Placental Parts Research Articles

Expression of CD68 by macrophages and histopathology of the placenta in COVID-19: association with obstetric and neonatal complications

Introduction. COVID-19 causes direct and indirect placental damage through inflammatory monocytes/ macrophages, increasing the risk of infectious and inflammatory diseases in newborns.Aim. To analyze the expression of CD68 by macrophages and structural changes in the placenta, and to assess the risks of obstetric and neonatal complications in cases of moderate COVID-19 during the third trimester of pregnancy.Materials and methods. A histological examination was conducted on 33 placentas from women with moderate COVID-19 in the third trimester of pregnancy and 30 placentas from women not infected with SARS-CoV-2. Tissue sections were analyzed using an automated microscopy system for histological studies. CD68 expression on placental macrophages was studied using flow cytometry. Detection of SARS-CoV-2 RNA in placental tissue samples, as well as in nasopharyngeal swabs from newborns, was carried out by real-time reverse transcription polymerase chain reaction (RT-PCR).Results. An increase in the number of CD68-positive macrophages was observed in the placentas from women with COVID-19 (80.8 (78.2; 83.5) %; p<0.0001) compared to samples from women not infected with SARS-CoV-2 (19.6 (17.2; 21.8) %). All placental samples and nasopharyngeal swabs from newborns of mothers with COVID-19 tested negative for SARS-CoV-2, indicating a low risk of vertical transmission. Histological analysis revealed signs of infectious involvement of both maternal and fetal placental parts, including focal deciduitis, villitis, and histiocytic intervillositis. Circulatory disorders were characterized by decidual vasculopathy, accelerated villous maturation, perivillous fibrin deposition, thrombosis, villous necrosis, and an increase in syncytial knots. A link was established between structural placental abnormalities and the development of chronic placental insufficiency (relative risk (RR)=2.33), preterm birth and premature rupture of membranes (RR=4.26), and fetal growth restriction. Newborns from mothers with COVID-19 exhibited complications such as cerebral ischemia and respiratory distress syndrome.Conclusion. Moderate COVID-19 in the third trimester of pregnancy can induce structural changes in the placenta, reflecting both compensatory-adaptive responses and inflammation driven by CD68-expressing macrophages. These alterations are associated with a high risk of obstetric and neonatal complications.

The Number of Syncytial Knots and the Intensity of VEGF Expression in the Villi of the Monochorionic Diamniotic Placenta in Selective Fetal Growth Restriction.

A comparative study was carried out to analyze the number of syncytial knots and the intensity of expression of vascular endothelial growth factor (VEGF) in the villi of the monochorionic diamniotic placenta in pregnancies complicated by the syndrome of selective fetal growth restriction (sFGR). We performed a morphological analysis of 32 monochorionic diamniotic placentas after term delivery which were divided into two groups. The main group included the placentas of 15 puerperas whose pregnancies were complicated by sFGR. The control group included twin placentas of 17 puerperas without signs of sFGR. The number of syncytial knots was determined by histological studies, and the levels of VEGF expression in syncytiotrophoblast and capillary endotheliocytes of the placental villi were determined by immunohistochemical studies. The study showed an increase in the number of syncytial knots in the villi of the placental part of the fetus with sFGR which indicated the development of preplacental hypoxia. A significant increase in the level of VEGF expression in the syncytiotrophoblast and vascular endothelium of the villi should be considered as a manifestation of a compensatory adaptational response to hypoxia, though it is insufficient to prevent the development of sFGR.

Artery-to-vein anastomoses in unequally divided placentas and their association with birthweight discordance

IntroductionThis study investigated the impact of the shared intertwin circulation in unequally divided monochorionic (MC) placentas on fetal growth. MethodsThis retrospective analysis included color-dyed, unequally shared placentas from two tertiary centers. Exclusions included twin-twin transfusion syndrome, twin anemia polycythemia sequence, and lethal anomalies. Measurement of the external diameters and areas of the artery-to-artery (AA), artery-to-vein (AV), and vein-to-vein (VV) anastomoses was performed. The ratio of the shared circulation (AV ratio) was determined by comparing the areas of the summed venous components of shared AV anastomoses to those in the individual AV anastomoses of the smaller placental part. The birth weight ratio/placental ratio (BWR/PR), total AV size areas and net AV transfusion were calculated. Univariable and multivariable linear regressions were performed to assess the relationship between BWR/PR, the AV ratio, the areas of the different anastomoses and cord insertion discordance. ResultsAmong 352 placentas, 97 % (340) had intertwin AV anastomoses, and 50 % (176) were from pregnancies with selective growth restriction. The AV ratio, AA, VV, total AV areas, and cord insertion discordance negatively correlated with BWR/PR. Multivariable linear regression confirmed the independent negative association between BWR/PR and the AV ratio, suggesting that a larger shared circulation benefits the twin with the smaller placental part. Type III sFGR placentas exhibited the highest AV ratio, resulting in the lowest BWR/PR. DiscussionA larger shared circulation mitigates the impact of an unequally divided placenta on fetal growth. This effect surpasses the influence of AA and VV diameters and is most prominent in Type III sFGR placentas.

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

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

Imbalance of angiogenic and growth factors in the placenta in maternal hyperhomocysteinemia

Numerous studies have shown that various adverse factors of different nature and action mechanisms have similar negative influence on placental angiogenesis, resulting in insufficiency of placental blood supply. One of the risk factors for pregnancy complications with placental etiology is an increased level of homocysteine in the blood of pregnant women. However, the effect of hyperhomocysteinemia (HHcy) on the development of the placenta and, in particular, on the formation of its vascular network is at present poorly understood. The aim of this work was to study the effect of maternal HHcy on the expression of angiogenic and growth factors (VEGF-A, MMP-2, VEGF-B, BDNF, NGF), as well as their receptors (VEGFR-2, TrkB, p75NTR), in the rat placenta. The effects of HHcy were studied in the morphologically and functionally different maternal and fetal parts of the placenta on the 14th and 20th day of pregnancy. The maternal HHcy caused increase in the levels of oxidative stress and apoptosis markers accompanied by an imbalance of the studied angiogenic and growth factors in the maternal and/or fetal part of the placenta. The influence of maternal HHcy in most cases manifested in a decrease in the protein content (VEGF-A), enzymatic activity (MMP-2), gene expression (VEGFB, NGF, TRKB), and accumulation of precursor form (proBDNF) of the studied factors. In some cases, the effects of HHcy differed depending on the placental part and stage of development. The influence of maternal HHcy on signaling pathways and processes controlled by the studied angiogenic and growth factors could lead to incomplete development of the placental vasculature and decrease in the placental transport, resulting in fetal growth restriction and impaired fetal brain development.

Imbalance of Angiogenic and Growth Factors in Placenta in Maternal Hyperhomocysteinemia

Numerous studies have shown that various adverse factors of different nature and action mechanisms have similar negative influence on placental angiogenesis, resulting in insufficiency of placental blood supply. One of the risk factors for pregnancy complications with placental etiology is an increased level of homocysteine in the blood of pregnant women. However, the effect of hyperhomocysteinemia (HHcy) on the development of the placenta and, in particular, on the formation of its vascular network is at present poorly understood. The aim of this work was to study the effect of maternal HHcy on the expression of angiogenic and growth factors (VEGF-A, MMP-2, VEGF-B, BDNF, NGF), as well as their receptors (VEGFR-2, TrkB, p75NTR), in the rat placenta. The effects of HHcy were studied in the morphologically and functionally different maternal and fetal parts of the placenta on the 14th and 20th day of pregnancy. The maternal HHcy caused increase in the levels of oxidative stress and apoptosis markers accompanied by an imbalance of the studied angiogenic and growth factors in the maternal and/or fetal part of the placenta. The influence of maternal HHcy in most cases manifested in a decrease in the protein content (VEGF-A), enzymatic activity (MMP-2), gene expression (VEGFB, NGF, TRKB), and accumulation of precursor form (proBDNF) of the investigated factors. In some cases, the effects of HHcy differed depending on the placental part and stage of development. The influence of maternal HHcy on signaling pathways and processes controlled by the studied angiogenic and growth factors could lead to incomplete development of the placental vasculature and decrease in the placental transport, resulting in fetal growth restriction and impaired fetal brain development.

Evento tromboembólico em neonato de mãe com COVID-19

INTRODUCTION: Premature birth is one of the main perinatal complications of maternal SARS-CoV-2 infection. CASE REPORT: Premature newborn, the daughter of a mother with a severe condition of COVID-19, who presented a thromboembolic event on the first day of life and evolved with hypoxic-ischemic encephalopathy. DISCUSSION: Investigation was carried out on the cause of the framework, management with enoxaparin and curative with collagenase, even though it was not possible to avoid the loss of the auricular region. Immunohistochemical evidence of Spike-19 protein was found in the fetal placental part. RT-PCR tests for SARS-CoV-2 without oropharyngeal swab were negative. A maternal coronavirus infection should be included in any differential diagnosis as a cause of a thromboembolic event in the neonatal period.

Cytokines and parturition: investigating adiponectin, TNF-α, and IL-6 in mother–newborn pairs

Objective Cytokines are reported to be associated with various pregnancy complications and health outcomes of the offspring. However, reference values during pregnancy have not been established, effects of clinical and obstetric factors have not been examined, and interactions between different cytokines have not yet been reported. Methods In this cross-sectional study, we recruited 120 mother–newborn pairs. Maternal venous blood samples (6 mL) were taken on admission to the labor ward; newborn venous blood samples (6 mL) were drawn from the placental part of the umbilical cord (UC). Adiponectin, TNF-α, and IL-6 serum concentrations were measured by commercial immunoassays. Clinical and obstetric variables were analyzed for their association with maternal and UC cytokine concentrations. Results Forty-six adiponectin pairs, 55 TNF-α pairs, and 14 IL-6 pairs were available for analysis. Correlation between UC and maternal adiponectin-, IL-6-, and TNF-α levels was low. We found a significant correlation of UC adiponectin with maternal brain-derived neurotrophic factor (BDNF) and maternal adiponectin, and between maternal leptin and maternal TNF-α. Conclusions Clinical and obstetric variables as well as interactions between cytokines may have an impact on serum concentrations of the respective cytokines in maternal and UC blood. Further studies are required to confirm our findings.

Resistin in pregnancy: Analysis of determinants in pairs of umbilical cord blood and maternal serum

ObjectiveDespite intensive research on the cytokine resistin only few studies investigated mother-newborn-pairs during healthy pregnancy and reported about interactions with clinical obstetric variables or other cytokines. Comparison of existing studies is difficult due to differences between assays, sample collection, gestational age, definition of healthy controls and patient characteristics. Furthermore, differences between rodent models and humans do not allow for a direct comparison. MethodsIn this cross-sectional, prospective study 109 healthy mother-newborn pairs were analyzed. Maternal venous blood samples were taken on admission to the labor ward; newborn venous blood samples were drawn from the placental part of the umbilical cord (UC), immediately after clamping. Resistin, leptin, adiponectin, TNF-α, IL-6 and brain derived neurotrophic factor (BDNF) serum concentrations were measured with commercially available immunoassays. Determinants of maternal and newborn resistin levels were analyzed using simple and multiple linear regression. ResultsUC resistin levels were higher than maternal concentrations (median 17.69 ng/mL, IQR 7.36 vs. median 8.04 ng/mL, IQR 4.30). Correlation between UC and maternal resistin levels was moderate (R = 0.503, p < 0.01). In multiple regression analysis levels of maternal resistin and newborn TNF-α remained significant determining factors for UC resistin levels. Gestational age and maternal BDNF-levels remained significant factors for maternal resistin levels. ConclusionIn healthy, term newborns and their respective mothers a positive correlation between maternal and newborn levels and an association with gestational age around term can be found and point to a placental source of resistin. Further investigations are needed to clarify the possible contribution of transplacental transport of resistin into the fetal circulation. Except for gestational age most of the clinical obstetric variables tested do not seem to be determining factors for fetal or maternal resistin. Interactions of resistin with other cytokines like TNF-α and BDNF could be the missing link for the conflicting results in literature.

Role of the Uterine Artery Ligation (UAL) In Control of Postpartum Hemorrhage

Objective: To determine the efficacy and safety of uterine artery ligation (UAL) in control of Postpartum Hemorrhage.&#x0D; Methodology: This case series study was conducted at Department of Gynecology and Obstetrics Peoples University of Medical &amp; Health Sciences for Women Nawabshah. All the women age between 20-45 years, gestation duration at and beyond 34 weeks, antepartum hemorrhage; intraoperative atonic postpartum hemorrhage and discovery of a placenta accreta; or an adherent placental part after piecemeal removal of the placenta, with bleeding from the placental site were included. After failure of treatment from medical measures, the initial surgical approach of uterine artery ligation (UAL) was done. Efficacy was defined as positive when patient improves or clinically doesn’t develop any complication throughout admission after UAL. Safety was assessed by appearance of side effects if any occurred after procedure. Data was recorded via study proforma and analysis was done by using SPSS version 20.&#x0D; Results: Out of 76 patients admitted of postpartum hemorrhage mean age was 58 years. Most of the patients 59.2% were multiparous and 40.8% were primiparous. The most common cause of postpartum hemorrhage was uterine atony 56.5% and adherent Placenta accreta 43.42%. Most of the patients 81.6% had no postoperative complications except for 11 patients, who had developed gaping of the wound from which they recovered and discharged. The patients required hysterectomy due to intractable hemorrhage and 2.3% mortality was observed due to DIC.&#x0D; Conclusion: Uterine devascularization by bilateral uterine artery ligation is a simple, effective and the safest initial surgical option with less blood loss and less surgical time for controlling postpartum hemorrhage during cesarean section. It should be used as the first surgical step of choice after medical managements fail in controlling postpartum hemorrhage due to minimal rate of complications and mortality.

Targeted Rhesus immunoglobulin for RhD-negative women undergoing an induced abortion: A clinical pilot study.

The aim of this clinical pilot study was to examine the accuracy of noninvasive fetal RHD genotyping in early pregnancy (8+0 to 11+6 weeks) and to clarify whether targeted administration of Rhesus immunoglobulin (RhIg) is possible for women undergoing an induced abortion such that unnecessary injections can be avoided. The study examines the correlation between gestational age and the amount of cell-free fetal DNA in maternal plasma, the fetal fraction of DNA and whether transportation time or body mass index affects these parameters. Fifty-two RhD-negative women undergoing a surgically induced abortion were included. A maternal blood sample was collected prior to the abortion and a tissue sample was collected from the placental part of the abortion material after the intervention. Fetal RhD type was determined by PCR analysis of cell-free fetal DNA extracted from maternal plasma and on DNA from the tissue sample, with the latter providing a reference standard. Copies of RHD/mL were determined on RHD-positive samples and the fetal fraction of DNA was calculated. We demonstrated complete concordance between results from plasma and tissue, with 31 RhD-positive and 21 RhD-negative samples, corresponding to 40% being RhD-negative, specificity 100% [95% confidence interval (CI) 88.8-100] and sensitivity 100% (95% CI 83.9-100). We found no significant correlation between gestational age and the amount or the fraction of cell-free fetal DNA in maternal plasma, nor did we find that transportation time or BMI significantly affected these factors in this setup. Fetal RHD genotyping can be accurately performed from the 8th week of gestation and unnecessary injections of RhIg can be avoided for women undergoing an induced abortion. A larger study is needed to determine a more accurate sensitivity for the analysis early in pregnancy.

Complete hydatidiform mole with a twin pregnancy at 26 weeks: a rare obstetric complication.

Complete hydatidiform mole with a twin pregnancy at 26 weeks: a rare obstetric complication.

Prolonged parturition and impaired placenta expulsion increase the risk of postpartum metritis and delay uterine involution in sows

It was hypothesized that prolonged parturition and impaired placenta expulsion increase the risk of postpartum metritis and delay uterine involution. At parturition, for 99 Yorkshire x Large White sows (parity 2–5), we determined the number of liveborn (NLP; 14.8 ± 3.4) and stillborn piglets (NSP; 1.1 ± 1.1), farrowing duration (FAR, time between first and last piglet; 333 ± 249 min), placenta expulsion duration (PLA, time between first and last placental part; 292 ± 241 min) and number of expelled placental parts (PART; 3.0 ± 1.0). FAR was categorized as ‘normal’ (<300 min; n = 44/99) or ‘prolonged’ (>300 min; n = 55/99). The relative PLA (rPLA; (PLA * 100)/FAR; 76 ± 101%) and the relative PART (rPART; (PART * 100)/(NLP + NSP); 22 ± 8%) were calculated and placenta expulsion was categorized as ‘normal’ (rPLA and rPART > 10%; n = 93/99) or ‘impaired’ (relPLA and relPART < 10%; n = 6/99). We also recorded whether manual palpation occurred (Yes/No) and/or oxytocin was used (Yes/No). After parturition, an ultrasound examination of the uterus was performed once for each sow between the 2nd and 7th day postpartum and the uterine size (mean sectional area of three to five uterine cross-sections) and intrauterine fluid accumulation (Yes/No) were recorded. Uterine size was categorized as ‘normal’ (n = 55/99) or ‘enlarged’ (n = 44/99) and used as an indicator of delayed uterine involution. Intrauterine fluid was used as an indicator of metritis. Prolonged FAR (35/54, 2.0 ± 0.5, 13.1, 7.6; n/N, β ± SE, Wald χ2, Odds; P = 0.001), manual palpation (12/17, 1.5 ± 0.7, 4.4, 4.3; P = 0.036), oxytocin administration (18/31, - 1.5 ± 0.7, 4.7, 0.2, P = 0.040) and NSP ≥ 2 (15/21, 1.4 ± 0.7, 3.8, 3.9; P = 0.052) were associated with increased uterine size (n = 44/99) and NSP ≥ 2 (7/21, 2.6 ± 0.9, 8.7, 13.7; P = 0.003), manual palpation (10/17, 1.8 ± 0.8, 5.0, 6.0; P = 0.025), prolonged FAR (13/15, 1.7 ± 0.8, 4.3, 5.7; P = 0.039) and impaired PLA (4/6, 3.3 ± 1.7, 4.0, 26.9; P = 0.044) with intrauterine fluid accumulation (n = 15/99). The results confirm the hypothesis, indicating that prolonged parturition and impaired placenta expulsion increased the risk for postpartum metritis. Stillborn piglets and manual palpation were also identified as risk factors. Postpartum metritis delays uterine involution whereas the use of exogenous oxytocin supports it.

The effect of litter size, parity and farrowing duration on placenta expulsion and retention in sows

The hypothesis was that a prolonged parturition impairs placenta expulsion and can lead to retained placentas in sows. Furthermore, we hypothesized that application of oxytocin around the time of expulsion of the first placental part improves placenta expulsion.We recorded 142 parturitions of 101 Yorkshire x Large White sows. We determined parity, gestation length, number of liveborn and stillborn piglets, farrowing duration (time between first and last piglet) and the outcome variables: number of expelled placental parts, placenta expulsion duration (time between first and last placental part), first placental part expulsion (time between last piglet and first placental part) and last placental part expulsion (time between last piglet and last placental part). The relationship between farrowing duration and each of the outcome variables was investigated using four distinct multivariable models.Use of oxytocin (used in 44 out of 142 parturitions) increased number of expelled placental parts (3.8 ± 0.2 vs. 2.9 ± 0.3; P = 0.035), decreased the placenta expulsion duration (172 ± 44 vs. 328 ± 26 min; P = 0.011) and time of last placental part expulsion (148 ± 48 vs. 300 ± 24 min; P = 0.025). If oxytocin was not used, farrowing duration obeyed a quadratic relationship with the number of expelled placental parts (P = 0.001), placenta expulsion duration (P = 0.002) and time of last placental part expulsion (P = 0.024). If oxytocin was used, number of expelled placental parts was positively associated with number of liveborn piglets (β = 0.2 ± 0.1; P = 0.002) and affected by parity. 5th parity sows expelled more placental parts (4.3 ± 0.4) than 4th (3.2 ± 0.3; P = 0.024) and 3rd parity sows (2.7 ± 0.4; P = 0.008). Furthermore, placenta expulsion duration was positively associated with number of liveborn piglets (β = 18 ± 8 min; P = 0.025). First placental part expulsion was negatively correlated with farrowing duration (β = 0.3 ± 0.1; P = 0.001). Sows that experienced total (no expulsion of placental parts; n = 4) and partial retained placentas (no expulsion of placental parts after birth of the last piglet; n = 4) had longer farrowing durations (1009 ± 275 and 734 ± 136 min) than sows with no retained placentas (369 ± 202 min; P = 0.021 and P = 0.004).The results show that a prolonged parturition impaired and oxytocin improved placenta expulsion in sows. Furthermore, retained placentas occurred in 3–6% of the sows and was correlated with a prolonged parturition.

HDliveFlow with HDlive Silhouette Mode in Antenatal Diagnosis of Bilobed Placenta

ABSTRACT We present a case of bilobed placenta diagnosed by HDliveFlow with the HDlive silhouette mode early in the 2nd trimester of pregnancy. A 29-year-old Japanese pregnant woman, gravida 4, para 1, was referred to our hospital based on the patient's wish at 23 weeks and 3 days of gestation. Two-dimensional (2D) sonography showed a single live fetus with biometry consistent with the gestational age. Moreover, two separated parts of the placenta were noted at the anterior and posterior uterine walls. HDliveFlow with the HDlive silhouette mode clearly depicted two lobes of the placenta (near equal size), and the main umbilical cord attached to the periphery of the anterior part of the placenta. One large connecting vessel between these two placental parts was also clearly identified. Bilobed placenta was strongly suggested. After birth, the gross specimen of the placenta confirmed the diagnosis. HDliveFlow with the HDlive silhouette mode may be an adjunctive tool to 2D sonography to diagnose abnormalities of the placenta in utero. How to cite this article Yang P-Y, Kanenishi K, Ishibashi M, Mori N, Hata T. HDliveFlow with HDlive Silhouette Mode in Antenatal Diagnosis of Bilobed Placenta. Donald School J Ultrasound Obstet Gynecol 2016;10(4):415-417.

Monochorionic twins with unequal placental sharing: why can the outcome still be favorable?

Objective: In monochorionic diamniotic (MCDA) twin pregnancies, unequal placental sharing does not always lead to adverse outcomes. The aim of this study is to investigate how unequal placental sharing may be compensated by placental anatomical changes.Methods: Between January 2012 and July 2013, a total of 60 uncomplicated MCDA pregnancies ending in live birth of healthy twins were studied. Placentas were divided into two groups; an equally shared placenta group (placenta territory discordance ≤25%, N = 40) and an unequally shared placenta group (placenta territory discordance >25%, N = 20). Angioarchitecture, cord insertion type and the distance between two cord insertions were compared.Results: Vascular anastomoses were seen in all 60 placentas, and 58 placentas (96.7%) had arterioarterial anastomoses (AA). The overall diameter of the AA was larger in the unequally shared placenta group as compared to the equally shared placentas (0.27 ± 0.12 cm versus 0.19 ± 0.1 cm, p < 0.05). The distance between the cord insertions was shorter in the unequally shared group (14.5 ± 6.0 cm versus 18.3 ± 6.5 cm, p < 0.05).Conclusion: The absence of adverse outcomes in unequally shared placenta group can be explained by the presence of large AA and shorter distance between cord insertions, protecting the twin with the smaller placental part against growth restriction and other pathology.

Matrix Metalloproteinase (MMP)‐2 and MMP‐9 Activity in the Canine Uterus Before and During Placentation

The aim of the present study was to demonstrate the presence and localization of MMP-2 and -9 by means of RT-PCR and immunohistochemistry (IHC) within the canine uterus from the pre-implantation stage until mid-gestation and to determine MMP-2 and -9 activities by means of zymography. For this purpose, samples of the uterus and salpinx from bitches were obtained after ovariohysterectomy. Pre-implantation stages (5-12 days after mating, n = 11) were determined by verifying embryos after flushing the uterus. Further groups were determined as implantation (15-19 days after mating, n = 9), post-implantation (20-30 days after mating, n = 9) and placental stages (30-45 days after mating, n = 3). A non-pregnant group (17-30 days after mating, n = 4) served as control. MMP-2 and -9 positive cells were detected in all specimens from pregnant and nonpregnant bitches, however, with different distributions. MMP-2 was present in endothelium and smooth muscles of blood vessels and the myometrium of pregnant and nonpregnant bitches, additionally in the surface epithelium of the oviduct. The latter also stained positive for MMP-9. During placentation, MMP-2 was detected mainly in fetal blood vessels and trophoblastic cells. Higher MMP-2 activity was observed in the endometrium and myometrium of all pregnant groups compared with the nonpregnant group (p < 0.05). The pregnant groups did not differ significantly from each other (p > 0.05). MMP-9 was present in blood vessels, smooth muscle cells and epithelia, such as maternal surface epithelial cells, uterine crypts and glands. During placentation, the deep uterine glands and the epithelium of the glandular chambers were immunoreactive to MMP-9. Highest MMP-9 activities were reached in the endometrium of the pre-implantation group (23.2% of total MMP-9) and placental parts (33.3%).

Placental sharing, birthweight discordance and vascular anastomoses in monochorionic diamniotic twin placentas

ObjectiveTo examine the relationship between the discordance in placental territory (PT), birthweight (BW), and vascular anastomoses in placentas from a prospective series of monochorionic diamniotic (MCDA) twins included in the 1st trimester.Study designCord vessels were injected with dyed barium sulphate. Rx angiograms and digital photographs of the chorionic surface were taken. BW discordance was defined as BW heavier/BW lighter twin. PT discordance was determined on Rx angiogram as the ratio of venous surface areas of the larger and smaller placental part. On the digital photograph, minimal diameters (mm) of arterio-arterial (AAs) and of each vein of an arterio-venous (AV) anastomosis were measured. An estimate of net AV transfusion was calculated as the difference of total diameters of AVs draining in either direction.Results76 placentas were analysed. BW discordance increased with PT discordance (P<0.0001). AA diameter (P<0.01) and net AV transfusion (P<0.001) towards the larger placental part increased with PT discordance. For a given PT discordance, BW discordance decreased with increasing AA diameter (P<0.01) and net AV transfusion towards the larger placental part (P<0.05).ConclusionUnequally shared placentas have larger AAs and a larger estimated net AV transfusion towards the larger placental part, as compared to equally shared placentas, which decreases BW discordance for a given PT discordance. Supported by European Commission-Eurotwin2twin - QLG1-CT-2002-01632. ObjectiveTo examine the relationship between the discordance in placental territory (PT), birthweight (BW), and vascular anastomoses in placentas from a prospective series of monochorionic diamniotic (MCDA) twins included in the 1st trimester. To examine the relationship between the discordance in placental territory (PT), birthweight (BW), and vascular anastomoses in placentas from a prospective series of monochorionic diamniotic (MCDA) twins included in the 1st trimester. Study designCord vessels were injected with dyed barium sulphate. Rx angiograms and digital photographs of the chorionic surface were taken. BW discordance was defined as BW heavier/BW lighter twin. PT discordance was determined on Rx angiogram as the ratio of venous surface areas of the larger and smaller placental part. On the digital photograph, minimal diameters (mm) of arterio-arterial (AAs) and of each vein of an arterio-venous (AV) anastomosis were measured. An estimate of net AV transfusion was calculated as the difference of total diameters of AVs draining in either direction. Cord vessels were injected with dyed barium sulphate. Rx angiograms and digital photographs of the chorionic surface were taken. BW discordance was defined as BW heavier/BW lighter twin. PT discordance was determined on Rx angiogram as the ratio of venous surface areas of the larger and smaller placental part. On the digital photograph, minimal diameters (mm) of arterio-arterial (AAs) and of each vein of an arterio-venous (AV) anastomosis were measured. An estimate of net AV transfusion was calculated as the difference of total diameters of AVs draining in either direction. Results76 placentas were analysed. BW discordance increased with PT discordance (P<0.0001). AA diameter (P<0.01) and net AV transfusion (P<0.001) towards the larger placental part increased with PT discordance. For a given PT discordance, BW discordance decreased with increasing AA diameter (P<0.01) and net AV transfusion towards the larger placental part (P<0.05). 76 placentas were analysed. BW discordance increased with PT discordance (P<0.0001). AA diameter (P<0.01) and net AV transfusion (P<0.001) towards the larger placental part increased with PT discordance. For a given PT discordance, BW discordance decreased with increasing AA diameter (P<0.01) and net AV transfusion towards the larger placental part (P<0.05). ConclusionUnequally shared placentas have larger AAs and a larger estimated net AV transfusion towards the larger placental part, as compared to equally shared placentas, which decreases BW discordance for a given PT discordance. Supported by European Commission-Eurotwin2twin - QLG1-CT-2002-01632. Unequally shared placentas have larger AAs and a larger estimated net AV transfusion towards the larger placental part, as compared to equally shared placentas, which decreases BW discordance for a given PT discordance. Supported by European Commission-Eurotwin2twin - QLG1-CT-2002-01632.

Clinical Application of Grey Scale and Colour Doppler Sonography during Abnormal Third Stage of Labour

The purpose of the study was to investigate whether colour Doppler sonography is helpful in the surveillance of abnormal third stage of labour. 20 patients were enrolled in the prospective study. Inclusion criteria were third stage of labour > 15 min and/or clinical suspicion of retained placenta. By means of grey scale and colour Doppler sonography the length of distinct phases of third stage of labour and length of visualisation of blood flow between myometrium and placenta were measured. These data were compared with previously published normal values. The patients were allocated into four groups: 1. Patients with prolonged third stage of labour, but normal vaginal delivery of the placenta (Group 1, 8 cases). 2. Patients with clinically suspected retained placental parts (Group 2, 4 cases). 3. Patients with manual removal of the placenta without confirmation of placenta accreta (Group 3, 4 cases). 4. Patients with manual removal of the placenta with confirmation of placenta accreta (Group 4, 4 cases). A significant longer latent phase was responsible for the prolonged third stage of labour in Group 1 (p < 0.05). Blood flow between myometrium and placenta was significantly longer visible in Group 4 than in the normal cohort (p < 0.0001). Grey scale sonography can help to distinguish between uncomplicated and complicated prolonged third stage of labour. Colour Doppler sonography can detect persistent blood flow between myometrium and placenta during third stage of labour in cases of placenta accreta. In these instances, the patient may benefit from colour Doppler sonography-guided curettage.

OC23.01: Reference data representative of normal findings at 2D and 3D gray scale ultrasound examination of the cervix from 17 to 41 gestational weeks

Background: Fetoscopic laser coagulation of the vascular anastomoses is currently the best available treatment method for severe twin–twin-transfusion syndrome (TTTS) diagnosed < 26 weeks. However, postoperative single intrauterine fetal death (sIUFD) commonly occurs, in which unequal placental distribution may play an important role. Objectives: To evaluate the use of preoperative Magnetic Resonance Imaging (MRI) to determine placental volume distribution and to correlate unequal placental distribution with the occurrence of postoperative sIUFD. Material and methods: Preoperative MRI (T1-T2-Diffusion) of the monochorionic placenta was performed in 28 cases of TTTS to determine the placental volume ratios. Placental distribution was considered to be unequal when the placental volume ratios were less than 30/70. An ultrasound scan was performed 24 and 48 hours after the procedure to check fetal viability. Postoperative sIUFD was defined as demise of 1 twin within 48 hours. After birth, volumetric CT angiography was performed of 9 placentas with double survivors. The placental volume ratios measured on postnatal CT angiography were compared with the predicted values on preoperative MRI. Results: Determination of the placental volume ratios was possible in 22/28 (79%) of cases on T2-weighted MRI as well as on ADC maps. In 8/9 placentas examined after birth, preoperative MRI had accurately predicted the placental distribution. In 3/4 cases with predicted unequal placental distribution, sIUFD occurred, of which 2 fetuses had the largest placental part and 1 had the smallest part. In contrast, sIUFD occurred in only 3/18 cases (17%) with equal placental distribution (P < 0.05). Conclusion: Preoperative MRI seems to accurately predict placental volume distribution in most cases with TTTS. Also, unequal placental distribution appears to be a risk factor for sIUFD after laser treatment. However, sIUFD was not restricted to the fetus with the smallest placental part.