Chronic histiocytic intervillositis (CHI): an under-recognised condition with potential serious sequelae in pregnancy.

Chronic histiocytic intervillositis (CHI) is a rare placental disorder associated with adverse pregnancy outcomes and high recurrence rates in subsequent pregnancies. We discuss a case of CHI diagnosed incidentally in a young primigravida who presented with a first trimester miscarriage. CHI is usually diagnosed after an adverse pregnancy outcome by microscopic placental histopathology. Currently, CHI is a poorly understood condition by clinicians in many aspects, including its aetiology and subsequent management of patients in their future pregnancies. This is due to the lack of awareness and underdiagnosis of CHI among general pathologists and obstetricians. The authors would like to highlight this interesting case to encourage more research on CHI to understand its pathophysiology and optimal management better. Clinicians should also focus on providing holistic care to this group of patients by considering the impact of adverse pregnancy outcomes on their emotional well-being.

[Antenatal management for patients with increased risk of post-partum hemorrhage (excluding abnormal placentation)]. / Prise en charge anténatale des patientes à risque d'hémorragie du post-partum (hors anomalies de l'insertion placentaire).

OBJECTIVES: To describe management and screening for high-risk patients concerning post-partum hemorrhage (PPH) and antenatal management for severe anemia, thrombopenia, bleeding disorders and anticoagulant therapy. METHODS: Bibliographic search restricted to French and English languages using Medline database and recommendations of medical societies. RESULTS: The appropriate place for delivery should be chosen after multidisciplinary concertation based on level of risk (especially past-history of severe PPH and bleeding disorder) and easy access to blood products (Professional Consensus). Prevention for severe anemia is mainly based on oral iron supplementation (grade B). Explorations are required in case of thrombopenia<100Giga/L (grade C). Patients with bleeding disorder require the assistance of a physician skilled in hemostasis for perinatal management (grade C). Preventive anticoagulant therapy has no impact on PPH risk and perimedullar analgesia is usually authorized 12hours after last injection (grade C). Curative anticoagulant therapy slightly increases PPH risk and perimedullar analgesia is authorized only after 24hours since last injection (Professional Consensus). CONCLUSION: Prenatal identification of high-risk patients concerning PPH implies multidisciplinary concertation to determine the most appropriate birthplace where technical and human resources are available.

Risk of necrotizing enterocolitis and feeding interventions for preterm infants with abnormal umbilical artery Doppler.

Infants exposed to absent or reversed end-diastolic flow (ARE DF) in utero may be at an increased risk of developing necrotizing enterocolitis (NEC). This article reviews placental function and the development of ARE DF. Studies examining the relationship between AREDF and NEC are reviewed, yet research remains inconclusive regarding this relationship. Recent studies reveal that early minimal enteral feeding does not increase the incidence of NEC in infants with AREDF. Initiation and advancement of enteral feedings should be monitored closely in this subset of the neonatal intensive care unit (NICU) population.

Trombohematoma subcorionico masivo: una patología placentaria emergente / Massive subchorionic thrombohematoma

El trombohematoma subcoriónico es una extravasación de sangre localizada en la placa coriónica, entre amnios y corion. Es muy infrecuente, el diagnóstico no es común, tiene alto riesgo perinatal y no hay casos comunicados en nuestro medio. Se presentan 12 casos de sospecha diagnóstica antenatal, confirmada en el examen histopatológico placentario. Se describe y discute el cuadro clínico, las complicaciones maternas y perinatales, el diagnóstico ultrasónico, el manejo y los resultados obtenidos. En nueve casos se identifcó una fase latente con hematoma de tamaño estable, entre el inicio de los síntomas y el parto, que duró en promedio 7,3 semanas. En ocho casos la fase latente fue seguida por una fase activa con aumento del hematoma asociado al parto prematuro. Tres embarazadas presentaron patología médica compleja con una muerte materna. Seis casos hicieron anemia severa y tres patología miscelánea. Hubo ocho amenazas de parto prematuro con tocolisis, tres rotura prematura de membranas, una colestasis y una preeclampsia. Los partos fueron prematuros, dos de 36 y 33 semanas y diez menores a 32 semanas. Siete prematuros tuvieron peso inferior a 1000 gramos y seis hicieron restricción fetal grave, en percentil <5 de la curva de crecimiento. Hubo complicaciones neonatales relacionadas con prematurez, restricción y bajo peso, manejados con hospitalización prolongada con promedio de 74 días (rango: 6-298 días). Diez neonatos sobrevivieron; hubo un mortinato y un mortineonato. La sobrevida fue 83,3 por ciento y la mortalidad de 16,6 por ciento que se comparan favorablemente con las cifras comunicadas.

Subchorial thrombohaematoma is caused by blood extravasations in the corionic plate, between amnion and chorion. It is a rare pathologic entity, that carries a high perinatal risk, which has not being published in our country up to now. We report 12 cases in which the diagnosis was suspected before birth, and confirmed in the placentary pathological examination. We describe the clinical presentation, fetal and maternal risks, ultrasonographic findings, treatment and clinical outcomes. In 9 patients a latent phase was identified with a stable size hematoma, which had a mean duration of 7.3 weeks. In 8 cases the latent phase was followed by an active phase, with increasing size of the hematoma associated with preterm labour. Three pregnant women had severe complications which caused one maternal death. Six had severe anemia and other three had minor complications. Eight had preterm labor symptoms which required tocolysis. Three had prelabour rupture of membranes, one cholestasis disease and preeclampsia. Preterm labours were at 36, 33 and other ten before 32 weeks of gestation. Seven preterm newborns weight less than 1000 grams and six had severe fetal restriction (p<5). Newborn complications were related with prematurity, requiring prolonged hospitalization (mean 74 days, range 6-298 days). Ten newborns survived. There were 1 still birth and 1 dead newborn. Survival rate was 83.3 percent and 16.6 percent mortality, better rates than previously published.

[New aspects in diagnosis and therapy of placental insufficiency. Placental perfusion measurements; placental perfusion test (PPT) and betamimetic long term treatment (clinical and experimental data (authors transl)]. / Neue Gesichtspunkte zur Erfassung und Behandlung der Plazentainsuffizienz.

The rate of utero-placental blood flow depends on functional components (perfusion pressure and flow resistance within the area of the vascular bed of the placenta), as well as on morphological factors (regressive changes in the placenta). Different primary maternal conditions and diseases may lower the rate of placental flow, leading to placental insufficiency; the highest percentage, by far, of placental dysfunction is found in patients suffering from gestosis. Hypocirculation initially present in cases of EPH gestosis and caused by arteriolar spasms triggers off a vicious circle involving placental infarction and severe reduction in the utero-placental perfusion rate. This in turn leads to fetal hypotrophy, a high rate of premature births and perinatal mortality. Verification of HPL, HCG, alpha-Fetoprotein or E3 in maternal serum and amniotic fluid or urine greatly improved the recording of partial placental functions. Along with ultrasonic biometry, cardiotocography and amnioscopy, these hormonal parameters allow only indirect assessment of the placental function. On the other hand, measurements of the utero-placental flow offers a direct approach. In order to evaluate the placental flow measurements it is imperative to obtain a curve indicating the course over the last third of the pregnancy-in addition to establishing a general normal range. In case of placental insufficiency, it is necessary to determine whether this is due to functional disorders alone, or to more extenisve morphological changes. A placental perfusion test (PPT) was developed in order to make this distinction. Beta2-mimetic treatment is indicated if functional factors predominate, whereby it appears essential to obtain the requisite experimental data for precise quantification of beta-mimetic action.