Placental Histology After Minor Trauma in Pregnancy: A Pilot Study.

OBJECTIVE: Trauma in pregnancy may cause placental abruption. Consequences of moderate placental injury on neurodevelopment are unknown. The aim was to evaluate placental histology after maternal trauma. METHODS: A prospective study was conducted at 2 tertiary medical centers in the Netherlands. Placentas from women exposed to maternal trauma ≥ 20 weeks' gestational age were histologically examined. Neurological follow-up of the infants was performed at 1 year of age by means of Alberta Infant Motor Scale. Histological findings were compared to placentas from pregnancies without trauma. PRINCIPAL RESULTS: Thirteen placentas were investigated in the trauma group. The control group consisted of 15 placentas. Placental pathology was seen more often in the trauma cases (11 of the 13) than in the controls (6 of the 15), P = .024. Neurological follow-up was normal. CONCLUSIONS: In this small population, majority of the placentas showed pathology after minor trauma in pregnancy without consequences for neurodevelopment at 1 year.

Spontaneous haemoperitoneum in pregnancy and endometriosis: a case series.

OBJECTIVE: To report pregnancy outcomes of SHiP (spontaneous haemoperitoneum in pregnancy) and the association with endometriosis. DESIGN: Retrospective case note review. SETTING: Dutch referral hospitals for endometriosis. SAMPLE: Eleven women presenting with 15 events of SHiP. METHODS: In collaboration with the Dutch Working Group on Endometriosis, unpublished cases of SHiP that occurred in the Netherlands between 2010 and 2015 were retrieved. MAIN OUTCOME MEASURES: Maternal and perinatal mortality and morbidity. RESULTS: SHiP occurred predominantly in the second and third trimester of pregnancy. The earliest and major presenting symptom was an acute onset of abdominal pain, often combined with low haemoglobin levels or signs of fetal distress. Imaging was a diagnostic tool when free peritoneal fluid could be observed. For surgical treatment of the bleeding site, a midline laparotomy was mostly needed, the median estimated amount of blood loss was 2000 mL. No fetomaternal or perinatal mortality was reported, despite a high rate of preterm births (54.5%). In all women, endometriosis was diagnosed at a certain moment in time and therefore was probably involved in the pathogenesis of SHiP. Four women showed recurrence of SHiP. In one of these cases the second event of SHiP occurred in a subsequent pregnancy. CONCLUSION: Pregnancy outcomes of SHiP are improving when compared with previous reports, with absent fetomaternal and perinatal mortality in this recent series. Growing knowledge and adequate multidisciplinary intervention may have contributed to these favourable results. Increasing awareness of this serious complication of pregnancy is advocated, especially in women diagnosed with endometriosis. TWEETABLE ABSTRACT: Growing awareness of SHiP is advocated, especially in women diagnosed with endometriosis.

Does low-molecular-weight heparin influence fetal growth or uterine and umbilical arterial Doppler in women with a history of early-onset uteroplacental insufficiency and an inheritable thrombophilia? Secondary randomised controlled trial results.

OBJECTIVE: Does low-molecular-weight heparin (LMWH) added to low-dose aspirin influence fetal growth and flow velocity in uterine and umbilical arteries in women with an inheritable thrombophilia and previous early-onset uteroplacental insufficiency? DESIGN: Secondary outcomes of the FRUIT-RCT. SETTING: Multicentre, international. POPULATION: The FRUIT-RCT included 139 women with inheritable thrombophilia before 12 weeks of gestation. Inclusion criteria were previous delivery before 34 weeks of gestation with a hypertensive disorder of pregnancy and/or small-for-gestational-age infant and an inheritable thrombophilia. METHODS: After randomisation to either daily LMWH with aspirin, or aspirin only, ultrasound measurements were performed at 22-24, 28-30 and 34-36 weeks of gestation. Development during gestation of growth, birthweight and flow velocity of the umbilical artery was examined using the linear mixed model. Uterine artery flow velocity at a single time-point (22-24 weeks) was examined using a chi-square test. MAIN OUTCOME MEASURES: Fetal growth over time including birthweight, using Scandinavian, Dutch and customised growth curves; and flow velocity within the uterine and umbilical arteries. RESULTS: No difference of fetal growth over time could be demonstrated between the study arms, regardless of which reference criteria were used. The flow velocity within the uterine artery and umbilical artery did not differ between study arms. CONCLUSION: The addition of LMWH to aspirin did not influence fetal growth or umbilical artery flow velocity over time; nor did it influence uterine artery flow velocity. TWEETABLE ABSTRACT: LMWH does not influence fetal growth or uterine or umbilical flow velocities.

A Bayesian network to simulate macroinvertebrate responses to multiple stressors in lowland streams.

Aquatic ecosystems are affected by multiple environmental stressors across spatial and temporal scales. Yet the nature of stressor interactions and stressor-response relationships is still poorly understood. This hampers the selection of appropriate restoration measures. Hence, there is a need to understand how ecosystems respond to multiple stressors and to unravel the combined effects of the individual stressors on the ecological status of waterbodies. Models may be used to relate responses of ecosystems to environmental changes as well as to restoration measures and thus provide valuable tools for water management. Therefore, we aimed to develop and test a Bayesian Network (BN) for simulating the responses of stream macroinvertebrates to multiple stressors. Although the predictive performance may be further improved, the developed model was shown to be suitable for scenario analyses. For the selected lowland streams, an increase in macroinvertebrate-based ecological quality (EQR) was predicted for scenarios where the streams were relieved from single and multiple stressors. Especially a combination of measures increasing flow velocity and enhancing the cover of coarse particulate organic matter showed a significant increase in EQR compared to current conditions. The use of BNs was shown to be a promising avenue for scenario analyses in stream restoration management. BNs have the capacity for clear visual communication of model dependencies and the uncertainty associated with input data and results and allow the combination of multiple types of knowledge about stressor-effect relations. Still, to make predictions more robust, a deeper understanding of stressor interactions is required to parametrize model relations. Also, sufficient training data should be available for the water type of interest. Yet, the application of BNs may now already help to unravel the contribution of individual stressors to the combined effect on the ecological quality of water bodies, which in turn may aid the selection of appropriate restoration measures that lead to the desired improvements in macroinvertebrate-based ecological quality.

Quantifying cumulative stress acting on macroinvertebrate assemblages in lowland streams.

Macroinvertebrates in lowland streams are exposed to multiple stressors from the surrounding environment. Yet, quantifying how these multiple stressors impact macroinvertebrate assemblages is challenging. The aim of this study was to develop a novel method to quantify the cumulative stress acting on macroinvertebrate assemblages in lowland streams. To this purpose, we considered 22 stressors from different stressor categories such as hydrological, morphological and chemical stressors, acting over multiple spatial scales ranging from instream to the catchment scale. Stressor intensity was categorized into classes based on impact on the macroinvertebrate assemblages. The main stream was divided into segments, after which for each stream segment, the cumulative stressor contribution from headwater catchments, from the riparian zone and from upstream was calculated. To validate the cumulative stress quantification method, the lowland stream Tungelroyse Beek in the Netherlands was used as a case study. For this stream it was shown that independently derived ecological quality scores based on macroinvertebrate samples collected at multiple sites along the stream decreased with increasing calculated cumulative stress scores, supporting the design of the cumulative stress quantification method. Based on the contribution of each specific stressor to the cumulative stress scores, the reasons for the absence and presence of macroinvertebrate species may be elucidated. Hence, the cumulative stress quantification method may help to identify and localize the most stringent stressors limiting macroinvertebrate assemblages, and can thereby provide a better focus for management resources.