Portion Of Placenta Research Articles

Задержка рождения второго и третьего плодов при многоплодной беременности тройней (Клинический случай)

This article describes a clinical case of vaginal delivery in nulliparous women 24 years old delayed interval delivery of the second and third fetuses in spontaneous multiple pregnancy dichorionic triamniotic triplet in a tertiary perinatal center. After preterm delivery in 27+5 weeks of gestation the first fetus to reduce perinatal morbidity and mortality of two fetuses that are left in the uterus, with informed consent of the woman preterm delivery the second and third fetuses occurred at intervals of 38 days, in 33+1 weeks of gestation. Careful monitoring of the state of the mother and fetuses was conducted. To increase the interval between the birth of the first fetus and the second and the third fetuses, prevention of obstetric and perinatal complications used tocolysis, antibiotics, progesterone, the prevention of respiratory distress syndrome of the newborn by corticosteroids and bed rest. Three girls were born alive with a weight of 980, 1800 and 1950 grams correspondingly. Childbirth complicated second degree perineal laceration and retained portions of placenta and membranes, puerperal period was uneventful. After 1.5 months, all infants discharged with her mother in a satisfactory condition with a weight of more than 3000 grams. Key words: multiple pregnancy, triplet pregnancy, delayed interval delivery in triplet pregnancy, preterm delivery.

Fine particulate matter in the air within the limits recommended by WHO alters placental structure

ObjectiveTo evaluate the effects of PM during the perinatal period on placenta.MethodsFemale Wistar rats (7‐9/group) were exposed to filtrated air (F) or PM2.5 (P) for 15 days. After mating, rats were divided in 4 groups and again exposed to F or P (FF, FP, PF, PP). At the 19th day of pregnancy, fetal (fPl) and maternal (mPl) portions of placenta were collected. Several placental parameters and renin‐angiotensin system were evaluated.Results(mean±SEM – p<0.05): FF FP PF PP Mass (g) fPl 0.42±0.01 0.44±0.01 0.40±0.011,2,4 0.43±<0.01 mPl 0.13±0.01 0.14±0.01 0.12±0.011,2 0.12±0.011,2 Thickness (mm) fPl 4.42±0.10 4.16±0.06 3.93±0.091,4 4.40±0.11 mPl 3.15±0.10 2.77±0.091 2.92±0.09 2.95±0.11 Surface area (mm2) fPl 117.6±2.37 90.20±2.191 101.1±2.971,2 101.7±2.281,2 mPl 32.64±1.46 24.0±0.601 28.4±1.111,2 26.73±1.461 TGFβ (%) fPl 100 76.93±8.581 76.63±3.761 83.30±5.96 mPl 100 72.70±6.351 48.58±5.901,2 49.54±5.771,2 AGTO (%) fPl 100 121.7±15.69 127.9±10.29 115.3±11.36 mPl 100 104.9±10.75 114.6±19.30 85.87±4.28 ECA (%) fPl 100 90.17±5.27 74.20±4.841,2 59.78±3.361,2 mPl 100 96.96±4.39 82.04±3.161,2 80.41±4.961,2 Renin (%) fPl 100 192.8±27.791 204.3±21.371 149.9±20.021 mPl 100 139±11.06 113.5±18.57 120.7±26.42 ANG II (%) fPl 100 90.52±3.711 90.82±2.311 83.28±2.131 mPl 100 104.5±11.72 105.2±8.82 75.97±3.291,2,3 AT1R (%) fPl 100 202.1±41.161 118.7±17.69 142.3±15.91 mPl 100 99.71±11.19 75.58±5.21 36.63±4.021,2,3 AT2R (%) fPl 100 97.06±8.51 63.69±11.221,2 39.46±7.541,2 mPl 100 91.10±7.97 73.86±10.37 39.77±7.101,2 P<0.05 1vs FF; 2vs FP; 3vs PF; 4vs PP.ConclusionsParticulate matter alters placental structure and local renin‐angiotensin system with a possible prejudice on maternal‐fetal interface.

Conservative management of placenta accreta with injection methotrexate to preserve fertility

Placenta accreta is described as anchoring placental villi directly contact the myometrium resulting in firm attachment of the placenta to the myometrium. The incidence of placenta accreta is increasing parallel to raising cesarean section rate. Women at greatest risk of placenta accreta are those who have myometrial damage caused by a previous cesarean delivery with either an anterior or posterior placenta previa overlying uterine scar. Control of bleeding is the main goal in such cases, which usually necessitates hysterectomy or hypogastric artery ligation; embolization of uterine artery that is done by expert interventional radiologists. However, alternative methods are useful when retaining fertility is important in young women with low parity. We present a 28-year old G5P2+0+2+2 who was admitted at 33 weeks of period of gestation for antepartum hemorrhage (APH) with previous cesarean. Even after conservative treatment for APH, she delivered still born preterm baby at 34 weeks with retained placenta where manual removal of placenta failed to remove the placenta. Placenta was removed piecemeal leaving major portion of placenta, which was morbidly adherent. After 13 days of delivery ultrasonography (USG) showed plenty of placental tissue in the uterine cavity with peripheral vascularity and increased serum beta-human chorionic gonadotrophin (β-hCG) level (1980mIU/ml). Injection methotrexate was administered on the 18 th post-partum day following the regime of 1, 3, 5 and 7 days. Repeat USG after 1 week of treatment showed decrease size in placental mass with a decrease in serum β-hCG level and after 6 th post-partum week D&E done with complete removal of placental tissue and at 8 th post-partum week USG shows normal with no retained products of conception and the patient was stable. Hence, methotrexate can thus be helpful as conservative treatment for placenta accreta in conserving the uterus and hence, the fertility.

Real-Time Placental Perfusion on Contrast-Enhanced Ultrasound and Parametric Imaging Analysis in Rats at Different Gestation Time and Different Portions of Placenta

ObjectivesTo quantitatively analyze placental perfusion in a rat model at different gestation time and different portions of placenta by real-time contrast-enhanced ultrasound (CEUS) and parametric imaging analysis.Materials and MethodsSixty pregnant rats at different gestation time (15 dys,17 days and 20 days) were injected intravenously with microbubbles (5×105 microbubbles /ml, 1.0 ml/kg), and cadence contrast pulse sequencing (transmission frequency of 7 MHz, mechanical index 0.18) was performed. Dynamic enhancement changes in placenta at different gestation time and different portions of placenta were measured and enhancement parameters analyzed with software. Correlation between enhancement parameters and average area densities of placenta vascular compartment was compared.ResultsThe pattern and real-time sequence of enhancement in uterus and placenta were clearly depicted by CEUS. The time-to-peak enhancement was earlier in central portion than that in peripheral portion (12.30±6.33s vs 36.26±10.65 s, p = 0.005), and peak intensity of enhancement is much higher in central portion than that in peripheral portion (30.20±2.85 dB vs 20.95±6.25 dB, p = 0.000). The peak intensity of enhancement at day 15 (27.70±4.47 dB) was lower than that at day 17 (30.20±2.85 dB, p = 0.042) and at day 20 (31.85±4.41 dB, p = 0.015) of gestation. Significant correlation between average area densities of vascular compartment and the peak intensity of enhancement was identified in placenta at different gestation time (p<0.05). The average area densities of vascular compartment was higher in central portion than that in peripheral portion and has significant correlation with peak intensity of enhancement of the two potions (p<0.01).ConclusionCEUS is feasible to depict real-time sequence and quantitative parameters of perfusion in different portion of placenta at different gestational time in a rat model.

P33.14: Cytomegalovirus infection in pregnancy

Part of the placenta was left in situ. Estimated blood loss was 2500mls. Postpartumly the patient had minimal bleeding for about a week and was discharged. The patient returned with increasing brownish vaginal discharge at 5 weeks postnatally. On ultrasound examination, the retained portion of placenta was confirmed to be in the uterine cavity with no vascularity observed between the placenta and the uterine wall on Doppler imaging. Vaginal misoprostol was given followed by manual removal of the retained placental tissue. There was minimal bleeding associated with the procedure. In conclusion, ultrasound is useful in guiding the management of morbidly adherent placenta. When there is no or little vascularity between the placenta and the uterine wall demonstrable postnatally, it may be safe to remove the placenta.

Abdominal pregnancy—Fifth month

From a review of the above descriptions and diagnoses, it is apparent that this represents an abdominal ectopic pregnancy, apparently originating within the tube. The development of the placenta had taken place principally within the wall of the tube and along the surface of the tube, ovary and broad ligament. The tube and ovary were the seat of an old, healed inflammatory reaction in which the lumen of the tube had become partially obliterated. There was still a mild chronic inflammatory reaction in portions of the broad ligament. The cord and the amnion and the chorionic membrane and chorionic villi adjacent to the attachment of the cord were healthy, mature and free of disease. The chorionic villi in this portion of the placenta were loosely attached to the broad ligament in the region of the tube and ovary. In this area, there were well developed intervillous spaces, bordered by chorion on the one hand, and by fibrin, decidua, and smooth muscle fibers of the broad ligament, on the other. There was a hypertrophy and a hyperplasia of the smooth muscle fibers of the broad ligament, and of the vessels of the broad ligament, especially those in the immediate vicinity of the attachment of the placenta. The vessels here were large, dilated, and gave rise to broad, thin, endothelial lined sinuses, bordered by edema fluid, fibroblasts and decidua. Chorionic villi and nests of trophoblasts were found within the lumma of some of these thin-walled sinuses. The decidua, connective tissue stroma, smooth muscle fibers of the broad ligament, and the dilated and hypertrophied vessels represented the functioning portion of the maternal placenta. The remainder of the placenta was thin, and for the most part, non-functioning, and was composed of a compact layer of chorionic villi that showed degeneration and necrosis, fibrin, and bloodclot. This portion of fetal placenta was attached to portions of the broad ligament and pelvic peritoneum and to the surface of the ovary by dense fibrin, which showed very little attempt at organization. There was no evidence of malignancy.

Retained Portions of Placenta; Their Significance and Management

Retained Portions of Placenta; Their Significance and Management

Shall Portions of Placenta Retained after Full-term Labor Be Removed or Allowed to Remain?

Shall Portions of Placenta Retained after Full-term Labor Be Removed or Allowed to Remain?

THE USE OF THE CURETTE IN ACUTE INFECTION OF UTERUS WITH ADHERENT PLACENTA.

In the midst of the discussions of the more difficult and complex questions of abdominal and pelvic surgery our leading and most eminent gynecologists, whose opinions are of inestimable value to workers in more limited fields of general gynecologic work, often fail to furnish us lessons from the results of their own varied experience in the less brilliant but equally important matters pertaining to every-day practice. I have often been impressed with the thought, if our information was definite enough in relation to the use of the curette in removing attached portions of placenta in cases of abortion, premature labor or labor at full term when infection has occured. It is clear enough that in diseases of the endometrium the curette is of great value and is, as a general rule, properly used in the cases which come under our daily notice. But in the cases where, from the retention