Retroplacental Hemorrhage Research Articles

Accidental Haemorrhage

Edward Rigby of Norwich, in a treatise on uterine haemorrhage published in 1776, first shed light on the problem of bleeding from the vagina during later pregnancy. In this essay he differentiated between an accidental haemorrhage and the haemorrhage of a placenta praevia. From his observations accidental haemorrhage was defined as "bleeding from a normally situated placenta, after the 28th week of gestation, and up to the end of the second stage of labour."Accidental haemorrhage is divided into three varieties:1. Revealed Accidental Haemorrhage.-where the bleeding is entirely external;2. Concealed Accidental Haemorrhage.-where there is no sign of blood externally;3· Mixed or Combined Accidental Haemorrhage.-which shows features of both concealed and revealed.The most important of these is the concealed variety and there are four ways in which a haemorrhage may remain concealed:1. A retroplacental haemorrhage occurs in the central area of the placenta, but the margins of the placenta remain adherent to the uterine wall.2. If the placenta becomes completely separated the membranes remain attached to the uterine wall.3· The blood may burst through the membranes into the amniotic sac mingling with the liquor, and immersing the foetus in a blood bath (Lesser 1951).4· When the foetal head is accurately applied to the lower uterine segment so that the blood cannot make its way past it into the vagina.In spite of these mechanisms it is much more common for blood to escape externally ; a concealed accidental haemorrhage thus becomes a mixed accidental haemorrhage.

Dekolman Plasenta ve Risk Faktörleri

Objective: It was aimed to evaluate pregnancies with suspected placental abruption and investigate the related risk factors. Methods: Ninety-four pregnancies who delivered by cesarean section for suspected placental abruption in Zeynep Kamil Hospital between 01.03.2012 and 31.01.2013 were included in this study. During the operation, the placenta was examined macroscopically. The presence of retroplacental bleeding or clots in the placenta confirmed the diagnosis of placental abruption. Age, parity, height, weight, blood group, placental localization, previous delivery type, presenting symptoms, pregnancy complications were recorded. Results: The diagnosis of placental abruption was confirmed in 43 (46%) patients while 51 of them (54%) were not confirmed. There was no significant difference between the groups in terms of maternal age, gestational age and body mass index. Mean arterial pressure (MAP) was 95.1±17.8 at the group with placental abruption confirmed and 85.4±8.7 (p=0.006) at the group with placental abruption not confirmed. Placental abruption is more frequent in patients with preeclampsia (OR=8.5; p=0.022). When the groups were compared according to their blood groups; 87.5% of pregnant women with 0 Rh (+) blood group was confirmed for diagnosis of placental abruption (OR=8.7; P=0.005). Conclusion: Identification of risk factors for placental abruption is the basic criterion for the management and reduction of potential complications.

Post B-lynch uterine rupture: case report and review of literature.

Postpartum hemorrhage (PPH) remains one of the three leading causes of maternal death and uterine atony accounts for 75–90 % of primary PPH. Apart from traditional conservative methods such as medical therapy, tamponades, the B-Lynch surgical technique has been widely used around the world. In 1997, Christopher B. Lynch devised these mechanical uterine compressing sutures to avoid hysterectomy in cases of severe PPH due to uterine atony, and since then, anecdotal evidence suggests that around 1,300 cases have been performed successfully worldwide including in India, Africa, North and South America, and Europe (Figs. 1, ​,22). Fig. 1 Ruptured uterus Fig. 2 Sutured uterus Case Report A 23-year G4P1L1A2 was admitted from casualty on November 5, 2011 with 4 months of amenorrhea and pain in the abdomen since the morning. She was very pale, had tachycardia, and a BP of 90/60 mmHg. There was abdominal tenderness and guarding. There was also a suprapubic transverse scar of a previous surgery. The uterine size could not be assessed due to extreme tenderness and guarding. At the time of the previous normal delivery, the patient had atonic PPH for which B-Lynch suturing was done. The suture material used for B-Lynch was Polyglactin No 1 (delayed absorbable suture material) on round body needle. The ultrasound showed moderate free fluid in the abdomen, the fetus lying outside the uterine cavity, and a 7 × 7 cm retro placental hemorrhage -s/o uterine rupture. Under general anesthesia, an exploratory laparotomy was performed. The uterine rupture was approximately 6 cm in length at the fundal region. The fetus with the amniotic sac lying out of ruptured site and around 1,500 ml of hemoperitoneum. The uterus was sutured with delayed absorbable sutures in three layers. Peritoneal lavage was given and an intraperitoneal drain was kept. The uterine height was marked and monitored postoperatively. She received five units of whole blood, fresh frozen plasma, and platelets intra- and postoperatively. The postoperative course was uneventful and she was discharged on seventh postoperative day. The risk of uterine rupture in future pregnancy was explained to the patient and her relatives.

Recurrent abruptio placentae in a cynomolgus monkey (Macaca fascicularis)

IntroductionAbruptio placentae, defined as premature separation of a normally implanted placenta, is a life threatening pregnancy complication with unknown pathophysiology. A history of abruptio placentae is the major risk factor for this pregnancy complication in humans. We describe the first case of recurrent abruptio placentae in a Macaca fascicularis. Material and methodsA pregnant M. fascicularis at term gestation was presented with weakness and hypothermia. Cesarean section revealed retroplacental hemorrhage with partial placental separation from the uterus. ResultsThe weight of the female fetus was within the lower birth weight range for these species. The maternal side of placenta contained necrotic tissue, occupying approximately 60% of the maternal surface. The placental implantation bed demonstrated neutrophil infiltration. Perivascular collections of lymphocytes were noticed in the uterine smooth muscle. ConclusionThis case report underlines the importance of neutrophil infiltration and uterine venous drainage in the cascade of events leading to abruptio placentae.

Placental pathology, birthweight discordance, and growth restriction in twin pregnancy: results of the ESPRiT Study

We sought to evaluate the association between placental histological abnormalities and birthweight discordance and growth restriction in twin pregnancies. We performed a multicenter, prospective study of twin pregnancies. Placentas were examined for evidence of infarction, retroplacental hemorrhage, chorangioma, subchorial fibrin, or abnormal villus maturation. Association of placental lesions with chorionicity, birthweight discordance, and growth restriction were assessed. In all, 668 twin pairs were studied, 21.1% monochorionic and 78.9% dichorionic. Histological abnormalities were more frequent in placentas of smaller twins of birthweight discordant pairs (P = .02) and in placentas of small for gestational age infants (P = .0001) when compared to controls. The association of placental abnormalities with both birthweight discordance and small for gestational age was significant for dichorionic twins (P = .01 and .0001, respectively). No such association was seen in monochorionic twins. In a large, prospective, multicenter study, we observed a strong relationship between abnormalities of placental histology and birthweight discordance and growth restriction in dichorionic, but not monochorionic, twin pregnancies.

Antenatal Closure of the Ductus Arteriosus and Hydrops Fetalis

Antenatal closure of the ductus arteriosus has been speculated, but rarely reported, as a cause of hydrops fetalis. The purpose of this prospective autopsy study was to find the incidence of antenatal closure of the ductus arteriosus and hydrops fetalis in a high-risk obstetric population and to find associated factors that might give clues to the cause of antenatal closure of the ductus arteriosus. Antenatal closure of the ductus arteriosus had to be stringently sought by in situ examination. Fifteen stillborns with antenatal closure of the ductus arteriosus were found in 684 perinatal autopsies (2.2%), including 511 stillborns (2.9%). All 15 stillborns with antenatal closure of the ductus arteriosus also had hydrops fetalis and accounted for 35% of the 43 stillborns with hydrops fetalis. Antenatal closure of the ductus arteriosus in these 15 stillborns was not associated with maternal aspirin use but was associated with a myriad of factors, including intrauterine infection (60%), umbilical cord abnormalities (67%), and retroplacental hemorrhage (87%), that can cause hypoxic-ischemic stress.

Association of non-reassuring fetal heart rate and fetal acidosis with placental histopathology

Objective To investigate the association between different placental lesions and non-reassuring fetal heart rate (NRFHR) pattern and fetal acidosis in labor. Study design Placentas from 213 women who underwent cesarean section because of NRFHR with or without fetal acidosis (pH < 7.2) were classified by histopathologic findings: consistent with maternal circulation abnormalities i.e., namely, marginal or retroplacental hemorrhage (M0), maternal underperfusion, vascular (M1) or villous changes (M2), and those consistent with fetal thrombo-occlusive disease due to vascular (F1) or villous (F2) changes. Lesions were also analyzed by maternal (MIR) or fetal (FIR) origin of inflammatory responses. Results Cord blood pH was normal in 169 neonates (7.29 ± 0.04; control group) and <7.2 in 44 (7.10 ± 0.07; study group). The study group had higher rates of histologic chorioamnionitis; MIR was detected in 34.1% compared to17.8% of controls ( p = 0.018), and FIR, in 18.2% compared to 6.5% ( p = 0.016). Neonates in the study group had lower Apgar scores and longer hospitalization. Conclusions Placental MIR and FIR are associated with cord blood acidosis in neonates delivered by cesarean section for NRFHR tracings in labor.

Review of Autopsies of Stillborn Infants with Retroplacental Hematoma or Hemorrhage

Intrathoracic petechiae are a potential marker of acute asphyxia in stillborn infants. Retroplacental hematoma (RPH) is a cause of acute asphyxia. The histological features of RPH can be timed using criteria for intrauterine duration of fetal death. Autopsies of stillborn infants of >26 weeks in gestation with RPH were evaluated for gross or microscopic evidence of petechiae. Placental gross and microscopic features were recorded. Eleven controls from other mechanisms of death were randomly selected. Intrathoracic petechiae were present in all 17 infants with RPH of >50% of the placental area, in 3 of 7 infants with <50% area RPH, and in 2 of 11 infants with other diagnoses. The placenta demonstrated basal plate neutrophils in all cases of RPH (N = 21). Early coagulation necrosis in the villi overlying the RPH was present in 5 of 13 cases after 4 to 24 hours, and complete coagulation necrosis was present in 3 of 4 cases after 24 hours. Infants with RPH underlying >50% of the placenta demonstrate intrathoracic petechiae, but controls and infants with smaller RPH do so much less frequently. This is consistent with the hypothesis that intrathoracic petechiae are a marker for intrauterine asphyxia. Basal plate neutrophils are a useful early marker of retroplacental hemorrhage. Early coagulation necrosis of the placenta over RPH begins in 4 to 24 hours but is not complete after more than 24 hours.

Diagnosis of Placental Abruption: Relationship Between Clinical and Histopathological Findings

Despite intensive investigation, it is unclear whether the diagnosis of placental abruption should be based on established clinical criteria or histopathological findings. Although the vast majority of placental abruption cases appear to have a chronic etiology, it also remains speculative as to whether abruption is an acute or chronic process. The aim of the present multicenter, case-control study was to assess the concordance between clinical and histopathological diagnostic indicators of placental abruption. A secondary aim was to investigate acute and chronic histological lesions associated with clinical abruption. The clinical and histologic criteria for abruption were compared using data obtained from the New Jersey-Placental Abruption Study. The study subjects, 162 women with a confirmed clinical diagnosis of placental abruption, were matched with 173 controls without placental abruption. Criteria for the clinical diagnosis of placental abruption included painful vaginal bleeding accompanied by nonreassuring fetal status, uterine hypertonicity, evidence of clinically significant retroplacental bleeding, or clot(s) or placental abruption diagnosed on prenatal ultrasound. The pathological criteria for a diagnosis of abruption included hematoma with or without recent or old infarctions, foci of villous compression, fibrin deposition, and hemosiderin-laden histiocytes in cases with older hematomas. Histologic lesions were grouped as acute or chronic histologic lesions. Acute lesions included chorioamnionitis, funisitis, acute deciduitis, meconium-stained membranes associated with amnion necrosis and pigmented macrophages, villous stromal hemorrhage, and villous edema. Chronic lesions included chronic deciduitis, maternal floor decidual necrosis, decidual vasculopathy, placental infarction, villous mal-development with delayed or accelerated maturation, hemosiderin deposition, intervillous thrombosis, and villitis. Of the 162 clinically diagnosed cases, only 30.2% (n = 49) were confirmed as placental abruption based on gross or histological findings, whereas the specificity for a histologic confirmation of abruption was 100%. Among clinically diagnosed cases, the most common indication for a clinical diagnosis of abruption was evidence of retroplacental clot(s) or bleeding (77.1%). Two chronic lesions, placental infarction and decidual vasculopathy, were significantly associated with abruption, but no acute lesions were significantly associated with abruption. The investigators conclude from these finding that there is poor concordance between the clinical and pathological diagnosis of placental abruption. The diagnosis of abruption should be based on clinical criteria such as evidence of retroplacental bleeding or clot(s), ultrasound visualization of abruption, or painful vaginal bleeding accompanied by either nonreassuring fetal status or uterine hypertonocity.

A Retrospective Analysis of Placentas From Twin Pregnancies Derived From Assisted Reproductive Technology

There are conflicting studies associating twin pregnancies derived from assisted reproductive technology (ART) with preterm birth, low birthweight, and other negative outcomes. This work investigates whether ART is linked with any placental pathology, given that placentation significantly influences fetal development. A 5-year, retrospective cohort study was conducted on placentas from twin pregnancies. The placental information from 417 patients was divided into two groups: placentas derived from ART and placentas derived from spontaneous pregnancies (non-ART). Available clinical information and pathologic findings from both groups then were compared. There was no statistical difference in the prevalence of placental pathology between the non-ART and ART cohorts (i.e., cord insertion, single umbilical artery, cord knot, retroplacental hemorrhage, infarction, vasculopathy, vascular anastomoses, chorangiosis, villitis, deciduitis, chorioamnionitis, meconium staining). However, 8% of ART multiple pregnancies were monochorionic. While monochorionicity is a known risk factor for adverse obstetric and neonatal outcomes, the rate of monochorionic placentation did not increase as a result of ART. Nevertheless, it is interesting to note that this small percentage of monochorionic placentation occurred in the ART cohort despite the implantation of individual embryos. Overall, the data suggests that ART does not have a role in the pathologic placentation of twin pregnancies.

Regional Anesthesia for a Parturient with Venous Sinus Thrombosis and Placental Abruption Undergoing Fractional Heparin Therapy

THE increased incidence of thrombosis and hypercoagu-lability during pregnancy are well recognized and require anticoagulation for symptomatic sequelae. The following case illustrates our perioperative treatment of a patient with vaginal bleeding while undergoing treatment for a transverse sinus thrombosis.

Pregnancy Outcomes in Patients With Previous History of Abruptio Placentae

Abruptio placentae (AP) is a major cause of poor obstetric outcomes. Although AP has been reported to recur in 10% of women who have had one abruption and in as many as one fourth of those who have had 2 previous episodes, all factors leading to recurrence are not known. This study examined the recurrence of AP in a retrospective series of 6054 deliveries in women of low socioeconomic status. Criteria for inclusion included a pregnancy lasting more than 24 weeks, a history of antepartum hemorrhage with demonstrated retroplacental bleeding, and exclusion of placenta previa. Forty-five women with a history of AP were matched for age and parity with 63 control women having no history of AP. Abruption was confirmed using hospital records and patient information, and was defined as a retroplacental clot exceeding 200 mL and receipt of a blood transfusion. Two hundred seventeen women (3.6%) had AP. The index pregnancy was complicated by hypertension in 55% of women with AP and in 8% of control women (P <.001). All 217 women with AP were delivered at 34 weeks gestation, approximately 40% of them by elective cesarean section, and there were no obstetric complications. Forty-five women had a history of previous AP. Thirty-five percent (16 of 45) had another AP (including one patient who had her third AP) compared with 3.1% of control women with no history of AP. All but one of the 16 abruptions resulted in stillbirth compared with 10 stillbirths among the controls (33% vs 10%, P <.0004). Of the 16 women with recurrent abruptions, only 10 had antenatal care and 9 of these had untreated hypertension. The rate of preterm delivery was 85% for women with a history of AP compared with 27% for the control group. AP recurs more frequently than previously thought. Presumably, obstetric outcomes can be improved in women with a history of AP by providing quality antenatal care. The investigators believe that these women will benefit from delivery shortly after fetal lung maturity is confirmed at 34 to 37 weeks gestation.

Pregnancy outcomes in patients with previous history of abruptio placentae

Abruptio placentae (AP) is a major cause of adverse obstetric outcome. Recurrence rates of 10% after 1 episode and 25% after 2 episodes have been reported. The present study evaluated obstetric outcome in women who were from a low socio-economic population and had a history of AP. A retrospective study of 6054 deliveries performed over 9 months was carried out. The inclusion criteria were (1) a pregnancy duration greater than 24 weeks based on menstrual history palpation and ultrasonography; (2) a history of antepartum hemorrhage with demonstration of retroplacental hemorrhage; and (3) the possibility of placenta previa was excluded. (excerpt)

Parvovirus infects cardiac myocytes in hydrops fetalis.

Parvovirus infection during pregnancy is an important cause of hydrops fetalis. It is attributed to anemia caused by viral-induced destruction of red blood cells. Infection of other organs has been reported including the heart, liver, and lungs. Few of these reports, however, convincingly demonstrate virions within the functional parenchyma of the tissue. This is of particular concern regarding myocardium in the context of hydrops fetalis which is, in part, due to cardiac failure. The problem in routine pathology practice is that most fetuses with the infection are macerated. This, in part, probably explains the paucity of published information on cardiac involvement. This study examined five cases of fatal hydrops fetalis with variable maceration with serologically proven parvovirus B19 infection. Transmission electron microscopy of cardiac tissue demonstrated intranuclear virions in both erythroid precursor cells and in cardiac myocytes in three of these cases. In each of these, immuno-gold electron microscopy provided confirmatory evidence of parvovirus infection. Virions were not identifiable where maceration had caused disintegration of nuclei in the myocytes. In addition, virions were absent in the three negative control cases where retroplacental hemorrhage was confirmed as the cause of death. This study suggests that parvovirus infection of cardiac myocytes may play a more important role in causing hydrops fetalis than previously realized. It also demonstrates that maceration should not discourage the use of electron microscopy.

Discrepancy in Pathologic Diagnosis of Placental Lesions

Placentas are routinely examined by surgical pathologists, but peer review of placental diagnosis is rarely performed. To determine the frequency of discrepant placental diagnosis between general surgical pathologists and a pediatric pathologist. One hundred fourteen placentas from infants with intrauterine growth restriction (IUGR) and 170 placentas from infants appropriate for gestational age (AGA) were reviewed for 10 lesion types using standardized criteria. The review diagnosis was compared with original reports. The review identified 333 lesions, 168 in the IUGR group and 165 in AGA group. Discrepant diagnosis occurred in 137 lesions (41.1%). There was no significant difference in the frequency of discrepant diagnosis between the IUGR (44.7%) and AGA groups (37.6%) (P >.05). Most discrepancies (92.7%) were due to underdiagnosis (identified on review but not mentioned in original diagnosis), but a few (7.3%) were due to misdiagnosis (mentioned in original report but disagreed on review). The common underdiagnoses with their corresponding rates were as follows: hemorrhagic endovasculitis (84.6%), fetal thrombotic vasculopathy (75%), massive perivillous fibrin deposition (68.4%), maternal floor infarction (66.7%), retroplacental hemorrhage (60.6%), intervillous thrombus (57.1%), decidual angiopathy (33.3%), placental infarction (25.4%), acute chorioamnionitis (22.7%), and chronic villitis (21.7%). Misdiagnosis was found in 10 cases: 5 cases of infarction (review diagnosis was perivillous fibrin deposits in 4, intervillous thrombus in 1), 3 cases of acute chorioamnionitis, and 2 cases of decidual angiopathy. Among the 8 general surgical pathologists involved, the frequency of discrepant diagnosis ranged from 31.5% to 58.6% (P >.05). The intraobserver discrepancy rate for the reviewer was 4.8%, significantly lower than the discrepancy rate for the 8 general surgical pathologists. It is common for general surgical pathologists not to recognize placental lesions, which may have clinical significance. Awareness of this deficiency, standardization of diagnostic criteria, and increased knowledge in placental pathology may improve the quality of diagnosis in this area.

Local cold stress to the soles induces retroplacental hemorrhage in rats.

The aim of this study was to investigate the effect of local cold stress to the soles on placental histology in rats. Pregnant rats were subjected to a cold provocation (0 degrees C, 12 degrees C) and room temperature (23 degrees C) for 15 and 30 minutes. During cold stimulation and at the control temperature, uterine blood flow and uterine contraction were measured simultaneously. Histological studies of the placentas of these rats were also performed. Cold stress at 0 degrees C and 12 degrees C significantly decreased uterine blood flow (P < .005, P < .02) compared with controls (23 degrees C). The decrease in uterine blood flow was greater at 0 degrees C than at 12 degrees C stress. Cold-induced stress (0 degrees C) also evoked an isometric tension with increased frequency and amplitude in the rat uterus (P < .003, P < .0002) compared with controls (23 degrees C). Stimulation at 12 degrees C did not induce any uterine contractions. Placental histology of rats stressed at 0 degreesC revealed hemorrhages into the decidua basalis. These findings suggest that local cold stress decreases uterine blood flow and increases uterine contraction, resulting in retroplacental hemorrhage in rats. This model may account for human abruptio placentae.

The emerging role of immunoregulation of fibrinogen-related procoagulant Fgl2 in the success or spontaneous abortion of early pregnancy in mice and humans.

Abortion of chromosomally normal embryos in the CBA X DBA/2 mating combination is triggered by release of Th1 cytokines (tumor necrosis factor [TNF]-alpha, interferon [IFN]-gamma, and interleukin [IL]-1), which cause abortion via a novel prothrombinase, Fgl2, and polymorphonuclear leukocytes. The site of activation may be maternal vascular endothelium on arteries and veins nourishing the placenta. Activation of coagulation is also prominent in spontaneous abortion of chromosomally normal human embryos. We asked where is Fgl2 up-regulated in the uterus in murine abortions, and if similar Fgl2 expression occurs in human pregnancy failure. Control CBA X DBA/2 pregnant mice, or from mice injected with TNF-alpha + IFN-gamma on day 7.5 of gestation, were removed on day 8.5, fixed, sectioned, and subject to in situ hybridization for Fgl2. Sections were also stained for fibrin. Elective first trimester termination samples or biopsies taken early in the course of a recurrent miscarriage were similarly fixed, sectioned, and analyzed by in situ hybridization. Control and cytokine-treated mice were anticoagulated with heparin, an activator of antithrombin III, and/or the direct anti-thrombin inhibitor hirudin. Low level Fgl2 expression localized to basal decidua remote from the embryo was noted in control mice; cytokine treatment, which causes greater than 80% of abortions, produced a striking up-regulation in this area as well as in a band at the junction of decidua and myometrium. Trophoblast also became strikingly positive. Fgl2 expression was associated with increased fibrin staining. Anticoagulation significantly protected against abortions, but doses were limited by the complication of retroplacental hemorrhage. In tissue from normal first trimester pregnancy, minimal Fgl2 positivity was seen in some villous syncytiotrophoblast, in villous stroma, cytotrophoblast, and in some cells in decidua. In spontaneous abortion of normal embryo, striking Fgl2 positivity was seen in syncytiotrophoblast and extravillous cytotrophoblast, in association with areas of thrombus formation. Fgl2 appears to be physiologically expressed and may protect against the internal danger of maternal and/or fetal bleeding during pregnancy and at parturition; a role in inhibiting transplacental traffic is also possible. External dangers in the form of stress, endotoxin, and antigens eliciting Th1 cytokine responses upregulate Fgl2 prothrombinase in trophoblast as well as in decidua, which results in spontaneous abortion of immunogenetically "weaker" embryos.

A clinicopathological aspect of chorionic villous hemorrhage leading to formation of intervillous thrombosis.

Recently it was reported that chorionic villous hemorrhage (CVH) had a significant association with retroplacental hemorrhage (RPH). In this study, to determine whether CVH has a correlation with RPH or intervillous thrombosis (IVT), placentas associated with CVH were clinico-histopathologically investigated and compared to those with IVT. Obstetric complications in 32 cases with CVH were compared with 258 cases with IVT. Placental abruption was significantly higher (18.7%) in the CVH group than in the IVT group (5.03%) and the incidences of intrauterine fetal death (IUFD) as well as intrauterine growth retardation (IUGR) were also significantly higher (18.7% and 9.37%) in the CVH group than in the IVT group (3.10% and 2.32%). Of the pathological characteristics of the placentas with CVH, IVT was found in 46.8%, but marginal or retroplacental hemorrhages were seen in 34.3%, compared to 14.2% of the IVT group. Premature infants with low birth weight (under 2000 g) and before 36 weeks of gestation were born in 53.1% and 34.3% of cases with CVH placentas. CVH was not only located near the basal plate of the placentas and decidual hemorrhages, but was also highly associated with chorangiosis in 75% of cases. Using histological and ultrastructural studies in CVH cases, villous stroma was filled with fetal erythrocytes and leakage of blood cells was observed through a disruption of the trophoblast layer of hemorrhagic villi. In conclusion, it is suggested that CVH may rather be related to formation of the intervillous thrombosis than to RPH.

Placental Pathology in Patients Using Cocaine: An Observational Study

Objective: Although retroplacental hemorrhage is a major cause of fetal death, its etiology often remains obscure. In some reports, cocaine use by pregnant women has been associated with retroplacental hemorrhage and clinical abruptio placentae. This study was designed to assess the occurrence of chorionic villus hemorrhage, an entity shown recently to be associated with retroplacental hemorrhage, in the placentas of cocaine users. Methods: Twenty-nine placentas from cocaine users and 15 placentas from drug-free controls, as determined by questionnaire and urine toxicology screen, were examined prospectively, and pathological findings documented. The prevalence of retroplacental hemorrhage, chorionic villus hemorrhage, edema, chorioamnionitis, funisitis, infarction, fetal vessel thrombosis, and intervillus hemorrhage was examined in the two groups. Results: Chorioamnionitis was the most frequent finding in both groups (58% of cocaine users, 66% of controls). Edema of moderate severity or greater was found only in the cocaine-using group (17%). The prevalence of chorionic villus hemorrhage among women using cocaine also was 17%. Conclusion: Cocaine use during pregnancy may be associated with chorionic villus hemorrhage and villus edema, even in the absence of clinical abruptio placentae. The relationship between abnormal placental morphology and adverse perinatal outcomes remains to be determined.

Rectal bleeding: a rare complication of abdominal pregnancy.

A rare case of abdominal pregnancy, causing massive rectal bleeding due to invasion of the rectal wall by the placenta, is reported.