Rare Complete Hydatidiform Mole With p57 Expression in Villous Mesenchyme: Case Report and Review of Discordant p57 Expression in Hydatidiform Moles.

Complete hydatidiform mole (CHM) is a premalignant proliferative disease of the placenta characterized by misexpression of imprinted gene products, most notably p57. The majority of CHM exhibit immunohistochemical absence of p57 protein in villous mesenchyme (VM) and cytotrophoblast (CT) and are thus p57 VM/CT concordant. However, some gestations show loss of p57 in only VM or CT, either in all chorionic villi or a subset thereof (VM/CT discordant). Here, we present a rare case of a p57 VM/CT-discordant CHM with diffuse retention of p57 expression in VM but complete absence in CT. Histologically, the case exhibited typical features of CHM including trophoblast hyperplasia and severe nuclear atypia, but was unusual in the presence of gestational membranes identified ultrasonographically and histologically. Ploidy determination by FISH and genotyping by short tandem repeat analyses showed that this was a diploid gestation with variable allelic ratios and with an androgenetic lineage, similar to previously reported p57 VM/CT-discordant cases.

The Use of Atomic Force Microscopy in Comprehensive Assessment of the "Mother-Placenta-Fetus" System in Obstetric and Endocrine Pathology during Pregnancy.

Atomic force microscopy is not very popular in practical health care, therefore, its potential is not studied enough, for example, in obstetrics when studying the "mother-placenta-fetus" system. Our study summarizes the possibilities of using atomic force microscopy for detection of various circulatory disorders and vascular changes at the microscopic level in the uterus (endometrium and myometrium), placenta, and umbilical cord in the main variants of obstetric and endocrine pathology. For instance, in the case of endocrine pathologies, changes in the form of stasis, sludge, diapedesis, ischemia, destruction and separation of endotheliocytes in villous blood vessels were found in the mother. The oxygen content in erythrocytes also naturally decreased in pathologies; poikilo- and anisocytosis were observed.

Performance of conventional cytogenetic analysis on chorionic villi when only one cell layer, cytotrophoblast or mesenchyme alone, is analyzed.

OBJECTIVE: To provide an estimation of the probability of error when chorionic villi (CV) cytogenetic analysis is limited to a single placental layer; either a direct preparation (Dir) or long-term culture (LTC). METHODS: We retrospectively reviewed cytogenetic studies on 81,593 consecutive CV samples in which both Dir and LTC were analyzed. All mosaic cases received amniocentesis. The false omission and false discovery rates were calculated by assessing the results that would have been reported when analysis was limited to either Dir or LTC. RESULTS: For all abnormalities combined, the proportion of normal Dir or LTC only reports that would have been inconsistent with a subsequent amniocentesis was 0.09% and 0.03%, respectively (false omissions). Among abnormal reports based on Dir or LTC alone, 8.01% and 3.17%, respectively, would be inconsistent with a subsequent amniocentesis result (false discoveries). Differences are present for individual abnormalities. CONCLUSIONS: From the perspective of identifying all abnormalities of potential clinical significance, the analysis of both placental layers is optimal. LTC alone is the preferred approach if only one layer of placenta is to be analyzed. Although rare, it is important to acknowledge that one cell layer analysis alone can cause misdiagnosis due to undetected mosaicism.

Diagnosis and Management of Placental Mesenchymal Disease. A Review of the Literature.

OBJECTIVE: To review what is currently known about placental mesenchymal dysplasia (PMD) including imaging techniques for diagnosis and differentiation from a molar pregnancy, genetics, maternal/fetal effects, and management. EVIDENCE ACQUISITION: A literature search by research librarians at 2 universities was undertaken using the search engines PubMed and Web of Science. The search terms used were "etiology" OR "cause" OR "risk" OR "risks" OR "epidemiology" OR "diagnosis" OR "therapy" OR "prognosis" OR "management" AND "placental mesenchymal dysplasia" OR "placenta" AND "mesenchymal dysplasia." No limit was put on the number of years searched. RESULTS: The etiology of PMD remains uncertain, although there are a number of theories on causation. An elevated maternal serum α-fetoprotein level, slightly elevated human chorionic gonadotropin level, normal karyotype, multicystic lesions on ultrasound, and varying degrees of flow within cysts using color Doppler (stained-glass appearance) are helpful in making the diagnosis. On pathologic examination of the placenta, PMD is differentiated from molar pregnancy by the absence of trophoblastic hyperplasia. Fetal complications of PMD include hematologic disorders, Beckwith-Wiedemann syndrome, liver tumors, fetal growth restriction, preterm delivery, and intrauterine fetal demise. Maternal complications include gestational hypertension, preeclampsia, HELLP (hemolysis, elevated liver function tests, low platelets) syndrome, and eclampsia. CONCLUSIONS: Accurate diagnosis of PMD is imperative for appropriate management and surveillance to minimize adverse maternal and fetal outcomes. RELEVANCE: The importance of a correct diagnosis of PMD is important because it can be misdiagnosed as a partial molar pregnancy or a complete mole with coexisting normal fetus, and this can result in inappropriate management.

Primary Ovarian Pregnancy: A Case Series and Analysis.

The preoperative diagnosis of primary ovarian pregnancy (POP) remains elusive and the final diagnosis relies heavily on histologic findings. The diagnostic criteria for POP, established in 1878 by Spiegelberg, are based primarily on the identification of an embryonic sac within the ovary and the localization of conception products therein. However, these diagnostic criteria may be overly strict, which may not only significantly underestimate the prevalence of POP, but also potentially mislead patient management. In this series, we present 7 cases that showed no embryonic sac within the ovary (thus not meeting the Spiegelberg criteria for POP), but were nonetheless classified by the authors as POP based on the unequivocal presence of chorionic villi and implantation sites within the ovary. Immmunohistochemical studies for beta-human chorionic gonadotropin, human placental lactogen, and inhibin highlighted the trophoblastic populations. These findings indicate that POP may occur even if no embryonic sac is pathologically demonstrable. Accordingly, we propose the following modified diagnostic criteria for POP: (1) no pathologic evidence of ipsilateral fallopian tube involvement is present; and (2) evidences of gestation, including presence of chorionic villi and/or implantation site are present within the ovary. If both criteria are met, the diagnosis of POP should be rendered. These proposed diagnostic criteria should lead to more accurate diagnoses of POP, provide more contemporary insights into its true prevalence, heighten clinical awareness of the disease, and ultimately, optimize its clinical management.

Clarification and confocal imaging of the nonhuman primate placental micro-anatomy.

Geometry of the placental villous vasculature is a key determinant of maternal-fetal nutrient exchange for optimal fetal growth. Recent advances in tissue clarification techniques allow for deep high-resolution imaging with confocal microscopy; however, the methodology lacks a signal:noise ratio of sufficient magnitude to allow for quantitative analysis. Thus, we sought to develop a reproducible method to investigate the 3D vasculature of the nonhuman primate placenta for subsequent data analysis. Fresh placental tissue was dissected, formalin fixed, clarified using a modified Visikol® protocol and immunolabeled for CD31 (fetal endothelium) and cytokeratin-7 (villous trophoblast) for confocal imaging of the microanatomy. We present a detailed clarification and staining protocol augmented for imaging of nonhuman primate placental tissue. The image stacks generated by this refined staining method and our data acquisition parameters can be analyzed quantitatively to provide insights regarding the villous and vascular micro-anatomy of the placenta.

Heterotopic Pregnancy Including Intrauterine Normal Gestation and Tubal Complete Hydatidiform Mole: A Case Report and Review of the Literature.

We report a rare case of heterotopic pregnancy with intrauterine normal gestation alongside tubal complete hydatidiform mole (CHM) that resulted in a viable pregnancy after removal of molar tissue. Because of their rarity and inherent complexity, such cases represent a significant challenge in diagnosis and management. A 34-year-old female in her 10th week of gestation presented with nausea, vomiting, and intermittent abdominal pain that progressively worsened. Imaging studies revealed a normal intrauterine fetus and an 11-cm heterogenous mass in the left adnexal region. The patient's serum human chorionic gonadotropin was higher than the reference range. Diagnostic laparoscopy revealed a large hemorrhagic mass involving the left adnexa that was removed completely. The mass was composed of blood clots admixed with necrotic tissue of vesicular appearance on gross inspection. Microscopic examination revealed large chorionic villi with circumferential trophoblastic proliferation and cisterns, all of which are characteristic of CHM. An implantation site was identified at the tubal fimbriae. Immunohistochemistry p57 demonstrated negative staining in the villous stromal and cytotrophoblastic cells, supporting the diagnosis of CHM. Chromosomal karyotyping and cytogenetic analysis were performed on chorionic villi samples from the intrauterine gestation and reported as normal (46, XX). The patient elected to continue the intrauterine pregnancy, delivering a healthy female infant at 39 weeks. Our case reaffirms that to successfully manage this rare yet life-threatening condition, heterotopic pregnancy should be included in the differential diagnosis for any gravid women presenting with persistent abdominal pain and/or extrauterine mass.

Automated image analysis of placental villi and syncytial knots in histological sections.

INTRODUCTION: Delayed villous maturation and accelerated villous maturation diagnosed in histologic sections are morphologic manifestations of pathophysiological conditions. The inter-observer agreement among pathologists in assessing these conditions is moderate at best. We investigated whether automated image analysis of placental villi and syncytial knots could improve standardization in diagnosing these conditions. METHODS: Placentas of antepartum fetal death at or near term were diagnosed as normal, delayed or accelerated villous maturation. Histologic sections of 5 cases per group were photographed at ×10 magnification. Automated image analysis of villi and syncytial knots was performed, using ImageJ public domain software. Analysis of hundreds of histologic images was carried out within minutes on a personal computer, using macro commands. RESULTS: Compared to normal placentas, villi from delayed maturation were larger and fewer, with fewer and smaller syncytial knots. Villi from accelerated maturation were smaller. The data were further analyzed according to horizontal placental zones and groups of villous size. DISCUSSION: Normal placentas can be discriminated from placentas of delayed or accelerated villous maturation using automated image analysis. Automated image analysis of villi and syncytial knots is not equivalent to interpretation by the human eye. Each method has advantages and disadvantages in assessing the 2-dimensional histologic sections representing the complex, 3-dimensional villous tree. Image analysis of placentas provides quantitative data that might help in standardizing and grading of placentas for diagnostic and research purposes.

Dynamic contrast enhanced MRI of the placenta: A tool for prenatal diagnosis of placenta accreta?

BACKGROUND: Ultrasound (US) is the primary imaging modality for the diagnosis of placenta accreta, but it is not sufficiently accurate. MRI morphologic criteria have recently emerged as a useful tool in this setting, but their analysis is too subjective. Recent studies suggest that gadolinium enhancement may help to distinguish between the stretched myometrium and placenta within a scar area. However, objective MRI criteria are still required for prenatal diagnosis of placenta accreta. The purpose of this study was to assess the diagnostic value of dynamic contrast gadolinium enhancement (DCE) MRI patterns for placenta accreta. MATERIALS AND METHODS: MR images were acquired with a 1.5-T unit at 30-35 weeks of gestation in women with a history of Caesarian section, a low-lying anterior placenta, and US features compatible with placenta accreta. Sagittal, axial and coronal SSFP (Steady State Free Precession) sequences were acquired before injection. Then, contrast-enhanced dynamic T1-weighted images were acquired through the entire cross-sectional area of the placenta. Images were obtained sequentially at 10- to 14-s intervals for 2 min, beginning simultaneously with the bolus injection. Functional analysis was performed retrospectively, and tissular relative enhancement parameters were extracted from the recorded images. The suspected area of accreta (SAA) was placed in the region of the previous scar, and a control area (CA) of similar size was placed on the same image plane, as far as possible from the SAA. Semi-quantitative analysis of DCE-MR images was based on the kinetic enhancement curves in these two regions of interest (ROI). Three tissular relative enhancement parameters were compared according to the pregnancy outcomes, namely time to peak, maximal signal intensity, and area under the enhancement curve. RESULTS: We studied 9 women (43%) with accreta and 12 women (57%) with a normal placenta. All three tissular relative enhancement parameters differed significantly between the two groups (p < 10-3). CONCLUSION: The use of dynamic contrast-enhanced MRI at 30-35 weeks of gestation in women with a high risk of placenta accreta allows the extraction of tissular enhancement parameters that differ significantly between placenta accreta and normal placenta. It therefore provides objective parameters on which to base the diagnosis and patient management.

Choriovitelline placenta: prenatal sonographic imaging and clinical characteristics.

OBJECTIVES: To describe the fetal sonographic characteristics, in-utero natural history and postnatal outcome of choriovitelline placenta, in which the fetal umbilical vein is replaced by the extra-embryonic vitelline circulation. METHODS: This was a retrospective study of pregnancies examined during the period 2010-2014. Fetuses which presented with sonographic criteria of a downward caudal course of an enlarged vein from the umbilical annulus to the hepatic hilum were followed prospectively. Two-dimensional and three-dimensional color Doppler with high-definition flow were used in order to investigate the extra- and intrahepatic venous system. Ultrasound images and volumes were stored digitally, clinical data were obtained from patients' medical files and telephone interviews were conducted regarding the course of the pregnancy, perinatal data and developmental milestones. RESULTS: Four cases were identified during the study period. The mean ± SD gestational age at diagnosis was 19.5 ± 4.3 (range, 13-23) weeks. The characteristic downward course of the persistent vitelline vein was associated with aneurysmal dilatation and anomalous anatomical configuration of the intrahepatic venous system. One case ended with antepartum death at 28 weeks. The mean gestational age at delivery was 34.6 (±5.0) weeks and the birth weight corresponded to the 57.2nd (± 16.8 SD) centile. In two cases, a thrombotic mass was detected in the portal venous system after birth. One necessitated antithrombotic treatment for 6 months; in the other case, spontaneous resolution occurred 7 days after birth. In the three surviving infants, the persistent extrahepatic vitelline vein regressed gradually within 6 months after birth. Neurodevelopment was normal at follow-up aged 1 year and 7 months, 3 years and 6 months and 5 years and 5 months. CONCLUSION: The main clinical importance of choriovitelline placentation derives from the possible formation of thrombus in the portal venous system. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

[Morphological Features of Mesenhymal Stroma Cells of Chorionic Villi].

Background: Nowadays autologous mesenchymal placental stromal cells (MSCs) may use to treat for various diseases both of the mother and the child. Stroma of the placenta villi is appropriated origin for cell culture isolation. Aim: of the study was to evaluate the possibility for selection and use of placental tissue for mesenchymal stromal cells. Materials and methods: The present study was based on 45 placental samples of women aged 27−38 yy. who underwent surgical delivery at 36−40 weeks of gestation. 30 of these women have been enrolled in the basic group including children with congenital abnormalities (CA). The comparison group consisted of 15 patients with physiological pregnancy. We performed histological examination (with hematoxylin and eosin staining), immunohistochemical examination (with use monoclonal antibodies CD90 (1:25; Abcam, UK), СD105 (1:500; Abcam, UK), CD44 (1:25; Dako), СD73 (1:200, Abcam, UK), and electron microscopy (by microscope Philips/FEI Corporation, Eindhoven, Holland). Eclipse 80i microscope (Nikon Corporation, Japan) was used to examine the immunohistochemical reactions as a brown staining. The evaluation of the intensity of reaction was conducted by NIS-Elements Advanced Research 3.2 program (Czech Republic). Student's t-test and analysis of variance were used to compare the mean values. Differences were considered statistically significant at p<0.05. Results: Interstitial cells of the stroma of the villi with CA had fibroblastic differentiation as revealed degenerative changes of the cells. The histologic examination with hematoxylin and eosin staining revealed significant fibrosis of the stroma of the placenta villi in CA group (p<0,01). Immunohistochemical study of stem and intermediate chorionic villi revealed no significant differences in staining of CD44+, СD90+, СD73+, and CD105+ cells if compared to the control group (p>0.05). Although CD105 expression was significantly lower in the CA group (0.058±0.0049) than in the control group (0.088±0.0039) (p<0.05). However, electron microscopy detected the villi interstitial stromal cells with fibroblastic differentiation in CA group. Conclusions: Thus, it is necessary to exclude placenta with obstetrical history, somatic, and congenital pathology of the mother and the child when selecting the placental cell culture. Moreover, choosing a sample the morphological structure of the placenta should be taken into consideration. However, congenital malformations of the fetus, pathology of the mother cultivate mesenchymal stromal cells of placentas is inappropriate and should be taken advantage of the donor cells.

Placental Pathology of Zika Virus: Viral Infection of the Placenta Induces Villous Stromal Macrophage (Hofbauer Cell) Proliferation and Hyperplasia.

CONTEXT: -The placenta is an important component in understanding the fetal response to intrauterine Zika virus infection, but the pathologic changes in this organ remain largely unknown. Hofbauer cells are fetal-derived macrophages normally present in the chorionic villous stroma. They have been implicated in a variety of physiological and pathologic processes, in particular involving infectious agents. OBJECTIVES: -To characterize the fetal and maternal responses and viral localization in the placenta following Zika virus transmission to an 11 weeks' gestation fetus. The clinical course was notable for prolonged viremia in the mother and extensive neuronal necrosis in the fetus. The fetus was delivered at 21 weeks' gestation after pregnancy termination. DESIGN: -The placenta was evaluated by using immunohistochemistry for inflammatory cells (macrophages/monocytes [Hofbauer cells], B and T lymphocytes) and proliferating cells, and an RNA probe to Zika virus. The fetal brain and the placenta were previously found to be positive for Zika virus RNA by reverse transcription-polymerase chain reaction. RESULTS: -The placenta demonstrated prominently enlarged, hydropic chorionic villi with hyperplasia and focal proliferation of Hofbauer cells. The degree of Hofbauer cell hyperplasia gave an exaggerated immature appearance to the villi. No acute or chronic villitis, villous necrosis, remote necroinflammatory abnormalities, chorioamnionitis, funisitis, or hemorrhages were present. An RNA probe to Zika virus was positive in villous stromal cells, presumably Hofbauer cells. CONCLUSIONS: -Zika virus placental infection induces proliferation and prominent hyperplasia of Hofbauer cells in the chorionic villi but does not elicit villous necrosis or a maternal or fetal lymphoplasmacellular or acute inflammatory cell reaction.

Clinical and imaging predictors of management in retained products of conception.

OBJECTIVES: To determine if clinical and ultrasound (US) imaging features help predict management in clinically suspected retained products of conception (RPOC). METHODS: 334 patients sonographically evaluated for RPOC were included in this IRB-approved retrospective study. Of the 334 patients, 176 had sonographic diagnosis of RPOC and comprised the final study group. Patients were managed expectantly, medically, or surgically in accordance with clinical judgment of treating physicians. Pelvic sonograms were retrospectively reviewed for endometrial stripe thickness and vascularity was graded on a 0-3 scale based on appearance relative to myometrium (Grade 0: no vascularity, Grade 1: minimal vascularity, Grade 2: moderate vascularity, Grade 3: marked vascularity). Clinical and imaging predictors of management were evaluated in univariate and multivariate analysis. RESULTS: Mean patient age was 29.6 years and mean gestational age was 17.4 weeks. Most (74.4%) women presented with vaginal bleeding. 83 patients (47.2%) were treated conservatively with expectant management, 42 (23.8%) were treated medically, and 51 (29.0%) required surgical intervention. Mean endometrial stripe thickness was 21.3 mm. 47 women (26.7%) had vascularity score of 0; 50 (28.4%) had score 1; 52 (29.6%) had score 2; and 27 (15.3%) had score 3. In univariate analysis, serum hemoglobin (Hb) (p < 0.0001), endometrial stripe thickness on US (p < 0.005), presenting symptoms (p = 0.03), and US vascularity score (p < 0.005) were statistically significant predictors of final management. In multivariate logistic regression, serum Hb (OR 0.69, 95% CI 0.55-0.86, p < 0.0009), endometrial stripe thickness (OR 1.08, 95% CI 1.04-1.12, p < 0.0001), and US vascularity score (OR 1.77, 95% CI 1.16-2.70, p < 0.01) were statistically significant predictors of need for surgery. CONCLUSIONS: Serum Hb, endometrial stripe thickness, and US vascularity score were significant predictors of clinical management, particularly the need for surgical intervention, in women with clinically suspected RPOC.

SMI for imaging of placental infarction.

Since superb Micro-vascular Imaging (SMI) is a new blood flow imaging technique that employs a unique algorithm to minimize motion artifacts, it can visualize low-velocity blood flow in small vessels. We demonstrate SMI imaging of the placental infarction in a case with fetal growth restriction, comparing a normal placenta on the same gestation. While SMI image in normal placenta clearly shows structures from the branching vessels to the peripheral villous trees in the cotyledons, they could not be seen in the case of fetal growth restriction. We think that the clinical value and future potential of SMI in placental evaluation have been clearly demonstrated.

Quantitative assessment of placental perfusion by contrast-enhanced ultrasound in macaques and human subjects.

BACKGROUND: The uteroplacental vascular supply is a critical determinant of placental function and fetal growth. Current methods for the in vivo assessment of placental blood flow are limited. OBJECTIVE: We demonstrate the feasibility of the use of contrast-enhanced ultrasound imaging to visualize and quantify perfusion kinetics in the intervillous space of the primate placenta. STUDY DESIGN: Pregnant Japanese macaques were studied at mid second trimester and in the early third trimester. Markers of injury were assessed in placenta samples from animals with or without contrast-enhanced ultrasound exposure (n = 6/group). Human subjects were recruited immediately before scheduled first-trimester pregnancy termination. All studies were performed with maternal intravenous infusion of lipid-shelled octofluoropropane microbubbles with image acquisition with a multipulse contrast-specific algorithm with destruction-replenishment analysis of signal intensity for assessment of perfusion. RESULTS: In macaques, the rate of perfusion in the intervillous space was increased with advancing gestation. No evidence of microvascular hemorrhage or acute inflammation was found in placental villous tissue and expression levels of caspase-3, nitrotyrosine and heat shock protein 70 as markers of apoptosis, nitrative, and oxidative stress, respectively, were unchanged by contrast-enhanced ultrasound exposure. In humans, placental perfusion was visualized at 11 weeks gestation, and preliminary data reveal regional differences in intervillous space perfusion within an individual placenta. By electron microscopy, we demonstrate no evidence of ultrastructure damage to the microvilli on the syncytiotrophoblast after first-trimester ultrasound studies. CONCLUSIONS: Use of contrast-enhanced ultrasound did not result in placental structural damage and was able to identify intervillous space perfusion rate differences within a placenta. Contrast-enhanced ultrasound imaging may offer a safe clinical tool for the identification of pregnancies that are at risk for vascular insufficiency; early recognition may facilitate intervention and improved pregnancy outcomes.

Variable color Doppler sonographic appearances of retained products of conception: radiologic-pathologic correlation.

OBJECT OF STUDY: Retained products of conception (RPOC) displays variable vascularity, ranging from avascular to markedly vascular on color Doppler sonography. We hypothesize that variability in sonographic vascularity may be due to histopathologic variation in the placental tissue. MATERIALS, METHODS, AND PROCEDURES: After institutional review board approval, sonographic images and pathologic specimens were retrospectively reviewed in 26 patients with pathologically proven RPOC. Ultrasound (US) images were scored 0-3 for the degree of vascularity by two radiologists blinded to the diagnosis. Corresponding pathologic specimens were evaluated for vascularization of chorionic villi, degree of inflammation, morphology of maternal arteries, chorionic villous preservation, and percentage of clot, membranes, chorionic villi, and decidua/myometrium. Statistical analysis, including multiple linear regression, was performed. RESULTS: RPOC with histologically avascular chorionic villi or those with markedly reduced vascularization had significantly lower US vascularity scores (p = 0.030) than those with chorionic villi showing normal or decreased vascularization. Sonographically avascular RPOC had a significantly lower percentage villi (p = 0.028) and higher percentage of decidua (p = 0.004) than specimens where US showed any Doppler vascularity. Histologic vascularity of villi (p = 0.049) and non-observation of maternal arteries (p = 0.001) were significant predictors of US vascularity scores in multivariate linear regression analysis, while inflammation of villi (p = 0.053) was a marginally significant predictor. SIGNIFICANCE OF THE CONCLUSIONS: Histologic vascularity of villi appears to contribute to the observed variation in sonographic vascularity. This finding may underlie known differences in clinical outcomes between sonographic vascularity groups.

Effect of transvaginal ultrasound on human chorionic villus cell apoptosis during pregnancy.

With the advancement of ultrasonic technology in recent years, sonography has become a common medical diagnostic tool, as it has elevated output sonic intensity and elongated exposure time. This study investigates the effect of ultrasound on human chorionic villus cell apoptosis during early pregnancy. Transvaginal ultrasound was performed for a total of 60 women who had undergone induced abortion at our hospital. They were randomly divided into the control, short ultrasound (10 min), and long ultrasound (20 min) groups (N = 20 each). Twenty-four hours after ultrasonic exposure, chorionic villus tissues were extracted during induced abortion, and were tested for cell apoptosis using flow cytometry. Bax and B cell lymphoma-2 (Bcl-2) protein levels were also quantified by immunohistochemistry. We found that the long ultrasound group had significantly higher cell apoptosis rates compared to the short ultrasound group, which in turn had higher rates compared to the control group (P < 0.05 in both cases). Bax protein levels were elevated in both the long and short ultrasound groups (P < 0.05). Bcl-2 proteins in two ultrasound groups, however, were downregulated as compared to those in the control group (P < 0.05). It is therefore possible that transvaginal sonography can potentiate the apoptosis of human chorionic villus cells by increasing the Bax/Bcl-2 protein ratio.

A transcervical chorionic villus sampling model for teaching.

We sought to create a transcervical chorionic villus sampling model for teaching that would mimic a lifelike model. A model was created using silicone resembling the maternal interface. A cervix with an endocervical canal able to accommodate a catheter and a vagina was also created. Tap water was used as the amniotic fluid. Chorionic villus sampling was accomplished using this model with the actual ultrasound machines and environment as in the real model. This simulator allowed placental placement in different locations to increase the difficulty level as well as angulations and catheter handling. Given the low cost (less than $200), this model could be used indefinitely in a relaxed and controlled environment.

The impact of ultrasonographic lesion size and initial human chorionic gonadotropin values on treatment success in cases with complete hydatidiform mole.

OBJECTIVE: Our aim to assess the impact of sonographically measured lesion size and initial human chorionic gonadotropin levels on treatment success in cases of complete hydatidiform mole (CHM). PATIENTS AND METHODS: Patients with CHM diagnosed between January 2007 and January 2012 were included in the study. Clinical parameters such as patient age, fertility history, smoking, alcohol consumption, presenting symptom, pregnancy duration, ultrasonographic mean lesion size, beta-hCG level on admission, primary treatment method, beta-hCG normalization time (NT) and adjuvant treatments were recorded and analyzed. RESULTS: One hundred-twelve cases of CHM were identified in the study period. Mean patient age was 27.3 ± 8.2 years. Suction curettage was employed as the primary treatment in all of the study cases. No perioperative complications were encountered. None of the patients were treated with prophylactic adjuvant chemotherapy. Twelve patients (10.7%) required adjuvant chemotherapy. Beta-hCG NT did not have an association with patient age and initial beta-hCG levels (p > 0.05). Also, patient age, gravidity, parity, smoking, initial beta-hCG and ultrasonographic mean lesion size did not predict adjuvant chemotherapy requirement (p > 0.05). CONCLUSIONS: Early detection and treatment of CHM is associated with a favorable clinical outcome.