Placental Implantation Research Articles

Application of Scanning Magnetic Resonance Imaging in the Diagnosis of Prenatal Placental Implantation and Related Care.

In order to solve the problem of scanning magnetic resonance imaging in prenatal diagnosis, the application and research of placental implantation have been proposed. Placental implantation is a serious obstetric emergency, which refers to the abnormal attachment of placental villi caused by the dysplasia of decidual basal layer. A study from the United States showed that the incidence of placental implantation in pregnant women during delivery increased from 9.9/30000 to 11.6/20000 from 2006 to 2019, which increased the risk of prenatal or postpartum hemorrhage, hysterectomy, stillbirth, abdominal organ injury, and so on. Clinically, patients can show severe prenatal or postpartum hemorrhage, postpartum placental retention, uterine perforation, and secondary infection, which may seriously endanger the lives of pregnant mothers and fetuses. Placental implantation can also have no obvious symptoms before delivery, which leads to insufficient prenatal diagnosis. Gielchinsky retrospectively studied 410 patients with placental implantation and found that only 9 patients were detected by prenatal ultrasound or magnetic resonance imaging (MRI), and the detection rate was only 6.6%. It can be seen that if the accurate diagnosis of placental implantation can be made before prenatal or symptoms appear, clinical intervention treatment can be carried out in time to reduce the probability of hysterectomy and improve the examination means of patients' prerecovery. At present, studies at home and abroad suggest that it has good clinical application value and research prospect in the clinical diagnosis of placental implantation.

Aberrant H3K4me3 modification of epiblast genes of extraembryonic tissue causes placental defects and implantation failure in mouse IVF embryos.

Assisted reproductive technology has been widely applied in the treatment of human infertility. However, accumulating evidence indicates that invitro fertilization (IVF) is associated with a low pregnancy rate, placental defects, and metabolic diseases in offspring. Here, we find that IVF manipulation notably disrupts extraembryonic tissue-specific gene expression, and 334 epiblast (Epi)-specific genes and 24 Epi-specific transcription factors are abnormally expressed in extraembryonic ectoderm (ExE) of IVF embryos at embryonic day 7.5. Combined histone modification analysis reveals that aberrant H3K4me3 modification at the Epi active promoters results in increased expression of these genes in ExE. Importantly, we demonstrate that knockdown of the H3K4me3-recruited regulator Kmt2e, which is highly expressed in IVF embryos, greatly improves the development of IVF embryos and reduces abnormal gene expression in ExE. Our study therefore identifies that abnormal H3K4me3 modification in extraembryonic tissue is a major cause of implantation failure and abnormal placental development of IVF embryos.

The Volume of T2 Low-Signal Band and the Width of the Widest Blood Vessel in Placenta Measured by MRI in Pregnant Women with Different Types of Placental Implantation and Its Differential Value.

Objective To explore the value of magnetic resonance imaging (MRI) in measuring the volume of T2 low-signal band and the width change of the widest blood vessel in placenta in pregnant women with different types of placenta implantation (PI). Methods From November 2020 to August 2021, 116 patients in our hospital who underwent placental MRI because of ultrasound or clinical suspicion of PI were selected as the research object. According to the “gold standard” (clinical or surgical pathological results), 79 cases with PI were diagnosed as PI group, and 37 cases without PI were no PI group. The clinical features, MRI signs, T2 hyposignal zone volume, and the width of the widest blood vessel in placenta were compared between the two groups and different types of PI patients. Logistic regression was used to analyze the influencing factors of PI and PI classification, and the receiver-operating characteristic (ROC) was used to analyze the value of T2 low-signal zone volume and the widest blood vessel width in the placenta for different types of PI. Results The history of cesarean section, uneven placental signal, the proportion of T2 low-signal band shadow, the volume of T2 low-signal band, and the width of the widest blood vessel in placenta in PI group were higher than those in non-PI group (p < 0.05); the history of cesarean section, uneven placental signal, T2 hypointense band shadow, the volume of T2 hypointense band, and the increase of the width of the widest blood vessel in placenta are independent risk factors for PI (p < 0.05); with the increase of implantation depth, the proportion of T2 hypointense band shadow, the volume of T2 hypointense band, and the width of the widest blood vessel in placenta gradually increased (p < 0.05); T2 hypointense band shadow, T2 hypointense band volume, and the widest blood vessel width in placenta are all influencing factors of PI classification (p < 0.05); ROC showed that the volume of T2 low-signal band and the width of the widest blood vessel in placenta, the AUC of combined identification of adhesive PI, implanted PI, implanted PI, and penetrating PI were 0.846 and 0.899, respectively, which was higher than that of single identification (p < 0.05). Conclusion MRI measurement of T2 hyposignal zone volume and the widest blood vessel width in placenta can be used for PI diagnosis and classification differentiation and provide reliable basis for clinical prenatal preparation and treatment planning.

In Vitro Model of Human Trophoblast in Early Placentation.

The complex process of placental implantation and development affects trophoblast progenitors and uterine cells through the regulation of transcription factors, cytokines, adhesion receptors and their ligands. Differentiation of trophoblast precursors in the trophectoderm of early ontogenesis, caused by the transcription factors, such as CDX2, TEAD4, Eomes and GATA3, leads to the formation of cytotrophoblast and syncytiotrophoblast populations. The molecular mechanisms involved in placental formation inside the human body along with the specification and differentiation of trophoblast cell lines are, mostly due to the lack of suitable cell models, not sufficiently elucidated. This review is an evaluation of current technologies, which are used to study the behavior of human trophoblasts and other placental cells, as well as their ability to represent physiological conditions both in vivo and in vitro. An in vitro 3D model with a characteristic phenotype is of great benefit for the study of placental physiology. At the same time, it provides great support for future modeling of placental disease.

Predictive performance of first trimester serum galectin-13/PP-13 in preeclampsia screening: A systematic review and meta-analysis.

Placental protein-13 (PP-13) is a member of the galectin group involved in placental implantation, maternal artery remodeling, and placental inflammatory processes. Its levels are lower in the first trimester for pregnancies later affected by ischemic placental disease, and slowly increase during the second and third trimesters of pregnancy. The aim of the present meta-analysis is to assess the predictive performance of PP-13 in first trimester preeclampsia screening. PubMed, Web of Science, Scopus, Embase, BIOSIS, and Cochrane databases were used to find relevant studies. All prospective and retrospective observational studies that evaluated the accuracy of PP-13 in predicting preeclampsia were assessed. The investigation revealed that the quantitative synthesis was based on 14 studies with a total number of 8,239 women. The pooled sensitivity of PP-13 for the prediction of preeclampsia was 0.53 [95% (confidence interval (CI), 0.08-0.99], and the pooled specificity was 0.83 (95% CI, 0.38-1.29). Further analysis revealed a higher accuracy of PP-13 for the screening of late-onset preeclampsia [pooled sensitivity of 0.58 [95% CI, -0.17-1.33) with a specificity of 0.85 (95% CI, 0.10-1.60)] when compared with early-onset preeclampsia [pooled sensitivity of 0.51 (95% CI, -0.04-1.05) with a specificity of 0.88 (95% CI, 0.33-1.42)]. In conclusion, PP-13 appears to be a promising biomarker for evaluating the risk of developing preeclampsia during the first trimester of pregnancy. As a result, incorporating it into future predictive models is a viable option.

Current Studies of Mitochondrial Quality Control in the Preeclampsia.

Mitochondria are cellular energy powerhouses that play important roles in regulating cellular processes. Mitochondrial quality control (mQC), including mitochondrial biogenesis, mitophagy, mitochondrial fusion and fission, maintains physiological demand and adapts to changed conditions. mQC has been widely investigated in neurodegeneration, cardiovascular disease and cancer because of the high demand for ATP in these diseases. Although placental implantation and fetal growth similarly require a large amount of energy, the investigation of mQC in placental-originated preeclampsia (PE) is limited. We elucidate mitochondrial morphology and function in different pregnancy stages, outline the role of mQC in cellular homeostasis and PE and summarize the current findings of mQC-related PE studies. This review also provides suggestions on the future investigation of mQC in PE, which will lead to the development of new prevention and therapy strategies for PE.

Manajemen Atonia Uteri

Background: Uterine atony is one of the post-partum bleeding that can cause death in the mother. Uterine atony is an obstetric emergency and is one of the top five causes of maternal death. Post-partum/post-partum bleeding (PPH) is bleeding that occurs after delivery. Uterine atony is the 5th cause of maternal death. Method: The source search was carried out on the online portal of journal publications as many as 16 sources from MedScape, Google Scholar and the Nation Center for Biotechnology Information / NCBI with the keywords "uterine atony" and “postpartum hemorrhage”. Discussion: Bleeding in uterine atony occurs during the third stage of labor, where after the delivery of the placenta the myometrial muscles should contract to constrict the arteries and stop bleeding at the placental implantation site. Management of the third stage is an important stage in labor that plays a role in preventing post-partum bleeding. Conclusion: Uterine atony can be diagnosed when there is more blood loss than usual and a flaccid and enlarged uterus. Active management of the third stage is a way to prevent uterine atony.

Maternal serum leptin in the pregnant rat: fetal-placental implantation number and progesterone.

This study was designed to determine whether there is a role of the placenta in the regulation of maternal serum leptin levels in the pregnant rat. We have adjusted the number of fetal-placental implants on day 9 in the pregnant rat by aspirating fetal-placental units to adjust the number to 1-2, 4-5 per rat or >10 in controls. Serum levels of leptin and progesterone were determined by radioimmunoassay. A separate group of pregnant rats were ovariectomized and maintained with progesterone silastic capsules (10, 20 or 40 mm). In the pregnant rats with varied fetal-placental implant numbers, the maternal serum leptin were greatest in the group with the smallest number (1-2) of implants; intermediate in the midgroup (4-5 implants); and lowest in the group with a full complement of implantations (>10) (p < 0.001). Serum progesterone levels are lowest in the 1-2 implantation group. In the ovariectomized rats there was a stepwise decline in serum leptin (p < 0.05) as the dose of progesterone increased (p < 0.01). Both of these studies suggest that progesterone suppressed maternal serum leptin levels. Increasing placental mass is not associated with increasing maternal serum leptin levels in the pregnant rat; the contrary condition is observed with the least placental implants having the highest leptin levels. Progesterone seems to suppress serum leptin levels in several physiological models.

Placental CD34 immunohistochemistry in fetal vascular malperfusion in stillbirth.

To assess the use of CD34 immunostaining in diagnosing of fetal vascular malperfusion (FVM) in stillborns. We examined 25 independent clinical (pregnancy and fetal outcomes) and 48 placental phenotypes in 100 placentas of consecutive stillborns at ≥20 weeks of gestation. Group 1 comprised 34 cases with no distal villous FVM; Group 2 comprised 36 placentas with clustered distal villous FVM (sclerotic villi, hypovascularity, stromal vascular karyorrhexis, and/or mineralization) determined using hematoxylin-eosin staining not upgraded by CD34 immunostaining, and Group 3 comprised 30 placentas with FVM diagnosed or upgraded by CD34 immunostaining (distal villous endothelial fragmentation and/or villous hypovascularity). Diffuse villous lesions of fetal retention with various degrees were present in approximately 50% of the cases in all groups; however, histological evaluation for FVM was still possible in most stillborns. Abnormal clinical phenotypes were significantly less frequent than abnormal placental phenotypes of FVM (8.6% vs. 24%, respectively). Chronic hypoxic placental injury patterns, fetal blood erythroblastosis, some features of shallow placental implantation, and muscular FVM lesions were most common in Group 2. Only decidual arteriopathy (hypertrophic and or hyaline necrosis/atherosis) was most frequent in Group 3. Most distal FVM lesions can be observed on hematoxylin-eosin placental slides only several days following the inciting event. CD34 immunostaining can reveal recent distal villous lesions of FVM featuring segmental villous endothelial fragmentation for de novo diagnosis or for upgrading FVM. Routine CD34 immunostaining has demonstrated FVM to be the major pattern of placental injury in stillborns.

A retrospective analysis of emergency hysterectomy intervention strategy in obstetrics.

Objectives:To investigate the indications of obstetric emergency hysterectomy and analyze the clinical effects of subtotal hysterectomy and total hysterectomy.Methods:We included 247 hospitalized women who had undergone abdominal hysterectomy due to obstetric reasons in Fujian Province Maternity and Child Health Hospital (a provincial class-A hospital) and Ningde People’s Hospital (a primary Class-B hospital) between January 2002 and December 2018. We identified surgical indications and clinical characteristics of the patients. Furthermore, the patients from Fujian Provincial Maternity and Child Health Hospital were subdivided into subtotal hysterectomy group and total hysterectomy group to examine general operation conditions, and postoperative complications.Results:The main surgical indications for emergency obstetric hysterectomy in Fujian Maternity and Child Health Hospital were placental implantation (49.6%) and uterine weakness (31.9%), while uterine weakness (37.5%) was the most important indication in Ningde People’s Hospital. No differences were found in operation time, hospitalization time, intraoperative blood loss, postpartum blood loss, and intraoperative fresh frozen plasma transfusion between the subtotal hysterectomy group and the total hysterectomy group. Postoperative test parameters, including postoperative prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT), hemoglobin (HGB), and hematocrit (HCT), were not significantly different between the two groups. No significant difference was noted in postoperative vesicoureteral injury, pelvic hematoma, infection, and disseminated intravascular coagulation (DIC) incidence, but renal failure incidence was different (P=0.040).Conclusion:The treatment effect of subtotal hysterectomies for the cases without placenta accreta and placenta previa was similar in the two hospitals. There is no statistically significant difference in therapeutic effect between total hysterectomy and subtotal hysterectomy.

Association between in vitro fertilisation embryo transfer and placental pathology in women with preterm birth: a retrospective cohort study.

The number of women who achieve pregnancy through assisted reproductive technology (ART), including in vitro fertilisation and embryo transfer (IVF-ET), is increasing worldwide. Placenta-mediated diseases associated with ART, such as gestational hypertension, preeclampsia, disorders of placental implantation, and placental abruption, are also increasing. To determine the association between placental pathologies and IVF-ET in women with preterm births. This retrospective cohort study examined archived placenta specimens of women who achieved pregnancy through either spontaneous conception or IVF-ET. In total, 1677 women with singleton pregnancies who gave birth consecutively between 20 and 37weeks of gestation at Seoul National University Bundang Hospital and underwent placental pathologic evaluation between April 2013 and October 2018 were included. Data from all pathologic reports were reviewed. The IVF-ETgroup had a higher median maternal age and rate of nulliparity than the natural conception group. The incidence rate of obstetric complications, except preterm premature rupture of membranes and placenta previa, was similar in both groups. The IVF-ET group had a higher incidence rate of placental infarction than the natural conception group (26.4% vs 16.4%, P =0.012). Multivariate logistic regression analysis indicated that IVF, hypertensive disorders, and fetal growth restriction were significantly associated with placental infarction. IVF-ET was independently associated with the risk of placental infarction in women with preterm births. The use of IVF-ET may cause abnormal placental formation with an increased risk of anatomical and vascular pathology, which are observed in preterm deliveries and may contribute to pregnancy complications.

Maternal and Perinatal Outcomes in Placenta Previa: A Retrospective Study at a Tertiary Care Centre of Western India

Introduction: Placenta previa is a condition characterised by abnormal placental implantation and usually presented as painless vaginal bleeding in second or third trimester of pregnancy. Various studies have reported adverse outcomes in the cases of placenta previa. Aim: To find incidence, maternal and perinatal outcomes in placenta previa. Materials and Methods: This retrospective study was carried out during April-June 2021 at a Government Tertiary care centre in Maharashtra. Total 260 cases of placenta previa managed at the institute between 1st January 2017 to 31st December 2019 were included in study. Primary data from labour room and operation theatre was collected and detailed case papers were accessed from medical records section. Data was analysed using Microsoft Excel Windows 2013. Results: Incidence of placenta previa was 1.09%. Majority of cases were from age group of 26-30 years, booked, gravida 2-3, belonging to low socio-economic status and without any history of risk factors. In 81.15% cases Lower Segment Cesarean Section (LSCS) was required. Post Partem Haemorrhage (PPH) (32.30%) and need for blood transfusion (86.15%) were major complications. Maternal mortality in cases of placenta previa was 4.23%. In perinatal outcome, prematurity was reported 44.30% cases while 57.46% needed NICU admission. Perinatal mortality was 17.53%. Conclusion: There is need for regular Antenatal Care (ANC) check-up and timely referral to tertiary care obstetrical care centre with availability of Blood bank and NICU for better outcome.

Lower uterine segment scar assessment at 11-14 weeks' gestation to screen for placenta accreta spectrum in women with prior Cesarean delivery.

To validate prospectively transvaginal ultrasound assessment of the lower uterine segment (LUS) scar at the time of first-trimester screening in women with previous Cesarean section (CS) and to determine its feasibility and accuracy in stratifying women according to the risk for placenta accreta spectrum (PAS) disorder. Women with a history of CS were recruited between 11 + 0 and 13 + 6 weeks' gestation and underwent LUS scar assessment using transvaginal ultrasound. A standardized midsagittal plane, which included the cervicoisthmic canal (CIC), the uterine scar and the placental site, was obtained. The scar was described in terms of its size (narrow or dehiscent) and its location in relation to the CIC (within or above), with each LUS scar classified into one of four groups based on these features. Placental location was assessed and classified as high- or low-lying. Women were stratified according to the risk of PAS, based on the relationship between the scar location and placental site. Women were considered high risk when the scar was above the CIC and the placenta was low-lying (i.e. when the placenta was overlying an exposed scar) and low risk when the scar was within the CIC and/or the placenta was high. High-risk patients were followed up at 20 weeks and 28-30 weeks for the development of PAS. Maternal demographics, detailed obstetric history and obstetric outcome were collected. First-trimester transvaginal ultrasound was offered to 535 women with prior CS during the study period. A LUS scar was visualized in 79.9% (401/502) of those who agreed to undergo the examination. At this scan, the LUS scar was above the CIC in 9.0% (36/401) of women, but only 5.7% (23/401)additionally had a low-lying placenta overlying the scar. Of these 23 high-risk women, two were found to have PAS on the mid-trimester screening scan and one was noted to have placental adherence during evacuation following mid-trimester termination of pregnancy. On the first-trimester scan, 94.3% (378/401) of women were at low risk of PAS. This screening protocol yielded a positive likelihood ratio of 21.33 (95% CI, 13.02-34.96), sensitivity of 100% (95% CI, 29.24-100%), specificity of 95.31% (95% CI, 92.39-97.35%), positive predictive value of 16.7% (95% CI, 5.8-39.2%) and negative predictive value of 100% (95% CI, 98.4-100%). On multivariable regression analysis performed to identify confounding variables associated with a LUS scar above the CIC, only maternal body mass index ≥ 30 kg/m2 was significant (odds ratio (OR), 2.42 (95% CI, 1.04-5.39); P = 0.03). Although there was a trend towards an increased risk of a LUS scar above the CIC in women with prior elective prelabor CS (OR, 1.72 (95% CI, 0.80-3.68)), this association did not reach statistical significance. Routine transvaginal ultrasound assessment of the location of the LUS scar and placenta at the time of first-trimester screening between 11 + 0 and 13 + 6 weeks' gestation in women with prior CS is a feasible and effective tool to identify those at risk of subsequent development of PAS disorder. A finding of placental implantation over an exposed LUS scar seems to be cardinal in predicting the risk of PAS disorder in women with prior CS, with an excellent negative predictive value. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Association between placental implantation abnormalities and hypertensive disorders of pregnancy.

This study aimed to investigate the association between placental implantation abnormalities (PIAs) and gestational hypertension-preeclampsia (GH-PE) in pregnant women. Patients were recruited from 2010 to 2019 into this retrospective study at the International Peace Maternity & Child Health Hospital. PIAs were classified as follows: placenta previa (PP), low-lying placenta (LP), placenta accreta, and placenta adherence (PA). Logistic regression models were constructed to analyze the associations between placental abnormalities and GH-PE. Propensity score matching (PSM) was conducted to reduce confounders. The relationship between PP with placenta accreta spectrum (PAS) and GH-PE were assessed. In total, 5527 women were recruited, and 2614 women had an abnormal placenta (992 with LP; 749 with PP 839 and PA; and 34 with placenta accreta). There were 296 patients with GH-PE in those groups. After adjustments for confounding factors, women with PP had a lower risk of PE (odds ratio [OR]: 0.43; 95% confidence interval [CI]: 0.19-0.86, p=0.025) than those in the control group. Women with PA had a higher risk of GH-PE (OR: 1.45; 95% CI: 1.05-1.99, p=0.022). In addition, we categorized PP into marginal, complete, and partial PP and investigated these associations. We found a lower risk of PE in complete PP (OR: 0.09, 95% CI: 0.01-0.44, p=0.020) than in marginal or partial PP. There was no significant difference regarding GH-PE in the PP with PAS group (OR=0.67, 95% CI: 0.82-2.34, p=0.525). PP, especially complete PP, is associated with a lower risk of PE. PA is associated with higher risks of GH-PE.

Factors Associated with Primary Postpartum Hemorrhage in Elderly Women Undergoing Repeated Cesarean Deliveries.

PurposeThe aim of this study was to analyze the risk factors for primary postpartum hemorrhage in elderly parturients undergoing repeated cesarean delivery (PHEPWRCD).Participants and MethodsThe clinical data of 1675 elderly parturients who underwent repeated cesarean delivery in our hospital from May 2011 to March 2020 were retrospectively collected for analysis. The women were divided into a postpartum hemorrhage group (116 individuals) and a nonpostpartum hemorrhage group (1559 individuals). We analyzed the association of maternal age, maternal history, pregnancy complications, placenta and other factors with postpartum hemorrhage in elderly women who underwent repeated cesarean delivery and screened out independent risk factors by multivariate logistic regression analysis.ResultsThe incidence rate of PHEPWRCD was 6.92% (116/1675). Using single-factor analysis of variance, we found that maternal age (p=0.012), the number of pregnancies (p=0.007), the number of cesarean deliveries (p<0.001), fetal position (p<0.001), fetal macrosomiaren (p<0.001), placental attachment position (p<0.001), placenta previa (p<0.001), and placental implantation (p<0.001) were significantly associated with PHEPWRCD. Multivariate logistic regression analysis showed that the number of cesarean deliveries (OR=2.457, 95% CI=1.453–4.540, P=0.013), placenta previa (OR=11.741, 95% CI=5.874–26.078, P<0.001), placenta implantation (OR=6.844, 95% CI=3.514–14.873, P<0.001), placental attachment position (OR=2.421, 95% CI=1.275–3.917, P=0.009) and fetal position (OR=5.722, 95% CI=3.817–16.577, P<0.001) were independent risk factors for PHEPWRCD.ConclusionThis study found that the number of cesarean deliveries, placental attachment, placental previa, and placental implantation are independent risk factors for PHEPWRCD.

Unexpected Advanced Abdominal Pregnancy from a Placenta Previa Suspicion: A Case Report

Advanced abdominal pregnancy is a condition of pregnancy that continues beyond 20 weeks of gestational age in the abdominal cavity. Estimation of the case occurrence is between 1:10,000 to 1:30,000 live birth. This happens as a result of fertilization in abdominal cavity, tubal rupture, or tubal abortion. This condition causes a high morbidity and mortality rate in the mother and baby. We presented a case of a 41-year-old woman with G2P1 term pregnancy referred to our OBGYN clinic in Dr. Zainoel Abidin Hospital, Banda Aceh, from a regional hospital with morbidly adherent placenta previa with no suspicion to abdominal pregnancy. She had no history of antepartum hemorrhagic. The patient was put through several examinations and prepared for elective c-section to hysterectomy. After opening the peritoneum during C-Section, we had difficulty identifying the lower segment of the uteri. The amniotic membrane was covered with omentum. We incised the amniotic membrane and delivered a 3500gr, AS 8/9 male baby. Placental implantation was identified at the omentum, uterine fundus, and some of the pelvic wall. Bleeding was controlled and a large part of the placenta was evacuated adequately, but some part was left in the abdominal cavity. The patient?s and the baby?s condition were stable after the surgery and was discharged after the fifth day of hospitalization in a good condition. This case report provided insights that advanced abdominal pregnancy shows no typical symptom and is similar to placenta previa. Its diagnosis at an advanced gestational age is apparently more challenging. Some cases were able to be diagnosed preoperatively, but most other cases were only diagnosed intraoperatively.

The diagnostic accuracy of mean arterial pressure in second trimester for prediction of preeclampsia in females.

Objective: To assess the diagnostic accuracy of mean arterial pressure in second trimester for prediction of pre-eclampsia in females. Study Design: Cross-sectional study. Setting: Department of Obstetrics &amp; Gynecology Unit III, Allied hospital, Faisalabad. Period: October 2016 to September 2017. Material &amp; Methods: Total 386 patients were enrolled after obtaining informed consent. Booked females of age 18-40 years, parity&lt;5 presenting at gestational age &gt;16 weeks (on LMP) for antenatal checkup were included in study. Patients with multiple gestation (on medical record and USG), Females with chronic hypertension (BP≥140/90mmHg), chronic or gestational diabetes (BSR&gt;186mg/dl), Females having oligohydramnios (AFI&lt;5cm) or polyhydramnios (AFI&gt;21cm) on USG, females having abnormal placental implantation or placental abruption (on USG) were excluded. The mean age of the patients was 28.59±6.93 years. The MAP of the patients was 94.88±14.68 mmHg. Results: The sensitivity, specificity and diagnostic accuracy of MAP was 92.89%, 89.12% and 91.45% respectively taking preeclampsia as gold standard. Conclusion: The mean arterial pressure in second trimester is very effective and useful screening method for prediction of preeclampsia with high values of sensitivity, specificity and diagnostic accuracy.

The Top 100 Most Cited Articles on Intrauterine Adhesion: a Bibliometric Analysis

Bibliometric analysis is a statistical method that attempts to assess articles by their citations, analyzing their frequency and citation pattern, which subsequently gleans direction and guidance for future research. Over the past few years, articles focused on intrauterine adhesions have been published with increasing frequency. Nevertheless, little is known about the properties and qualities of this research, and no current analysis exists that has examined the progress in intrauterine adhesion research. Web of Science Core Collection, BIOSIS Citation Index, and MEDLINE database were searched to identify articles on intrauterine adhesion published from 1950 to October 2020. The 100 most cited articles were chosen to analyze citation count, citation density, authorship, theme, geographic distribution, time-related flux, level of evidence, and network analysis. An overwhelming majority of these 100 articles were published in the 2010s (35%). Citations per article ranged from 30 to 253. Chinese authors published the most papers in the top 100, followed by the USA, France, Israel, and Italy. The most salient study themes included operative hysteroscopy and adjunctive treatments for improving reproductive outcomes. The most common level of evidence was level II, and there was no statistical difference in the number of citations between the levels. The network analysis indicated that hysteroscopy, hysteroscopic adhesiolysis, infertility, and the reproductive outcome had a great degree of centrality in the 2000s and 2010s. In comparison, placental implantation had a great degree of centrality in the 2000s, and stem cell and fibrosis had a great degree of centrality in the 2010s. The value of IUA investigation has been gradually appreciated recently. Hysteroscopic adhesiolysis was continuously explored to achieve better reproductive outcome. Over time, the main focus of research has gradually shifted from complications to postoperative adjuvant treatment. Moreover, breakthrough progress is needed in underlying mechanism and early prevention of IUA.

Could Vitamin D Be Effective in Prevention of Preeclampsia?

Prevention of preeclampsia (PE) remains one of the most significant problems in perinatal medicine. Due to the possible unpredictable course of hypertension in pregnancy, primarily PE and the high complication rate for the mother and fetus/newborn, it is urgent to offer pregnant women in high-risk groups effective methods of preventing the PE development or delaying its appearance. In addition, due to the association of PE with an increased risk of developing cardiovascular diseases (CVD) in later life, effective preeclampsia prevention could also be important in reducing their incidence. Ideal PE prophylaxis should target the pathogenetic changes leading to the development of PE and be safe for the mother and fetus, inexpensive and freely available. Currently, the only recognized method of PE prevention recommended by many institutions around the world is the use of a small dose of acetylsalicylic acid in pregnant women with risk factors. Unfortunately, some cases of PE are diagnosed in women without recognized risk factors and in those in whom prophylaxis with acetylsalicylic acid is not adequate. Hence, new drugs which would target pathogenetic elements in the development of preeclampsia are studied. Vitamin D (Vit D) seems to be a promising agent due to its beneficial effect on placental implantation, the immune system, and angiogenic factors. Studies published so far emphasize the relationship of its deficiency with the development of PE, but the data on the benefits of its supplementation to reduce the risk of PE are inconclusive. In the light of current research, the key issue is determining the protective concentration of Vit D in a pregnant woman. The study aims to present the possibility of using Vit D to prevent PE, emphasizing its impact on the pathogenetic elements of preeclampsia development.

FPR2 serves a role in recurrent spontaneous abortion by regulating trophoblast function via the PI3K/AKT signaling pathway.

Recurrent spontaneous abortion (RSA) effects both the physical and mental health of women of reproductive age. Trophoblast dysfunction may result in RSA due to shallow placental implantation. The mechanisms underlying formyl peptide receptor 2 (FPR2) on the biological functions of trophoblasts remain to be elucidated. The present study aimed to explore the potential functions of FPR2, a G protein-coupled receptor, in placental trophoblasts. The location and expression levels of FPR2 in the villi tissue of patients with RSA were detected using immunohistochemical staining, reverse transcription-quantitative PCR and western blotting. Following the transfection of small interfering RNA targeting FPR2 in HTR-8/SVneo cells, a Cell Counting Kit-8 assay was used to determine the levels of cell viability. Flow cytometry was used to examine the levels of cell apoptosis and gap closure and Transwell assays were carried out to evaluate the levels of cell migration and invasion. A tube formation assay was performed to detect the levels of capillary-like structure formation. Western blotting was used to detect the expression levels of proteins in the associated signaling pathways. The expression of FPR2 was present in villi trophoblasts and was markedly increased in patients with RSA. The levels of trophoblast invasion, migration and tube formation were markedly increased following FPR2 knockdown, whereas the levels of apoptosis were markedly decreased. In addition, FPR2 knockdown caused an increase in the phosphorylation levels of AKT and PI3K. Thus, FPR2 may be involved in the regulation of trophoblast function via the PI3K/AKT signaling pathway. The results of the present study provided a theoretical basis for the use of FPR2 as a target for the treatment of trophoblast-associated diseases, such as RSA.