Placental pathology findings in perinatal deaths from 28 weeks gestation in Aotearoa New Zealand.

INTRODUCTION: Women of South Asian ethnicity are overrepresented in adverse pregnancy outcome across high-income countries, including those related to placental dysfunction. It has been hypothesised that placental aging occurs at earlier gestation in South Asian pregnancies. We aimed to identify differences in placental pathology among perinatal deaths ≥28 weeks gestation, between South Asian, Maori and New Zealand (NZ) European women in Aotearoa NZ, with a focus on women of South Asian ethnicity. METHODS: Placental pathology reports and clinical data from perinatal deaths between 2008 and 2017 were provided by the NZ Perinatal and Maternal Mortality Review Committee, blinded, and analysed by an experienced perinatal pathologist using the Amsterdam Placental Workshop Group Consensus Statement criteria. RESULTS: 790 of 1161 placental pathology reports, 346 preterm (28+0 to 36+6 weeks) and 444 term (≥37+0 weeks) deaths, met the inclusion criteria. Among preterm deaths, South Asian women had higher rates of maternal vascular malperfusion compared with Maori (aOR 4.16, 95%CI 1.55-11.15) and NZ European (aOR 2.60, 95%CI 1.10-6.16). Among term deaths, South Asian women had higher rates of abnormal villous morphology compared with Maori (aOR 2.19, 95%CI 1.04-4.62) and NZ European (aOR 2.12, 95%CI 1.14-3.94), mostly due to increased rates of chorangiosis (36.7%, compared to 23.3% and 21.7%, respectively). DISCUSSION: Differences in placental pathology by ethnicity were observed among preterm and term perinatal deaths. While we suspect differing underlying causal pathways, these deaths may be associated with maternal diabetic and red blood cell disorders among South Asian women, leading to a hypoxic state in-utero.

Race and risk of maternal vascular malperfusion lesions in the placenta.

INTRODUCTION: The biological mechanisms that underlie racial disparities in placenta-mediated pregnancy complications remain unknown. Placental evidence of maternal vascular malperfusion (MVM), a common pathologic feature of these outcomes, represents hypoxic-ischemic damage to the placenta. We sought to separately estimate the risk of MVM and individual lesions associated with maternal race. METHODS: This was a retrospective cohort study of black and white women with singleton live births and placental pathology data at Magee-Womens Hospital during 2008-2012 (n = 15,581). MVM consisted of ≥1 individual lesions: low placental weight, decidual vasculopathy, accelerated villous maturation, infarcts, and fibrinoid deposition. We separately compared the incidence of MVM and individual lesions in black and white women using logistic regression with generalized estimating equations. RESULTS: After adjusting for covariates, black women had increased risks of MVM (aOR 1.14, 95% CI 1.05-1.23), low placental weight (aOR 1.41, 95% CI 1.28-1.55), and decidual vasculopathy (aOR 1.58, 95% CI 1.36-1.83), also observed in uncomplicated, preterm, and term births. Conversely, black women had decreased risk of infarcts (aOR 0.84, 95% CI 0.75-0.95) compared with white women, also observed in uncomplicated and full-term births. Race was not associated with accelerated villous maturation or fibrinoid deposition. Inverse probability weighting to account for potential selection bias generated similar results. DISCUSSION: Our findings suggest that excess risks of MVM, specifically low placental weight and decidual vasculopathy in black women may be due to a pathological susceptibility to an underlying high-risk vascular phenotype. The clinical significance of race differences in the occurrence of infarcts warrants further investigation.

Dermatoglyphic patterns on fingers and gynecological cancers.

OBJECTIVES: Fingerprints have so far been used for determining the basis of certain malignant diseases, with positive outcomes. Considering the high rates of cancer-related mortality in Iran, this study was conducted for the purpose of examining the dermatoglyphic pattern of fingers in patients with gynecological cancers as compared to healthy people. STUDY DESIGN: The present study was conducted on 151 women with gynecological cancers as the case group and 152 healthy women with no history of such cancers as control group. The dematographic details of participants from both control and case groups were collected using a checklist, and the pattern of their fingerprints was prepared and examined. The data were analyzed for their significance using chi-square test and t- test. Odds ratio with 95% confidence intervals were calculated. RESULTS: Dermatoglyphic analysis showed that arch and loop patterns significantly changed in cases group as compared to control. However, the odds ratio suggested that loop pattern in 6 or more fingers might be a risk factor for developing gynecological cancers. CONCLUSION: Our results showed that there is an association between fingerprint patterns and gynecological cancers and so, dermatoglyphic analysis may aid in the early diagnosis of these cancers.

Placental villitis of unknown origin: epidemiologic associations.

OBJECTIVES: This study was undertaken to investigate the incidence and associations of placental villitis of unknown origin or etiology (VUE). STUDY DESIGN: Five hundred nine placentas from women delivered of small-for-gestational-age infants (SGAP) and 529 placentas from women delivering infants with birth weights appropriate for gestational age (AGAP) were examined prospectively for VUE as part of a population-based case control study of SGA infants at term. RESULTS: VUE was found in 17.3% of SGAP and 11.7% of AGAP and was an independent risk factor for SGA (adjusted odds ratio 2.35, 95% CI 1.55-3.56). Villitis in conjunction with maternal hypertension increased the risk of SGA substantially (adjusted odds ratio 17.7, 95%CI 3.6-86.9). A study of a wide range of pregnancy-related factors found no significant associations with VUE in AGAP. In contrast, VUE in SGAP had significant associations after multivariate analysis with maternal body mass index, multigravidity, ethnicity, and 1 index of maternal infection. CONCLUSION: VUE is an independent risk factor for SGA at term. Maternal factors influence this association, possibly by modifying a systemic effect on fetal growth of villous inflammation at commonly occurring defects in the maternal-fetal immune barrier.

Cancer of the female genital tract in Circumpolar Inuit.

Cervical cancer incidence among Inuit is high. Especially women from Greenland exhibit rates which are among the highest in the world. Compared with women in Denmark, USA and Canada, Inuit women have a 3-4 time higher cervical cancer risk. By contrast, the incidence of uterine corpus cancer is low in the Circumpolar area. Both in Greenlandic and Canadian Inuit women, ovarian cancer rates are similar to those in Danish women and non-Inuit women from Canada respectively. Only 9 cases of placenta cancer were recorded in the Circumpolar area during the 20 years of observation. Compared with available incidence rates for Denmark the incidence in Greenland was significantly higher.