), intervillous thrombi (53.8% vs. 38.5%), perivillous fibrin deposits (59% vs. 46.2%), inflammatory infiltrate (69.2% vs. 46.2%), chorangiosis (17.9% vs. 10.3%), and accelerated maturation of the villi (23.1% vs. 28.2%).

Placental morphology in Covid-19: A study in tertiary hospital in Telangana

Due to emerging new variants of Corona virus, study of placental histopathological changes helps in understanding its tissue tropism and effects of the virus of maternal and foetal morbidities. Prospective Observational Study.To evaluate and describe histopathologic findings in the placentas of women affected with COVID19. A total of 16 placentas from pregnant women who were infected with COVID-19 in any gestational age and delivering between March 2020 and February 2022 were examined and compared with normal third trimester placentas received in the same time period. Among the 16 placentas examined, most significant change as a sign of maternal malperfusion is increased intervillous fibrin deposition, which is seen in 81.25% cases, followed by infarction, calcification, increased syncytial knots, haemorrhage, calcification, vascular congestion and fibrin thrombi. Most significant foetal malperfusion sign is Chorangiosis which is seen in 37.5% cases, followed by thrombi in umbilical vessels. Also, 25% of the placentas examined showed Villitis, 18.75% showed Deciduitis, 6.25% showed Chorioamnionitis and 6.25% showed vasculitis. COVID-19 placentas show increased prevalence of decidual arteriopathy and features of foeto-maternal vascular malperfusion which can be related to the consequences in foetus like Preterm delivery, IUGR and respiratory distress.

Factors Associated with the Severity of Pregnancy-Related Hypertensive Disorder: Significance of Clinical, Laboratory, and Histopathological Features.

The purpose of this paper is to evaluate the association of maternal clinical and laboratory features and placental histopathological changes with disease severity in pregnancy-related hypertensive disorders. From January 2021 to December 2021, clinical and laboratory data at the time of delivery and histopathological features of the placenta were collected from pregnant women with pregnancy-related hypertensive disorders at a single institution. The women were classified according to the pregnancy-related hypertensive disorder clinical severity, and each variable was compared accordingly. Gestational age-matched normotensive groups were also compared. Univariate and multivariate regression analyses were used to identify factors influencing pregnancy-related hypertensive disorder severity. Fifty-eight pregnancies were analyzed. Maternal albumin levels before delivery (beta coefficient −0.83, p = 0.043) and increased placental syncytial knots (beta coefficient 0.71, p = 0.026) are important parameters that are closely related to disease severity in women with pregnancy-related hypertensive disorders. The combination of albumin, PAPP-A, total bilirubin, and eGFR levels appears to be optimal for predicting pregnancy-related hypertensive disorder severity.

Association of Maternal Serum Ischemia Modified Albumin (IMA) with Placental Histopathological Changes and Fetomaternal Outcome: A Prospective Case Control Study in Normotensive and Pre-eclamptic Women.

Ischemia and oxidative stress leads to generation of hydroxyl free radicals and modification of 'N-terminus' of human serum albumin. This modified albumin molecule, known as Ischemia Modified Albumin (IMA), is elevated in early stages of ischemia. It has recently been approved by US Food and Drug Administration (US FDA) for its clinical use, as early marker of myocardial ischemia in cardiology. IMA is a novel marker of ischemia and is elevated in other clinical conditions associated with ischemia like pulmonary embolism, uncontrolled type II diabetes mellitus, acute decompensated heart failure, preeclampsia, recurrent pregnancy losses and IUGR. Role of IMA in birth asphyxia in perinatology is of current interest and needs further research. A prospective case control study was conducted in a tertiary center in North India for one year. Total 80 pregnant women between 34 and 40weeks were recruited and allocated in two groups. Case group comprised of 40 pre-eclamptic pregnant women and control group comprised of 40 normotensive pregnant women. Comparison and association of maternal serum IMA levels with fetomaternal outcome and number and types of placental histopathological changes was done in two groups. In preeclampsia group mean serum IMA (115.23 ± 49.51) was significantly higher as compared to the normotensive group (79.21 ± 14.35). The optimum cut off value of IMA to detect a case was 94.5IU/ml (sensitivity 65%, specificity 87.5%, PPV 83.9%, NPV 71.4% and diagnostic accuracy of 76.3). Pre-eclamptic women, had significantly higher incidence of PTVD, lower fetal birth weight and placental histopathological changes as compared to normotensive group. 83.8% of the women with raised IMA levels were pre-eclamptic. Raised IMA levels were significantly associated with higher incidence of PTVD, birth weight ≤ 2kg and hypoxic histopathological lesions of chorangiosis, intervillous fibrin and hyalinization. Determination of maternal serum IMA levels early in pregnancy can predict preeclampsia and avoid future severe preeclampsia related complications. It might be useful to optimize both maternal and fetal/neonatal outcomes.

Does COVID-19 cause pre-eclampsia?

Does COVID-19 cause pre-eclampsia?

Impact of oxidative stress in response to malarial infection during pregnancy: Complications, histological changes, and pregnancy outcomes.

Background and Objectives:Pregnancy malaria is a major underestimated global public health problem. To understand the involvement of oxidative stress (OS) in the pathophysiology of placental malaria, OS biomarkers, malondialdehyde (MDA), uric acid (UA), and superoxide dismutase (SOD) levels were analyzed and correlated to placental histopathological changes and pregnancy outcomes.Methods:A hospital-based study was conducted in Mangaluru, Karnataka, India, to analyze the changes in hematological parameters and the serum OS biomarker levels. Histological analysis of placenta, associated complications, and pregnancy outcomes were compared using Kruskal–Wallis test, and pairwise comparison between two groups was made by Mann–Whitney U-test. Correlations were calculated by Pearson's and Spearman's rank correlations.Results:Among 105 pregnant women, 34 were healthy controls and the infected group comprised of Plasmodium Vivax (Pv) (n = 48), Plasmodium falciparum (Pf) (n = 13), and mixed (n = 10) malaria infections. Of 71 infected cases, 67.6% had mild malaria, whereas 32.4% had severe malaria. The white blood cell and C-reactive protein levels were found to increase, whereas hemoglobin, red blood cell, and platelet levels decreased during both types of malarial infections. The MDA and UA values increased and SOD levels decreased particularly during severe Pf infections. Histological changes such as syncytial knots, syncytial ruptures, and fibrinoid necrosis were observed particularly during Pf infections and leukocyte infiltration was observed in Pv malariaConclusion:Evaluation of MDA, UA, and SOD levels can serve as an indicator of OS during pregnancy malaria. The OS during pregnancy may lead to complications such as severe anemia, pulmonary edema, intra uterine growth retardation, premature delivery, and low birth weight, not only during Pf but also in Pv malaria. It is important to create awareness among rural and immigrant population residing in Mangaluru and its surroundings about required preventive measures and free government-supported antenatal care services.

Apoptotic endocrinal toxic effects of perchlorate in human placental cells.

Perchlorate is a strong oxidizing agent and has many adverse health effects. This study investigated the potential oxidative, apoptotic, and endocrinal toxic effects of perchlorate in human placenta-derived mesenchymal stem cells (HP-MSCs). HP-MSCs were treated with two doses of perchlorate (5 and 15 μg/L) for three days. The perchlorate's effects were detected by histopathological examination, aromatase/CYP19 A1 activity, reactive oxygen species production (ROS), and Caspase-3 expression. The highest perchlorate concentration (15 μg/L) caused significant placental histopathological changes. The placental cell viability was significantly affected by a significant increase in ROS generation; caspase-3 expression, and a significant reduction of CYP 19 activity. Despite the slight induction effect of the lowest perchlorate concentration (5 μg/L) on caspase 3 expression, CYP 19 activity, and ROS generation, it did not affect placental cellular viability. This study suggested that perchlorate could modulate aromatase activity and placental cytotoxicity. The continuous monitoring of the actual perchlorate exposure is needed and could be cost-effective.

Placental fractalkine immunoreactivity in preeclampsia and its correlation with histopathological changes in the placenta and adverse pregnancy outcomes*

Introduction: Preeclampsia is a systemic inflammatory disorder and a major cause of maternal and fetal mortality. Fractalkine (CX3CL1) is a member of the chemokine family with multiple functions in the organization of the immune system. It is up-regulated in inflammatory disorders. During inflammation, fractalkine enhances tissue destruction and inflammatory cell invasion. We aimed to investigate the alteration of fractalkine in the placental tissues of pregnant women with preeclampsia and the correlation of this alteration with clinicopathological variables.Materials and methods: Alteration of fractalkine in placental tissue specimens was determined immunohistochemically in 84 pregnant women: 33 women with mild preeclampsia, 19 women with severe preeclampsia, and 30 women with normal pregnancy. Preeclampsia was diagnosed using current guidelines of the American College of Obstetricians and Gynecologists.Results: Pregnant women with mild and severe preeclampsia revealed significantly higher fractalkine expression in syncytiotrophoblast cells than in the normotensive group (p = .0051 and .0001, respectively). The expression of fractalkine in preeclampsia was positively correlated with clinical parameters including the presence of intrauterine growth restriction, systolic and diastolic blood pressure, and 24-h urine protein, whereas it was negatively correlated with plasma albumin levels and placental weight. Additionally, the pathological changes in the placenta-including the presence of syncytiotrophoblast basement membrane thickening, increased number of syncytial knots, and vascularization of terminal villi were significantly correlated with fractalkine expression in pregnant women with preeclampsia.Conclusions: Overexpression of fractalkine in pregnant women with preeclampsia, as well as the correlation between fractalkine expression and poor pregnancy outcomes and placental histopathological changes may be associated with the underlying mechanisms of preeclampsia.

Bronchopulmonary dysplasia-associated pulmonary hypertension: clues from placental pathology.

Bronchopulmonary dysplasia (BPD) and the associated complication of pulmonary hypertension (PH) leads to increased mortality and a longer length of stay among survivors. Placental histopathology may give early clues of subsequent events. The objective was to evaluate the relationship of maternal vascular underperfusion (MVU) changes on placental histopathology with subsequent development of BPD-associated PH in a cohort of extremely premature infants. In a cohort of preterm infants '⩽28 weeks' gestational age (GA) and with 'severe' BPD, this retrospective study evaluated specific placental histopathological changes and assessed the relationship with subsequent development of PH. 'Severe' BPD was defined as the need for ⩾30% oxygen and/or positive pressure ventilation at 36 weeks postmenstrual age. Placental and echocardiographic assessments were done by investigators masked to the grouping and clinical outcomes. Fifty six infants with severe BPD formed the cohort; PH was noted in 22 (39.3%) infants. The GA of the infants with and without PH was comparable (25.8±1.6 vs 25.8±1.3 weeks, P=0.9). On placental histopathological examination, 13 (23%) had features of MVU. On univariate logistic regression, the presence of changes consistent with MVU increased the relative risk of subsequent BPD-associated PH by 2.75 (95% confidence interval 1.56 to 4.85, P=0.004). The significance persisted after adjustment for GA. Stratification by the presence or absence of fetal growth restriction, yielded nonsignificant associations (P=0.17). Based on the results of the present study, specific placental histopathological changes may give early clues to the subsequent development of BPD-associated PH.

Factors Associated With Toxoplasma gondii IgG and IgM Antibodies, and Placental Histopathological Changes Among Women With Spontaneous Abortion in Mwanza City, Tanzania

Background: Toxoplasma gondii infection in early pregnancy has been associated with significant adverse pregnancy outcomes. Despite being common in the city of Mwanza, its association with spontaneous abortion has never been studied. Here, we report the IgG and IgM seropositivity and histopathological changes of toxoplasmosis among women with spontaneous abortion. Methods: A total of 260 women with spontaneous abortion were enrolled between November 2015 and April 2016 from 4 hospitals in Mwanza city. Specific T. gondii IgG and IgM antibodies were detected from sera by indirect enzyme-linked immunosorbent assay (ELISA) while the conceptus tissues were stained with haematoxylin and eosin to demonstrate histopathological changes. Data were analysed by using Stata version 13. Results: The mean age of the enrolled women was 26±5.9 years. The seropositivity of IgG and IgM antibodies were 144/260 (55.4%; 95% confidence interval [CI], 49–61) and 6/260 (2.3%; 95% CI, 3–8), respectively. IgG seropositivity was significantly high among women in the first trimester (59.1% vs.43.5%; P=.03). Only low gestation age (odds ratio [OR] 1.11; 95% CI, 1.02–1.20; P=.02) and keeping a cat (OR 11.80; 95% CI, 1.32–10.5; P=.03) independently predicted IgG and IgM seropositivity, respectively. Presence of inflammation (OR 1.95; 95% CI, 1.05–3.64; P=.03), calcification (OR 3.28; 95% CI, 1.01–10.63; P=.04), necrosis (OR 2.86; 95% CI, 1.39–5.89; P=.04), and lymphocyte infiltrations (OR 2.24; 95% CI, 1.17–4.24; P=.01) were significantly associated with T. gondii IgG seropositivity. Conclusions: Almost half of women with spontaneous abortion in the city of Mwanza have specific T. gondii IgG antibodies. Placental histopathological changes suggestive of toxoplasmosis were significantly found among IgG seropositive women. This calls for the need to screen these women during antenatal visits in order to institute appropriate measures, such as treatment and counselling, to prevent complications associated T. gondii infection.

Factors Associated With Toxoplasma gondii IgG and IgM Antibodies, and Placental Histopathological Changes Among Women With Spontaneous Abortion in Mwanza City, Tanzania.

Background:Toxoplasma gondii infection in early pregnancy has been associated with significant adverse pregnancy outcomes. Despite being common in the city of Mwanza, its association with spontaneous abortion has never been studied. Here, we report the IgG and IgM seropositivity and histopathological changes of toxoplasmosis among women with spontaneous abortion.Methods:A total of 260 women with spontaneous abortion were enrolled between November 2015 and April 2016 from 4 hospitals in Mwanza city. Specific T. gondii IgG and IgM antibodies were detected from sera by indirect enzyme-linked immunosorbent assay (ELISA) while the conceptus tissues were stained with haematoxylin and eosin to demonstrate histo-pathological changes. Data were analysed by using Stata version 13.Results:The mean age of the enrolled women was 2665.9 years. The seropositivity of IgG and IgM antibodies were 144/260 (55.4%; 95% confidence interval [CI], 49–61) and 6/260 (2.3%; 95% CI, 3–8), respectively. IgG seropositivity was significantly high among women in the first trimester (59.1% vs.43.5%; P=.03). Only low gestation age (odds ratio [OR] 1.11; 95% CI, 1.02–1.20; P=.02) and keeping a cat (OR 11.80; 95% CI, 1.32–10.5; P=.03) independently predicted IgG and IgM seropositivity, respectively. Presence of inflammation (OR 1.95; 95% CI, 1.05–3.64; P=.03), calcification (OR 3.28; 95% CI, 1.01–10.63; P=.04), necrosis (OR 2.86; 95% CI, 1.39–5.89; P=.04), and lymphocyte infiltrations (OR 2.24; 95% CI, 1.17–4.24; P=.01) were significantly associated with T. gondii IgG seropositivity.Conclusion:Almost half of women with spontaneous abortion in the city of Mwanza have specific T. gondii IgG antibodies. Placental histopathological changes suggestive of toxoplasmosis were significantly found among IgG seropositive women. This calls for the need to screen these women during antenatal visits in order to institute appropriate measures, such as treatment and counselling, to prevent complications associated T. gondii infection.

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Objectives To evaluate if placental histopathological changes of vascular insufficiency correlate with circulating angiogenic factors in patients with preeclampsia. Methods Subjects were selected from a previous prospective cohort study of preeclampsia based on availability of plasma anti-angiogenic factor (sFlt1) and pro-angiogenic factor (PlGF) measurements and placental histology specimens. Preeclamptic patients were divided into two groups based on plasma levels of these factors described as a ratio; anti-angiogenic preeclampsia with sFlt1/PlGF ratio ⩾85 and normal angiogenic preeclampsia with sFlt1/PlGF n (%) when appropriate. Results The anti-angiogenic preeclampsia group ( N = 48) presented at an earlier gestational age (weeks) than the normal angiogenic group ( N = 28); {32 (28, 34) vs. 35 (32, 36), P = 0.002}, had higher systolic blood pressure (mmHg) {154 (147, 168) vs. 147 (132, 158), P = 0.02}, delivered early (weeks) {(32 (29, 34) vs. 36 (34, 37), P P P P = 0.002} and syncytial knots {81.3% vs. 39.3%, P Conclusions Preeclamptic patients with imbalance in circulating angiogenic factors have disproportionally higher rates of placental vascular lesions historically associated with severe disease. Disclosures K. Baltajian: None. J.L. Hecht: None. J.B. Wenger: None. S. Salahuddin: None. S.S. Verlohren: Consultant, Research Support Recipient, Commercial Interest: Roche Diagnostics, ThermoFisher, Novartis. F.H. Perschel: None. Z.K. Zsengeller: None. R. Thadhani: named as co-inventors of patents related to use of angiogenic biomarkers in preeclampsia that are held by Harvard Hospitals, has financial interest in Aggamin LLC. S. Karumanchi: named as co-inventors of patents related to use of angiogenic biomarkers in preeclampsia that are held by Harvard Hospitals, S.A.K has financial interest in Aggamin LLC, Consultant to Siemens, and Roche diagnostics. S. Rana: None.

Effects of perfluorooctane sulfuric acid on placental PRL-family hormone production and fetal growth retardation in mice

Perfluorooctane sulfuric acid (PFOS) is a persistent organic pollutant, causes fetal growth retardation but the mechanism is still unclear. This study focused on PFOS-induced toxicity such as placental trophoblast cell histopathological changes, endocrine function (i.e., prolactin (PRL)-family hormone production) and subsequent fetal growth retardation in mice. Maternal body weight gain, placental and fetal weights were significantly decreased in proportion to PFOS dosage. Placental efficiency (fetal weight/placental weight) was significantly reduced dose-dependently. Necrotic changes were observed in PFOS-treated placental tissues, and the area of injury increased dose-dependently. Finally, mRNA levels and maternal serum concentrations of the PRL-family hormones (mPL-II, mPLP-Cα, mPLP-K) were significantly reduced dose-dependently. In addition, the changing pattern between PRL-family hormone concentrations and fetal body weight was positively correlated. These results suggest that gestational PFOS treatment induces placental histopathological changes and disruption of endocrine function, finally may lead to fetal growth retardation in mice.

Placental lesions of vascular insufficiency are associated with anti-angiogenic state in women with preeclampsia

Objective: To evaluate if placental histopathological changes of vascular insufficiency correlate with circulating angiogenic factors in patients with preeclampsia. Materials and methods: Subjects were selected from a previous prospective cohort study of preeclampsia based on the availability of plasma anti-angiogenic factor (sFlt1) and pro-angiogenic factor (PlGF) measurements and placental histology specimens. Preeclamptic patients were divided into two groups based on plasma levels of these factors described as a ratio: anti-angiogenic preeclampsia with sFlt1/PlGF ratio ≥85 and normal angiogenic preeclampsia with sFlt1/PlGF < 85. The placental lesions of vascular insufficiency that were studied specifically included atherosis, infarcts, syncytial knots, acute and chronic abruption, hematoma, and fetal thrombosis. The data are shown as median (quartile 1 and quartile 3) or n (%) when appropriate. Results: The anti-angiogenic preeclampsia group (N = 48) presented at an earlier gestational age (weeks) than the normal angiogenic group (N = 28); {32 (28, 34) versus 35 (32, 36), p = 0.002}, had higher systolic blood pressure (mmHg) {154 (147, 168) versus 147 (132, 158), p = 0.02}, delivered early (weeks) {(32 (29, 34) versus 36 (34, 37), p < 0.001} and had lower birth weight (grams) {(1550 (1055, 2060) versus 2655 (2285, 3343), p < 0.001}. Several pathologic lesions were found significantly more often in the anti-angiogenic preeclampsia group; atherosis {27.7% versus 3.6%, p < 0.05}, infarcts {58.3% versus 3.6%, p = 0.002}, and syncytial knots {81.3% versus 39.3%, p < 0.001}. Conclusion: Preeclamptic patients with imbalance in circulating angiogenic factors have disproportionally higher rates of placental vascular lesions historically associated with severe disease.

Correction: Placental Histopathological Changes Associated with Plasmodium vivax Infection during Pregnancy

Panel B of Figure 3 is incorrectly labeled. It should read Total leucocytes. Additionally, there is a misspelling in the name of author 8. Her name should be spelled Sabrina Epiphanio. The corrected figure image can be found here:

Placental Histopathological Changes Associated with Plasmodium vivax Infection during Pregnancy

Histological evidence of Plasmodium in the placenta is indicative of placental malaria, a condition associated with severe outcomes for mother and child. Histological lesions found in placentas from Plasmodium-exposed women include syncytial knotting, syncytial rupture, thickening of the placental barrier, necrosis of villous tissue and intervillositis. These histological changes have been associated with P. falciparum infections, but little is known about the contribution of P. vivax to such changes. We conducted a cross-sectional study with pregnant women at delivery and assigned them to three groups according to their Plasmodium exposure during pregnancy: no Plasmodium exposure (n = 41), P. vivax exposure (n = 59) or P. falciparum exposure (n = 19). We evaluated their placentas for signs of Plasmodium and placental lesions using ten histological parameters: syncytial knotting, syncytial rupture, placental barrier thickness, villi necrosis, intervillous space area, intervillous leucocytes, intervillous mononucleates, intervillous polymorphonucleates, parasitized erythrocytes and hemozoin. Placentas from P. vivax-exposed women showed little evidence of Plasmodium or hemozoin but still exhibited more lesions than placentas from women not exposed to Plasmodium, especially when infections occurred twice or more during pregnancy. In the Brazilian state of Acre, where diagnosis and primary treatment are readily available and placental lesions occur in the absence of detected placental parasites, relying on the presence of Plasmodium in the placenta to evaluate Plasmodium-induced placental pathology is not feasible. Multivariate logistic analysis revealed that syncytial knotting (odds ratio [OR], 4.21, P = 0.045), placental barrier thickness (OR, 25.59, P = 0.021) and mononuclear cells (OR, 4.02, P = 0.046) were increased in placentas from P. vivax-exposed women when compared to women not exposed to Plasmodium during pregnancy. A vivax-score was developed using these three parameters (and not evidence of Plasmodium) that differentiates between placentas from P. vivax-exposed and unexposed women. This score illustrates the importance of adequate management of P. vivax malaria during pregnancy.

Neonatal Alloimmune Thrombocytopenia Associated with Massive Chronic Intervillositis: A Case Report and Review of the Literature

Neonatal alloimmune thrombocytopenia (NAIT) presents as isolated thrombocytopenia in a normal neonate as a result of destruction of fetal platelets by maternal antibodies against paternally derived human platelet antigens. Neonatal alloimmune thrombocytopenia affects 0.1% of births, with maternal antibodies crossing the placenta as early as 14 weeks' gestation. Few reports describe placental histopathological changes occurring in NAIT cases. We present a case of NAIT associated with massive chronic intervillositis, a rare entity occurring in 0.06% to 0.8% of reviewed 2nd- and 3rd-trimester placentas; to our knowledge, this is the 1st report of such an association.