Is there an association between isolated sonographic abdominal circumference below the 10th percentile and placental vascular lesions?

OBJECTIVE: To study the association between prenatal diagnosis of isolated abdominal circumference (AC) below the 10th percentile (AC <10th) in appropriate for gestational age (AGA) neonates and placental vascular lesions. METHODS: A prospective study was conducted of healthy women who underwent sonographic fetal biometric measurements, up to 7 days before delivery, and delivered AGA neonates. The study cohort was divided into those with and without prenatal isolated AC <10th. Placental histopathology lesions were classified into maternal and fetal vascular malperfusion (MVM, FVM) lesions. RESULTS: Compared to the AC over 10th percentile group (n = 85), the AC <10th group (n = 85) was characterized by lower maternal body mass index, higher rate of smokers, and increased rate of induced labor (P = 0.029, P = 0.029, P = 0.001, respectively). There were no between-group differences regarding maternal age, gestational age, and neonatal outcome. Mean placental weight was lower in the isolated AC <10th (P < 0.001). The rate of MVM or FVM lesions did not differ between the groups. By multivariate logistic regression analysis, isolated AC <10th was not found to be associated with increased risk for placental vascular lesions. CONCLUSION: Isolated AC <10th is associated with increased rate of induction of labor; however, it is not associated with increased placental vascular lesions.

Placental abnormalities differ in small for gestational age neonates in relation to their prenatal sonographic abdominal circumference measurements.

BACKGROUND: Antenatal detection of abdominal circumference (AC) <10th percentile, among small for gestational age (SGA) neonates, probably reflects the severity of their growth restriction. We aimed to study neonatal outcome and placental pathology among SGA neonates in correlation to their AC measurements. METHODS: Maternal and neonatal computerized medical records and placental histopathology reports of all SGA neonates, (neonatal birth-weight ≤10th percentile), born between 24 and 42 weeks, during 2015-2018 were reviewed. Included cases with fetal biometric measurements conducted up to 7 days prior labor. Results were compared between cases with sonographic antenatal AC <10th percentile and neonates with sonographic antenatal AC ≥10th percentile. Placental lesions were classified according to "Amsterdam" Placental workshop criteria. RESULTS: The AC <10th percentile group (n = 148) was characterized by higher rate of nulliparity (p = .003), and induction of labor (p = .009), as compared to the AC ≥10th percentile group (n = 41). There were no between groups differences in the rate of maternal BMI (kg/m2), hypertensive disorders, diabetes or smoking. Neonatal hypoglycemia was more common in the AC <10th percentile group as compared to the AC ≥10th percentile group (p = .04). Placentas from the AC <10th percentile group were smaller (p < .001), with more MVM lesions (p = .02) and chronic villitis (p = .04). By multivariate regression analysis, AC <10th percentile and maternal hypertensive disorders, were found to be independently associated with placental MVM lesions, aOR = 2.43 (95% CI 1.04, 5.88) and aOR = 3.15 (95% CI 1.06, 9.31), respectively. CONCLUSIONS: Higher rate of placental maternal malperfusion lesions, chronic villitis, and more neonatal hypoglycemia characterize SGA neonates with AC <10th percentile, pointing to the importance of AC measurement as an indicator for placental insufficiency.

Passively inhaled tobacco smoke - pregnancy and neonatal outcomes in correlation with placental histopathology.

INTRODUCTION: We aimed to investigate the effect of maternal passive smoking (MPS) during pregnancy-on placental pathology and pregnancy outcomes. METHODS: A prospective case-control study. We recruited low-risk laboring women at 37+0-41 + 0 weeks between 9/2019-7/2020. MPS was defined as exposure to in-house spouse tobacco smoking of >20 cigarettes/day in the absence of maternal active-smoking. In attempt to "purify" the effect of MPS on placental pathology-we excluded cases with preeclampsia, diabetes, suspected fetal growth restriction (FGR), preterm labor, and illicit drug use. Maternal characteristics, pregnancy outcomes, and placental pathology were compared between the MPS group and a control group matched for gestational age, maternal age, and delivery date. Placental lesions were classified according to the "Amsterdam" criteria. The study was powered to detect a 33% difference in placental malperfusion lesions. Multivariable regression was performed to identify independent associations with placental malperfusion lesions. RESULTS: In labor, the MPS group (n = 115) had higher rates of meconium stained amniotic fluid (MSAF, p < 0.001) and non-reassuring fetal heart-rate (NRFHR,p = 0.006), compared to controls (n = 115). Neonates in the MPS group had higher rates of undiagnosed FGR (p = 0.01) and NICU admissions (p = 0.004). The MPS group had higher rates of placental-hypoplasia (p = 0.02) and fetal vascular malperfusion (FVM) lesions (p = 0.04). In regression analysis MPS was associated with FVM lesions independent of background confounders (aOR = 1.24 95% CI 1.10-2.65). DISCUSSION: In otherwise low-risk pregnancies, MPS was associated with higher rates of MSAF, NRFHR, undiagnosed FGR, and NICU admissions, probably mediated via placental FVM. These worrisome findings mandate patient counseling and further investigation in larger population-based studies.

Management of pregnancies with suspected preeclampsia based on 6-hour vs 24-hour urine protein collection-a randomized double-blind controlled pilot trial.

BACKGROUND: Traditionally, the diagnosis of preeclampsia requires elevated blood pressure measurements and proteinuria demonstrated in a 24-hour urine collection. This prolonged urine collection is associated with patient discomfort, a delay in diagnosis, and in some cases, hospitalization for further management of outcomes. OBJECTIVE: We aimed to assess the feasibility, reliability, and association between maternal and neonatal outcomes of pregnancies managed according to a 6-hour vs 24-hour urine protein collection for suspected preeclampsia. STUDY DESIGN: This was a randomized controlled trial conducted at a tertiary university hospital between January 2019 and January 2021 (ClinicalTrials.gov Identifier: NCT03724786). Patients who were hospitalized for preeclampsia workup were asked to participate and randomized at a 1:1 ratio to 6- and 24-hour urine protein collection groups. Both groups collected urine for 24 hours, during which the collection was also tested after 6-hours. After 24 hours, both results were reviewed by one of the research staff, and either the 6- or 24-hour collection result was reported to the patient's managing physician and was documented in the patient's medical record. Both patient and the managing physician were blinded to group allocation. Unblinding was undertaken in cases of a discrepancy between the results (1 of 2 results of >300 mg protein), and the results were analyzed by intention to treat. The primary study outcome was defined as a composite of adverse maternal outcomes. The sample size was set empirically as per proof on concept design. RESULTS: During the study period, 115 patients participated in the trial, 101 of whom completed the follow-up and were analyzed-51 in the 6-hour group and 50 in the 24-hour group. Patient demographics were similar between the study groups. Unblinding occurred in 7 cases in the 6-hour group, in which the initial 6-hour result ranged from 168 to 475 mg. The rates of composite adverse maternal outcomes were 15.6% and 12.0% in the 6- and 24-hour groups, respectively (P=.59). No significant difference was demonstrated in the rate of adverse neonatal outcomes, cesarean delivery, induction of labor, gestational age at delivery, betamethasone treatment, or neonatal birthweight. CONCLUSION: Managing pregnancies suspected of preeclampsia with a 6-hour urine protein collection is feasible and associated with similar maternal and neonatal outcomes. In cases where the 6-hour result is in the 168 to 475 mg range, we propose completing a 24-hour collection.

Placental histopathology in IVF pregnancies resulting from the transfer of frozen-thawed embryos compared with fresh embryos.

PURPOSE: To study whether placentas of singleton pregnancies conceived after fresh embryo transfer (ET) contain more histopathological lesions compared with placentas of singleton pregnancies conceived after frozen-thawed embryo transfer (FET). METHODS: A prospective cohort study of placental histopathology in 131 women with singleton IVF pregnancies who delivered at a single medical center, between December 2017 and May 2019. The prevalence of different placental histopathology lesions was compared between women who conceived after fresh ET and FET. RESULTS: Women who conceived after fresh ET (n = 74) did not differ from women who conceived after FET (n = 57) with regard to maternal age, BMI, nulliparity, or infertility diagnosis. Gestational week at delivery was lower in pregnancies conceived after fresh ET (38.5 vs. 39.2 weeks, respectively, p = 0.04), and a trend for a lower birthweight following fresh ET was noted (3040 vs. 3216 g, respectively, p = 0.053). However, placental histopathology analysis from pregnancies conceived after fresh ET was comparable to pregnancies conceived after FET, with regard to the prevalence of maternal vascular malperfusion lesions (45.9% vs. 50.9%, respectively, p = 0.57), fetal vascular malperfusion lesions (17.6% vs. 21.1, p = 0.61), acute inflammatory response lesions (28.4% vs. 28.1%, respectively, p = 0.96), and chronic inflammatory response lesions (13.5% vs. 8.8%, respectively, p = 0.48). CONCLUSION: Placental histopathology did not differ between IVF pregnancies conceived after fresh and frozen ET. These results are reassuring for clinicians and patients who wish to pursue with transferring fresh embryos.

Is there a role for placental histopathology in predicting the recurrence of preterm birth?

PURPOSE: Spontaneous preterm birth (sPTB) is a major cause of neonatal morbidity and mortality with a relatively high rate to recurrence. Our aim was to study the role of placental histopathology in predicting recurrence of sPTB. METHODS: We conducted a retrospective cohort study. The medical records and placental pathologic reports of all women with sPTB (gestational age 230/7-366/7 weeks), during 2008-2015, were reviewed. Only women who had a subsequent delivery were included. Multiple pregnancies and women with known uterine anomalies were excluded. Placental histopathology lesions were classified into maternal and fetal vascular malperfusion lesions, acute maternal and fetal inflammatory responses lesions, and chronic inflammatory lesions. Placental lesions were compared between patients with and without recurrent sPTB on their subsequent pregnancies. RESULTS: Maternal characteristics, gestational age, birthweight, and the rate of preterm rupture of membrane at index delivery were similar between the recurrent sPTB (n = 72) and the non-recurrent sPTB (n = 167) groups. The incidence of placental vascular malperfusion lesions, or inflammatory lesions did not differ between the study groups. However, on multivariate logistic regression analysis, the presence of only acute inflammatory response lesions was associated with recurrence of early sPTB ( < 34 weeks) (adjusted OR 3.16; 95% CI 1.22-8.18). CONCLUSION: The presence of isolated placental acute maternal or fetal inflammatory response in index sPTB may be associated with recurrence of early sPTB.

The Impact of Salpingectomy on Anti-Mullerian Hormone Levels and Ovarian Response of In Vitro Fertilization Patients.

BACKGROUND: Laparoscopic salpingectomy is strongly related to successful in vitro fertilization (IVF) treatments. OBJECTIVES: To compare the ovarian reserve, including anti-mullerian hormone (AMH) levels, in patients who underwent salpingectomy before IVF to IVF patients who had not been salpingectomized. METHODS: In this retrospective study, medical records of women who were treated by the IVF unit at our institute were reviewed. We retrieved demographic data, surgical details, and data regarding the ovarian reserve. Details of 35 patients who were treated by IVF after salpingectomy were compared to 70 IVF patients with no history of salpingectomy treatment. Nine women underwent IVF treatment before and after having salpingectomy, and their details were included in both groups. RESULTS: The levels of AMH, follicular stimulating hormone (FSH), estradiol, and progesterone were not significantly different in the groups. The antral follicular count (AFC), number of oocytes retrieved, amount of gonadotropin administered for ovarian stimulation, and number of embryos transferred (ET) were also not significantly different. CONCLUSIONS: Salpingectomy does not seem to affect ovarian reserve in IVF patients.