Morphological and histopathological changes in placentas of pregnancies with intrauterine growth restriction.

AIM: The definition of fetal growth restriction (FGR) refers to the incapability of a fetus to achieve the appropriate estimated growth, with expected fetal weight below the 10th percentile calculated for its gestational age. Placental factors and hypoxemia are considered to be essential elements with influence on intrauterine growth restriction (IUGR) and fetal death. The purpose of the present study was to investigate the macroscopic and microscopic pathological findings regarding the placentas in pregnancies complicated by influence on IUGR. PATIENTS, MATERIALS AND METHODS: Our study included 42 third-trimester pregnant patients admitted to the Cuza Voda Hospital of Obstetrics and Gynecology, Iasi, Romania, in the last three years. Soon after delivery, the 42 placentas were collected and analyzed; 32 placentas came from cases previously diagnosed with influence on IUGR and were included in our study group. Ten other placentas included in the control group were selected from uncomplicated pregnancies. Standard Hematoxylin-Eosin (HE) staining method, as well as Periodic Acid-Schiff (PAS) staining, and immunohistochemical techniques for cluster of differentiation 31 (CD31) and collagen IV were used in order to highlight the morphological features of the studied placentas. RESULTS: Our study revealed that reduced placental dimensions and eccentric umbilical cord insertion are correlated with the birthweight of the fetuses with IUGR (p<0.05). The most common histological finding in our study group was placental infarction later correlated with IUGR, but a certain causality could not be demonstrated, as this finding was also present in normal pregnancies. Other histopathological findings were also present in the influence on IUGR group, such as fibrin deposits, diffuse calcification, chronic villitis, avascular chronical villi, with no significant statistical correlations. CD31 was strongly immunoexpressed in the villous endothelial cells. Collagen IV presented a strong immunoreaction in the basement membrane and mesenchyme of the placental villi. CONCLUSIONS: Our study revealed a correlation between the dimensions of the diameters and volume of the maternal placenta and the presence of influence on IUGR. Moreover, it confirms the available data suggesting that the place of insertion of the umbilical cord is correlated with the weight of the fetus. Further studies with extended panel antibodies are needed in order to determine and complete the role of these morphological changes in the development of influence on IUGR.

Better prediction for FGR (fetal growth restriction) with the sFlt-1/PIGF ratio: A case-control study.

The aim of this study was to check whether the sFlt-1/PIGF ratio, established as the biomarker for preeclampsia, reduces the false positive rate of late fetal growth restriction (FGR) detection by ultrasound biometry.This was a prospective case-control study, conducted at one regional maternity hospital in Romania. Study participants included singleton pregnancy women for whom the estimated fetal weight (EFW) at 28 to 35 weeks was < 10 percentiles and as controls, pregnant women with EFW >10 percentiles. All pregnancies were dated in the first trimester by crown-rump-length. We also recorded maternal characteristics, pregnancy and neonatal outcomes.The primary outcome measures were the relation between the sFlt-1/PIGF ratio and incidence of FGR. Secondary outcome was establishing a threshold for statistical significance of the marker and influence of other conditions (e.g., pre-eclampsia) on the accuracy of the marker in FGR prediction.Included in the study were 37 pregnant women and 37 controls.When we used ultrasound (US) biometry and maternal risk factors to estimate EFW <10 percentiles, the sensitivity was 44.4% with a specificity of 89% for an FPR (false positive result) of 10%. When we combined the US biometry and maternal risk factors with sFlt1/PIGF ratio, for a cut off of 38, the sensitivity was 84.21%, and the specificity was 84.31% for an FPR of 10%. The cut off value (36) did not change if we considered all cases of SGA, including those with associated preeclampsia or if we considered only FGR cases without associated preeclampsia.When associated with maternal factors and US biometry, the sFlt1/PIGF ratio enhanced the sensitivity for detecting late FGR.

INTRAUTERINE GROWTH RESTRICTION--PREDICTIVE SERUM MARKERS.

AIM: To determine during the first trimester of pregnancy some serum and ultrasound markers that could improve perinatal morbidity and mortality in women with intrauterine growth restriction (IUGR). MATERIAL AND METHODS: Prospective study of pregnant women gestational age 11 weeks and 0 days--13 weeks and 6 days, consisting in the determination of pregnancy associated plasma protein (PAPP-A), mean platelet volume (MPV), and ultrasound appearance of placenta. DISCUSSION AND CONCLUSIONS: This study suggests that screening by detailed history and PAPP-A and MPV determination during the first trimester of pregnancy in women at risk for IUGR makes possible the prophylactic treatment and monitoring of pregnancy according to a given protocol and thus neonatal morbidity and mortality to be reduced.

[Large ovarian cyst associated with pregnancy. Case report]. / Chist ovarian gigant asociat cu sarcina.

The incidence of adnexal masses in pregnancy is rather low. The diagnosis has become more common with the routine use of ultrasonography in prenatal care. The management of adnexal masses during pregnancy remains controversial. Ultrasonography can characterise correctly the adnexal mass and avoid antepartum surgery. We present the case of a 32 years old gravida, IV gesta, I para, with an ovarian cystic tumour that enlarged during pregnancy from 7 cm to 20 cm. The tumour was correctly characterised by ultrasound exam (Sassone 3) and surgery was not indicated. The pregnancy evoluated well and the patient delivered at term by c. section and ovariectomy was also performed. The postpartum evolution was good.

[Hysteroscopy in the diagnosis and treatment of tubal infertility]. / Histeroscopia în diagnosticul si tratamentul infertilitatii de cauza tubara.

The aim of this study is to present the authors' experience in the diagnosis and treatment of tubal proximal disease by means of hysteroscopy. The study includes 96 patients with tubal infertility to which hysteroscopy was performed in 1998-2003 in the 2nd Clinic of Obstetrics and Gynecology, Iasi. The average age was 32.5 +/- 1.2 years. The indication was proximal tubal obstruction diagnosed by hysterosalpingography or sono-hysterosalpingography. The hysteroscopy revealed lesions affecting fertility that were treated in the same operative sequence. Proximal tubal obstruction was present in 50 cases (52%): unilateral--41 cases, bilateral--9 cases. Tubal permeabilization was performed by tubal catheterization or by removing polyps, adhesion and was verified by chromo-tubation at the end of hysteroscopy and by sono-hysterosalpingography, 2 months after the intervention. When proximal tubal obstruction is suspected, hysteroscopy offers a solution by confirming the diagnosis and by efficiently treating the lesions, leading to an increased average of pregnancies.

[Specifics of therapy of tubal infertility in patients with endometriosis]. / Particularitatile tratamentului infertilitatii tubare la pacientele cu endometrioza.

Our purpose was to define the best way of treating tubal infertility caused by endometriosis. We have studied 24 patients with tubal infertility caused by endometriosis; the etiology has been laparoscopically established in the 2nd Clinic of Obstetrics and Gynecology Iasi. The endometriosis score (r-AFS) was used to establish the therapy. We performed laparoscopic treatment when endometriosis was visible. Postoperative medical therapy (Diphereline, 3 months) was indicated; patients with ,,unpigmented endometriosis" received the same medical therapy. The rate of pregnancies in patients that had benefit of combined therapy: surgical and medical (n=9) was superior (44.4%) to that obtained in patients that were only surgical treated (n=15): 26.6% (Spearman correlation--0.6595, p < 0.0012). Endometriosis is an important etiological factor in female infertility. The pathway is mechanic as well as chemical and it justifies the combined therapy. There are better results, as fertility prognosis in patients with endometriosis that receive both, surgical and medical therapy.