Case Report: Abruptio placentae and epileptic seizure after occurrence of perinatal hyperglycaemia in woman with gestational diabetes mellitus and hypertriglyceridemia-induced acute pancreatitis.

Hypertriglyceridemia-induced acute pancreatitis seldom occurs in the second trimester of pregnancy with gestational diabetes mellitus. For these patients, the existing knowledge on concomitant hyperglycemia is not sufficient. We report a case of abruptio placentae and epileptic seizure following perinatal hyperglycaemia in woman with gestational diabetes mellitus and hypertriglyceridemia-induced acute pancreatitis. The occurrence of abruptio placentae and epileptic seizure may be associated with concomitant hyperglycemia, and the epileptic seizure was terminated after she underwent treatment with insulin. We should pay more attention to the adverse effects of perinatal hyperglycemia and continue to give appropriate insulin treatment even if patients have passed the acute phase of hypertriglyceridemia-induced acute pancreatitis.

A Five-Year Review of Feto-Maternal Outcome of Antepartum Haemorrhage in a Tertiary Center.

Background: Pregnancies complicated with antepartum-haemorrhage is high risk pregnancies associated with adverse maternal, fetal-and-perinatal-outcomes. It contributes significantly to fetal and maternal mortality especially in the developing countries. Proper antenatal care and prompt intervention is necessary to forestall adverse and improve outcome. Objective: To determine the prevalence, sociodemographic characteristics, risk factors, fetomaternal outcome of pregnancies with antepartum haemorrhage. Methods: The case files of the patients were retrieved from the medical records department. The total number of deliveries within the study period was obtained from the labour ward records. The feto-maternal-outcome-measures were; prevalence of caesarean-section, postpartum-haemorrhage, hysterectomy, need for blood-transfusion, maternal-death, prematurity, need for admission in intensive-care-unit and still births. The data was analysed using SPSS version 21. Chi-square was used to test for significance. Results: Within the 5-year period under review, out of a total of 6974 deliveries, 234 had antepartum-haemorrhage (3.4% prevalence rate). Abruptio-placentae was the commonest cause and accounted for 69.5% of the cases (prevalence of 2.1%) while placenta praevia accounted for 28.2% of the cases (prevalence rate of 0.9%). The mean age of the women was 31.8±5.3 years. The mean parity was 3.4±1.7 and majority (63.8%) of the women were unbooked. The commonest identifiable risk factors were multiparity and advanced maternal age. One-hundred-and sixty-six (77.9%) women were delivered through the abdominal route. Postpartum-haemorrhage occurred in 22.1% (47) of the cases while prematurity was the commonest fetal complications. Maternal mortality was 0.47% (1) while still birth was 44.1% (94). Conclusion: There is high prevalence of antepartum-haemorrhage in our environment. Abruptio-placentae was the commonest cause and associated with significant adverse fetomaternal-outcome when compared with placenta-praevia. Thus, good and quality antenatal care as well as high index of suspicion, prompt diagnosis and treatment remain the key to forestall these complications and improve fetomaternal-outcome.

Reverse diastolic flow of the fetal middle cerebral artery associated with placental chorangiomatosis and asymptomatic concealed placental abruption.

Reverse diastolic flow of the fetal middle cerebral artery is a rare, yet ominous finding which has been associated with adverse perinatal outcomes including: intracranial hemorrhage, growth restriction, fetal-maternal hemorrhage, severe anemia, hydrops, hepatic anomaly, subsequent stillbirth, and early neonatal death. We report a case in which following notation of a nonreassuring fetal heart rate at 32 weeks' gestation, sonographic documentation of persistent reverse diastolic flow of the fetal middle cerebral artery was noted in association with sonographic findings of vascular placental dysmorphology and an asymptomatic concealed placental abruption. Subsequent fetal heart rate tracing consistent with uteroplacental insufficiency led to immediate Cesarean birth of an anemic yet nonacidotic, nonhypoxic neonate, who did well following management of respiratory distress syndrome and partial exchange transfusion. Placental abruption was confirmed at delivery. Histopathology of the placenta confirmed the presence of localized chorangiomatosis ("wandering" chorangioma). The association of reverse diastolic flow of the fetal middle cerebral artery, placental chorangiomatosis and placental abruption has not been reported previously. We conclude that in the presence of prenatal sonographic findings of placental dysmorphology and or placental abruption, insonation of the fetal middle cerebral artery should be performed to assess the possibility of increased peak systolic velocity and possible reverse diastolic flow, both associated with fetal anemia and increased likelihood of an adverse perinatal outcome.

Plasma Homocysteine, Folic Acid and Vitamin B12 in Abruptio Placentae: A Cross-Sectional Study of Their Role and Feto-Maternal Outcome.

Background Out of the many causes of abruptio placentae, the micronutrient association with its occurrence and severity has not been researched extensively till now. We aim to measure the serum levels of homocysteine, folic acid and vitamin B12 in patients with abruptio placentae in the third trimester of pregnancy and compare the levels with those without the complication. We also propose to compare the feto-maternal outcome between the groups. Methods The cross-sectional study was undertaken in 50 pregnant women with abruption before or during delivery and 50 controls with uncomplicated pregnancy over 28 weeks of gestation. Serum levels of homocysteine, folic acid, and vitamin B12 were determined and feto-maternal outcome was compared between the groups Results Mean age of the cases and controls are 26.82 ± 5.5 and 28.82 ± 4.88 years respectively. Obstetric characteristics have significant difference between the groups in terms of gravidity, mode of delivery, timing of delivery, proportion of stillbirths and blood transfusion. The mean concentration of homocysteine and vitamin B12 between the groups also have a significant difference . The serum level of homocysteine is significantly correlated with serum vitamin B12 level (Pearson correlation= -0.601, P=0.000). However, folic acid concentration between the groups remains comparable. Conclusion Hence we conclude that vitamin B12 and homocysteine are significant determinants of abruptio placentae in pregnant women. Supplementation with the vitamin in the high-risk Indian population can avert a number of obstetric complications occurring due to raised homocysteine.

Influential factors of adverse pregnancy outcome in women with subchorionic hematoma / 中国基层医药

Objective:To investigate the influential factors of adverse pregnancy outcomes in women with subchorionic hematoma.Methods:A total of 101 women with subchorionic hematoma who received treatment in the People's Hospital of Xinjiang Uygur Autonomous Region from January 2017 to June 2020 were included in this study. They were divided into a control group and an adverse pregnancy outcome group according to whether there was an adverse pregnancy outcome. The epidemiological characteristics, hematoma characteristics observed on ultrasound images, and pregnancy outcomes were compared between the two groups.Results:There was no significant difference in the number of women who used assisted reproductive technology between the control and adverse pregnancy outcome groups [6 (8.0%) vs. 8 (30.7%), χ2 = 8.38, P = 0.004]. There was a significant difference in hematoma volume between adverse pregnancy outcome and control groups [(4.12 ± 0.61) mL vs. (6.36 ± 0.87) mL, t = 6.73, P = 0.009]. There was a significant difference in the number of patients who had obstetric complications between control and adverse pregnancy outcome groups [11 (14.7%) vs. 16 (61.5%), χ2 = 21.66, P = 0.001]. There was a significant difference in the number of patients who had hematomas located at the edge of the placenta between the control and adverse pregnancy outcome groups [15 (20.0%) vs. 12 (46.2%), χ2 = -4.81, P = 0.001]. Conclusion:Women who use assisted reproductive technology for pregnancy, have obstetric complications, or have a subchorionic hematoma with hematoma at the edge of the placenta are more likely to experience a miscarriage. Therefore, women of childbearing age should actively treat the primary disease and be alert to the occurrence of placental abruption.

Corrigendum: Case report: Abruptio placentae and epileptic seizure after occurrence of perinatal hyperglycaemia in woman with gestational diabetes mellitus and hypertriglyceridemia-induced acute pancreatitis.

[This corrects the article DOI: 10.3389/fendo.2023.1220957.].

RISK OF PLACENTA-ASSOCIATED COMPLICATIONS AT PREECLAMPSIA IN PREGNANT WOMEN WITH THROMBOPHILIA.

OBJECTIVE: The aim: To study the distribution and influence of coagulation factor gene polymorphisms, endothelial dysfunction, blood pressure regulator on the development of obstetric and perinatal complications in women with preeclampsia (PE). PATIENTS AND METHODS: Materials and methods: The prospective cohort study included 46 women with PE and maternal or fetal complications and 87 pregnant women with PE, without complications. Genetic polymorphisms of coagulation factors and fibrinolysis (1691 G→A FVL, 20210 G→A prothrombin, 675 5G/4G PAI-1, 455 G→A fibrinogen ß), endothelial dysfunction (192 Q→R PON-1, 677 C→T MTHFR) and blood pressure regulator (235 M→T angiotensinogen II) were studied with the help of allele-specific polymerase chain reaction. RESULTS: Results: Markers of predisposition to the development of obstetric and perinatal complications in pregnant women with PE are the following genotypes: 1691 GA by V Leiden factor gene - increases the risk in 2.9 times (95% CI 1.94-4.33), 20210 GA by prothrombin gene - in 2.36 times (95% CI 1.54-3.6), 20210 AA by prothrombin gene - in 3.12 times (95% CI 2.4-4.0). Pathological polymorphisms in the genes of angiotensinogen II 235 M→T, PAI-1 5G/4G, fibrinogen ß 455 G→A, paraoxonase-1 192 Q→R do not significantly affect the development of complications during preeclampsia. CONCLUSION: Conclusions: The development of PE against the background of the existence of acquired and hereditary types of thrombophilia is associated with a more severe course, early-onset and the development of life-threatening complications for a mother and fetus.

The Association of Placental Abruption and Pediatric Neurological Outcome: A Systematic Review and Meta-Analysis.

Placental histopathology provides insights, or "snapshots", into relevant antenatal factors that could elevate the risk of perinatal brain injury. We present a systematic review and meta-analysis comparing frequencies of adverse neurological outcomes in infants born to women with placental abruption versus without abruption. Records were sourced from MEDLINE, Embase, and the CENTRAL Trials Registry from 1946 to December 2019. Studies followed the PRISMA guidelines and compared frequencies of neurodevelopmental morbidities in infants born to pregnant women with placental abruption (exposure) versus women without placental abruption (comparator). The primary endpoint was cerebral palsy. Periventricular and intraventricular (both severe and any grades of IVH) and any histopathological neuronal damage were the secondary endpoints. Study methodologic quality was assessed by the Ottawa-Newcastle scale. Estimated odds ratios (OR) and hazards ratio (HR) were derived according to study design. Data were meta-analyzed using a random effects model expressed as pooled effect sizes and 95% confidence intervals. We included eight observational studies in the review, including 1245 infants born to women with placental abruption. Results of the random effects meta-analysis show that the odds of infants born to pregnant women with placental abruption who experience cerebral palsy is higher than in infants born to pregnant women without placental abruption (OR 5.71 95% CI (1.17, 27.91); I2 = 84.0%). There is no statistical difference in the odds of infants born to pregnant women with placental abruption who experience severe IVH (grade 3+) (OR 1.20 95% CI (0.46, 3.11); I2 = 35.8%) and any grade of IVH (OR 1.20 95% CI (0.62, 2.32); I2 = 32.3%) vs. women without placental abruption. There is no statistically significant difference in the odds of infants born to pregnant women with placental abruption who experience PVL vs. pregnant women without placental abruption (OR 6.51 95% CI (0.94, 45.16); I2 = 0.0%). Despite our meta-analysis suggesting increased odds of cerebral palsy in infants born to pregnant women with placental abruption versus without abruption, this finding should be interpreted cautiously, given high heterogeneity and overall poor quality of the included studies.

Impact of Co-Existing Placental Pathologies in Pregnancies Complicated by Placental Abruption and Acute Neonatal Outcomes.

Placental abruption (PA) is a concern for maternal and neonatal morbidity. Adverse neonatal outcomes in the setting of PA include higher risk of prematurity. Placental pathologies include maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM), acute chorioamnionitis, and villitis of unknown etiology (VUE). We aimed to investigate how placental pathology contributes to acute neonatal outcome in PA. A retrospective cohort study of all placentas with PA were identified. Exposures were MVM, FVM, acute chorioamnionitis and VUE. The primary outcome was NICU admission and the secondary outcomes included adverse base deficit and Apgar scores, need for resuscitation, and small-for-gestational age. A total of 287 placentas were identified. There were 160 (59.9%) of placentas with PA alone vs 107 (40.1%) with PA and additional placental pathologies. Odds of NICU admission were more than two times higher in pregnancies with placental pathologies (OR = 2.37, 95% CI 1.28-4.52). These estimates were in large part mediated by prematurity and birthweight, indirect effect acting through prematurity was OR 1.79 (95% CI 1.12-2.75) and through birthweight OR 2.12 (95% CI 1.40-3.18). Odds of Apgar score ≤ 5 was more than four times higher among pregnancies with placental pathologies (OR = 4.56, 95% CI 1.28-21.26). Coexisting placental pathology may impact Apgar scores in pregnancies complicated by PA. This knowledge could be used by neonatal teams to mobilize resources in anticipation of the need for neonatal resuscitation.

Abruptio placentae y trombofilia hereditaria / Abruptio placentae and hereditary thrombophilia / Abruptio placentae e trombofilia hereditária

Resumen: El abruptio placentae o desprendimiento prematuro de placenta normoinserta se define como el desprendimiento parcial o completo de la placenta normalmente implantada que ocurre antes del parto en embarazos mayores a 20 semanas. Entidad de elevada morbimortalidad (75%). La pato-fisiología es multifactorial, disminución de la invasión trofoblástica de las arterias espirales, disfunción endotelial y activación anormal de la coagulación a nivel de la interface materno-fetal. Es controversial si la trombofilia hereditaria contribuye a este proceso y de ser así como lo haría. Se realiza una revisión del tema con recomendaciones de estudio y tratamiento en pacientes que tienen esta patología.

Abstract: Abruptio placentae or premature detachment of the normoinserted placenta is defined as partial or complete detachment of the normally implanted placenta that occurs before delivery in pregnancies greater than 20 weeks. Entity with high morbidity and mortality (75%). The pathophysiology is multifactorial, decreased trophoblastic invasion of the spiral arteries, endothelial dysfunction and abnormal activation of coagulation at the level of the maternal-fetal interface. It is controversial whether and if hereditary thrombophilia contributes to this process. A review of the subject is carried out with study and treatment recommendations in patients who have this pathology.

Resumo: O descolamento da placenta ou descolamento prematuro da placenta normoinserida é definido como o descolamento parcial ou completo da placenta normalmente implantada que ocorre antes do parto em gestações com mais de 20 semanas. Entidade com alta morbimortalidade (75%). A fisiopatologia é multifatorial, diminuição da invasão trofoblástica das artérias espirais, disfunção endotelial e ativação anormal da coagulação ao nível da interface materno-fetal. É controverso se e se a trombofilia hereditária contribui para esse processo. É feita uma revisão do assunto com recomendações de estudo e tratamento em pacientes portadores dessa patologia.

Infección por listeria monocytogenes en el embarazo, asociado a desprendimiento de placenta y complicaciones perinatales: reporte de un caso / Listeria monocytogenes infection in pregnancy, associated with placental abruption and perinatal complications: case report

INTRODUCCIÓN la listeriosis, aunque es una infección infrecuente, debe ser considerada en pacientes inmunocomprometidos y gestantes, especialmente en aquellos que consumen alimentos crudos o productos lácteos no pasteurizados, lo que pone en riesgo a un gran número de mujeres embarazadas en países de habla hispana. Es importante que el médico considere su inclusión en los posibles diagnósticos diferenciales cuando la sospecha clínica lo amerite, lo que permitirá hacer un diagnóstico temprano y por lo tanto un tratamiento oportuno, evitando así las posibles complicaciones en el binomio madre-hijo. CASO CLÍNICO clínico multigestante, con embarazo de 33 + 5 semanas, que ingresó a una institución de alto nivel de complejidad en la ciudad de Medellín, Colombia, por síndrome febril asociado a sepsis obstétrica debido a infección intraamniótica por Listeria monocytogenes, que requirió cesárea de urgencia, en donde se evidenció un desprendimiento placentario del 100 % secundario al proceso infeccioso y asociado a complicaciones neonatales. CONCLUSIONES: el diagnóstico de listeriosis gestacional supone un reto clínico por su presentación inespecífica y baja incidencia. Sin embargo, las consecuencias obstétricas arrastran una gran morbilidad de la madre y morbi-mortalidad neonatal, lo que hace de suma importancia que el clínico lo tenga presente en su arsenal diagnóstico, ya que una vez diagnosticado, el tratamiento oportuno tiene desenlaces clínicos favorables.

INTRODUCTION: although listeriosis is a rare infection, it should be considered in immunocompromised patients and pregnancy, especially in those who consume raw food or unpasteurized dairy, which puts a large number of pregnant women in Hispanic countries at risk. It is of special importance for physicians to include listeriosis among possible diagnoses when clinical suspicion arises in order to timely treat it and thus avoid the complications that may occur in the mother-child binomial. CLINICAL CASE: a pregnant woman (33 + 5 weeks) with multiple gestations, was admitted to a high level of complexity institution in the city of Medellín, Colombia, presenting a febrile syndrome associated with obstetric sepsis due to intra-amniotic infection by Listeria monocytogenes, which required emergency cesarean section where a 100 % placental abruption was evidenced secondary to the infectious process and associated with neonatal complications. CONCLUSIONS: The diagnosis of gestational listeriosis is a clinical challenge due to its nonspecific presentation and low incidence. However, the obstetric consequences drag a great maternal morbidity and neonatal morbidity and mortality, which is why it is important for physicians to consider this in the diagnostic arsenal because once diagnosed, the appropriate treatment has favorable clinical outcomes.

The etiology of stillbirth over 30 years: A cross-sectional study in a tertiary referral unit.

INTRODUCTION: Stillbirth remains an often unpredictable and devastating pregnancy outcome, and despite thorough investigation, the number of stillbirths attributable to unexplained causes remains high. Placental examination has become increasingly important where access to perinatal autopsy is limited. We aimed to examine the causes of stillbirth in normally formed infants over 30 years and whether a declining autopsy rate has affected our ability to determine a cause for stillbirths. MATERIAL AND METHODS: All cases of normally formed singleton infants weighing ≥500 g that died prior to the onset of labor from 1989 to 2018 were examined. Trends for specific causes and uptake of perinatal autopsy were analyzed individually. RESULTS: In all, 229 641 infants were delivered, with 840 stillbirths giving a rate of 3.66/1000. The rate of stillbirth declined from 4.84/1000 in 1989 to 2.51 in 2018 (P < .001). There was no difference in the rate of stillbirth between nulliparous and multiparous women (4.25 vs 3.66 per 1000, P = .026). Deaths from placental abruption fell (1.13/1000 in 1989 to 0 in 2018, P < .001) and the relative contribution of placental abruption to the incidence of stillbirth also fell, from 23.3% (7/30) in 1989 to 0.0% (0/19) in 2018 (P < .001). Stillbirth attributed to infection remained static (0.31/1000 in 1989 to 0.13 in 2018, P = .131), while a specific causal organism was found in 79.2% (42/53) of cases. Unexplained stillbirths decreased from 2.58/1000 (16/6200) in 1989 to 0.13 (1/7581) in 2018 (P < .001) despite a fall in the uptake of perinatal autopsy (96.7% [29/30] in 1989 to 36.8% (7/19) in 2018; P < .001). Placental disease emerged as a significant cause of stillbirth from 2004 onwards (89.5% [17/19] in 2018). CONCLUSIONS: The present analysis is one of the largest single-center studies on stillbirth published to date. Stillbirth rates have fallen across the study period across parity. A decrease in deaths secondary to placental abruption contributed largely to this. Infection-related deaths are static; however, in one-fifth of cases a causative organism was not found. Despite a decreasing autopsy rate, the number of unexplained stillbirths continues to fall as the importance of placental pathology is increasingly recognized.

Emergency Obstetric Hysterectomy, the Histopathological Perspective: A Cross-Sectional Study From a Tertiary Care Hospital.

Introduction Emergency obstetric hysterectomy (EOH) is a life-saving procedure which involves the surgical removal of uterus and is usually performed for uncontrollable maternal hemorrhage when all other conservative management has failed. This study was conducted to evaluate the histopathological findings in the EOH specimen received in the department of pathology. Methods This hospital-based cross-sectional study was conducted in the Histopathology Laboratory, Department of Pathology, and Dow Medical College (DMC) from September 2017 to December 2018. The histopathological findings in the EOH specimen were recorded and data was analyzed. Results Ninety-six cases of EOH were received. The incidence of emergency obstetric hysterectomy was 58.37/10,000 deliveries. The mean age of patients was 30.59 years (range 20-45 years). The main histopathological findings were placenta accreta spectrum in 61 (63.54%) cases, cervical tear in eight (8.33%), uterine rupture in seven (7.29%) and endomyometritis in six (6.25%) cases. In the placenta accreta spectrum, placenta accreta was the most frequent diagnosis in 23 (23.96%) of cases, placenta increta in 17 (17.71%), placenta percreta in 10 (10.42%) cases. Seven (7.29%) cases of placenta percreta and four (4.17%) cases of placenta accreta were diagnosed in association with placenta previa. Twenty placentas were received with the hysterectomies, of these eight (40%) placentas showed infarction and six (30%) had intervillous fibrin, both findings were suggestive of uteroplacental insufficiency, while three (15%) placentas had normal histology. Ovaries were received with the hysterectomies in 11 (11.46%) cases. Mature cystic teratoma was diagnosed in two (2.08%) ovaries while the majority of ovaries were normal on histology. Conclusion Placenta accreta spectrum is the leading histopathological finding in the EOH specimen. Regular antenatal follow-up and radiological examination of pregnant women is inferred to prevent obstetric complications and near-miss event of EOH. Further research is recommended to confirm the findings in placenta. Ovarian conservation is suggested in patients undergoing EOH with no clinical and surgical indication for oophorectomy.

Application of low molecular weight heparin plus low dose aspirin in preventing twin pregnancy with preeclampsia high risk factors / 中国基层医药

Objective@#To explore the clinical value of low molecular weight heparin(LMWH) plus low dose aspirin(LDA) in preventing twin pregnancy with preeclampsia high risk factors.@*Methods@#From January 2013 to December 2017, the twin pregnancy cases with preeclampsia high risk factors who were diagnosed in Shanxi Rongjun Hospital were randomly divided into two groups according to the order of the treatment.The observation group(n=53) used LMWH plus LDA to prevent preeclampsia, while the control group(n=53) used LDA alone.The incidence of preeclampsia and pregnancy outcome were compared between the two groups.@*Results@#The incidence of severe preeclampsia in the observation group(5.7%) was lower than that in the control group(18.9%)(χ2=4.296, P<0.05), and there was statistically significant difference in the delivery time between the two groups(χ2=7.993, P<0.05). While the incidence of preeclampsia, placental abruption, postpartum hemorrhage and FGR between the two groups had no statistically significant differences (all P>0.05). The proportion of NICU transferred fetus in the observation group(18.3%) was lower than that in the control group(30.7%)(χ2=4.289, P<0.05). There were no statistically significant differences in perinatal mortality and neonatal asphyxia(all P>0.05).@*Conclusion@#Compared with using the LDA alone, LMWH plus LDA prevention can effectively reduce the incidence of severe preeclampsia in twin pregnancies; at the same time, it also can delay the delivery time and reduce the rate of NICU transferred.

Application of low molecular weight heparin plus low dose aspirin in preventing twin pregnancy with preeclampsia high risk factors / 中国基层医药

Objective To explore the clinical value of low molecular weight heparin(LMWH) plus low dose aspirin(LDA) in preventing twin pregnancy with preeclampsia high risk factors.Methods From January 2013 to December 2017,the twin pregnancy cases with preeclampsia high risk factors who were diagnosed in Shanxi Rongjun Hospital were randomly divided into two groups according to the order of the treatment .The observation group(n=53) used LMWH plus LDA to prevent preeclampsia ,while the control group ( n=53) used LDA alone.The incidence of preeclampsia and pregnancy outcome were compared between the two groups .Results The incidence of severe preeclampsia in the observation group(5.7％) was lower than that in the control group (18.9％)(χ2 =4.296,P<0.05),and there was statistically significant difference in the delivery time between the two groups (χ2 =7.993,P<0.05).While the incidence of preeclampsia ,placental abruption,postpartum hemorrhage and FGR between the two groups had no statistically significant differences (all P >0.05).The proportion of NICU transferred fetus in the observation group(18.3％) was lower than that in the control group (30.7％)(χ2 =4.289,P<0.05).There were no statistically significant differences in perinatal mortality and neonatal asphyxia ( all P >0.05 ).Conclusion Compared with using the LDA alone , LMWH plus LDA prevention can effectively reduce the incidence of severe preeclampsia in twin pregnancies;at the same time,it also can delay the delivery time and reduce the rate of NICU transferred.

Placental bed research: I. The placental bed: from spiral arteries remodeling to the great obstetrical syndromes.

The term placental bed was coined to describe the maternal-fetal interface (ie, the area in which the placenta attaches itself to the uterus). Appropriate vascularization of this area is of vital importance for the development of the fetus; this is why systematic investigations of this area have now been carried out. Initially, the challenge was the identification and classification of the various successive branching of uterine arteries in this area. These vessels have a unique importance because failure of their physiological transformation is considered to be the anatomical basis for reduced perfusion to the intervillous space in women with preeclampsia, fetal growth restriction, preterm labor, preterm premature rupture of membranes, abruptio placentae, and fetal death. To investigate in depth the pathophysiology of the placental bed, some 60 years ago, a large number of placental bed biopsies, as well as of cesarean hysterectomy specimens with placenta in situ, from both early and late normotensive and hypertensive pregnancies, were carefully dissected and analyzed. Thanks to the presence of a series of specific physiological changes, characterized by the invasion and substitution of the arterial intima by trophoblast, this material allowed the identification in the placental bed of normal pregnancies of the main vessels, the uteroplacental arteries. It was then discovered that preeclampsia is associated with defective or absent transformation of the myometrial segment of the uteroplacental arteries. In addition, in severe hypertensive disease, atherosclerotic lesions were also found in the defective myometrial segment. Finally, in the basal decidua, a unique vascular lesion, coined acute atherosis, was also identified This disorder of deep placentation, coined defective deep placentation, has been associated with the great obstetrical syndromes, grouping together preeclampsia, intrauterine growth restriction, preterm labor, preterm premature rupture of membranes, late spontaneous abortion, and abruptio placentae. More recently, simplified techniques of tissue sampling have been also introduced: decidual suction allows to obtain a large number of decidual arteries, although their origin in the placental bed cannot be determined. Biopsies parallel to the surface of the basal plate have been more interesting, making possible to identify the vessels' region (central, paracentral, or peripheral) of origin in the placental bed and providing decidual material for immunohistochemical studies. Finally, histochemical and electron microscopy investigations have now clarified the pathology and pathogenetic mechanisms underlying the impairment of the physiological vascular changes.

Childhood abuse, intimate partner violence, and placental abruption among Peruvian women.

PURPOSE: Experiencing childhood abuse (CA) or intimate partner violence (IPV) has been linked to adverse pregnancy outcomes. We examined whether CA history and current IPV are independently and jointly associated with placental abruption (PA). METHODS: We recruited 662 PA cases and 665 controls in Lima, Peru. We used multivariate logistic regression to calculate odds ratios (OR), adjusting for age, education, and parity. RESULTS: Approximately 42% of cases and controls reported CA; 50% of cases and 49% of controls reported IPV. History of any CA was not associated with PA, but history of severe CA was associated with 38% increased odds of PA (adjusted OR [aOR], 1.38; 95% confidence interval (CI), 1.07-1.80), adjusting for IPV. There was a statistically nonsignificant association between severe IPV and odds of PA (aOR, 1.22; 95% CI, 0.92-1.62), adjusting for CA. Women who experienced severe CA and severe IPV had 2.06-fold (95% CI, 1.25-3.40) increased odds of PA compared with women who did not experience severe abuse. The joint effect of CA and IPV was positive but statistically nonsignificant on the multiplicative (aOR, 1.48; 95% CI, 0.79-2.80) and additive scale (relative excess risk due to interaction, 0.70; 95% CI, -0.39 to 1.78). CONCLUSIONS: Preventing exposure to violence may improve maternal outcomes.

Disección espontánea de la arteria descendente anterior en gestante con desprendimiento prematuro de placenta normoinserta: reporte de caso / Case report spontaneous descending artery dissection in pregnant woman with premature placental abruption

La patología coronaria no es frecuente dentro de la población joven. El diagnóstico en la paciente obstétrica no es fácil dado los cambios fisiológicos que esta población presenta. La disección espontánea de una arteria coronaria es una afección muy poco frecuente que puede ser causa de isquemia miocárdica y asociarse a un síndrome coronario agudo. Se trata del caso de una paciente de sexo femenino de 38 años cursando 33 semanas de gestación, la cual presentó un síndrome coronario agudo con elevación del segmento ST, por una disección coronaria, desprendimiento prematuro de placenta normo inserta (DPPNI) y óbito fetal.

Coronary disease is infrequent among young population. Diagnosis in the obstetric population is not easy, due to the physiological changes that this population presents. Spontaneous coronary artery dissection, not a frequent medical condition, can be a cause of myocardial ischemia and be associated with and acute coronary syndrome. We present the case of a 38-year-old female patient, at 33 weeks gestation, who presented an acute coronary syndrome with ST segment elevation, caused by coronary artery dissection. This syndrome was accompanied with abruptio placentae and fetal death.

Clinical value of color doppler ultrasonography combined with CA125 and AFP in the early diagnosis of placental abruption / 中国基层医药

Objective To explore the clinical value of color doppler ultrasonography combined with CA125 and AFP in the early diagnosis of placental abruption.Methods From January 2015 to December 2017,120 patients with placental abruption in the Maternal and Child Health Hospital of Zhoushan were selected as observation group. 120 healthy pregnant individuals were selected as control group.They all received the color Doppler ultrasound and detection of serum CA125 and AFP levels.The clots checking on the surface of placenta post-delivery was conducted at the same time. The statistical analysis was set up to compare two groups according to those tests from the lab reports.Results The levels of serum CA125 and AFP were higher in the observation group compared with those in the control group.In details,the CA125[(69.1 ± 8.9) U/mL] and AFP[(279.8 ± 41.3) μg/L] levels in placental abruption grade Ⅲ were significantly higher than those in gradeⅡ[ CA125 ( 61.6 ± 9.4 ) U/mL, AFP ( 234.9 ± 46.2)μg/L] and gradeⅠ[ CA125 (52.2 ± 8.9) U/mL,AFP(205.7 ± 43.1) μg/L] ( all P<0.01).The positive predictive values of placental abruption by the color Doppler ultrasound alone was 46.7%.The combination of the color Doppler ultrasound with serum CA125 was 81.7%.The combination of the color Doppler ultrasound with serum AFP was 78.3%.The combination of those three tests was increased up to 90.8% ,which was the best pre-diagnosis compared to the color Doppler ultrasound alone and the other two combinations(χ2 =11.67,P<0.01).The detective rate of combination of the color Doppler ultrasound with serum CA125 and AFP was higher than the other two combi-nations(χ2 =12. 56, 12. 64, all P <0. 01 ). Conclusion The levels of serum CA125 and AFP are positively correlated with placental abruption.The combination tests using the color Doppler ultrasound and both serum CA125 and AFP is a novel and sensitive method as to pre-diagnose high risk placental abruption during pregnancy.

Clinical value of color doppler ultrasonography combined with CA125 and AFP in the early diagnosis of placental abruption / 中国基层医药

Objective@#To explore the clinical value of color doppler ultrasonography combined with CA125 and AFP in the early diagnosis of placental abruption.@*Methods@#From January 2015 to December 2017, 120 patients with placental abruption in the Maternal and Child Health Hospital of Zhoushan were selected as observation group.120 healthy pregnant individuals were selected as control group.They all received the color Doppler ultrasound and detection of serum CA125 and AFP levels.The clots checking on the surface of placenta post-delivery was conducted at the same time.The statistical analysis was set up to compare two groups according to those tests from the lab reports.@*Results@#The levels of serum CA125 and AFP were higher in the observation group compared with those in the control group.In details, the CA125[(69.1±8.9)U/mL]and AFP[(279.8±41.3)μg/L] levels in placental abruption grade Ⅲ were significantly higher than those in gradeⅡ[CA125(61.6±9.4)U/mL, AFP(234.9±46.2)μg/L] and gradeⅠ[CA125(52.2±8.9)U/mL, AFP(205.7±43.1)μg/L](all P<0.01). The positive predictive values of placental abruption by the color Doppler ultrasound alone was 46.7%.The combination of the color Doppler ultrasound with serum CA125 was 81.7%.The combination of the color Doppler ultrasound with serum AFP was 78.3%.The combination of those three tests was increased up to 90.8%, which was the best pre-diagnosis compared to the color Doppler ultrasound alone and the other two combinations(χ2=11.67, P<0.01). The detective rate of combination of the color Doppler ultrasound with serum CA125 and AFP was higher than the other two combinations(χ2=12.56, 12.64, all P<0.01).@*Conclusion@#The levels of serum CA125 and AFP are positively correlated with placental abruption.The combination tests using the color Doppler ultrasound and both serum CA125 and AFP is a novel and sensitive method as to pre-diagnose high risk placental abruption during pregnancy.