Histopathological, ultrastructural, and immunohistochemical examination of changes in the placenta as a result of severe preeclampsia

Purpose: To investigate the role of hypoxia-inducible transcription factor-1 alpha (HIF-1α) and angiogenetic factor endothelin-1 (ET-1) expression in regulating hypoxia and placental development by routine histopathological methods. Methods: Twenty preeclamptic and normal placentas were used. Placenta tissue pieces were examined histopathologically after routine paraffin follow-ups. HIF-1α and ET-1 proteins were examined immunohistochemically, and placental tissues were examined ultrastructurally. Results: Increase in syncytial proliferation, endothelial damage in vessels, and increase in collagen were observed in preeclamptic placentas. As a result of preeclampsia, an increase was observed in HIF-1α and ET-1 protein levels in the placenta. Dilatation of endoplasmic reticulum and loss of cristae in mitochondria were observed in trophoblast cells in preeclamptic placental sections. Conclusion: High regulation of oxygen resulting from preeclampsia has been shown to be a critical determinant of placentagenesis and plays an important role in placental differentiation, changes in maternal and fetal blood circulation, trophoblastic invasion, and syncytial node increase. It has been thought that preeclampsia affects secretion by disrupting the endoplasmic reticulum structure and induces mitochondrial damage, and that ET-1 may potentially help in the induction of stress pathways as a result of hypoxia in preeclampsia.

Percepção sobre o cuidado à perda gestacional: estudo qualitativo com casais brasileiros / Perceptions on pregnancy loss care: a qualitative study with brazilian couples / Percepción sobre la atención a la pérdida del embarazo: estudio cualitativo con parejas brasileñas

Este artigo analisou a percepção e os sentimentos de casais sobre o atendimento recebido nos serviços de saúde acessados em função de perda gestacional (óbito fetal ante e intraparto). O convite para a pesquisa foi divulgado em mídias sociais (Instagram e Facebook). Dos 66 casais que contataram a equipe, 12 participaram do estudo, cuja coleta de dados ocorreu em 2018. Os casais responderam conjuntamente a uma ficha de dados sociodemográficos e uma entrevista semiestruturada, realizada presencialmente (n=4) ou por videochamada (n=8). Os dados foram gravados em áudio e posteriormente transcritos. A Análise Temática indutiva das entrevistas identificou cinco temas: sentimento de impotência, iatrogenia vivida nos serviços, falta de cuidado em saúde mental, não reconhecimento da perda como evento com consequências emocionais negativas, e características do bom atendimento. Os achados demonstraram situações de violência, comunicação deficitária, desvalorização das perdas precoces, falta de suporte para contato com o bebê falecido e rotinas pouco humanizadas, especialmente durante a internação após a perda. Para aprimorar a assistência às famílias enlutadas, sugere-se qualificação profissional, ampliação da visibilidade do tema entre diferentes atores e reorganização dos serviços, considerando uma diretriz clínica para atenção ao luto perinatal, com destaque para o fortalecimento da inserção de equipes de saúde mental no contexto hospitalar.(AU)

This study analyzed couples' perceptions and feelings about pregnancy loss care (ante and intrapartum fetal death). A research invitation was published on social media (Instagram and Facebook) and data collection took place in 2018. Of the 66 couples who contacted the research team, 12 participated in the study by filling a sociodemographic questionnaire and answering a semi-structured interview in person (n=04) or by video call (n=08). All interviews were audio recorded, transcribed, and examined by Inductive Thematic Analysis, which identified five themes: feelings of impotence, iatrogenic experiences in health services, lack of mental health care, not recognizing pregnancy loss as an emotionally overwhelming event, and aspects of good healthcare. Analysis showed experiences of violence, poor communication, devaluation of early losses, lack of support for contact with the deceased baby, and dehumanizing routines, especially during hospitalization after loss. Professional qualification, extended pregnancy loss visibility among different stakeholders, and reorganization of health services are needed to improve the care offered to grieving families, considering a clinical guideline for perinatal grief care with emphasis on strengthening the insertion of mental health teams in the hospital context.(AU)

Este estudio analizó las percepciones y sentimientos de parejas sobre la atención recibida en los servicios de salud a los que accedieron debido a la pérdida del embarazo (muerte fetal ante e intraparto). La invitación al estudio se publicó en las redes sociales (Instagram y Facebook). De las 66 parejas que se contactaron con el equipo, 12 participaron en el estudio, cuya recolección de datos se realizó en 2018. Las parejas respondieron un formulario de datos sociodemográficos y realizaron una entrevista semiestructurada presencialmente (n=4) o por videollamada (n=08). Los datos se grabaron en audio para su posterior transcripción. El análisis temático inductivo identificó cinco temas: Sentimiento de impotencia, experiencias iatrogénicas en los servicios, falta de atención a la salud mental, falta de reconocimiento de la pérdida como un evento con consecuencias emocionales negativas y características de buena atención. Los hallazgos evidenciaron situaciones de violencia, comunicación deficiente, desvalorización de las pérdidas tempranas, falta de apoyo para el contacto con el bebé fallecido y rutinas poco humanizadas, especialmente durante la hospitalización tras la pérdida. Para mejorar la atención a las familias en duelo, se sugiere capacitación profesional, ampliación de la visibilidad del tema entre los diferentes actores y reorganización de los servicios, teniendo en cuenta una guía clínica para la atención del duelo perinatal, enfocada en fortalecer la inserción de los equipos de salud mental en el contexto hospitalario.(AU)

Corioamnionitis Histológica Asociada a Muerte Fetal / Histological Chorioamnionitis Associated with Fetal Death

INTRODUCCIÓN. Anualmente ocurren más de 2 millones de muertes fetales a nivel mundial, siendo fundamental el estudio anatomopatológico placentario para disminuir el número de muertes inexplicadas. OBJETIVO. Revisar la literatura existente acerca de corioamnionitis histológica, los criterios para establecer su diagnóstico, su presencia y posible asociación en estudios de causas de muerte fetal. METODOLOGÍA. Se realizaron búsquedas en bases de datos electrónicas para recopilar estudios de causas de muerte fetal que incluyeron corioamnionitis histológica. RESULTADOS. Se encontraron 13 estudios que evaluaron mortalidad fetal y que entre sus causas incluyeron corioamnionitis histológica. DESARROLLO. El estudio microscópico placentario en muertes fetales es esencial al investigar una muerte fetal. Las anomalías placentarias son la causa más común de muerte fetal, la corioamnionitis aguda es la lesión inflamatoria más frecuente. Se detallaron los criterios más relevantes para definir corioamnionitis aguda histológica pero aún no se establece un consenso. Estudios de causas de muerte fetal en años recientes han reportado corioamnionitis histológica entre 6,3% y 41,3% de casos. Las alteraciones inflamatorias del líquido amniótico son una causa importante de muerte fetal, siendo la corioamnionitis la más frecuente en este grupo. CONCLUSIÓN. En estudios para determinar las causas de muerte fetal se evidenció corioamnionitis aguda histológica en hasta el 41,3% de casos, por lo que podría estar asociada a dicho evento. Sin embargo, es necesario establecer un sistema de estadiaje de corioamnionitis histológica mediante un panel de expertos a nivel mundial.

INTRODUCTION. Annually more than 2 million fetal deaths occur worldwide, being fundamental the placental anatomopathological study to reduce the number of unexplained deaths. OBJECTIVE. To review the existing literature on histological chorioamnionitis, the criteria to establish its diagnosis, its presence and possible association in studies of causes of fetal death. METHODOLOGY. Electronic databases were searched to collect studies of causes of fetal death that included histologic chorioamnionitis. RESULTS. Thirteen studies were found that evaluated fetal mortality and that included histologic chorioamnionitis among their causes. DEVELOPMENT: Placental microscopic study in fetal deaths is essential when investigating a fetal death. Placental abnormalities are the most common cause of fetal death, acute chorioamnionitis being the most frequent inflammatory lesion. The most relevant criteria for defining histologic acute chorioamnionitis have been detailed but consensus has not yet been established. Studies of causes of fetal death in recent years have reported histologic chorioamnionitis in between 6,3% and 41,3% of cases. Inflammatory changes in the amniotic fluid are an important cause of fetal death, with chorioamnionitis being the most frequent in this group. CONCLUSIONS. In studies to determine the causes of fetal death, histological acute chorioamnionitis was evidenced in up to 41,3% of cases, so it could be associated with this event. However, it is necessary to establish a histological chorioamnionitis staging system by means of a worldwide panel of experts.

Equine abortion associated with placentitis caused by Pasteurella pneumotropica / Aborto equino associado a placentite por Pasteurella pneumotropica

Pasteurella pneumotropica is a bacterium that has so far not been described as a cause of placentitis in animals. Two cases of aborted equine fetuses were sent to the Department of Veterinary Pathology of the "Universidade Federal do Rio Grande do Sul" (SPV-UFRGS) for anatomopathological examination. Both cases presented suppurative placentitis associated with multiple basophilic bacterial cells. After bacterial isolation and biochemical analysis, P. pneumotropica was identified.(AU)

Pasteurella pneumotropica é uma bactéria que até o momento não foi descrita como causa de placentite em animais. Dois casos de fetos equinos abortados foram enviados ao Setor de Patologia Veterinária da Universidade Federal do Rio Grande do Sul (SPV-UFRGS) para exame anatomopatológico. Em ambos os casos se observou placentite supurativa associada a múltiplas colônias bacterianas basofílicas. Após o isolamento bacteriano e análise bioquímica, indentificou-se P. pneumotropica.(AU)

Equine abortion associated with placentitis caused by Pasteurella pneumotropica / Aborto equino associado a placentite por Pasteurella pneumotropica

Pasteurella pneumotropica is a bacterium that has so far not been described as a cause of placentitis in animals. Two cases of aborted equine fetuses were sent to the Department of Veterinary Pathology of the "Universidade Federal do Rio Grande do Sul" (SPV-UFRGS) for anatomopathological examination. Both cases presented suppurative placentitis associated with multiple basophilic bacterial cells. After bacterial isolation and biochemical analysis, P. pneumotropica was identified.

Pasteurella pneumotropica é uma bactéria que até o momento não foi descrita como causa de placentite em animais. Dois casos de fetos equinos abortados foram enviados ao Setor de Patologia Veterinária da Universidade Federal do Rio Grande do Sul (SPV-UFRGS) para exame anatomopatológico. Em ambos os casos se observou placentite supurativa associada a múltiplas colônias bacterianas basofílicas. Após o isolamento bacteriano e análise bioquímica, indentificou-se P. pneumotropica.

Singleton placentas with abnormal shape: a clinicopathological analysis of 130 cases / 中华病理学杂志

Objective: To investigate the pathological characteristics of singleton placenta with abnormal shape and its influence on the outcome of maternal-fetal pregnancy. Methods: The clinicopathological data of singleton placentas with abnormal shape from January 2014 to December 2020 in the Department of Pathology, Haidian Maternal and Children Health Hospital were analyzed retrospectively. Results: There were 130 singleton placentas with abnormal shape in this cohort, including 48 succenturiate placentas, 12 bilobed placentas, 50 marginate placentas, 13 circumvallate placentas, 3 annular placentas, 2 membranous placentas and 2 fenestrated placentas. Gestational age ranged from 29+5 to 40+4 weeks. There were 51 cases of premature rupture of membranes, 11 cases of placenta previa, 5 cases of placental abruption, 15 cases of placental adhesion/implantation and 27 cases of postpartum hemorrhage. There were 46 preterm fetuses,28 fetuses with fetal growth restriction, 22 fetuses with intrauterine distress, and 1 fetus with intrauterine death. Grossly, the placental lobules of succenturiate placentas had apparent size difference, while two lobules of bilobate placenta were more consistent. The chorionic plate size was smaller than the bottom plate of circumvallate placenta, the folded fetal membrane in the rim of placenta was thickened (termed marginate placenta if there was no thickening). The membranous placenta was characterized by a thin, large membrane-like shape. Annular placenta showed characteristic hollow cylinder, ring or horseshoe-shape. Fenestrated placenta was characterized by tissue defects near central area. Microscopically, functional/morphologic changes were the main manifestations of inadequate maternal-fetal perfusion, including villous infarction, distal villous dysplasia and excessive villous maturation. Conclusions: The abnormal shaped singleton placentas showed variable extent of inadequate maternal-fetal perfusion, which may lead to adverse pregnancy outcomes such as premature delivery, fetal growth restriction, intrauterine distress or fetal death.

Síndrome en espejo con miocardiopatía no compactada en la madre y el feto. Reporte de caso / Mirror syndrome with noncompaction cardiomyopathy in the mother and fetus. Case report

Objetivo: reportar el caso de una gestante con síndrome en espejo asociada a miocardiopatía no compactada (MNC), tanto en la madre como el feto, en los que el tratamiento médico antenatal en la madre llevó a un resultado materno perinatal favorable. Presentación del caso: se describe el caso de una primigestante de 16 años, con 33 semanas de embarazo, remitida desde una institución de primer nivel de atención a una institución privada de cuarto nivel en la ciudad de Medellín, Colombia, por presentar feto con hidropesía en ultrasonido obstétrico de control. Durante la hospitalización, la paciente presentó signos clínicos y ecocardiográficos de falla cardiaca (disnea, edema e hipoxemia), a la vez que se confirmó el diagnóstico de Hydrops fetalis (síndrome en espejo). Se instauró tratamiento diurético con furosemida en la madre, logrando mejoría del cuadro materno y del edema fetal. En el puerperio mediato hospitalario se confirmaron la presencia de miocardiopatía no compactada en la resonancia magnética nuclear cardiaca, tanto de la madre como del recién nacido. Ambos egresaron en adecuadas condiciones y fueron vinculados al programa de seguimiento cardiovascular: falla cardiaca y de cardiopatía congénitas, respectivamente. Conclusión: se presenta un caso de síndrome en espejo asociado a miocardiopatía no compactada materna y fetal. Es limitado el número de reportes de síndrome en espejo por anomalías cardiacas (maternas y fetales) y pobre la descripción de los tratamientos realizados que surgen como temas a investigar. Sería importante considerar el diagnóstico de MNC en fetos con hidropesía no asociados a isoinmunización y con disfunción cardiaca, así como su atención por equipos multidisciplinarios.

ABSTRACT Objective: To report the case of a pregnant woman with mirror syndrome associated with noncompaction cardiomyopathy in the mother and the fetus, in which antenatal medical treatment provided to the mother resulted in a favorable perinatal maternal outcome. Case presentation: A 16-year old primigravida with 33 weeks of gestation referred from a Level I institution to a private Level IV center in Medellín, Colombia, because of a finding of fetal hydrops on obstetric ultrasound. During hospitalization, the patient showed clinical and ultrasonographic signs of heart failure (dyspnea, edema and hypoxemia), with the diagnosis of hydrops fetalis (mirror syndrome) also confirmed. Diuretic treatment with furosemide was initiated in the mother, with subsequent improvement of the maternal condition as well as of the fetal edema. During the subacute postpartum period in the hospital, the presence of non-compaction cardiomyopathy was confirmed on cardiac nuclear magnetic resonance imaging in both the mother and the newborn. After discharge in adequated condition, they were included in the cardiovascular follow-up program for heart failure and congenital heart disease, respectively. Conclusion: A case of mirror syndrome associated with maternal and fetal non-compaction cardiomyopathy is presented. There is a limited number of reports on mirror syndrome due to cardiac anomalies (maternal and fetal), with weak treatment descriptions, pointing to the need for research in this area. It would be important to consider the diagnosis of non-compaction cardiomyopathy in fetuses with hydrops unrelated to isoimmunization or cardiac dysfunction and approach these cases from a multidisciplinary perspective.

COVID-19 y embarazo: caso clínico de presentación crítica, inflamación placentaria y transmisión vertical fetal demostrada / COVID-19 and pregnancy: clinical case of critical presentation, placental inflammation and demonstrated fetal vertical transmission

ANTECEDENTES: La pandemia global de COVID-19 llega al continente americano en marzo del año 2020 y en menos de dos meses reúne a más de la mitad de los casos a nivel global. OBJETIVO: Caso clínico de una mujer embarazada con una presentación crítica de COVID-19 y embarazo a las 25 semanas de gestación, en el contexto del peak de la pandemia en Chile en el otoño del año 2020. CASO CLÍNICO: El 20 de junio de 2020, una mujer de 34 años, con 25 semanas de embarazo, es trasladada desde Hospital de San Bernardo a Clínica Las Condes en Santiago, Chile, con un cuadro de 10 días de evolución de COVID-19, que evoluciona a una situación crítica con insuficiencia respiratoria severa. Ingresa a unidad de cuidados intensivos para ventilación mecánica. Las imágenes de radiología simple y de tomografía axial computarizada de tórax demuestran una neumopatía bilateral con imágenes características opacidades en vidrio esmerilado, asociado a engrosamiento intersticial, imágenes descritas previamente como características para COVID-19. La paciente permanece en unidad de cuidados intensivos en ventilación mecánica por siete días, con evolución favorable posterior, mejoría del cuadro séptico y alta después de 22 días de hospitalización. El parto ocurre en forma espontánea a las 38 semanas, la madre y el recién nacido evolucionan en buen estado general. El examen histopatológico placentario demuestra compromiso inflamatorio vellositario y los exámenes de anticuerpos en sangre del recién nacido demuestran la presencia de anticuerpos del tipo IgG e IgM. Se trata de uno de los pocos casos demostrados reportados de transmisión transplacentaria vía sanguínea de SARS-CoV-2 de la madre al recién nacido.

BACKGROUND: The global COVID-19 pandemic reaches the American continent in March 2020 and in less than two months it brings together more than half of the cases globally.OBJECTIVE: The clinical case of a 25-week pregnant woman with a critical presentation of COVID-19 and pregnancy at 25 weeks of gestation, is presented in the context of the peak of the pandemic in Chile in the fall of 2020. CLINICAL CASE: On June 20, 2020, a 34-year-old woman, 25 weeks pregnant, is transferred from Hospital de San Bernardo to Clinica Las Condes in Santiago, Chile, with a ten-day evolution of a COVID-19 that evolves to critical with severe respiratory failure. She is admitted to the intensive care unit for mechanical ventilation. Chest computerized axial tomography images demonstrate bilateral pneumopathy with characteristic images of ground-glass opacities, associated with interstitial thickening, images previously described as characteristics for COVID-19. The patient remains in the intensive care unit on mechanical ventilation for seven days, with subsequent favorable evolution, improvement of the septic condition, and discharge after 22 days of hospitalization. Delivery occurs at 38 weeks, the mother and the newborn evolve in good general condition. The placental histopathological examination demonstrates villous inflammatory involvement, and the newborn's blood tests show the presence of IgG and IgM antibodies. It is one of the few reported cases of transplacental transmission of SARS-CoV-2 from the mother to the newborn.

Placenta percreta com invasão de bexiga: um relato de caso / Percretal placenta with bladder invasion: a case report

O acretismo placentário consiste na aderência anormal da placenta na parede uterina. Ao aderir-se diretamente ao miométrio, denomina-se placenta acreta; ao estender-se mais profundamente, placenta increta, e ao invadir a serosa uterina ou órgãos adjacentes, percreta. O fator de risco mais frequente constitui cesarianas anteriores. Paciente 27 anos, G3P1CA1 (cesariana há 8 anos/ parto prematuro 25 sem há 4 anos), IG: 25sem3d; com alteração da vitalidade fetal e placenta prévia com sinais de acretismo (sugerindo placenta percreta). Foi indicada a interrupção da gestação com 27 semanas e 1 dia. No período intraoperatório foi evidenciada, por meio de ultrassom, presença de acretismo placentário com invasão miometrial e invasão de serosa vesical sendo posteriormente realizado a histerectomia subtotal e rafia das lacerações da mucosa vesical. A placenta percreta é mais frequente em grávidas com placenta prévia no local da cicatriz de cesariana e o órgão mais frequentemente acometido é a bexiga; estando associada a maior morbimortalidade materna. O diagnóstico definitivo é anatomopatológico, porém é presumível durante a cirurgia abdominal com a visualização da invasão placentária, devendo ser confirmado por Histopatologia.

Placental accretism consists of abnormal placental adherence to the uterine wall. When adhering directly to the myometrium it is called placenta accreta; when extending more deeply, placenta increta; and when invading the uterine serosa or adjacent organs, percrete. The most frequent risk factor is previous cesarean sections. The patient is 27 years old with altered fetal vitality and placenta previa with signs of accreation (suggesting percretal placenta). Pregnancy termination at 27 weeks and one day was indicated. In the intraoperative period, the presence of placental accretion with myometrial invasion and bladder serous invasion was evidenced by ultrasound, with subtotal hysterectomy and raffia of lacerations of the bladder afterwards. The percretal placenta is more frequent in pregnant women with placenta previa at the site of the scar of a cesarean section and the organ most frequently affected is the bladder; being associated with higher maternal morbidity and mortality. The definitive diagnosis is anatomopathological, but it is presumed during abdominal surgery with the visualization of the placental invasion and must be confirmed by Histopathology

Characterization of placental infection by zika virus in humans: A review of the literature / Caracterização da infecção placentária pelo vírus zika em humanos: Uma revisão da literatura

Abstract Objective The aim of the current review is to present a systematic evaluation of reported human placental findings in cases of zika virus (ZIKV) infection. Data sources We reviewed the EMBASE, PUBMED, and SCIELO databases until June 2019, without language restrictions. Selection of studies The search terms placenta AND zika virus were used. The inclusion criteria of the studies were studies that reported placental findings in humans. Experimental studies, reviews, notes or editorials were excluded. A total of 436 studies were retrieved; after duplicate exclusion, 243 articles had their titles screened, and 128 had their abstract read; of those, 32 were included in the final analysis (18 case reports, 10 case series, and 4 cohorts) Data collection We collected data concerning the author, year of publication, study design, number of participants, number of placental samples, onset of symptoms, perinatal outcomes, and main findings on histological analysis. Data synthesis The placental pathologic findings were described as mild and nonspecific, similar to those of other placental infections, including chronic placentitis, chronic villitis, increased Hofbauer cells, irregular fibrin deposits, increased mononuclear cells in the villus stroma, villous immaturity, edema, hypervascularization, stromal fibrosis, calcification, and focal necrosis of syncytiotrophoblasts. Conclusion Zika infection presents unspecific placental findings, similar to other infections in the toxoplasmosis, other agents, rubella, cytomegalovirus, and herpes (TORCH)group. Characterizing and standardizing placental findings after zika virus infection is key to understanding the mechanisms of congenital diseases.

Resumo Objetivo O objetivo desta revisão é apresentar uma avaliação sistemática dos achados relacionados à infecção por zika vírus (ZIKV) na placenta humana. Fontes de dados As bases de dados EMBASE, PUBMED, e SCIELO foram pesquisadas, até junho de 2019, sem qualquer restrição de língua. Seleção dos estudos Os termos placenta E zika virus foram utilizados na busca. Foram incluídos estudos que reportassem achados placentários de infecção em seres humanos, enquanto estudos experimentais, revisões, notas e editoriais foram excluídos. Um total de 436 estudos foram identificados, e 243 tiveram seus títulos lidos após a exclusão de duplicatas. Cento e vinte e oito artigos tiveram seus resumos avaliados, dos quais 32 foram incluídos na análise final (18 relatos de caso, 10 séries de casos, e 4 estudos de coorte). Dados obtidos Foram pesquisados dados relativos ao autor, ano da publicação, desenho do estudo, número de participantes, número de amostras de placenta, início dos sintomas, desfechos perinatais, e principais achados histológicos. Síntese dos dados Os principais achados placentários descritos foram leves e inespecíficos, similares a outras infecções placentárias, incluindo infecção placentária crônica, vilosite crônica, aumento das células de Hofbauer, depósitos irregulares de fibrina, aumento das células mononucleares no estroma viloso, imaturidade vilosa, edema, hipervascularização, fibrose estromal, calcificação, e necrose focal dos sincicitrofoblastos. Conclusão Infecções por ZIKV têm achados placentários inespecíficos, similares aos de outras infecções do grupo toxoplasmose, rubéola, citomegalovírus e herpes (TORCH). Caracterizar e padronizar os achados placentários após infecção por ZIKV é fundamental para entender o mecanismo das infecções congênitas.

Factores de riesgo de la enfermedad trofoblástica gestacional: Hospital Central Universitario Dr. Antonio María Pineda / Risk factors of gestational trofoblastic disease: Hospital Central Universitario Dr. Antonio María Pineda

La Enfermedad Trofoblástica Gestacional (ETG) es una patología de la primera mitad del embarazo caracterizada por una degeneración hidrópica de las vellosidades coriales que abarca la placenta y el resto del complejo ovular; es generalmente benigna pero puede malignizarse y distribuirse hacia otros tejidos. Se realizó un estudio descriptivo transversal con recolección retrospectiva de datos cuyo objetivo fue determinar los factores de riesgo de la ETG en pacientes que acudieron al Servicio de Emergencia Gineco-Obstétrica del Hospital Dr. Antonio María Pineda durante el período enero-agosto 2018. Dentro de la muestra se incluyeron las historias clínicas de 55 pacientes siendo la mayor parte mujeres menores de 28 años, de procedencia urbana, multigestas, sin antecedentes de aborto espontáneo o embarazo molar y sin uso de dispositivos intrauterinos o uso prolongado de anticonceptivas orales. En conclusión, se hace necesario un mayor seguimiento a mujeres embarazadas jóvenes con las características anteriormente expuestas con la finalidad de realizar un diagnóstico temprano de la enfermedad y de esta manera implementar medidas que garanticen su salud y vida(AU)

Gestational Trophoblastic Disease (TSG) is a pathology of the first half of pregnancy characterized by a hydropic degeneration of the chorionic villi that spans the placenta and the rest of the ovular complex; it is usually benign, but it can become malignant and spread to other tissues. A descriptive transversal study with retrospective review of medical charts was performed in order to determine the risk factors for TSG of patients evaluated at the Servicio de Emergencia Gineco-Obstétrica of the Hospital Dr. Antonio Maria Pineda during the January-August 2018 period. Fifty-five medical charts were reviewed. Results show that TSG was more common in women < 28 years old that lived in urban areas, which had several pregnancies, with no prior history of spontaneous abortion, molar pregnancy, use of intrauterine devices or prolonged use of contraceptive pills. In conclusion, a follow-up of young pregnant women is necessary in order to have an on time diagnosis of this disease as well as promote measures that guarantee the patients' health as well as her life(AU)

Mortalidade infantil e fetal: análise dos casos no município de Barreiras, Bahia, 2008-2017 / Infant and fetal mortality: analysis of cases in the municipality of Barreiras-Bahia, 2008-2017 / Mortalidad infantil y fetal: análisis de los casos en el municipio de Barreiras, Bahia, 2008-2017

O índice de mortalidade infantil tem sido utilizado por muitos gestores como justificativa para implantação/implementação de políticas e programas com a finalidade de melhorar as condições de saúde e ampliar o acesso a serviços de saúde à gestante e ao recém-nascido. Tal proposta tem a premissa de reduzir a taxa de mortalidade infantil e neonatal a partir da melhoria da qualidade do pré-natal, do puerpério e do desenvolvimento da criança. O município de Barreiras, entre 2008 e 2017, apresentou flutuações no coeficiente de mortalidade infantil e fetal, com menor percentual em 2008 (11,13%) e maior em 2009 (18,37%). Todavia, apesar dessa flutuação, quando se compara o ano inicial ao último ano estudado, verifica-se uma tendência à ampliação dos números. Para entender esse comportamento, realizou-se um estudo da mortalidade infantil e fetal entre os anos de 2008 e 2017, enfatizando os fatores predisponentes e as causas dos óbitos, por meio de dados presentes no Datasus, no Sistema de Informação sobre Mortalidade e no Sistema de Informações sobre Nascidos Vivos. Entre as principais causas de óbitos infantis e fetais evitáveis registrados estão: sífilis em gestante, sífilis congênita, afecções infantis/ fetais associadas à infecção do trato urinário materno, transtornos hipertensivos maternos, complicações da placenta, cordão umbilical e membranas afetando feto e recém-nascidos, doenças pulmonares, prematuridade, sepse neonatal e hipóxia/anóxia.

The infant mortality index has been used by many managers to justify the implementation of policies and programs aimed at improving health conditions and expanding access to health services for pregnant women and newborn. This proposal has the premise of reducing the rate of infant and neonatal mortality by improving quality during prenatal, puerperium and child development. The municipality of Barreiras, between 2008 and 2017, showed fluctuations in the coefficient of infant and fetal mortality, with its lowest percentage in 2008 (11.13%) and highest value in 2009 (18.37%). However, despite the fluctuation in the period, when the initial year is compared to the last year studied, there is a growing trend. To understand this behavior, a study of infant and fetal mortality was carried out between 2008 and 2017 focusing on predisposing factors and causes of death using data from DATASUS, SIM and SINASC. Among the main causes of preventable fetal and infant deaths are: pregnant syphilis, congenital syphilis, infantile/fetal conditions associated with maternal urinary tract infection, maternal hypertensive disorders, placenta complications, umbilical cord and membranes affecting the fetus and newborns, diseases prematurity, neonatal sepsis and hypoxia/anoxia.

El índice de mortalidad infantil ha sido utilizado por muchos gestores como justificación para implantar/implementar políticas y programas con la finalidad de mejorar las condiciones de salud y ampliar el acceso a servicios de salud a la gestante y al recién nacido. Esta propuesta tiene la premisa de reducir la tasa de mortalidad infantil y neonatal a partir de la mejora de la calidad al prenatal, puerperio y desarrollo del niño. El municipio de Barreiras presentó, entre 2008 y 2017, fluctuaciones en el coeficiente de mortalidad infantil y fetal, con un menor porcentaje en 2008 (11,13%) y mayor en 2009 (18,37%). A pesar de la fluctuación en el período, cuando se compara el año inicial al último año estudiado, se observa una tendencia a la ampliación. Para entender este comportamiento, se realizó un análisis de la mortalidad infantil y fetal en los años de 2008 a 2017, enfatizando los factores predisponentes y las causas de las muertes, por medio de datos presentes en Datasus, Sistema de Información sobre Mortalidad y Sistema de Informaciones sobre Nacidos Vivos. Las principales causas de muertes infantiles y fetales evitables registradas fueron: sífilis en la gestante, sífilis congénita, afecciones infantiles/fetales asociadas a la infección del tracto urinario materno, trastornos hipertensivos maternos, complicaciones de la placenta, cordón umbilical y membranas afectando feto y recién nacidos, enfermedades pulmonares, prematuridad, sepsis neonatal e hipoxia/anoxia.

The impact of malaria parasites on the placenta and perinatal outcome at Korle Bu teaching hospital, Accra, Ghana: a case control study

Objective: Malaria remains a complex and overwhelming health problem affecting vulnerable groups such as pregnant women and their infants in Ghana. Malaria during pregnancy does not only pose a threat to the mother but can cause serious structural damages to the placenta and subsequently affect the pregnancy outcome. The aim of the study was to investigate the impact of Plasmodium parasites on the placenta and perinatal outcome of women delivering at Korle Bu Teaching Hospital. A better understanding of the impact of malaria parasites on the placenta morphology and prenatal outcome is crucial for better management of pregnant women and their babies. Methods: The study involved testing blood collected from postpartum placentas and examining the placental tissue for Plasmodium parasites, after which they were classified as study group (Plasmodium positive) or control (Plasmodium negative). The patients in the study group with similar gestational and maternal age were matched with patients from the control group. The morphological characteristics of the placenta and the perinatal outcome of the two patient groups were compared using an unpaired t-test. Results: Sixteen (16, 13.6%) out of 118 women tested positive for Plasmodium parasites on the maternal side of the placenta by both rapid diagnostic test and microscopy and /or tested positive for malarial parasite during pregnancy, whiles the rest (102, 86.4%) had no history of malaria in the index pregnancy and tested negative. The mean placenta weight was significantly reduced in the study group (difference: -102.0g; 95% Confidence Interval [CI]: 424.4g, 486.6g) who delivered during early term (p=0.02). Patients in the study group, who delivered during late term, had a significantly reduced mean placenta diameter (difference: -2.5cm; 95% CI: 20.0cm, 21.4cm) (p=0.003) and delivered infants with lower mean birth weight (difference: - 0.693kg; 95 CI: 3.268kg, 3.475kg) (p<0.001). Conclusion: Malaria during pregnancy does not only pose a threat to the mother but to the fetus and our results add evidence that malaria parasites cause alterations to certain morphological characteristics of the placenta which subsequently affect the birth weight as the pregnancy progresses to late term

Corangioleiomioma placentario / Placentary chorangio-leiomyoma

Los corangiomas son los tumores placentarios no trofoblásticos más frecuentes; generalmente aparecen como hallazgos al momento del alumbramiento. La presencia de leiomiomas en las placentas también ha sido descripta esporádicamente, siendo por lo general tumores maternos uterinos incorporados a la placenta durante la gestación. En este trabajo se informa un caso muy inusual de lesión mesenquimática, localizada en la cara fetal placentaria, caracterizada por la combinación de rasgos histopatológicos e inmunohistoquímicos de corangioma y leiomioma. Se encontró un solo caso informado en la bibliografía científica internacional con estas características, denominado "corangioleiomioma". En nuestro conocimiento, el caso aquí expuesto es el primero comunicado en nuestro país.

Chorangiomas are the most common non-trophoblastic tumors, generally appearing as incidental findings at the moment of delivery. The presence of leiomyomas inside placental parenchyma has been also described sporadically. In these cases, leiomyomas were primary maternal uterine neoplasms incorporated into the placenta during pregnancy. This case report presents a very unusual case of mesenchymal lesion, located in the fetal surface of the placenta, characterized by combined histopathologic and immunohistochemical features of chorangioma and leiomyoma. A single case reported with these characteristics was found in the international scientific literature, named as "chorangioleiomyoma". To our knowledge, this is the first case reported in our country.

Quistes subamnióticos en el contexto de restricción de crecimiento fetal / Subamniotic cysts in the context of growth restriction fetal

RESUMEN La restricción de crecimiento fetal (RCF) es el término con el que se define a aquellos fetos que no alcanzan el potencial de crecimiento intraútero esperado debido a factores genéticos o ambientales. Dentro de las causas de RCF asociadas a la placenta encontramos mosaicismo confinado a la misma, enfermedad isquémica placentaria y anomalías estructurales a este nivel. Se presenta el caso de una paciente de 32 años con diagnóstico de RCF que asocia múltiples quistes econegativos subamnióticos en la cara fetal de la placenta. Se finaliza la gestación en semana 34 mediante cesárea electiva por ausencia de diástole en el estudio Doppler de la arteria umbilical, evidenciando cinco quistes subamnióticos de 4 a 6 cm que alteran la superficie del amnios.

ABSTRACT Fetal growth restriction (FGR) is the term used to define those fetuses that do not reach the expected intrauterine growth potential due to genetic or environmental conditions. The causes of FGR associated with the placenta are confined placental mosaicism, placental ischemic disease and placental structural abnormalities. We report a case of a 32-year-old patient with a diagnosis of FGR associated with multiple subamniotic econegative cysts overlaying the fetal plate of the placenta. The gestation is ended in week 34 by elective cesarean section due to absence of diastolic flow in the umbil-ical artery, showing five subamniotic cysts from 4 to 6 cm that disrupt the surface of the amnion.

Avaliação hematológica e hemogasométrica de potros nascidos de éguas com placentite ascendente / Hematological and hemogasometric evaluation of foals born from mares with ascending placentitis

A placentite é a principal causa de partos prematuros, aborto e nascimento de potros comprometidos, podendo causar hipóxia e septicemia. A hematologia e a gasometria venosa fornecem informações importantes para o monitoramento da saúde de potros nascidos de éguas com placentite. O objetivo deste trabalho foi descrever os valores hematológicos e hemogasométricos durante as primeiras 24h de vida em potros nascidos de éguas mestiças Crioulas submetidas à indução experimental de placentite, com diferentes graus de maturidade. Foram utilizados 16 potros nascidos de éguas submetidas à indução experimental de placentite, divididos em três grupos de acordo com o grau de maturidade: prematuro (n=8), dismaturo (n=4) e a termo (n=4). Foram realizadas coletas sanguíneas nos momentos 0h, 12h e 24h para realização de hemograma completo e gasometria venosa. No eritrograma, foi observada anemia normocítica normocrômica no grupo prematuro em relação ao grupo dismaturo nas 12h e 24h. O grupo prematuro apresentou menor contagem de leucócitos totais nas 24h em relação ao grupo a termo (P=0,01). Os valores de pH, cHCO3 e SO2 não diferiram entre os grupos, porém os animais prematuros apresentaram acidose respiratória (pH=7,28). A PCO2 nos prematuros foi maior na 0h (P=0,02). Nos três grupos, a PCO2 apresentou uma curva adaptativa com redução dos valores durante as 12h e 24h. Os potros prematuros mostraram menores valores de excesso de base (BE) no nascimento (P=0,02), confirmando o quadro de acidose respiratória. Concluiu-se que as respostas hematológicas e hemogasométricas diferem entre potros com diferentes graus de maturidade. A acidose observada no grupo prematuro ao nascimento, com estabilização e resposta compensatória durante as 12h e 24h, demonstra a necessidade de avaliação hemogasométrica sequencial em potros de risco, o que permite a identificação da resposta clínica ao processo e, assim, auxilia no estabelecimento do tratamento e prognóstico para esses potros.(AU)

The placentitis is a major cause of premature birth, abortion and compromised foal delivery, and may result in hypoxia and sepsis. The blood gas analysis and hematology can provide important information for monitoring the foals born from mares with placentitis, with different degrees of maturity. The aim of this study was to describe the hematological and blood gas values during the first 24 hours of life in foals born from crossbreed mares with experimentally induced placentitis, presenting different degrees of maturity. Sixteen foals, born from mares with experimentally induced ascending placentitis were assigned to three groups according to degree of maturity: premature (n=8), dysmature (n=4), and full-term foals (n=4). Blood samples were collected at birth (0), at 12h and 24h, and hematological evaluation and blood gas variables were measured. In the premature group normocytic normochromic anemia was observed compared to dysmature group at 12h and 24h. The premature group showed lower count of white blood cells at 24h relative to the full-term group (p=0.01). The pH, cHCO3 and SO2 values do not differ among the groups; however the premature group showed respiratory acidosis (pH=7,28). The PCO2 was higher at 0h in the premature foals (p=0.02). In all groups, the PCO2 presented an adaptive curve with reduction between 12h and 24h. The premature foals showed lower base excess (BE) values at birth (p=0.02), confirming the respiratory acidosis in this group. We conclude that the hematological and blood gas response differs between foals with different degrees of maturity. Acidosis in the premature foals at birth, with stabilization and compensation of pH value during the first 12-24h demonstrate the necessity of sequential blood gas analysis in risk foals. This may help identify the clinical response to the process and assist in the establishment of adequate treatment and prognosis for these foals.(AU)

Risk factors for massive postpartum bleeding in pregnancies in which incomplete placenta previa are located on the posterior uterine wall

OBJECTIVE: To identify factors associated with massive postpartum bleeding in pregnancies complicated by incomplete placenta previa located on the posterior uterine wall. METHODS: A retrospective case-control study was performed. We identified 210 healthy singleton pregnancies with incomplete placenta previa located on the posterior uterine wall, who underwent elective or emergency cesarean section after 24 weeks of gestation between January 2006 and April 2016. The cases with intraoperative blood loss (≥2,000 mL) or transfusion of packed red blood cells (≥4) or uterine artery embolization or hysterectomy were defined as massive bleeding. RESULTS: Twenty-three women experienced postpartum profuse bleeding (11.0%). After multivariable analysis, 4 variables were associated with massive postpartum hemorrhage (PPH): experience of 2 or more prior uterine curettage (adjusted odds ratio [aOR], 4.47; 95% confidence interval [CI], 1.29 to 15.48; P=0.018), short cervical length before delivery (<2.0 cm) (aOR, 7.13; 95% CI, 1.01 to 50.25; P=0.049), fetal non-cephalic presentation (aOR, 12.48; 95% CI, 1.29 to 121.24; P=0.030), and uteroplacental hypervascularity (aOR, 6.23; 95% CI, 2.30 to 8.83; P=0.001). CONCLUSION: This is the first study of cases with incomplete placenta previa located on the posterior uterine wall, which were complicated by massive PPH. Our findings might be helpful to guide obstetric management and provide useful information for prediction of massive PPH in pregnancies with incomplete placenta previa located on the posterior uterine wall.

Placental malaria and neonatal anti-tetanus antibody status: any association?

Background. Neonatal tetanus(NT) has remained an important cause of neonatal morbidity and mortality in the tropics where high prevalence of placental malaria coexists. The current strategy for the control of NT involves stimulating production of protective level of anti-tetanus antibody in the mother, through tetanus toxoid immunization, and transferring same through the placental to the foetus. Placental malaria is known to alter the morphology and functions of the placenta, but the effect on transfer of anti-tetanus antibody specifically, remains unsettled. We studied the influence of placental malaria on transplacental transfer of anti-tetanus antibodies among mother-infant pairs at the University of Maiduguri Teaching Hospital North-Eastern Nigeria.Method. Maternal and cord blood samples were collected from 162 mother-baby pair and analysed for anti-tetanus antibody levels using ELISA. Placental biopsy was also taken from each mother-baby pair and placental malaria diagnosed histologically.Results. One hundred and sixteen (71.6%) of the 162 mother-infant pairs were positive for placental malaria out of which 59(50.9%) had chronic-active, 44 (37.9%) acute and 13 (11.2%) had past placental malaria. Forty-one (25.3%) babies were classified as seronegative for tetanus antibodies of whom 32 were delivered to mothers who were positive for placental malaria. Fifty-six (34.5%) mother-infant pairs had poor placental transfer for tetanus antibodies as signified by cord-maternal ratio of < 1.0 antibodies, out of these, 40 (24.7%) were positive for placental malaria. There was statistically significant association between type of placental malaria and serostatus (p = 0.0009) and efficiency of placental transfer (p = 0.0340). Mothers with chronic-active malaria were 7.4 times more likely to deliver a seronegative infant compared to mothers with acute malaria (p = 0.0002, OR =7.353, 95% CI = 2.327 -23.25). Similarly, maternal-infant pair with chronic-active malaria were 2.9 times more likely to have inefficient placental transfer (p = 0.0221, OR = 2.859, 95% CI = 1.200 ­ 6,859).Conclusion. Placental malaria has remained a very common medical condition in Maiduguri among pregnant women and may partly account for the high level of neonatal tetanus prevalent in the area

Proteinograma sérico de éguas com placentite ascendente e seus respectivos neonatos: dados preliminares / Serum protein concentrationin mares with ascending placentitis and their newborns: preliminary data

Este estudo teve por objetivo estabelecer o proteinograma sérico em éguas com placentite induzida e em seus respectivos neonatos. Foram coletadas amostras de sangue das éguas em oito momentos diferentes e dos potros em quatro momentos. Para obtenção da concentração das frações proteicas, utilizou-se eletroforese em gel de acrilaminada contendo dodecil sulfato de sódio (SDS-PAGE). No método utilizado, foram observadas 23 bandas proteicas, cujos pesos moleculares variaram de 16KDa a 245KDa, sendo possível a identificação das seguintes frações: 175KDa, 102KDa, 83KDa, 63KDa, 50KDa, 41KDa, 39KDa e 28KDa. De todas as bandas proteicas encontradas, somente as de 39KDa e 41KDa apresentaram alteração na cinética nos momentos avaliados. De acordo com a solução marcadora, pode-se sugerir que essas proteínas seriam alfa1-glicoproteína ácida (39KDa) e haptoglobina (41KDa). A concentração de imunoglobulinas nos potros apresentou aumento significativo a partir das 12 horas de nascimento. Não está elucidado se estes níveis refletem a persistência do processo inflamatório placentário ou se são alterações fisiológicas do periparto. Não foram observadas alterações na cinética das proteínas nos potros nas primeiras 48 horas.(AU)

The aim of this paper was to identify the serum acute phase protein concentration in mares with induced placentitis and their neonates. Blood samples were collected from the mares in 8 different moments, and from the foals, in 4 moments. To obtain the concentration of protein fractions acrilaminada gel electrophoresis in sodium dodecyl sulfate (SDS-PAGE) was used. In the used method 23 protein bands whose molecular weights ranged from 16kDa to 245kDa were observed, it is possible to identify the following fractions: 175kDa, 102kDa, 83kDa, 63kDa, 50kDa, 41kDa, 39kDa and 28kDa. Of all the protein bands found only the 39KDa and 41KDa have changes in the kinetics in the evaluated times. According to the marker solution, we would suggest that these proteins are alfa1-acid glycoprotein (39kDa) and haptoglobin (41kDa). The concentration of immunoglobulins in foals increased significantly from 12 hours of birth.(AU)

Histerectomía obstétrica en el Hospital General Dr. Aurelio Valdivieso, Oaxaca, México / Obstetric hysterectomy in a secondary hospital

Objetivo: Determinar la incidencia, principales indicaciones y complicaciones de la histerectomía obstétrica (HO) en un hospital de segundo nivel de atención a cuatro años de implementar el programa de prevención y manejo de la hemorragia obstétrica. Método: Estudio de tipo descriptivo de revisión de expedientes clínicos, de tipo transversal, analítico y retrospectivo. Resultados: Se hallaron 51 expedientes de pacientes a quiénes se realizó HO de enero de 2012 a noviembre de 2015. La prevalencia fue de 17,1/10.000 nacimientos, la incidencia por año fue de 1,7 (2012), 1,7 (2013), 1,4 (2014) y 1,9 (2015) por cada mil nacimientos respectivamente. La prevalencia de HO post-cesárea fue de 25,6/10.000 y en el post-parto de 10,6/10.000. Las variables que alcanzaron significancia entre cirugía programada y de emergencia fue pérdida sanguínea y necesidad de transfusiones sanguíneas. El procedimiento se asocia a anemia en el puerperio 7 veces más y las principales indicaciones para realizar el procedimiento fueron alteración de la adherencia placentaria e hipotonía. Conclusiones: El diagnóstico prenatal de anomalías en la adherencia placentaria, la mejor utilización de hemoderivados y la técnica quirúrgica ha eliminado la mortalidad materna por hemorragia obstétrica masiva en los últimos cuatro años en el Hospital General Dr. Aurelio Valdivieso.

Objective: To determine the incidence, main indications and complications of obstetric hysterectomy in a secondary hospital care to four years to implement the program of prevention and management of obstetric hemorrhage. Methods: Descriptive study of review of clinical records, transversal, analytical and retrospective. Results: 51 cases of patients who obstetric hysterectomy (OH) was held between January 2012 to November 2015. The prevalence was 17.1/10,000. The incidence per year was 1.7 (2012), 1.7 (2013), 1.4 (2014) and 1.9 (2015) per 1000 births, respectively. The prevalence of post-cesarean OH was 25.6/10,000 while postpartum OH was 10.6/10,000. The variables that reached significance between scheduled and emergency surgery was blood loss and need for blood transfusions. The procedure is associated with anemia in the postpartum period 7 times and the main indications for the procedure were alteration abnormal placental adhesion and uterine atony. Conclusions: The prenatal diagnosis of abnormal placental adhesion, better use of blood products and surgical technique has eliminated maternal mortality by massive obstetric hemorrhage in the last four years in the General Hospital Dr. Aurelio Valdivieso.