ABSTRACT
Introduction: Hypertensive disorders of pregnancy continue to pose the most important risks for adverse maternal and neonatal outcome. Among histological findings, decidual artery disease is one of the most common, one that has both good reproducibility among observers and whose abnormal vascular remodeling is the sole aspect of preeclampsia pathophysiology on which experts agree. Nevertheless, some aspects of arterial remodeling alterations are still under investigation. Methods: We selected 720 routine and consecutive placenta case studies, concordant with the Amsterdam consensus. From these studies, we collected maternal and neonatal clinical data and specific placental findings on spiral artery abnormalities. We took into account all criteria for decidual arteriopathy. Two hundred and fifteen (215) cases out of this population presented hypertensive disorders of pregnancy. Additional to expected arterial findings, we noted frequent persistent parietal trophoblast lining. Results: A large proportion of our population developed hypertensive disorders of pregnancy (30%). Among the histologic findings reported for preeclampsia, we paid particular attention to spiral artery abnormalities, and this interpretive analysis revealed high frequency of arterial remodeling abnormalities. We examined two additional aspects in our routine analysis: first, the novel one of parietal trophoblast persistence, and second, the established problem of associated acute inflammation, as a possible pitfall. Conclusion: In order to better understood, spiral maternal artery remodeling merits further study. The abnormalities in this process provide an objective tool in the study and diagnosis of important pregnancy complications; furthermore, abnormal remodeling is an expression of early pregnancy alteration, and subsequently related to preeclampsia etiology.
Subject(s)
Hypertension, Pregnancy-Induced , Pre-Eclampsia , Vascular Diseases , Infant, Newborn , Pregnancy , Female , Humans , Placenta/pathology , Decidua/blood supply , Pre-Eclampsia/diagnosis , Pre-Eclampsia/metabolism , Pre-Eclampsia/pathology , Hypertension, Pregnancy-Induced/metabolism , Hypertension, Pregnancy-Induced/pathology , Reproducibility of Results , Trophoblasts/metabolism , Trophoblasts/pathology , Vascular Diseases/pathology , Arteries/pathologyABSTRACT
Hepatic organogenesis is a complex process involving various molecular and cellular determinants. Knowledge of the anatomical and functional structure of the liver and its relationship with other abdominal organs is fundamental from a surgical point of view. Clinical autopsies were performed upon twelve fetal specimens. Photographic footage was reviewed for fetal livers presenting macroscopic abnormalities, and relevant cases were included. A search was conducted employing terms pertaining hepatic malformations morphogenetic, anatomical and pathological features. A thorough review was elaborated introducing an updated classification based on autopsy findings and available literature. Twelve fetal specimens underwent clinical autopsies. Gestational age ranged between 18 and 38 weeks (mean 28 weeks). All livers displayed symmetrical lobes. Seven of them presented at least one dysmorphic feature on macroscopic examination. Hepatic malformations can be classified into anomalies due to excessive development, defective development or extrinsic factors. The relevance of the proper identification of liver malformations lies in the broad spectrum of clinical manifestations with different degrees of morbidity associated with them
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