An Observational Study of Placental Changes among Term and Preterm Babies Delivered in Tertiary Care Hospital

Background and Objective: Placental pathology has been implicated in the pathogenesis of preterm neonatal morbidity.However, the role of placental infection in the occurrence of neurological, lung, and infection morbidity among prematurely borninfant remains controversial. Furthermore, there is disagreement regarding the association between sepsis in preterm neonateand in utero exposure to placental infection.Objective: The present study was undertaken to investigate the association of placental pathology with the preterm and termdelivery.Materials and Methods: Design: This was a hospital-based observation study. The study included 100 placentas including60 preterm placenta and 40 term placenta from singleton live birth delivered at Rajarajeshwari Medical College and Hospitalfrom November 2018 to November 2019.Results: As placental weight is one of the key indicators of fetal intrauterine status, among term placenta 26% weighedbetween 501 and 750 g and 14% weighed between 251 and 500 g. In the late preterm placenta, 6% were within 501–750 gand 38%were within 251–500 g. Among the early preterm placentas, 2% were found to be within 100–250 g and 14% werefound to be within 251–500 g. Histopathological findings among term placenta in which 23% of the placentas were found to bewith normal morphology, having two arteries and one vein embedded in myxoid matrix and unremarkable, maternal surfacesshow mature vascularized villi and fetal parenchyma also shows mature villi and 5% showed features of chorioamnionitis,8% of the placentas revealed occasional focal areas of calcification on the maternal as well fetal surfaces, 15% showedinfarction, and 3% showed hemorrhagic changes. Histopathology findings among preterm placenta in which 14% normalmorphology, 21% of chorioamnionitis, 10% shows focal and extensive areas of infarction with increased syncytial knots, 4%had hemorrhagic and perivasculitis changes with focal hyalinized villi, and 5% had villitis with mixed inflammatory infiltratein the chorionic villi. Histopathology study among term and preterm comparison, it shows chorioamnionitis with Chi-square19.604 with confidence interval of 35.66–77.04% with P < 0.0001, calcification with P = 0.466, placental infarction withconfidence interval of 41.51–92.47% with P = 0.0002, placental hemorrhage with confidence interval of −31.33%–52.31%with P = 0.613, and villitis with confidence interval of 38.55–100% with P = 0.002. Relative risk with respect to histopathologyamong term and preterm placenta relative risk is 2.3 which means that preterm group has 2.3 times more risk of abnormalplacental histopathology than term group.Conclusion: Among histopathological study between term and preterm placenta, preterm placentas were most commonlyassociated with abnormal histopathological findings, among abnormal histopathological finding chorioamnionitis is the mostcommon.

Pregnant women with new coronavirus infection: a clinical characteristics and placental pathological analysis of three cases / 中华病理学杂志

Objective@#To investigate the clinical characteristics and placental pathology of 2019-nCoV infection in pregnancy, and to evaluate intrauterine vertical transmission potential of 2019-nCoV infection.@*Methods@#The placentas delivered from pregnant women with confirmed 2019-nCoV infection which were received in the Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology collected by February 4th, 2020 and retrospectively studied. Their clinical material including placental tissue and lung CT, and laboratory results were collected, meanwhile, nucleic acid detection of 2019-nCoV of the placentas were performed by RT-PCR.@*Results@#Three placentas delivered from pregnant women with confirmed 2019-nCoV infection, who were all in their third trimester with emergency caesarean section. All of the three patients presented with fever (one before caesarean and two in postpartum), and had no significant leukopenia and lymphopenia. Neonatal throat swabs from three newborns were tested for 2019-nCoV, and all samples were negative for the nucleic acid of 2019-nCoV. One premature infant was transferred to Department of Neonatology due to low birth weight. By the end of February 25, 2020, none of the three patients developed severe 2019-nCoV pneumonia or died(two patients had been cured and discharged, while another one had been transferred to a square cabin hospital for isolation treatment). There were various degrees of fibrin deposition inside and around the villi with local syncytial nodule increases in all three placentas. One case of placenta showed the concomitant morphology of chorionic hemangioma and another one with massive placental infarction. No pathological change of villitis and chorioamnionitis was observed in our observation of three cases. All samples from three placentas were negative for the nucleic acid of 2019-nCoV.@*Conclusions@#The clinical characteristics of pregnant women with 2019-nCoV infection in late pregnancy are similar to those of non-pregnant patients, and no severe adverse pregnancy outcome is found in the 3 cases of our observation. Pathological study suggests that there are no morphological changes related to infection in the three placentas. Currently no evidence for intrauterine vertical transmission of 2019-nCoV is found in the three women infected by 2019-nCoV in their late pregnancy.

A near miss case of placenta percreta in a patient with post myomectomy scar

The term placenta accreta or placenta accrete syndrome is used to describe a spectrum of an abnormal placental implantation and firm adherence which are classified according to the depth of invasion into the uterus. A 28-year-old elderly primigravida presented AIIMS OPD to for the 1st time at 13+2 weeks of gestation with brownish discharge per vaginum. Ultrasonography done showed 12 weeks single intrauterine pregnancy with subchorionic haemorrhage of 3.7×2.52 cm with placenta being fundoanterior. She underwent myomectomy 2 years back and during her antenatal care in 3rd trimester growth scan at 30+2 weeks of gestation placenta was fundoanterior with loss of retroplacental hypoechoic in the upper margin of placenta at the myomectomy scar site with small extra uterine collection seen measuring 7.6×2.3 cm and hence possibility of placenta accreta was suggestive by the above findings confirmed by MRI. Emergency cesarean section done at 36+6 weeks of gestation for leaking per vaginum. Manual removal of placenta was tried but it failed and soon atonic PPH developed. Seeing no response with uterotonics internal iliac artery ligation was also attempted but failed. Immediate decision for hysterectomy was taken as a life-saving method. On adhesiolysis in the fundal region placental tissue perforating uterine serosa was visible on the surface of uterus, hence diagnosis of placenta percreta was confirmed which was further confirmed on histopathological report. Currently hysterectomy or local resection is preferred over conservative management with methotrexate.

Gestational hyperglycemia on diet and medication: impact on placental pathology and pregnancy outcomes

Background: To evaluate the placental morphology and perinatal outcome in patients with gestational hyperglycemia on diet and medication.Methods: Placental examinations performed at the Department of Pathology between August 2016 to August 2018 were retrospectively reviewed. Of the received 140 placentas, 35 of gestational diabetes (GDM) and pre gestational diabetes were identified and segregated into hyperglycemia on diet and on medication. The clinical details, placental findings and perinatal outcome of patients in both the groups (gestational hyperglycemia on diet and medication) were collected and analyzed.Results: Among the 35 cases, there were 24 cases of mild gestational hyperglycemia controlled with diet and 11 cases of hyperglycemia on medication (oral hypoglycemic drugs ± insulin).Most of the placentae in both the groups weighed less than tenth centile. The cord abnormalities such as hyper coiling, velamentous /marginal insertion and furcate cord were observed more in women with GDM on diet. There was no significant gross placental lesion in those on medication. Placental histological features most consistently associated with both the groups include, disturbances of villous maturation (DVM), Derangements in uteroplacental / foetoplacental circulation and villous capillary lesions. Small for gestational age and intrauterine foetal death were found in both the groups, but more commonly in patients with hyperglycemia on medication.Conclusions: Villous maturation defects, uteroplacental / foetoplacental malperfusion are the essential placental changes which can result in adverse perinatal outcomes in women with hyperglycemia irrespective of the diabetic control.

Placental weight and birth weight to placental weight ratio in monochorionic and dichorionic growth-restricted and non-growth-restricted twins

OBJECTIVE: The aim of the present study was to compare the placental weight and birth weight/placental weight ratio for intrauterine growth-restricted and non-intrauterine growth-restricted monochorionic and dichorionic twins. METHODS: This was a retrospective analysis of placentas from twin pregnancies. Placental weight and the birth weight/placental weight ratio were compared in intrauterine growth-restricted and non-intrauterine growth-restricted monochorionic and dichorionic twins. The association between cord insertion type and placental lesions in intrauterine growth-restricted and non-intrauterine growth-restricted monochorionic and dichorionic twins was also investigated. RESULTS: A total of 105 monochorionic (intrauterine growth restriction=40; non-intrauterine growth restriction=65) and 219 dichorionic (intrauterine growth restriction=57; non-intrauterine growth restriction=162) placentas were analyzed. A significantly lower placental weight was observed in intrauterine growth-restricted monochorionic (p=0.022) and dichorionic (p<0.001) twins compared to non-intrauterine growth-restricted twins. There was no difference in the birth weight/placental weight ratio between the intrauterine growth restriction and non-intrauterine growth restriction groups for either monochorionic (p=0.36) or dichorionic (p=0.68) twins. Placental weight and the birth weight/placental weight ratio were not associated with cord insertion type or with placental lesions. CONCLUSION: Low placental weight, and consequently reduced functional mass, appears to be involved in fetal growth restriction in monochorionic and dichorionic twins. The mechanism by which low placental weight influences the birth weight/placental weight ratio in intrauterine growth-restricted monochorionic and dichorionic twins needs to be determined in larger prospective studies.

Morphological changes in placentas of normal and high risk pregnancies – 2 years study in MGM hospital

Background: Placenta-related disorders of pregnancy are almost unique to human species. These disorders, which affect around a third of pregnancies, primarily include miscarriage and preeclampsia. Aim and objectives: The aim of the present study was to examine the morphological changes in placentas of normal and high risk pregnancies, and to evaluate the fetal outcome in these cases, which in turn will improve the quality of placental diagnosis. The objectives were to know the extent of the gross and microscopic placental changes that occur in normal pregnancies and to study the placentas of high risk pregnancies. Materials and methods: A study of 132 placentas in normal and high risk pregnancies was conducted in the Department of Pathology, Kakatiya Medical College, MGM Hospital, Warangal, from 1st September 2014 to 31st August 2016. The materials included in this study were placentas from thirty females with normal pregnancies (controls) and one hundred thirteen with high risk pregnancies (cases) comprising anemia (27), pregnancy-induced hypertension (38), intrauterine growth retardation (15), diabetes mellitus (13), and twins (9). Results: In high risk cases, women in the age group 21-25 years were 66.6% in anemia, 60.5% in PIH, and 60% in IUGR 69.2% in diabetes mellitus, and 33.3% in twin pregnancies. Only a few cases Samala Raghuram Mohan, Jyosna, Sandhya Anil, S. Chandra Sekhar. Morphological changes in placentas of normal and high risk pregnancies - 2 years study in MGM hospital. IAIM, 2017; 4(5): 61-78. Page 62 were seen in the age group of 26-30 in both controls and cases. Seventy percent of the controls belonged to primigravida and 30% were multiparous women. In high risk cases, 66.6% were primigravida and 33.3% multipara. Majority of the multiparous mothers were seen in anemia constituting 48.1%. High risk cases exhibited exaggerated changes, except for calcification, which was seen equally in both the groups. Infarction was seen in 50% cases of PIH. Single case of retroplacental hematoma was also observed in PIH. Subchorionic fibrinoid was seen in 53.4% of IUGR placentas. Maternal floor infarction was seen in 4 cases of PIH and 3 cases of IUGR placentas. Subchorionic hematoma was seen in 1 case of IUGR placenta. IUGR placentas were small in size and weight for the gestational age and twin placentas were of diamniotic dichorionic type. The most prominent microscopic features were syncytiotrophoblastic knot formation and calcification. The high risk groups were showing prominent infarcts, fibrinoid necrosis, and stromal fibrosis more than those of control group. Conclusion: The present study has highlighted the importance of examination of placenta in normal as well as high risk pregnancies. The placental changes are essential to correlate the fetal outcome, as it provides the information for the cause of death. Hence, it has an effective role in planning prenatal monitoring of a future pregnancy.

Placental pathology and neonatal brain injury / 中国小儿急救医学

Placental pathologies include placental insufficiency,infection,meconium stained,abnormal planting and placental vascular anastomosis,et al.All those can lead to fetal and neonatal hypoxia ischemia or premature birth,which can cause brain damage.

Current opinion of cerebral palsy / 대한산부인과학회지

Despite improvement in perinatal practice during the past several decades, the incidence of cerebral palsy has remained essentially unchanged. The cause of cerebral palsy is thought to be multifactorial, including prematurity, inflammation, genetic cause and environmental factors. Although evidences suggest that 70-80% of cerebral palsy is due to prenatal factors and birth asphyxia plays a relatively minor role (<10%), development of cerebral palsy is frequently attributed to the obstetric misstep. Therefore, it is of critical importance to keeping in touch with recent trend and advances regarding cerebral palsy. In this background, this review was mainly focused on the articles published from Jan 2006 to June 2007, excluding the orthopedic and rehabilitational aspects. The subjects are arbitrary divided into the following four categories; 1) recent epidemiologic studies of cerebral palsy, 2) recent evidences of antenatal risk factors, 3) cerebral palsy and placental pathology, 4) role of MRI in diagnosis of cerebral palsy.

Comparison between three sampling methods in the study of placental pathology / 医学研究生学报

Objective:The pathological characteristics of tissue obtained from the placental bed biopsies (method A), placental basal plate sections (method B) and placental bed vacuum suction(method C) were evaluated to find a best sampling method to study the uterine spiral arteries. Methods:Histology obtained from 33 patients using method A and B and obtained from 51 patients using method C was analysised ,retrospectively. The differences of tissue and the spiral artery pick-up rate were compared. Results:Both the decidua and myometrium could be obtained by method A and C. It is impossible to get myometrium by method B. The spiral artery pick-up rate of method C is significantly higher than that of method A(? 2 =7.31, P