Maternal malignancy metastatic to the products of conception: a review

Documented reports of maternal malignancy metastatic to the placenta and fetus are rare. From 1866 until the present there have been 52 cases reported in the Western literature. We report a case of maternal large-cell carcinoma of the lung metastatic to the maternal brain and the placenta without fetal involvement.

The prevalence and distribution of acute placental inflammation in uncomplicated term pregnancies

The clinical relevance of histologic evidence of acute ascending intrauterine infection has been called into question by descriptions of "silent" chorioamnionitis. The described frequencies of silent chorioamnionitis in normal and abnormal pregnancies vary widely because of differences in the definition of a normal pregnancy, methods of placental examination, and pathologic criteria. Therefore, we examined placentas from 161 uncomplicated gestations for the presence and severity of acute inflammation in the amnion, chorion-decidua, chorionic plate, and umbilical cord using strict gross and microscopic protocols. Indicators of amniotic fluid infection, specifically umbilical cord inflammation, amnionitis, and inflammation within the chorionic plate were present in 0, 1.2, and 4% of the cases, respectively. Silent chorioamnionitis was rare. There was a statistical association between the presence of acute inflammation and the occurrence of labor at term. Methods of tissue sampling that included a more extensive examination of the site of membrane rupture resulted in an increased frequency of diagnosis of acute inflammation at the site of rupture in vaginal deliveries at term.

Heritabilities of and genetic correlations among six health problems in Holstein cows

Information from 7712 lactations of Holstein dairy cows was collected from 33 commercial herds around Ithaca, NY in the 3 yr from 1981 to 1983. The data were divided into subsets corresponding to lactation 1, lactation 2, and lactation 3 or greater. To estimate heritabilities of dystocia, retained placenta, metritis, ovarian cysts, milk fever, and mastitis, a mixed linear model (herd-year fixed and sire random effects) with 0 or 1 as the observed response was used. Variance components were estimated using Henderson's Method 3. The results show moderate heritabilities (.15 to .40) for dystocia, metritis, milk fever, and mastitis and low heritability (less than .12) for retained placenta and cystic ovaries. Genetic correlations between dystocia, retained placenta, metritis, and mastitis were moderate in size and positive, whereas cystic ovaries were correlated negatively with dystocia and retained placenta. A general reproductive health trait (dystocia, retained placenta, metritis, cystic ovaries, and milk fever combined in one trait) also was analyzed. The estimated heritability of this trait was .21, .11, and .00 for first calf heifers, second lactation cows, and older cows, respectively.

Data assessing the usefulness of screening obstetrical ultrasonography for detecting fetal and placental abnormalities in uncomplicated pregnancy: effects of screening a low-risk population

To investigate the usefulness of screening in low-risk populations, the authors evaluated the yield of ultrasonography for detecting abnormalities in 678 clinically uncomplicated pregnancies. The yield of ultrasonography in high-risk women who were referred for amniocentesis was remarkably similar to the yield in other women. All four diagnoses of twins were correct, but overall only six of 12 initial ultrasound diagnoses of fetal demise or fetal anomalies were confirmed at delivery. Of the eight major fetal anomalies present at delivery, including two cases of Down's syndrome, three had been detected by ultrasonography; none of the nine minor anomalies had been detected, usually because they were too small or might be detectable only at a later gestational age. Although ultrasonography may have a nearly perfect predictive value for certain anomalies, on average, in this study, positive ultrasonography increased the probability of an adverse outcome of pregnancy from 5.3% to 36%, while a normal ultrasound examination decreased the probability to 4.4%. These data, which emphasize the implications of screening a low-risk population, suggest that recommendations regarding routine screening obstetrical ultrasonography should await sufficiently large controlled trials demonstrating consistent clinical benefit, in terms of reassurance or of providing a baseline for future comparison or in terms of improved outcome at a reasonable cost.

The umbilical cord twist: origin, direction, and relevance

The purpose of this study was to evaluate the origin, direction, and relevance of the umbilical cord twist. We initially hypothesized that the direction of the helix or twist of the human umbilical cord at birth correlated with the eventual handedness of the child. Among 2801 singleton placentas in this study, only 5% had no twist, and the left twist outnumbered the right twist by 7 to 1, a ratio that is strikingly similar to the predominance of right-handed persons to non-right-handed persons in the general population. Forty-five 3- and 4-year-old children with previously documented cord twists were evaluated with respect to hand preference and performance. The direction of the cord twist was independent of the handedness of the child as well as the mother. We have documented an increased incidence of absent twist and right twist in association with single umbilical artery, suggesting that the impetus for the cord twist is independent on hemodynamic forces in the umbilical cord itself. We further document an increased incidence of absent twist among intrauterine fetal deaths and twins, suggesting that decreased fetal movement can impede the forces leading to normal twisting of the umbilical cord. Absence of cord twist may be associated with adverse prognosis.

Mycotic abortion in cattle

Placentas and foetuses from 1107 bovine abortions were examined and a fungal infection was diagnosed in 131 instances. Fungi seen in silver impregnated sections of tissues could be placed into 3 categories designated aspergillus, phycomycete and atypical. Culture indicated that the first 2 of these categories were due to Aspergillus sp and Mortierella wolfii respectively. The infections in the atypical category are probably also due to Aspergillus sp. Gross or microscopic examination or culture of the placenta were valuable diagnostically but examination of the foetus was seldom of value as infection in most instances did not involve foetal tissues. Questionnaires indicated that many M. wolfii abortions were associated with the feeding of poorly prepared or stored grass silage. As the majority of cattle are fed hay or silage, no association could be demonstrated between Aspergillus sp abortion and these feeds. Fertility following fungal abortion was apparently unimpaired.

Periparturient traits in seven high dairy herds. Incidence rates, association with parity, and interrelationships among traits

Interrelationships among nine periparturient traits and their association with parity were investigated in 8521 calvings of dairy cows examined routinely between 5 to 14 d postpartum. Rates of twins, stillbirth, milk fever, prolapsed uterus, retained placenta, primary metritis, displaced abomasum, ketonuria, and aciduria were 5.8, 6.3, 1.4, 3, 17.8, 36.1, 1.7, 30.4, and 29.5%, respectively. The risk for twins, milk fever, prolapsed uterus, displaced abomasum, ketonuria, and aciduria increased with parity, whereas that for stillbirth and metritis was higher in heifers than in cows. Stillbirth, retained placenta, metritis, displaced abomasum, ketonuria, and aciduria were directly associated with birth of twins; prolapsed uterus and retained placenta with stillbirth; prolapsed uterus, retained placenta, and primary metritis with milk fever; displaced abomasum, ketonuria, and aciduria with retained placenta and with metritis; ketonuria and aciduria with displaced abomasum and aciduria with ketonuria.

Path analysis of dry period nutrition, postpartum metabolic and reproductive disorders, and mastitis in Holstein cows

Path analysis and logistic regression were used to model direct and indirect relationships among clinical periparturient (within 30 d after calving) retained placenta, metritis, veterinary-assisted dystocia, uncomplicated and complicated ketosis, left displaced abomasum, parturient paresis, mastitis, and estimated nutrient intakes (protein, calcium, phosphorus, energy; coded into terciles) in the last 3 wk of the dry period. Data were from 1,374 multiparous Holstein lactations for calvings from March 1981 through February 1982 in 31 commercial herds in central New York. Periparturient disorders occurred as a complex. Odds ratios for the multiplicative effects of parturient paresis on incidence of veterinary-assisted dystocia, retained placenta, complicated ketosis, and clinical mastitis were 7.2, 4.0, 23.6, and 5.4, respectively. Reproductive disorders were interrelated. Retained placenta, left displaced abomasum, and parturient paresis directly increased risk of complicated ketosis (odds ratios were 16.4, 53.5, and 23.6, respectively). Higher terciles of estimated energy intake in the last 3 wk of the dry period decreased risk of veterinary-assisted dystocia and left displaced abomasum, while higher terciles of estimated protein intake decreased risk of retained placenta and uncomplicated ketosis. Estimated nutrient intakes were directly related to subsequent metabolic disorders and directly and indirectly related (mediated by metabolic disorders) to reproductive disorders. The study suggests that feeding higher intakes (relative to National Research Council recommendations) of protein and energy in the last 3 week of the dry period may reduce the incidence of metabolic and reproductive disorders. Exact recommendations as to the amounts and types of feed cannot be made from our results.

Concomitant and repeated happenings of complications of the third stage of labour

Complications of the third stage of vaginal delivery have been studied among 36 312 women in Aberdeen between 1967 and 1981. There was no change in the incidence of retained placenta (RP), but there was a secular increase in postpartum haemorrhage (PPH). Postpartum haemorrhage was three times more common when there was a retained placenta. PPH was commoner in primiparae and after induced labour. The main focus of this paper is on the analysis of the risks of repetition among 6615 women with two or three live births between 1967 and 1980. A history of PPH and/or RP increased the relative risks of PPH and/or RP in a subsequent birth by between two and four times compared with women without such a history. The risk of repetition was increased if the subsequent birth was induced, or if there was an intervening abortion. Nevertheless, only a minority of the multiparae who experienced a third stage complication had a previous history of such a complication.

A pilot study of the frequency and significance of placental villitis

The prevalence of inflammatory villous lesions was determined in a prospective study of 120 consecutive placentas. Cord blood IgM level was measured as an indicator of fetal intrauterine infection, and the birthweights of the infants were noted. Ten cases of villitis were found. Two infants had elevated cord blood IgM and one of them also had amniotic infection. As only one case of villitis had corroborative evidence of transplacental intrauterine infection, 90% of the lesions require an alternative explanation. The severity of the lesions correlated with the presence of low birthweight. The quality of the inflammatory infiltrate was also considered. Only one case included plasma cells; the remainder showed lymphohistiocytic infiltration. The case with plasmacytic infiltration was the one with elevated cord blood IgM. It is concluded that placental villitis is usually not an infective condition and its aetiology remains unknown.

Effects of age, parity and length of pregnancy on the morphology and histology of human placenta

A great majority of death-in-utero in this country may be due to placental insufficiency. This problem may have some correlation between parity, maternal age and weight of placenta. The present work has been attempted towards determination of the morphological and histological aspect of human full-term placentae and their relation with different parity and age group of mothers. The weight, size and number of cotyledons of placentae were found to be directly proportional to the maternal age and parity. No definite change in histology was observed except for the increase in fibrinoid degenerations in the stem villi and calcium deposition on the septal region of the placentae. These changes may have some important bearing on the placental insufficiency in higher age group and parity of mother.

Villitis of unknown aetiology: its incidence and significance in placentae from a British population

A histological study of 1000 randomly selected placentae from women delivered in Manchester, UK, revealed 136 cases of villitis; this is a higher incidence than that recorded in Australia and North America but lower than that noted in South America. There were no obvious clinical differences between mothers whose placentae showed a villitis and those in a control group whose placentae were free of villitis. As in other studies, there was an association between the presence of a villitis, particularly severe villitis, and fetal intrauterine growth retardation. The nature of this association cannot, however, be clarified until the aetiology of villitis is determined.

Grade 3 placentation: incidence and neonatal outcome

Although ultrasonically detectable placental changes have been correlated with fetal maturity, the relative incidence of each placental grade at various gestational ages has not been known. During a one-year study period, placental grading was evaluated in 1709 scans performed at 27 weeks' gestation or after. At 40 weeks' gestation or beyond, only about 20% of placentas had extensive calcification (Grannum grade 3). Significant placental calcification was rarely seen before 37 weeks' gestation. Placental grading could not be used to predict postmaturity. The incidence of fetal distress in labor was found to be increased with postmaturity as well as with other pregnancy complications that give rise to premature placental senescence, rather than with grade 3 placentas per se.

Trends in perinatal mortality at a Hong Kong hospital

Causes of perinatal mortality at Tsan Yuk Hospital, Hong Kong, were classified into 14 categories from the "P" list of stillbirths and neonatal mortality in the International Statistical Classification of Diseases, Injuries and Causes of Death. Trends for each category over the period 1970-1979 were examined by regression analysis. Overall perinatal mortality fell from 17.80 in 1970 to 10.94 in 1979. A low incidence of deaths from congenital abnormality and medical complication in the mother was observed. Significant statistical correlations were obtained in the trends in mortality associated with placental hemorrhage, pre-eclampsia, difficult labor, hemolytic disease of the newborn, and prematurity. Improvements in perinatal mortality in these areas as well as inadequacies in perinatal care in other areas, are discussed.

Malaria infection of the placenta in The Gambia, West Africa; its incidence and relationship to stillbirth, birthweight and placental weight

The incidence of placental malaria at parturition and its effects on the conceptus have been investigated in The Gambia, West Africa. Malarious placentae occurred in 1300 (20.2%) of 6427 singleton births, in 32 (18.6%) of 172 sets of twins and in none of six sets of triplets. Plasmodium falciparum infections predominated; P. malariae or P. ovale infections were found in only nine instances. In the large group of single births placental malaria occurred less frequently (12.0%) in residents of urban than of other, more rural, communities (27.1%). In the former group incidence showed no clear change with season; in the latter group it was highest in the trimester following the end of the rains and lowest in the second half of the dry season. In both residential groups it was more frequent in primiparae (urban 16.1%; other 46.9%) than in multiparae (urban 8.9%; other 20.3%). The sex of the child did not influence malaria incidence. Dense placental infections were more frequent in primiparae. Stillbirth rates of singleton infants were significantly higher for males than for females, but no clear and consistent relationship between stillbirth and placental malaria was detected. Mean singleton birthweights were depressed by about 170 g in the presence of malaria; the deficits were statistically significant only among first born infants and tended to diminish progressively with increasing maternal parity. No distinct gradient linking birthweight with ascending density of placental parasitaemia was observed. Singleton birthweights of 2.5 kg or less occurred more frequently in association with malarious than non-malarious placentae and the association was more marked among first born than later birth rank infants. Differences between the weights of malarious and non-malarious placentae were small and not significant. The findings of the study are discussed in relation to the widely prevalent view that pregnancy exacerbates maternal malaria by attenuating acquired immunity.

Chronic villitis of unknown aetiology in placentae of idiopathic small for gestational age infants

Placentae from 63 term pregnancies were studied. Of these, 19 were from normal pregnancies in which the neonates were within the normal weight range for their gestational age. The remaining 44 placentae were from pregnancies in which the infants were small for their gestational age (SGA). A chronic villitis was found in 68 per cent of all placentae. In the control group this lesion was present in 26 per cent but a mean of only 1.2 per cent of villi in these cases was inflamed. In the SGA group 86 per cent of placentae showed a chronic villitis and in these an average of 10 per cent of the villi were inflamed. Lymphocytic infiltrates in basal plate anchoring villi were observed in 48 of the 63 placentae and there were no differences among the various groups. Vascular lesions were found, similar to those described in placental bed arteries in preeclampsia and more recently in biopsies of the placental bed of SGA infants and in the decidua of mothers with systemic lupus erythematosus: this type of vasculopathy has also been described in rejection of renal transplants. It is suggested that the cellular infiltrate around and inside anchoring villi and free villi in cases of chronic villitis may represent the histological hallmark of an immunological reaction between mother and fetus rather than a response to infection.

Induction of twins in different breeds of cattle

Two experiments were conducted examining bilateral transfer of Hereford X Angus crossbred embryos to Angus, Hereford and Hereford x Angus crossbred recipients. In Exp. 1, both virgin heifers and parous cows were used as recipients, in Exp. 2, only virgin heifers were used. No differences in production of twins due to breed of recipient was observed. In Exp. 1, heifers had as high a twinning rate and proportion of pregnancies carried to term as cows. About 9% of the heifers in Exp. 2 experienced late gestation abortion (based on recipients pregnant at 42 d), a problem which was not observed among heifers in Exp. 1. No association between body weight at transfer and abortion was observed. Twin pregnancy was associated with a higher incidence of retained placentas (Exp. 1, P less than .05; Exp. 2, P less than .10), lower birth weight/calf (P less than .01 in both experiments) and shorter gestation period (P less than .01 in both experiments). Calf mortality at birth was similar among twins and singles and, in Exp. 2, a lower (P less than .02) incidence of dystocia was observed among heifers giving birth to twins than among those with single calves. The results of these experiments indicate that both beef heifers and beef cows of three common breed types are capable of maintaining twin pregnancies and successfully producing twins.

Interrelationships between production and reproductive diseases in Holstein cows. Conditional relationships between production and disease

By methods of conditional odds ratio with a set of 2960 Holstein lactation records, relationships between occurrences of disease in a lactation were examined. There were strong positive relationships between retained placenta and metritis and between cystic follicle and luteal cyst. Interaction was among dystocia, retained placenta, and metritis and among retained placenta, cystic follicle, and luteal cyst. Metritis was an intervening variable between retained placenta and cystic follicle, retained placenta was a common cause variable for metritis and luteal cyst, and cystic follicle was either an intervening variable or a common cause for metritis and luteal cyst. Discriminant analyses were used to investigate production variables and other diseases as causes of disease, and multiple regression analyses indicated effects of disease on other diseases and current production in a subset of 810 lactation records. Breed class averages for milk and fat, days in milk, and dry period in one lactation had little effect on occurrence of disease in the subsequent lactation. Metritis, cystic follicle, and luteal cyst directly increased calving interval 20 to 27 days. Cystic follicle directly increased breed class averages 5.5 points. None of the five diseases directly increased days in milk.

Interrelationships between production and reproductive diseases in Holstein cows. Data

Described are data in a retrospective study of the epidemiology of dystocia, retained placenta, metritis, cystic follicle, and luteal cyst. The 2960 lactation records by 1401 registered Holstein cows in 20 commercial herds were from the Canadian Record of Performance, and the disease data were from the herd health program of the Ontario Veterinary College. Means and standard deviations of production variables were age 4.6 yr, days dry 77.0 +/- 46.9, calving interval 417.6 +/- 71.5 days, breed class average for milk 129.4 +/- 22.5, fat 132.5 +/- 25.5, and days in milk 342.1 +/- 60.6. Rates of disease per lactation were dystocia 5.0%, retained placenta 7.1%, metritis 13.8%, cystic follicle 12.9%, and luteal cyst 3.2%. The distribution of calving ages suggested that the annual herd turnover was 20 to 25%. The distribution of diseases per lactation suggested that diseases occurred together in lactations more often than expected.

Interrelationships between production and reproductive diseases in Holstein cows. Age and seasonal patterns

Influences of age and season on occurrence of dystocia, retained placenta, metritis, cystic follicle, and luteal cyst were studied retrospectively. The 6 yr of data were from 2960 lactation records of 1401 registered Holstein cows from 20 commercial herds that participated in the dairy herd health program of the Ontario Veterinary College. For each disease, odds ratio analyses compared the risk of disease in each age group to the risk in all other age groups pooled. The following age groups were at increased risks of diseases: dystocia, 2 to less than 4 yr; retained placenta and metritis, 7 to less than 10 yr and 10 or more yr; cystic follicle and luteal cyst, 10 yr or more. For all diseases except dystocia, age 2 to less than 4 yr was at decreased risk. Formal statistical methods were used to test for unimodal seasonal patterns in monthly calvings, in monthly disease incidence (number of diagnoses), and in risk (lactational incidence rate) of disease according to month of calving. There were the following significant peaks: fall calvings in the age group 2 to less than 4 yr, summer-fall risk of metritis, fall-winter incidence of dystocia and metritis, and fall-winter risk of dystocia.

Effect of prepartum selenium-vitamin E injection on time for placenta to pass and on productive functions

The effect of a single injection of selenium-vitamin E containing 21.9 mg sodium selenite upon time for placenta to pass following calving and on subsequent reproductive and lactational performance was evaluated. Incidence of retained placenta was 11.4%. This amount of selenium-vitamin E did not affect the time for placenta to pass, did not reduce calving difficulty, nor did it increase number of heats prior to first breeding, decrease days open or services per conception, or increase milk the next lactation.

Changes in milk production, fertility and calf mortality associated with retained placentae or the birth of twins

The milk yield and fertility records of cows which at any time either gave birth to twin calves or retained their placenta have been examined. Milk yield was higher in the lactation preceding the birth of twins than in any other lactation and the lactation following the birth of twins tended to be longer. Milk yields of cows which retained their placenta were not significantly different from those of cows which cleansed normally. Many cows which gave birth to twins or which retained their placenta were subsequently barren. There was significantly greater mortality among twin calves and after the birth of twins placentae were more often retained.

Effects of decreased prenatal activity in patients with twin pregnancy

In an attempt to reduce perinatal mortality in twin gestation, patients in whom the diagnosis was made prenatally were urged to remain in the hospital at reduced activity until the 36th week of pregnancy. Seventy patients accepted this therapy during the years 1964-1975. The perinatal mortality appeared to be reduced and a major benefit was noted in increased fetal weights.

Maternal and fetal outcome of Lamaze-prepared patients

To determine whether Lamaze childbirth preparation is harmless, harmful, or beneficial, 500 consecutive Lamaze-prepared patients were compared to 500 hand-picked controls, matched for age, race, parity, and educational level. Lamaze preparation was found to have a significant beneficial effect in almost every obstetric preformance category. The Lamaze-oriented patients had one-fourth the number of cesarean sections and one-fifth the amount of fetal distress (P less than .005). Postpartum infection, measured both by maternal febrile morbidity and by the incidence of antibiotic use, was one-third that of the controls (P less than .005). Similarly, the "prepared" patients had fewer perineal lacerations and those that occurred were not as serious as those in the control patients (P less than .005). The control patients had three times as many cases of toxemia of pregnancy (P less than .005) and twice as many of prematurity (P less than .05).

Alcohol consumption in pregnant women and the outcome of pregnancy

A prospective study of more than 9000 women shows that during pregnancy, women consuming alcoholic beverages in excess of 40 cl of wine per day have an increased risk of the following unfavorable pregnancy outcomes: (1) the risk of stillbirth is elevated, especially for death from abruptio placentae: (2) mean birth weight is lower, and the risk of a small-for-date infant is increased; (3) placental weight is also decreased. Although heavier drinkers differ from lighter drinkers in a certain number of variables that are risk factors for the outcome of pregnancy, the increase in risk with increased alcohol consumption remains evident after adjustment for these confounding variables. The increase in risk for heavier drinkers appears to be due to beer consumption, in spite of the lower average amount of ethanol consumed by beer drinkers as compared to wine drinkers.

Incidence of some diseases in connection with parturition in dairy cows

The incidence of dystocia, uterine, prolapse, retained placenta, puerperal metritis and vaginal prolapse was investigated in 283 herds over a period of eight years (about 2,590 cows per year). The incidence of dystocia (0.012 cases per cow and year), of uterine prolapse (0.002) and puerperal metritis (0.002) varied with the monthly variation in parturition. Retained placenta (incidence 0.025) occurred more frequently in March-June relative to parturition. The cows then calving were older than average. Vaginal prolapse (incidence 0.002) was also commoner in the spring months. Herds with a high incidence of retained placenta also showed more mastitis, ketosis and parturient paresis.

Pregnancy in women over forty

In a retrospective review of 440 pregnancies occurring in women over the age of 40, increased frequencies of both perinatal and maternal complications were noted. The perinatal mortality rate of the study group was three times greater than that of the general obstetric population. There were increased incidences of both low and high birthweight infants. Neonatal morbidity was increased. Congenital abnormalities were noted in 12 infants, including 2 infants with cytogenetic abnormalities. Hypertensive disorders complicated one-third of the pregnancies. Diabetes mellitus and abruptio placentae occurred with increased frequency. Cesarean section was required in 12.2% of the deliveries.

[Pregnancy in teenagers (author's transl)]

In this study pregnancy, delivery and the newborn infant of 151 juvenile primiparas and 1034 adolescent primiparas were analyzed and were compared with a group of 3563 primiparas 21, 23 and 25 years of age. Regarding the obstetric history and the intrapartum period there was no increase incidence of complications among the young patients, however we found among the older women an increase in the incidence of operative deliveries. In the postpartum period it was noted that the young primiparas had a higher incidence of postpartum bleeding caused by atonia of the uterus and also an increased incidence of placental complications with a high rate of manual placental extraction and curettages. A positive correlation was found between premature birth and perinatal mortality and the younger the age of the mother. The newborn of the young mothers was also lighter and shorter at birth and had a higher incidence of malformations. This study has shown, that juvenile expectant mothers are a risk group for obstetricians and pediatricians.