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1.
Eur J Obstet Gynecol Reprod Biol ; 259: 7-11, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33556768

RESUMO

BACKGROUND: The pandemic of the severe acute respiratory distress syndrome-associated Coronavirus-2 (SARS-CoV-2) has affected millions around the world. In pregnancy the dangers to the mother and fetus are still being explored. SARS-CoV2 can potentially compromise maternal and neonatal outcomes and this may be dependent on the pregnancy stage during which the infection occurs. OBJECTIVE: The present study was done to find the histopathological alterations in the placenta of SARS-CoV-2 positive pregnancies with either no symptoms or mild coronavirus disease (COVID)-19 related symptoms and its association with neonatal outcomes. STUDY DESIGN: This was a prospective analytical study. Twenty seven asymptomatic or mildly symptomatic SARS-CoV-2 positive pregnant women with a singleton pregnancy delivered between 1st July 2020 and 15th September 2020, were included as cases. An equal number of SARS-CoV-2 negative singleton pregnancies matched for maternal and gestational age during the same period were included as controls. After delivery the histopathological examination of the placenta of these women was done and the findings recorded on a predesigned proforma based on the Amsterdam consensus criteria for evidence of maternal and fetal vascular malperfusion changes. RESULTS: The baseline characteristics were comparable between the cases and controls. The following features of maternal vascular malperfusion (MVM) were significantly higher in the placentae of COVID-19 positive pregnancies: retroplacental hematomas (RPH), accelerated villous maturation (AVM), distal villous hyperplasia (DVH), atherosis, fibrinoid necrosis, mural hypertrophy of membrane arterioles (MHMA), vessel ectasia and persistence of intramural endovascular trophoblast (PIEVT). Fetal vascular malperfusion (FVM) significantly associated with the positive pregnancies were chorioangiosis, thrombosis of the fetal chorionic plate (TFCP), intramural fibrin deposition (IMFD) and vascular ectasia. Additionally, perivillous fibrin deposition was also significantly higher in the placentae of cases. The percentage of spontaneously delivered women was comparable in the two groups. The sex and weight of the newborn and the number of live births were comparable between the two groups. CONCLUSIONS: Asymptomatic or mildly symptomatic SARS-CoV-2 positive pregnant women, with otherwise uncomplicated pregnancies, show evidence of placental injury at a microscopic level. Similar findings have been demonstrated in other studies too. This placental injury apparently does not lead to poor pregnancy outcomes. The extent of this injury in symptomatic cases of COVID-19 pregnancies and its consequences on the outcomes need to be analysed.


Assuntos
/patologia , Doenças Placentárias/patologia , Placenta/patologia , Complicações Infecciosas na Gravidez/patologia , Adulto , Peso ao Nascer , /fisiopatologia , Portador Sadio , Estudos de Casos e Controles , Feminino , Humanos , Recém-Nascido , Masculino , Placenta/irrigação sanguínea , Doenças Placentárias/etiologia , Doenças Placentárias/fisiopatologia , Gravidez , Complicações Infecciosas na Gravidez/fisiopatologia , Resultado da Gravidez , Estudos Prospectivos , Índice de Gravidade de Doença , Adulto Jovem
2.
Arch Pathol Lab Med ; 145(5): 517-528, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33393592

RESUMO

CONTEXT.­: The number of neonates with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is increasing, and in a few there are reports of intrauterine infection. OBJECTIVE.­: To characterize the placental pathology findings in a preselected cohort of neonates infected by transplacental transmission arising from maternal infection with SARS-CoV-2, and to identify pathology risk factors for placental and fetal infection. DESIGN.­: Case-based retrospective analysis by a multinational group of 19 perinatal specialists of the placental pathology findings from 2 cohorts of infants delivered to mothers testing positive for SARS-CoV-2: live-born neonates infected via transplacental transmission who tested positive for SARS-CoV-2 after delivery and had SARS-CoV-2 identified in cells of the placental fetal compartment by molecular pathology, and stillborn infants with syncytiotrophoblast positive for SARS-CoV-2. RESULTS.­: In placentas from all 6 live-born neonates acquiring SARS-CoV-2 via transplacental transmission, the syncytiotrophoblast was positive for coronavirus using immunohistochemistry, RNA in situ hybridization, or both. All 6 placentas had chronic histiocytic intervillositis and necrosis of the syncytiotrophoblast. The 5 stillborn/terminated infants had placental pathology findings that were similar, including SARS-CoV-2 infection of the syncytiotrophoblast, chronic histiocytic intervillositis, and syncytiotrophoblast necrosis. CONCLUSIONS.­: Chronic histiocytic intervillositis together with syncytiotrophoblast necrosis accompanies SARS-CoV-2 infection of syncytiotrophoblast in live-born and stillborn infants. The coexistence of these 2 findings in all placentas from live-born infants acquiring their infection prior to delivery indicates that they constitute a pathology risk factor for transplacental fetal infection. Potential mechanisms of infection of the placenta and fetus with SARS-CoV-2, and potential future studies, are discussed.


Assuntos
/transmissão , Vilosidades Coriônicas/patologia , Transmissão Vertical de Doença Infecciosa , Doenças Placentárias/virologia , Complicações Infecciosas na Gravidez/virologia , Natimorto , Trofoblastos/patologia , Adulto , Vilosidades Coriônicas/virologia , Doença Crônica , Feminino , Humanos , Recém-Nascido , Masculino , Necrose , Doenças Placentárias/patologia , Gravidez , Complicações Infecciosas na Gravidez/patologia , Estudos Retrospectivos , Fatores de Risco , Trofoblastos/virologia
3.
J Clin Invest ; 131(6)2021 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-33497369

RESUMO

The effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on the pathophysiology of the placenta and its impact on pregnancy outcome has not yet been fully elucidated. Here, we present a comprehensive clinical, morphological, and molecular analysis of placental tissues from pregnant women with and without SARS-CoV-2 infection. SARS-CoV-2 could be detected in half of placental tissues from SARS-CoV-2-positive women. The presence of the virus was not associated with any distinctive pathological, maternal, or neonatal outcome features. SARS-CoV-2 tissue load was low in all but one patient who exhibited severe placental damage leading to neonatal neurological manifestations. The placental transcriptional response induced by high viral load of SARS-CoV-2 showed an immunopathology phenotype similar to autopsy lung tissues from patients with severe coronavirus disease 2019. This finding contrasted with the lack of inflammatory response in placental tissues from SARS-CoV-2-positive women with low viral tissue load and from SARS-CoV-2-negative women. Importantly, no evidence of vertical transmission of SARS-CoV-2 was found in any newborns, suggesting that the placenta may be an effective maternal-neonatal barrier against the virus even in the presence of severe infection. Our observations suggest that severe placental damage induced by the virus may be detrimental for the neonate independently of vertical transmission.


Assuntos
/complicações , Doenças Placentárias/virologia , Complicações Infecciosas na Gravidez/virologia , Adulto , Estudos de Coortes , Feminino , Perfilação da Expressão Gênica , Humanos , Recém-Nascido , Transmissão Vertical de Doença Infecciosa , Pandemias , Placenta/patologia , Placenta/virologia , Doenças Placentárias/genética , Doenças Placentárias/patologia , Gravidez , Complicações Infecciosas na Gravidez/genética , Complicações Infecciosas na Gravidez/patologia , Resultado da Gravidez , RNA Viral/genética , RNA Viral/isolamento & purificação , /isolamento & purificação , Adulto Jovem
4.
BMC Pregnancy Childbirth ; 21(1): 99, 2021 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-33516193

RESUMO

BACKGROUND: Chorangiosis is a vascular change involving the terminal chorionic villi in the placenta. It results from longstanding, low-grade hypoxia in the placental tissue, and is associated with such conditions as intrauterine growth restriction (IUGR), diabetes, and gestational hypertension in pregnancy. Chorangiosis rarely occurs in normal pregnancies. However, its prevalence is 5-7% of all placentas from infants admitted to newborn intensive care units. The present study was aimed at determining the association of chorangiosis with pregnancy complications and perinatal outcomes. METHODS: In this case-control study, 308 chorangiosis cases were compared with 308 controls (with other diagnoses in pathology) in terms of maternal, placental, prenatal, and neonatal characteristics derived from the medical records of participants retrospectively. R and SPSS version 22 software tools were used, and the statistical significance level was considered 0.05 for all the tests. RESULTS: Preeclampsia, diabetes mellitus, maternal hemoglobin, maternal hematocrit, C/S, oligohydramnios, fetal anomaly, dead neonates, NICU admissions were significantly higher in the chorangiosis group OR = 1.6, 3.98, 1.68, 1.92, 2.1, 4.47, 4.22, 2.9, 2.46, respectively (p-value< 0.05 for all). Amniotic fluid index, birth weight, cord PH amount, 1st, and 5th Apgar score was lower in the chorangiosis group OR = 0.31, 1, 0.097, 0.83, 0.85, respectively (p-value< 0.05 for all). Moreover, fundal placenta, retro placental hemorrhage, perivillous fibrin deposition, calcification, and acute chorioamnionitis were higher in the chorangiosis group OR = 2.1, 11.8, 19.96, 4.05, and 6.38 respectively, (p-value< 0.05). There was a high agreement between the two pathologists, and the power of the study was estimated at 99%. CONCLUSION: Although chorangiosis is an uncommon condition, it is associated with a higher incidence of perinatal and neonatal morbidity and mortality. Therefore, it should be considered an important clinical sign of adverse pregnancy outcomes and should be reported in the pathology evaluation.


Assuntos
Corioamnionite/patologia , Vilosidades Coriônicas/patologia , Doenças Placentárias/patologia , Placenta/patologia , Complicações na Gravidez/patologia , Resultado da Gravidez , Adulto , Índice de Apgar , Estudos de Casos e Controles , Feminino , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Gravidez , Adulto Jovem
5.
Placenta ; 104: 261-266, 2021 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-33465727

RESUMO

We present a case of third trimester pregnancy complicated by SARS-CoV-2 infection and subsequent reduced fetal movements, resulting in emergency Caesarean delivery with demonstrable placental SARS-CoV-2 placentitis. We show through illustration of this case and literature review that SARS-Co-V-2 placentitis is an uncommon but readily recognisable complication of maternal SARS-CoV-2 infection that may be a marker of potential vertical transmission and that may have the capacity to cause fetal compromise through a direct injurious effect on the placenta.


Assuntos
/complicações , Doenças Placentárias/virologia , Placenta/patologia , Complicações Infecciosas na Gravidez/virologia , Adulto , Feminino , Humanos , Doenças Placentárias/patologia , Gravidez , Complicações Infecciosas na Gravidez/patologia , Terceiro Trimestre da Gravidez
6.
Am J Surg Pathol ; 44(10): 1367-1373, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32773529

RESUMO

Chronic intervillositis of unknown etiology (CIUE) is a rare placental disease characterized by intervillous infiltration of maternal macrophages and associated with poor pregnancy outcomes and a high risk of recurrence in subsequent pregnancies. Its pathophysiology remains unclear and prognostic factors have not yet been established. In addition, clear relationships between the histologic extent of lesions and the severity of perinatal outcomes have not been demonstrated. Our objectives were to validate a CIUE classification system based on the gradation of macrophagic infiltration of the intervillous space, and to attempt to correlate these results with perinatal outcomes. For this multicenter retrospective study, 3 pathologists reviewed all cases diagnosed with "intervillositis" between 1997 and 2018. Confirmed CIUE cases were semiquantitatively graded based on the percentage of macrophagic infiltrate in the intervillous space: grade 1 (5% to 10%), grade 2 (10% to 50%), and grade 3 (>50%). Multiple pregnancies and pregnancies with medical follow-up completed outside of the study centers were excluded. In total, 122 cases of CIUE in 102 patients were included in the study. Microscopic classification based on one criterion was easy to perform, and interobserver correlation was good. Grade 3 infiltration was strongly associated with poor perinatal outcomes and fetal growth restriction (P<0.0001). After delivery, only 16.1% of newborns from the grade 3 CIUE group were alive, compared with 59% from the grade 2 and 86.5% from the grade 1 group (P=0.0002). Recurrence risk was associated with CIUE gradation of the index case (P=0.004), with 95% of recurrent CIUE cases being from patients with grades 2 and 3 CIUE. In this study, conducted with the largest CIUE cohort to date, a classification based only on the degree of macrophagic infiltration of the intervillous space was validated, and this classification was shown to be strongly associated with poor perinatal outcomes and risk of recurrence.


Assuntos
Doenças Placentárias/classificação , Doenças Placentárias/patologia , Resultado da Gravidez , Adulto , Doença Crônica , Feminino , Humanos , Gravidez , Estudos Retrospectivos
7.
Am J Physiol Endocrinol Metab ; 319(2): E315-E319, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32574110

RESUMO

The risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to maternal and newborn health has yet to be determined. Several reports suggest pregnancy does not typically increase the severity of maternal disease; however, cases of preeclampsia and preterm birth have been infrequently reported. Reports of placental infection and vertical transmission are rare. Interestingly, despite lack of SARS-CoV-2 placenta infection, there are several reports of significant abnormalities in placenta morphology. Continued research on pregnant women infected with SARS-CoV-2 and their offspring is vitally important.


Assuntos
Infecções por Coronavirus/fisiopatologia , Transmissão Vertical de Doença Infecciosa , Doenças Placentárias/fisiopatologia , Pneumonia Viral/fisiopatologia , Complicações Infecciosas na Gravidez/fisiopatologia , Aborto Espontâneo , Betacoronavirus , Cesárea , Infecções por Coronavirus/complicações , Infecções por Coronavirus/transmissão , Parto Obstétrico , Feminino , Morte Fetal , Idade Gestacional , Humanos , Recém-Nascido , Pandemias , Doenças Placentárias/etiologia , Doenças Placentárias/patologia , Pneumonia Viral/complicações , Pneumonia Viral/transmissão , Gravidez , Nascimento Prematuro , Índice de Gravidade de Doença
8.
Pediatr Dev Pathol ; 23(3): 177-180, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32397896

RESUMO

This study describes the pathology and clinical information on 20 placentas whose mother tested positive for the novel Coronovirus (2019-nCoV) cases. Ten of the 20 cases showed some evidence of fetal vascular malperfusion or fetal vascular thrombosis. The significance of these findings is unclear and needs further study.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/patologia , Doenças Placentárias/etiologia , Doenças Placentárias/patologia , Placenta/patologia , Pneumonia Viral/complicações , Pneumonia Viral/patologia , Complicações Infecciosas na Gravidez/patologia , Trombose/etiologia , Adolescente , Adulto , Feminino , Doenças Fetais/etiologia , Doenças Fetais/patologia , Humanos , Recém-Nascido , New York , Pandemias , Gravidez , Trombose/patologia , Adulto Jovem
9.
Arch Gynecol Obstet ; 301(5): 1147-1151, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32239281

RESUMO

INTRODUCTION: Adaptations to pathological intrauterine environment might differ in relation to fetal gender. We aimed to study sex-specific differences in placental pathology of pregnancies complicated by small for gestational age (SGA). METHODS: The medical records and placental histology reports of all neonates with a birth-weight ≤ 10th percentile, born between 24 and 42 weeks of gestation, during 2010-2018, were reviewed. Composite neonatal outcome was defined as one or more of early following complications: neonatal sepsis, blood transfusion, phototherapy, respiratory morbidity, cerebral morbidity, necrotizing enterocolitis, or death. Results were compared between the male and female groups of neonates. Placental lesions were classified into maternal and fetal vascular malperfusion (MVM and FVM) lesions, maternal and fetal inflammatory responses (MIR and FIR), and villitis of unknown etiology (VUE). RESULTS: The male SGA group (n = 380) and the female SGA group (n = 363) did not differ in regard to maternal age, BMI, smoking, associated pregnancy complications, gestational age, and mode of delivery. Neonates in the SGA male group had increased birth-weight and increased respiratory morbidity as compared to the female SGA group (p = 0.007, p = 0.005, respectively). There was no between-group differences in the rate of placental lesions. By multivariate logistic regression analysis, male gender (aOR 1.55, 95% CI 1.05-2.30, p = 0.025), FIR (aOR 4.83, 95% CI 1.07-13.66, p = 0.003), and VUE (aOR 1.89, 95% CI 1.03-3.47, p = 0.04), were found to be independently associated with adverse composite neonatal outcome. DISCUSSION: Male gender as well as placental FIR and VUE are independently associated with adverse neonatal outcome in SGA neonates.


Assuntos
Recém-Nascido Pequeno para a Idade Gestacional/fisiologia , Doenças Placentárias/patologia , Placenta/patologia , Resultado da Gravidez/genética , Adulto , Feminino , Identidade de Gênero , Humanos , Gravidez
10.
Am J Clin Pathol ; 154(2): 225-235, 2020 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-32338725

RESUMO

OBJECTIVES: Obesity is an increasing health problem that has become a common medical disorder among women of childbearing age, representing worldwide a risk factor for stillbirth. The aim of the study is to evaluate the association between placental histopathologic findings and obesity in stillbirth. METHODS: Placentas were analyzed according to the Amsterdam consensus statement. Histologic findings in stillbirth from obese and lean mothers were analyzed and compared with those observed in liveborn controls. RESULTS: Stillbirth in obese mothers displayed placental pathology in all gestational ages, mostly at term of pregnancy. The most observed placental lesions were those consistent with maternal vascular malperfusion of the placental bed. Decidual arteriopathy and placental infarcts appeared specifically associated with maternal obesity. Moreover, obese women with stillbirth showed the highest cumulative number of placental lesions. CONCLUSIONS: Considering the significant association between stillbirth, maternal obesity, and placental histopathologic findings, health care providers should be aware about the importance of placental examination in obese women, especially in stillborn cases. The high prevalence of lesions consistent with vascular malperfusion of the placental bed suggests that stillbirth prevention strategies in obese women should rely on the development of tools to study and improve decidual artery functioning early in pregnancy.


Assuntos
Obesidade Materna/patologia , Doenças Placentárias/patologia , Placenta/patologia , Natimorto , Adulto , Feminino , Idade Gestacional , Humanos , Gravidez , Estudos Retrospectivos , Fatores de Risco
11.
Virchows Arch ; 477(1): 73-81, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32025822

RESUMO

Villitis of unknown etiology (VUE) and chronic deciduitis with plasma cells (CD) are supposed to be non infectious placental lesions caused by a pathologic immune reaction similar to a host versus graft mechanism. In some investigations, infection of human trophoblastic cells with human papilloma virus (HPV) has been described, and a relationship with miscarriage, preeclampsia, and chronic inflammatory placental lesions has been suspected. Infection with enterovirus, especially Coxsackievirus, has been observed in cases with spontaneous abortion and adverse perinatal outcome, respectively. We investigated 20 cases with VUE and 30 cases with chronic deciduitis with plasma cells. The placenta specimens were analyzed for expression of HPV capsid protein by immunohistochemistry, for presence of HPV DNA via polymerase chain reaction (PCR), and for presence of enterovirus mRNA using RT-PCR, respectively. VUE was associated with maternal diseases: atopic lesions in 21%, other autoimmune diseases in 15.5%, and obesity in 31.5%, respectively. Birth weight below the 10th percentile was detected in 63% of the cases with VUE. Chronic deciduitis was associated with preterm labor and preterm premature rupture of membranes (26%). Intrauterine fetal demise occurred in 5 cases with CD (18.5%). HPV DNA, HPV capsid protein, and enterovirus mRNA were not detected in all investigated VUE or CD cases. Our investigations show that a causal role for enterovirus and human papilloma virus in the development of VUE and CD is unlikely. Therefore, HPV vaccination is unlikely to reduce the incidence of VUE and CD in the future.


Assuntos
Corioamnionite/etiologia , Vilosidades Coriônicas/patologia , Papillomaviridae/patogenicidade , Placenta/virologia , Adulto , Corioamnionite/patologia , Corioamnionite/virologia , Infecções por Enterovirus/etiologia , Feminino , Humanos , Recém-Nascido , Placenta/patologia , Doenças Placentárias/etiologia , Doenças Placentárias/patologia , Gravidez , Trofoblastos/patologia , Trofoblastos/virologia
13.
Arch Pathol Lab Med ; 144(10): 1254-1261, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32101452

RESUMO

CONTEXT.­: The percentage of pregnant women with advanced maternal age (AMA) has increased during the past several decades due to various socioeconomic factors and advances in assisted reproduction. These pregnancies are associated with adverse maternal and fetal outcomes. However, the underlying placental pathology has not been well described. OBJECTIVE.­: To investigate the placental histopathology associated with AMA pregnancies. DESIGN.­: Placental pathology from 168 AMA women 35 years or older at delivery was reviewed. The cases were subdivided into 2 age subgroups, ages 35 to 39 and 40 or older, as well as a "pure AMA" subgroup where the only indication for placental examination was AMA. A group of 60 consecutive non-AMA placentas was also identified and used as comparison. The spectrum of histologic features in each case was catalogued. RESULTS.­: Of the overall AMA cases, meconium deposition was seen in 55% (93 of 168), chorangiosis in 40% (68 of 168), and acute chorioamnionitis in 36% (60 of 168). Fetal vascular malperfusion was also seen with high frequency (30%; 50 of 168). Two histologic alterations found to be significantly different between the 35 to 39 and greater than 40 age subgroups were fetal vascular malperfusion (11% [7 of 65] versus 42% [43 of 103]; P = .001) and delayed villous maturation (1.5% [1 of 65] versus 13% [13 of 103]; P = .02). The pure AMA subgroup showed no statistically significant differences compared with the overall AMA group. Chronic deciduitis was the only statistically significant difference between the overall AMA group and the non-AMA comparison group (14% [23 of 168] versus 30% [18 of 60]; P = .02). CONCLUSIONS.­: Our findings, particularly the high frequency of fetal vascular malperfusion, suggest that AMA should be an independent indication for placental pathologic examination.


Assuntos
Idade Materna , Doenças Placentárias/patologia , Placenta/patologia , Gravidez de Alto Risco , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez
16.
Z Geburtshilfe Neonatol ; 224(2): 103-106, 2020 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-31559610

RESUMO

Chorangiomas of the placenta, benign tumors of chorionic tissue, are a rare placental cause of adverse fetal and maternal outcomes. We describe the case of a large placental chorangioma leading to polyhydramnios as well as consecutive preterm birth and high output cardiac failure of the newborn. Derived from a literature review, we suggest instructions for diagnosis and optimal prenatal care in case of a a suspected placental chorangioma.


Assuntos
Insuficiência Cardíaca/patologia , Hemangioma/patologia , Doenças Placentárias/patologia , Placenta/patologia , Poli-Hidrâmnios/patologia , Complicações Neoplásicas na Gravidez/patologia , Feminino , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Cuidado Pré-Natal
17.
Am J Obstet Gynecol ; 222(4): 360.e1-360.e16, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31589863

RESUMO

BACKGROUND: The availability and use of frozen embryos after ovarian hyperstimulation for assisted reproduction has increased with improvement in vitrification techniques and the rise of preimplantation genetic testing. However, there are conflicting data regarding whether obstetric outcomes differ between fresh and frozen embryo transfer cycles. OBJECTIVE: To compare placental pathology from live births arising from fresh and frozen embryo transfer cycles. MATERIALS AND METHODS: A cohort of 1140 live births with placental pathology arising from autologous in vitro fertilization cycles with fresh or frozen programmed transfer performed at MGH Fertility Center between 2004 and 2017 was retrospectively reviewed. An experienced placental pathologist categorized the reported placental pathology as anatomic, infectious, inflammatory, or vascular/thrombotic. Our primary outcomes were differences in these placental pathologies between the 2 groups. Patient demographic, cycle, and birth outcomes were compared with the use of χ2 tests, Student t test, or nonparametric tests, as appropriate. Multivariate logistic regression models were used to compare placental pathology between the fresh and frozen transfer groups. RESULTS: Of the 1140 cycles included in our analysis, 929 arose from fresh embryo transfers (81.3%) and 211 arose from programmed frozen embryo transfers (18.5%). For both transfer types, the average age of the women at time of treatment was 35 years; mean body mass indices were within the normal range (23.6 kg/m2 for fresh transfers and 23.2 kg/m2 for frozen transfers, P = .26), and mean day 3 follicle-stimulating hormone values were 7.1 and 7.0 IU/L (P = .44), respectively. Deliveries occurred on average at 37.5 and 38.0 weeks' gestational age (P = .04) in the fresh versus frozen transfer group, with similar rates of obstetric complications. However, frozen transfers were more likely to be associated with marginal cord insertion (adjusted odds ratio, 1.87; confidence interval, 1.21, 2.91; P = .01), accessory lobe formation (adjusted odds ratio, 2.96; confidence interval, 1.12, 7.79; P = 0.03), subchorionic thrombi (adjusted odds ratio, 3.72; confidence interval, 1.80, 7.71; P < .001), and fetal vascular malperfusion characteristics with cord anomalies (adjusted odds ratio, 2.34; confidence interval, 1.22, 4.46; P = .01). These trends persisted when we analyzed day 5 transfers alone, and single frozen embryo transfers remained associated with increased rates of subchorionic thrombi compared to single fresh embryo transfers. CONCLUSION: Pregnancies arising from frozen embryo transfers demonstrated more anatomic and vascular placental pathology than those from fresh transfers in our cohort of patients, despite similar maternal outcomes. More research is needed to explore how these differences in pathology may influence obstetric and perinatal outcomes.


Assuntos
Criopreservação , Transferência Embrionária/métodos , Embrião de Mamíferos , Fertilização In Vitro/métodos , Doenças Placentárias/epidemiologia , Trombose/epidemiologia , Adulto , Peso ao Nascer , Feminino , Humanos , Recém-Nascido , Nascimento Vivo , Placenta/anormalidades , Doenças Placentárias/patologia , Gravidez , Estudos Retrospectivos
18.
Int J Gynecol Pathol ; 39(1): 1-7, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30394942

RESUMO

The use of p57 immunohistochemistry (IHC) can distinguish complete mole (CM) from partial mole (PM) and nonmolar abortus (NMA). Molecular genotyping (MG) is the gold standard method for the definitive diagnosis of PM and NMA. However, MG is expensive and not always available. Some data suggest Ki-67 IHC may be helpful in distinguishing NMAs from PMs and could be a substitute for MG. In this study, we examined the utility of p57 and Ki-67 IHC stains in the diagnosis of placental molar disease. The study cohort consisted of 60 cases of products of conception (20 CMs, 20 PMs, and 20 NMAs). All CM cases showed absent (<10%) p57 IHC in chorionic villi. All PM and NMA cases had been subjected to MG and showed diandric triploid or biparental inheritance, respectively. Ki-67 and p57 IHC staining was done on formalin-fixed paraffin-embedded sections from all 60 cases. Both IHC stains were interpreted blinded to the diagnosis. On rereview, we recorded the percentage of cells with nuclear p57 staining in villous cytotrophoblast and stromal cells. Ki-67 proliferative index (%) was determined by manual count of at least 500 villous cytotrophoblastic cells in areas with highest Ki-67 reactivity. Any intensity of nuclear staining was considered positive. The utility of p57 IHC is mainly to exclude or confirm CM. Although there is a significantly higher Ki-67 expression in CMs in comparison to PMs and NMAs, this did not add diagnostic utility. PMs tend to have higher Ki-67 expression than NMAs; however, the difference is not statistically significant. Our data suggest that the use of p57 and Ki-67 IHC cannot reliably distinguish PM from NMAs.


Assuntos
Mola Hidatiforme/diagnóstico , Antígeno Ki-67/metabolismo , Doenças Placentárias/diagnóstico , Neoplasias Uterinas/diagnóstico , Inibidor de Quinase Dependente de Ciclina p57/metabolismo , Feminino , Técnicas de Genotipagem , Humanos , Mola Hidatiforme/genética , Mola Hidatiforme/patologia , Imuno-Histoquímica , Doenças Placentárias/genética , Doenças Placentárias/patologia , Gravidez , Neoplasias Uterinas/genética , Neoplasias Uterinas/patologia
19.
Pan Afr Med J ; 34: 56, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31762922

RESUMO

The examination of the placenta is part of the assessment of intrauterine growth retardation (IUGR). Its interest lies in retardation etiology research and in maternal-fetal consequences which can arise from it as well as in the implementation of preventive strategies for subsequent pregnancies in patients with recurrent diseases. We conducted a study of patients with severe IUGR monitored in the Department of Neonatology of the Ibn Sina University Hospital in Rabat in order to identify possible anatomopathological lesions in the placenta.


Assuntos
Retardo do Crescimento Fetal/etiologia , Doenças Placentárias/diagnóstico , Placenta/patologia , Adulto , Feminino , Humanos , Doenças Placentárias/patologia , Gravidez , Índice de Gravidade de Doença
20.
Eur J Obstet Gynecol Reprod Biol ; 243: 32-35, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31670146

RESUMO

OBJECTIVES: To describe the placental histology and autopsy findings in pregnancies where fetal demise occurred before a gestational age of 22 weeks. STUDY DESIGN: This study was a subset of a larger study where the effect of alcohol exposure during pregnancy on stillbirths was studied. In a prospective cohort, 7,010 singleton pregnancies were followed from the first antenatal visit until infant one year of age visit. Gestational age was assessed by ultrasound, preferably at the first antenatal visit. All pregnancy losses were identified and when the fetuses delivered at or after a gestation of 20 weeks, the mother or parents were approached for consent for autopsy. This study describes the placental pathology and findings at autopsy in losses before 22 weeks gestation (late second trimester miscarriages). RESULTS: Fourteen cases were identified in which 13 had an autopsy and 12 had a histological examination of the placenta. The most prevalent histological abnormality was placental abruption which was seen in 6 miscarriages, occasionally on its own, or in combination with maternal vascular malperfusion or acute chorioamnionitis. The second most frequent finding was maternal vascular malperfusion, as found in five placentas, alone or in combination with other pathology. The third most frequent pathology was acute chorioamnionitis, found in four placentas, in combination or alone. Other causes were diffuse chronic villitis due to cytomegalovirus infection and early amnion rupture with anhydramnios and cord obstruction. CONCLUSIONS: Causes of fetal demise at the end of the second trimester differ little from causes of stillbirth. There is value in using placental histology in late second trimester miscarriages to try to identify the cause of demise.


Assuntos
Descolamento Prematuro da Placenta/patologia , Corioamnionite/patologia , Feto/patologia , Placenta/patologia , Aborto Espontâneo/etiologia , Descolamento Prematuro da Placenta/epidemiologia , Adolescente , Adulto , Autopsia , Corioamnionite/epidemiologia , Feminino , Morte Fetal/etiologia , Idade Gestacional , Humanos , Doenças Placentárias/epidemiologia , Doenças Placentárias/patologia , Gravidez , Segundo Trimestre da Gravidez , Adulto Jovem
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