Placental Edema Research Articles

Dilatative fetal cardiomyopathy followed by amirror syndrome.

Mirror syndrome (Ballantyne syndrome) is arare condition characterized by maternal edema, which often affects the lungs. It mirrors the image of fetal and placental edema; therefore, it is also called triple edema. We present the case of a37-year-old secundigravida, referred to our clinic at 26weeks of apregnancy complicated by fetal dilatative restrictive cardiomyopathy and hydrops, placentomegaly, new-onset dyspnea, and maternal calf edema. Due to worsening mirror syndrome, preterm labor was induced. Labor was complicated, with soft tissue dystocia, stillbirth, and postpartum hemorrhage. The first pregnancy was also complicated by fetal right ventricular noncompaction dilatative cardiomyopathy. Aeutrophic male child was born vaginally at term and died due to deterioration of the cardiac disease in the third year of life. Next-generation sequencing panel for pediatric cardiology was performed in the deceased child and parents. Two gene variants were recorded: MYOM1: c.770_771delCA (p.Thr257fs) and TPM1: c.814G>A (p.Glu272Lys). Both variants were classified as variants of uncertain significance. This case emphasizes the importance of antenatal counseling, the timing of labor induction, appropriate management of possible complications such as postpartum hemorrhage and soft tissue dystocia, and the interpretation of placental biomarkers in the context of mirror syndrome. Finally, it contributes to understanding the clinical significance of the MYOM1 and TPM1 gene variants.

COMMON CAUSES OF ABORTION IN COWS

The aim of this study is to determine the etiology of abortion in cows. The study was conducted in the period from 2019 to 2022. 162 cases of abortion from 65 farms from 14 regions of Ukraine were investigated. The study used pathological, histological, bacteriological and molecular genetic methods. The etiologic diagnosis was established in 24.07% of cases, the probable etiologic diagnosis in 29.01%, and the diagnosis of abortion of uncertain etiology in 46.91% of cases. Abortions with a definite etiology were caused by bacteria in 30.77% of cases, viruses in 10.26%, protozoa in 28.21%, and mixed infections in 30.77%. Abortions with established probable etiology were caused by bacteria in 10.64% of cases, viruses in 25.53%, protozoa in 34.04%, and mixed infections in 29.79%. The most common infectious agents are: BHV-4 was detected in 11, N. caninum - in 9, and Coxiella burnetii - in 6 regions of the country. Zoonotic pathogens such as Leptospira spp., Coxiella burnetii, Salmonella spp. Neospora caninum is the most common cause of cattle abortion. The most common pathological changes recorded were placental edema, liver irregularity, unevenly colored liver, cerebral hyperemia, multiple white streaks in skeletal muscles, gray-white foci in the liver, hemorrhages in/on internal organs, and placentitis. Also, a significant number of fetuses and/or placentas were in a state of autolysis. The main pathologic changes were encephalitis, gliosis, pericarditis, myocarditis, endocarditis, myositis, hepatitis, pneumonia, and placentitis. Pathologic and pathohistologic examination of the fetus and placenta is important for establishing the etiology of abortion.

The normality of the first-trimester placentae collected from elective terminations

Placentae collected from elective terminations during the first trimester are commonly used as control samples in research. However, it is widely acknowledged that many complications of pregnancies can occur or originate during the early stage of gestation. This raises the question that the placentae collected from the first trimester may not accurately reflect normal placental conditions. In this study, 95 placentae were collected from elective terminations and histology was performed. Out of these, 53 placentae (56 %) exhibited the typical structure of placental villi, indicating normal development. However, 42 placentae (44 %) showed placental hydrops, with varying degrees of severity (mild, moderate, or severe). Placental hydrops has been linked to several complicated pregnancies in the later stages of gestation. Our findings suggest that the development of pregnancy pathologies could start in the first trimester, as observed by the presence of hydrops. Placental researchers should be aware of when using first-trimester placentae from termination as controls in studies. However, it remains unclear whether pathological morphologies resolve or ameliorate as the pregnancy progression or whether such placentae continue to have such pathology, but clinical symptoms/signs do not manifest.

Mirror Image Syndrome: 1 Case and Literature Review

Mirror image syndrome is a triad of maternal, fetal and placental edema, which is a rare disease. In this paper, a clinical case of a patient with mirror syndrome admitted to our hospital in 2023 was reviewed, and relevant literature at home and abroad was analyzed, in order to improve the clinical understanding of mirror syndrome, so as to early diagnosis and treatment, and improve the prognosis of mother and child.

Prenatal MRI diagnosis and outcomes of abdominal or sacrococcygeal teratomas and parasitic fetuses.

To investigate the MRI findings of fetal abdominal or sacrococcygeal teratomas and parasitic fetuses and analyze the outcomes on the basis of follow-up assessments. The MRI data of 60 cases of abdominal or sacrococcygeal masses were examined. The outcomes were followed up and compared with the prenatal MRI diagnoses. The 60 cases included 52 cases of sacrococcygeal teratomas and eight cases of abdominal lesions. The common types of sacrococcygeal teratomas were type I (21/52, 40.4%) and type II (20/52, 38.5%); type III sacrococcygeal teratomas were rarer (8/52, 15.4%), while type IV tumors (3/52, 5.7%) were frequently complicated with hydronephrosis. Other complications included polyhydramnios in 22 cases, placental edema in six cases, and fetal hydronephrosis in three cases (all type IV). Seven of the eight parasitic fetuses were located in the abdominal cavity, and one was located in the sacrococcygeal region. Postnatal surgery was performed in 51 cases (51/60), including 44 with teratomas and seven with parasitic fetuses. In one case with hydronephrosis, peritoneal effusion, and subcutaneous edema, treatment was discontinued after birth (1/60). Fetal induction of labor was observed in eight cases (8/60). Prenatal ultrasound yielded incorrect or ambiguous diagnoses in 11 cases, while 51 cases showed a favorable course after surgery. MRI shows high accuracy in the diagnosis of fetal sacrococcygeal teratomas and parasitic fetuses. The prognosis in these cases is generally good. However, type IV sacrococcygeal teratomas are prone to fetal hydronephrosis and misdiagnosis and show a poorer prognosis.

Evidence of Equine Genital Leptospirosis (EGL) syndrome in a mare with chronic placentitis

Leptospirosis is an important disease in equine reproduction. Recently, a specific genital syndrome, named Equine Genital Leptospirosis (EGL), distinct from renal/systemic disease, was described (Di Azevedo & Lilenbaum, Theriogenology. 2022; 192:81-8). Herein we present a typical case of EGL in a pregnant mare diagnosed in the northeastern region of Brazil. A mixed-breed mare of 436kg at 243 days of gestation, presented with hyperechogenic allantoic fluid, placental edema, and fetal tachycardia in a routine obstetrics examination. Serum progesterone and estradiol (RIA) were normal (6.26ng/mL and 1404.76pg/mL, respectively). The serology for equine herpes virus1 or –4) was negative. Placentitis treatment was started with flunixin meglumine (1.1mg/kg, IV, SID, 5 days) and trimethoprim-sulfamethoxazole (30mg/kg, PO, BID). On subsequent evaluation (272 days of gestation), the placenta was heterogeneous, showing mild edema, with multiple folds in the cervical star region and placental detachment was suspected. The fetal evaluation did not show any abnormalities. Serum progesterone and estradiol were 9.86ng/mL and 872.73pg/mL, respectively. Cervicovaginal mucous (CVM) cytology did not show any abnormalcharacteristics. A PCR for leptospirosis was conducted from urine (negative) and from CVM (positive). Serology (Microscopic Agglutination Test) for Leptospira spp was positive (titre 200) for serogroup Australis. The low titers against this Leptospira serogroup (which includes serovar Bratislava), together with a negative PCR on urine and positive PCR on CVM, strongly supports a diagnosis of EGL syndrome. Trimethoprim-sulfamethoxazole was then substituted with doxycycline (10mg/kg, PO, BID) until parturition, which was uneventful at 332 days of pregnancy. The placenta had mild macroscopic lesions on the cervical star and at the tip of the gravid horn. The foal had normal general clinical parameters at birth, but physical signs of immaturity and leukopenia with a shift to the left. Treatment with amikacin (25mg/kg, IV, SID) and one liter of plasma was established and the foal made a full recovery. EGL is primarily a reproductive syndrome and is characterized by a chronic, silent, and genital-focused disease, distinct from renal or systemic syndromes. It is vastly underdiagnosed, and the disease is little studied and underestimated. This is the first case fully reported.

Diagnosis of imminent placentitis in mares

Pregnancy loss and neonatal mortality have a significant economic impact on the equine industry. Placentitis is a common cause of abortion, stillbirths, and neonatal infections. Early diagnosis of placentitis allows prompt treatment and increases the chances of a pregnancy reaching term. Our study was designed to identify blood parameters that are diagnostic of imminent placentitis under natural conditions. We hypothesized that differences from physiological parameters of a healthy pregnancy indicate imminent placentitis. Blood sample collections and reproductive exams were prospectively performed, monthly, between 180 to 320 days of gestation, in a cohort of mares from 2 large broodmare herds in Lexington, KY. Twelve mares were diagnosed with placentitis based on rectal ultrasonographic examination (opening at the cervix, thickened placenta, fluid collection, placental edema, and/or placental separation). Blood samples collected on the day of placentitis diagnosis were designated as early onset, and the blood samples collected in the previous reproductive exam with no ultrasonographic abnormalities of the fetoplacental unit were named as pre-onset (before placentitis diagnosis). In addition, 12 gestion and age-matched control mares carrying healthy pregnancies based on the same parameters were paired to the mares with placentitis. We measured several immunological, inflammatory, and hormonal parameters (Table 1). Values were compared between groups within the same timepoint (placentitis vs control) and between timepoints (pre-onset vs early onset) using Paired Student's T test and Mann-Whitney U test, and significance set at p < 0.05. According to the gestational age, the interval between pre-onset timepoint and the diagnosis of placentitis (early onset) was around 40 days (227±6 days and 267±5 days, respectively).No differences were found between groups and timepoints for immunological and inflammatory parameters in the maternal circulation, including serum amyloid A (SAA) and alpha-fetoprotein (AFP). Both proteins have been shown to markedly increase in maternal circulation after experimental induction of placentitis. In the hormonal analyses, no differences were found in plasma progesterone levels and estradiol-17β/progesterone ratio. Plasma estradiol-17β concentration approached statistical difference (p=0.08) in mares at early onset of placentitis (408±35 pg/mL) compared to the control group (498±35 pg/mL). In conclusion, our data showed that early events of spontaneous placentitis do not increase inflammatory and immunological parameters in the maternal circulation. In addition, plasma estradiol-17β may be further investigated as an early indicator of placental dysfunction in mares with naturally occurring placentitis. Acknowledgments: We thank the Harry M. Zweig Memorial Fund for Equine Research for supporting our study.

Patterns of placental injury in various types of fetal congenital heart disease.

Fetal blood circulation may be modified in congenital heart disease (CHD). This retrospective analysis was performed to study whether the type of CHD is associated with specific placental pathology. Three types of CHD based on presumed proportion of placental and systemic blood distribution in fetal circulation were analyzed: Group 1: 89 cases with low placental blood content (hypoplastic left heart syndrome, transposition of great arteries, coarctation of aorta), Group 2: 71 placentas with intermediate placental and systemic blood content due to increased intracardiac blood mixing (tetralogy of Fallot, truncus arteriosus, double inlet/outlet ventricle), and Group 3: 24 placentas with high placental blood content (tricuspid or pulmonary atresia, Ebstein anomaly). Frequencies of 27 independent clinical and 47 placental phenotypes of 184 placentas in those three groups were statistically compared. The most advanced gestational age at delivery, and large vessel (global) fetal vascular malperfusion (FVM) were most common in Group 1, while macerated stillbirths, neonatal mortality, abnormal amniotic fluid volume (oligohydramnios or polyhydramnios), other congenital anomalies, distal villous lesions of FVM, placental edema and amnion nodosum were most common in Groups 2 and 3, although the frequencies of placental lesions were statistically not significant. Left heart obstructive lesions potentially associated with brain maldevelopment show increase in lesions of global FVM (in aggregate and individually fetal vascular ectasia, stem vessel obliteration and intramural fibrin deposition) as may be seen in umbilical cord compromise. CHD with increased intracardiac blood mixing or with right heart defects is associated with average preterm gestational age at delivery and placental lesions of distal villous FVM, villous edema and amnion nodosum.

Hydrops Fetalis and Mirror Syndrome Secondary to Rh-D Alloimmunization, Associated With Oligohydramnious: A Case Report

One of the most common causes of fetal anemia is red cell alloimmunization. The most common routes of maternal sensitization are via blood transfusion or fetomaternal hemorrhage. Antibodies can cross the placenta during pregnancies in alloimmunized women and, if the fetus is positive for these specific erythrocyte surface antigens, result in hemolysis of fetal erythrocytes and anemia. This in turn, can lead to potentially disastrous consequence for the fetus, such as Hydrops Fetalis (HF), a high-output cardiac failure syndrome. The standard treatment in fetuses with anemia is intrauterine transfusion (IUT). Mirror Syndrome (MS) is a rare condition in pregnancy, in which maternal edema in pregnancy is seen in association with severe fetal and/or placental hydrops. The pathogenesis, although not well established, mimics trophoblastic damage and maternal vascular endothelial dysfunction, as is also observed in preeclampsia, and hence, the two conditions may have a similar clinical presentation [1]. The clinical manifestations of this disease are complex. It is easily underdiagnosed and timely intervention is needed to prevent fetal and maternal morbidity. MS can be reversible when the underlying factors are identified and modified [2, 3]. If correction of the underlying fetal abnormality is not possible, the consensual treatment is to deliver the hydropic fetus and placenta, with improvement of the maternal condition shortly thereafter. We report a case of HF and MS secondary to Rh-D alloimmunization that did not respond to IUT.

Transcriptomic analysis of the chorioallantois of equine cloned pregnancies

Despite notable accomplishments over the last 25 years, somatic cell nuclear transfer (SCNT) still suffers from high pregnancy loss rate and a high incidence of abnormal offspring. The problems could be related to placental anomalies, which in turn may originate in defective epigenetic reprogramming. It is well known that a high percentage of SCNT pregnancies are associated with placental abnormalities including hydrallantois, reduced vascularization, and edematous placental membranes. To date, there is little known about the underlying mechanisms of the placental pathologies associated with cloned equine fetuses. Our study aimed to (1) characterize the transcriptome and biological pathways of placentas from cloned pregnancies at term, and (2) compare the transcriptome of placentas from cloned pregnancies that result in normal foals with placentas of cloned pregnancies resulting in non-viable foals. Chorioallantois (CA) was collected from the pregnant horn of placentas after normal parturition (mean gestational age of 339 days). A total of 19 samples were analyzed from 5 healthy, age-matched control pregnancies by artificial insemination (CON), 7 cloned pregnancies resulting in a healthy live foal (SCNT-L), and 7 cloned pregnancies resulting in a foal that died within the hour after birth (SCNT-D). Total RNA was extracted and sequenced, generating ∼33 million reads/sample. The raw reads were trimmed (Trimmgalore) and mapped (STAR) to the current equine reference genome. Mapped reads were quantified (FeatureCounts), and differentially expressed genes (DEGs) were evaluatedusing DESeq2, followed by gene ontology (GO) analysis. Macroscopically, 50% of the placentas from SCNT derived pregnancies showed edema. We identified 1332 DEGs (FDR <0.05, FoldChange>2) between the SCNT-L and CON groups and 1651 DEGs between the SCNT-D and CON groups. Pathway analysis of DEGs demonstrated that these genes are involved with extracellular matrix/ structure organization, response to growth factor, angiogenesis, and integrin signaling pathway independent of the outcome of the cloned pregnancies. When comparing the SCNT-L and SCNT-D groups, we identified 44 DEGs, mainly involved in inflammatory processes, even though histopathological examinations of the CA samples did not reveal any ongoing inflammatory process. Overall, our data highlights the underlying molecular pathways associated with abnormal placental development in cloned equine fetuses. Moreover, our data demonstrated the disruption of angiogenesis in the cloned placenta, manifested as excessive edema in the placenta. Similarly, in a previous study, we demonstrated the association between abnormal angiogenesis and placental edema and hydrallantois in equine pregnancy, highlighting the importance of adequate angiogenesis in placental function. This study was funded by the Center for Equine Health at UC Davis, FAPESP 2020/10260-3, the BOF Special Research Fund at Ghent University, a Fellowship of the Belgian American Educational Foundation, and the L'Oréal-UNESCO Fellowship.

Autopsies and placental examinations of perinatal fetal deaths: a clinicopathological analysis of 105 cases

Objective: To summarize the clinicopathological factors related to perinatal fetal death and to evaluate importance of fetal autopsy and placental pathology. Methods: The clinicopathological data of 105 perinatal fetal deaths in Beijing Haidian Maternal and Child Health Hospital from November 2012 to December 2020 were retrospectively analyzed. Relevant literature was also reviewed. Results: The maternal age of the deceased fetuses ranged from 22 to 43 years with the average (31.35±4.04 years), and the gestational weeks were 28-40+6 weeks. Among them, 101 were singleton cases and 4 twin cases. 103 fetuses died in uterus and 2 died during delivery. Relevant factors analysis of the 105 perinatal fetal deaths showed that 86 cases (81.9%, 86/105) were related to umbilical cord/placental abnormality, 10 cases (9.5%, 10/105) uterine infection, 6 cases (5.7%, 6/105) fetal factors, 1 case was fetal maternal blood transfusion syndrome, 1 case twin blood transfusion syndrome, and 1 case died of complete uterine rupture. Among the 86 cases related to umbilical cord/placental abnormality, the diagnosis was most often based on the gross examination of placenta. The most common cause of death was umbilical cord torsion with thin root, followed by placental abruption, tight umbilical cord winding, vascular rupture and umbilical cord true knot. The morphology of placenta revealed mainly functional changes. Among the 10 cases related to intrauterine infections, the placenta generally showed lobular placental edema. The morphological characteristics of ascending infection were mainly acute chorioamnionitis, and the morphological characteristics of blood-borne infection were mainly acute or chronic villitis, as well as villous interstitial inflammation. Identification of viral inclusions suggested viral etiology, while the final diagnosis was relied on laboratory testing. Among the 6 cases related to fetal abnormality, the diagnostic value of placenta was limited and the diagnosis could be made with fetal autopsy. Conclusion: The causes of perinatal fetal death are complex, diverse, and often the synergistic result of multiple factors. Fetal autopsy and placental pathology are the key technical means to identify the cause of death and deserve more attention and utilization.

A very preterm infant born to mother of mirror syndrome secondary to fetomaternal hemorrhage: a case report

BackgroundMirror syndrome (MS) is defined as maternal edema with fetal hydrops and placental edema with different etiologies, such as rhesus isoimmunization and twin-twin transfusion syndrome. Herein, we showcased a unique MS case secondary to fetomaternal hemorrhage (FMH).Case presentationA 32-year-old gravida 2 para 0 woman diagnosed with fetal hydrops was admitted to our hospital. Maternal laboratory tests revealed anemia, slightly increased creatinine and uric acid levels, hypoproteinemia, and significantly increased alpha-fetoprotein and hemoglobin-F levels. Therefore, FMH was diagnosed initially. Two days after admission, the woman had unexpectedly progressive anasarca and started to feel chest distress, palpitations, lethargy, and oliguria, and MS was suspected. An emergency cesarean section was performed to terminate the pregnancy. The maternal clinical symptoms and laboratory tests rapidly improved after delivery. A very preterm infant with a 2080-g birthweight at 31 weeks gestation survived after emergency cesarean section, active resuscitation, emergency blood transfusion, abdominocentesis, and advanced life support.ConclusionsFMH could develop into MS, providing new insights into the etiology of MS. Once MS is diagnosed, emergency cesarean section might be an alternative treatment. The very preterm infant survived with a favorable long-term outcome, and a well-trained perinatal work team is needed for such cases.

Preeclampsia Falling into the Spectrum of Mirror Syndrome

Mirror syndrome, by definition, is maternal edema with fetal hydrops. Majority of the pregnancies in developing countries are complicated by preeclampsia and intrauterine growth retardation. Fetal ascites, on the other hand, is a part of spectrum of the condition under hydrops fetalis. Abnormal umbilical artery Doppler is an indicator of fetal growth retardation and not many cases are found with such diversely intermixed conditions. A 26-year-old primigravida with 36 weeks gestation by the last menstrual cycle and 34 weeks by ultrasound presented to our hospital with a history of decreased fetal movements, headache, fever, weakness, dizziness, and new-onset raised blood pressure. Her blood pressure was 164/118 and 3+ proteinuria on the urinary dipstick test. A diagnosis of preeclampsia was made. An antenatal ultrasound was performed, which showed fetal ascites, mild thickening of fetal skin, oligohydramnios with reversed umbilical artery flow but normal uterine arteries, and middle cerebral arteries. The blood pressure was controlled and she later delivered a low-birth weight baby that needed neonatal intensive care unit stay for fetal distress and abdominal distention. The baby did not survive the coming few days and died due to increasing fluid in the body cavity. The mother continued to have raised blood pressure in the postpartum period. Mirror syndrome is when the maternal pathology mirrors that of the fetus. Preeclampsia, fetal hydrops, and placental edema are the conditions lead to suspicion of it. In the case, we present, the mother had preeclampsia, and there was fetal ascites and reversed umbilical flow. The fetal and maternal outcome was in the form of intrauterine growth retardation, impending hydrops fetalis and chronic hypertension, respectively.

Foetal hydrops: new challenges

Abstract Background Foetal Hydrops (FH) is an abnormal accumulation of fluid inside two or more serous cavities and may be linked with polyhydramnios and/or placental oedema. It has been correlated with several causes such foetal anaemia, chromosomal anomalies, congenital abnormalities, infections, twin-to-twin transfusion syndrome and maternal causes such as diabetes. Regardless the advances in diagnosis and therapy, the overall perinatal mortality rate remains high. Thereby, the main goal is to evaluate the autopsy findings including between 2010 and 2019. Methods 105 cases including perinatal and new-born autopsies with different gestation stages were studied, in order to understand the macroscopic and microscopic events that can elucidate FH. Results Macroscopically, a large number of foetuses demonstrated oedema effusions and intrauterine growth restriction. Regarding placenta, the most common macroscopic finding is oedema, such as described in the literature. Nodules and hemorrhagic areas are the new findings observed. Oedema remains the most relevant microscopic finding, whereas unspecified villi alterations and trophoblast pseudoinclusions were the new findings. Conclusions The results allowed the identification of new characteristics that can contribute to the knowledge of this foetal condition that remains a challenge. Future studies need to focus on identifying strategies for diagnosis and treatment is critical for foetal hydrops.

Nonimmune hydrops fetalis with intrauterine fetal demise presenting at 41-weeks gestational age: the ultrasonographic findings and case report

Hydrops fetalis is the abnormal accumulation of fluid in two or more different fetal compartments and most times associated with polyhydramnios and placental edema, and has an estimated incidence of about 1 in 3000 pregnancies. A 27-year-old multigravida; G8P7, was referred for the first ultrasonography in the Index pregnancy on account of not feeling/observing fetal movement for about two-weeks. The obstetric ultrasonography demonstrated a single fetus with absent fetal heartbeat, in hyper-flexed position, accumulation of fluid in the abdominal cavity; right sub-diaphragmatic region and in the right pleural cavity in keeping with fetal ascites and fetal effusion. There is overriding of fetal skull with Thickened/edematous placenta with a thickness of about 7cm, and fetal skin thickness of about 10mm. There is associated intrafetal gas. The estimated femoral length gave a gestational age approximating 41-weeks. A diagnosis of hydrops fetalis most likely non-immune form with fetal demise presenting at 41-weeks gestational age in a multiparous woman with features anemia presumably from sepsis and urinary tract infection (bilateral pyelonephritis and cystitis) in a setting of poor antenatal care was entertained. The fetus was expelled following induction of labor at the peripheral centre, the patient had transfusion done with commencement of antibiotics for correction of anemia and sepsis with plans of further clinical and laboratory evaluation. We present the ultrasonographic features of hydrops fetalis with intrauterine fetal demise due to its unique presentation

Activities of matrix metalloproteinase-2 and -9 in amniotic fluid at parturition in mares with normal and high-risk pregnancy

The matrix metalloproteinases (MMPs) are a family of enzymes involved in extracellular matrix remodeling. MMPs are secreted in a latent form and activated by local and infiltrating cells. MMP-2 and -9 are the most studied in reproduction and have been detected in bovine, ovine, equine and human placenta. There is only one study on MMPs in the equine amniotic fluid (AF) reporting a decrease in the activity of MMP-2 in case of premature delivery. The aim of this study was focused on MMP-2 and -9 activity in AF collected at parturition from mares with normal or high-risk pregnancy. High-risk pregnancy was defined as a history of premature udder development/lactation, increase of combined thickness of the uterus and placenta, vulvar discharge and/or mare's systemic illness. The diagnosis of placental insufficiency was confirmed retrospectively after macroscopic and histopatologic examination of the placenta. AF was collected by needle puncture of the amnion within 5 min after its appearance through the vulva. The activity of MMP-2 and -9 was analyzed by in-gel zymography allowing the evaluation of both latent and active forms. Twenty mares with normal pregnancy (group 1) and 8 mares with high-risk pregnancy (group 2) were included. All mares in group 2 had a high-risk pregnancy with a diagnosis of placental insufficiency associated with placental villous hypoplasia, placentitis or placental edema. The bands relative to latent and active forms of MMP-2 were clearly visible in both groups and the activity of latent (P = 0.010) and active (P = 0.004) forms was lower in the AF samples of group 2. The band of the latent form of MMP-9 was visible in 17/20 samples of group 1, while it was completely absent in all samples of group 2. In contrast, the band of the active form was clearly visible and with a greater activity in AF samples of group 2 (P = 0.002). Placental dysfunction seems to induce a lower MMP-2 activity and a higher MMP-9 activity through the release of pro-inflammatory cytokines. Because fetal pulmonary secretions are a likely source of gelatinases in AF during late gestation, the increased MMP-9 activity could be related to fetal distress. These data provide a starting point to better understand the role of MMPs in equine pregnancy, although it should be confirmed in a larger and more homogeneous population of mares with high-risk pregnancy.

A Clinical Analysis of the Diagnosis and Treatment of Fetal Sacrococcygeal Teratomas.

ObjectiveThe present study aims to discuss the clinical features, treatment, and prognosis of fetal sacrococcygeal teratomas (SCTs) to improve the standard of diagnosis and treatment.MethodsThe clinical data of 15 pregnant females with fetal SCT, admitted to Fujian Maternity and Child Health Hospital from January 2013 to January 2020, were retrospectively analyzed with respect to clinical characteristics, imaging features, complications, treatment options, and pregnancy outcomes.ResultsThe 15 cases of fetal SCT were all detected by color ultrasonography. There were two cases of cystic tumors and 13 cases of solid cystic tumors. In terms of tumor blood supply, there was one case without blood flow signal, eight cases with little blood flow signal, and six cases with abundant blood flow. At the time of delivery, there were two cases with a tumor diameter less than 5 cm, five cases with a diameter of 5−10 cm, and eight cases with a diameter of more than 10 cm. In terms of tumor shape and location, there were two cases of type I, ten cases of type II, and three cases of type III. There were six cases with an increased fetal heart to chest ratio, four cases of fetal edema, three cases of placental edema, four cases of excessive amniotic fluid, one case of insufficient amniotic fluid, three cases of fetal distress, one case of stillbirth, two cases of gestational diabetes mellitus, two cases of mirror syndrome, and two cases of postpartum hemorrhage. According to the pathological diagnosis, there were seven cases of mature teratoma, seven cases of immature teratoma, and one case of mixed germ cell tumor. There were six cases of induced delivery, nine cases of cesarean section, one case of premature birth, and two cases of mild neonatal asphyxia.ConclusionFetal SCT was generally diagnosed by prenatal ultrasonography. The tumor blood supply, growth rate, size, nature of the tumor, clinical type, pathology, and maternal-fetal complications are all closely correlated with the prognosis. The timing and manner of the termination of pregnancy should be determined on the basis of the pregnant female, the fetus, and the tumor.

Hidrops Fetalis dengan Kistik Higroma

Pendahuluan: Hidrops fetalis adalah akumulasi cairan berlebihan di dalam tubuh janin, dapat berupa edema pada janin dan plasenta, asites, efusi pleura dan/atau efusi perikardial. Pada tahun-tahun sebelumnya, kebanyakan kasus hidrops disebabkan oleh eritroblastosis fetalis berat yang disebabkan oleh isoimunisasi Rh. Kebanyakan kasus saat ini disebabkan oleh kondisi lain (hidrops nonimun). Salah satu penyebab hidrop adalah kistik higroma. Kistik higroma dihubungkan dengan abnormalitas kromosomal. Kasus ini adalah seorang wanita yang hamil 21 minggu dengan hidrops fetalis dan kistik higroma yang diduga disebabkan oleh abnormalitas kromosom. Laporan kasus ini menyoroti hubungan kistik higroma dengan hidrops fetalis dan kebutuhan evaluasi genetik untuk dapat menegakan atau menyingkirkan aneuploid.

Mirroring preeclampsia: the molecular basis of Ballantyne syndrome

Objectives: The purpose of this article was to further elucidate the pathophysiology of Mirror (Ballantyne) syndrome within the context of known biomarkers for preeclampsia.Methods: This novel insight from clinical practice involved a case of post-twin-to-twin transfusion syndrome-laser hydrops in an ex-donor twin, corroborated by histopathologic placental territory edema and maternal sequelae of Mirror syndrome. We serially measured the levels of activin A, follistatin, endothelin-1 (ET-1), intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), soluble fms-like tyrosine kinase 1 (sFlt), and von Willebrand factor (vWF) in the maternal serum from disease evolution through to recovery.Results: The paired finding of hydropic ex-donor twin and placenta, supports the theory of placental injury as the source of potential molecular mediators, leading to local placental edema, associated fetal hydrops and the maternal preeclamptic picture. Notably, we elucidated a temporal spectrum of maternal serum mediators (soluble Flt-1, endothelin-1, 8-isoprostane, activin-A, ICAM-1, and vWF) involved in the pathogenesis of Mirror syndrome.Conclusion: Better understanding of the pathogenesis of Mirror syndrome has important implications for clinical management.

PLACENTAL CYTOPATHIC DAMAGE FACTOR DUE TO PARVOVIRUS B19 – AS A HALLMARK OF INTRAUTERINE SYMPTOMATHY OF INFECTED FETUS

Aim of the work. The focus of this study was to analyze the frequency of fetal intrauterine symptomatic realization as a result of B19 parvovirus infection of pregnant women during I and II gestation periods, with the combination of determination the levels of alpha-fetoprotein in maternal serum blood and histopathological investigation of placenta in cases of negative effects for infected fetuses. Materials and methods. A total of 478 pregnant women were at risk of infection and screened for parvovirus B19. The study was based on serological, morphological and virological testing of fetuses from mothers with confirmed parvovirus B19 infection. Infection of pregnant women was detected by serological diagnosis of specific antibodies IgM and IgG to parvovirus B19. Intrauterine fetal infection was confirmed by polymerase chain reaction method. Levels of alpha-fetoprotein in meternal venous blood were detected using an immunochemical test method. An antenatal diagnosis of hydrops fetalis was confirmed by ultrasound scanning. Placenta from the 8 infected fetuses was studied histologically with hematoxylin and eosin staining using electron microscope during gestational periods of 12-22 weeks. Statistical analysis of the obtained data was carried out using nonparametric statistics with the definition of Fisher's criterion. Results and discussion. The average gestational period of symptomatic manifestations of intrauterine fetal infection was 19.9±0.5 weeks of gestation. It was established that in 33 of cases were confirmed the intrauterine infection due to parvovirus B19 by using the morphological placenta tissue analysis. The research found that the levels of maternal serum alpha-fetoprotein was significantly higher (in 2.17 times) in group of fetuses who suffered from fetal hydrops and in cases of intrauterine fetal death before detecting the general echographic sings of fetal failure (p˂0.05). It will be very important to compare this indicator with the Doppler ultrasound measurements of the human fetal middle cerebral artery peak systolic velocity (MCA PSV) and blood flow parameters in the fetal ductus venosus and to predict the possibility of poor perinatal outcomes. It was identified a cytopathic effect in placental cells viral origin and detected in cells of the cytotrophoblast, syncytiotrophoblast, endothelial cells, and blood cells. Conclusions. Parvovirus B19 fractions were visualized in 100 % of cases of miscarriages with fetal hydrops and placental edema during 12-22 weeks of gestation, while acute maternal parvovirus infection (with the detection of IgM against to parvovirus B19) was diagnosed by immunoassay only in 62.5 % of cases. Detection of B19 particles in placental tissue from fetuses with non-immune origin hydrops is an auxiliary method in the diagnosis of vertical transmission of parvovirus during pregnancy. It is more preferable to estimate the levels of alpha-fetoprotein in maternal serum blood in case of parvovirus B19 affected pregnancies as raising rates of this marker may be an early prediction hallmark for adverse fetal outcome.