Bleeding after childbirth / miscarriage - practical notes on the examination of biopsy material.

Postpartum haemorrhage is a significant cause of maternal morbidity and mortality worldwide. The pathologist encounters only a limited spectrum of causes leading to postpartum haemorrhage. The most common causes are retained placenta and placental site subinvolution. Both of these lesions can be diagnosed from material obtained by uterine curettage. Morbidly adherent placenta (placenta accreta spectrum) is a less frequent subject of investigation, the diagnosis of which can be reliably established only on the basis of histological examination of uterine specimens after hysterectomy.

SARS-CoV-2 placentitis - report of two cases and review of the literature.

Covid-19 disease caused by severe acute respiratory syndrome 2 coronavirus (SARS-CoV-2) continues to be a global public health problem. Since the pandemic outbreak in early 2020, a number of cases have been reported in pregnant women whose infection has led to severe complications including preterm birth, miscarriage, intrauterine growth restriction or intrauterine fetal demise. The results of the current studies suggest that the transplacental transmission of infection from mother to fetus is a rare event and that the complications listed above are more likely due to damage of placental tissue. In this article, we describe two cases of SARS-CoV-2 placentitis with special consideration to the morphology and differential dia-gnosis of this newly defined entity.

Changes in capillary diameters in pregnancy-induced hypertension.

OBJECTIVE: To compare capillary diameters, density and reactivity in high-risk pregnancies complicated by pregnancy-induced hypertension (PIH) to other high-risk pregnancies not affecting microcirculation (O). METHODS: Patients hospitalized at a tertiary referral center from January to May 2012 were enrolled in the prospective pilot study. Five microscopic fields were recorded from the nailfold for capillary diameters and functional capillary density assessment. One microscopic field was assessed before and after venous congestion to evaluate the change in capillary diameters. The results were expressed as median (interquartile range). Wilcoxon rank-sum test was used for the analysis of statistical significance (level of significance was set to p < 0.05). RESULTS: In total, 31 patients were available for statistical analysis (PIH = 17;O = 14). Patients in the PIH group had significantly longer capillaries (123(91;182) vs. 72(65;107)µm, p = 0.003) and higher average capillary diameter (12(10;13) vs. 10(9;11)µm, p = 0.017). The difference in mean functional capillary density was not significant (20(17;25) vs. 19(15:21), p > 0.05), however, significantly reduced capillary recruitment (1(0;7) vs. 10(6;17), p = 0.006) was found in PIH. Preeclampsia was observed in 10 patients from the PIH group. These patients did not significantly differ from the rest of the PIH group in the abovementioned variables. CONCLUSION: This is the first pilot study concerning change of capillary diameters after venous congestion in pregnancy. The reduced capillary recruitment and reduced capability of further dilation of capillaries after venous congestion observed in women with PIH may suggest a significantly reduced functional capacity of the microcirculation and increased load on capillary endothelium in pregnancy complicated by gestational hypertension.

Agreement on intrapartum cardiotocogram recordings between expert obstetricians.

RATIONALE, AIMS AND OBJECTIVES: To evaluate obstetricians' inter- and intra-observer agreement on intrapartum cardiotocogram (CTG) recordings and to examine obstetricians' evaluations with respect to umbilical artery pH and base deficit. METHODS: Nine experienced obstetricians annotated 634 intrapartum CTG recordings. The evaluation of each recording was divided into four steps: evaluation of two 30-minute windows in the first stage of labour, evaluation of one window in the second stage of labour and labour outcome prediction. The complete set of evaluations used for this experiment is available online. The inter- and intra-observer agreement was evaluated using proportion of agreement and kappa coefficient. Clinicians' sensitivity and specificity was computed with respect to umbilical artery pH, base deficit and to Apgar score at the fifth minute. RESULTS: The overall proportion of agreement between clinicians reached 48% with 95% confidence intervals (CI) (CI: 47-50). Regarding the different classes, proportion of agreement ranged from 57% (CI: 54-60) for normal to 41% (CI: 36-46) for pathological class. The sensitivity of clinicians' majority vote to objective outcome was 39% (CI: 16-63) for the umbilical artery base deficit and 27% (CI: 16-42) for pH. The specificity was 89% (CI: 86-92) for both types of objective outcome. CONCLUSIONS: The reported inter-/intra-observer variability is large and this holds irrespective of clinicians' experience or work place. The results support the need of modernized guidelines for CTG evaluation and/or objectivization and repeatability by introduction of a computerized approach that could standardize the process of CTG evaluation within the delivery ward.