1
|
Fnon NF, Hassan AA, Hosney HH, Mohamed AK, Khalifa AM, Mostafa EMA, Ibrahim MA. Placenta percreta in primigravida with unscarred uterus complicated by uterine rupture and sudden maternal and fetal death: an autopsy case report. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00690-7. [PMID: 37632681 DOI: 10.1007/s12024-023-00690-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 08/28/2023]
Abstract
Placenta percreta is a rare, aggressive, and severe form of the placenta accreta spectrum. One of its most devastating effects is the sudden rupture of uterus. Uterine scarring is the leading risk factor for uterine rupture, although it can also happen, but rarely, in an unscarred uterus showing more severe repercussions. The present study reported a case of an Egyptian primigravida female, aged 29 years old, at 32 weeks of gestation who died suddenly due to uterine rupture complicating placenta percreta, the diagnosis of which was first settled during autopsy. There was no history of abdominal trauma. No medical history of significance was present. Autopsy denoted an intrauterine fetal death of 32 weeks gestational age. The fundus of the uterus had a laceration (rupture) of the uterine wall including the serosa and myometrium. The placenta has extensively infiltrated the fundus uterine wall and penetrated the myometrium and serosa. Histopathological examination of the ruptured site on the uterus confirms total invasion of the uterine wall by chorionic villi with the presence of hemorrhage and fibrin indicating placenta percreta. Uterine rupture due to placenta percreta may go unnoticed, especially when no associated high-risk factors exist. The current case depicts that placenta percreta is a rare but critical complication of pregnancy that may exist at any stage of pregnancy without any associated high-risk factors with unusual symptoms and leads to uterine rupture and sudden death.
Collapse
Affiliation(s)
- Nora F Fnon
- Forensic Pathology Unit, Forensic Medicine Authority, Ministry of Justice, Cairo, Egypt
| | - Ayman A Hassan
- Forensic Medicine Department, Forensic Medicine Authority, Ministry of Justice, Cairo, Egypt
| | - Hanan H Hosney
- Forensic Pathology Unit, Forensic Medicine Authority, Ministry of Justice, Cairo, Egypt
| | - Ayman K Mohamed
- Forensic Medicine Department, Forensic Medicine Authority, Ministry of Justice, Cairo, Egypt
| | - Athar M Khalifa
- Pathology Department, College of Medicine, Jouf University, Sakakah, Aljouf, Saudi Arabia
| | - Enas M A Mostafa
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Suez Canal University (SCU), Ismailia, 41522, Egypt
| | - Mahrous A Ibrahim
- Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Suez Canal University (SCU), Ismailia, 41522, Egypt.
- Forensic Medicine and Clinical Toxicology, College of Medicine, Jouf University, Sakakah, Aljouf, Saudi Arabia.
| |
Collapse
|
2
|
Consonni S, Salmoiraghi E, Vaglio Tessitore I, Pintucci A, Vitale V, Calzi P, Moltrasio F, Locatelli A. Intra-Amniotic Inflammation or Infection: Suspected and Confirmed Diagnosis of "Triple I" at Term. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1110. [PMID: 37508607 PMCID: PMC10378617 DOI: 10.3390/children10071110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023]
Abstract
Chorioamnionitis (CA) at term of pregnancy can have an infectious and/or inflammatory origin and is associated with adverse outcomes. Triple I (intrauterine inflammation, infection, or both, TI) has been proposed to reduce the overdiagnosis of infection and neonatal overtreatment. The aim of this study is to identify clinical and histological variables that could predict adverse outcomes when TI is suspected and/or confirmed. This retrospective cohort study included 404 pregnancies (gestational age ≥ 37 weeks) that were divided into 5 all-inclusive and mutually exclusive groups. TI was defined according to the NICHD definition of 2015, and it could be confirmed (TI+) or not confirmed (TI-) via histological examination. Signs of infection/inflammation that did not conform to the definition of TI were classified as "clinical suspicion" and could be supported (CS+) or not supported (CS-) by histology. Cases of histological chorioamnionitis (HCA) without clinical manifestation represented a fifth group. Whole placental involvement (WPLI) was defined as a histological inflammation involving the maternal and fetal sides. There were 113 TI+, 30 TI-, 186 CS+, 35 CS-, and 40 isolated HCA cases. WPLI was diagnosed in 133 cases (39.2%). Composite neonatal outcome (CNO) occurred in 114 cases (28.2%) while composite maternal outcome (CMO) occurred in 192 cases (47.5%). Compared with CS+, TI+ was more predictive of CNO (p = 0.001), CMO (p < 0.001), and WPLI (p = 0.005). WPLI was related both to CNO (p < 0.001) and to CMO (p = 0.046). TI+ and WPLI showed similar sensitivity but different specificity in predicting CNO. At logistic regression, CNO was independently predicted by TI+ (OR 2.21; p = 0.001) and by WPLI (OR 2.23; p = 0.001). Compared with CS, TI is a better predictor of CNO and can be useful for the identification of newborns at risk.
Collapse
Affiliation(s)
- Sara Consonni
- Department of Obstetrics and Gynecology, Carate Hospital, ASST Brianza, 20871 Vimercate, Italy
| | - Elettra Salmoiraghi
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | | | - Armando Pintucci
- Department of Obstetrics and Gynecology, Desio Hospital, ASST Brianza, 20871 Vimercate, Italy
| | - Valentina Vitale
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Patrizia Calzi
- Department of Pediatrics, Carate Hospital, ASST Brianza, 20871 Vimercate, Italy
| | - Francesca Moltrasio
- Department of Pathology, Desio Hospital, ASST Brianza, 20871 Vimercate, Italy
| | - Anna Locatelli
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
- Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| |
Collapse
|
3
|
Pathologic Assessment of the Placenta. Obstet Gynecol 2022; 139:660-667. [DOI: 10.1097/aog.0000000000004719] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/13/2022] [Indexed: 11/26/2022]
|
4
|
Stănculescu RV, Brătilă E, Socolov DG, Russu MC, Bauşic V, Chirculescu R, Coroleucă CA, Pristavu AI, Dragomir RE, Papuc P, Tanca A, Bauşic AIG, Bauşic AIG. Update on placenta accreta spectrum disorders by considering epidemiological factors, ultrasound diagnosis and pathological exam - literature review and authors' experience. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2022; 63:293-305. [PMID: 36374136 PMCID: PMC9801676 DOI: 10.47162/rjme.63.2.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this paper was to correlate the circumstances that could lead to an abnormal invasion of placenta with the updated requirements to perform screening by ultrasound for all pregnant women prone to develop this pathology. To screen in the middle trimester of gestation for placenta accreta spectrum (PAS) disorders sets up an in-time referral opportunity for pregnant women prenatally detected with this pathology to a medical center with elevated level of expertise in the management of PAS disorders, able to act permanently by a multidisciplinary team (MDT) and to have access at medical resources including blood bank available. The literature review reveals especially useful data for clinical practice as regards novel explanations related to the etiology and physiopathology of PAS disorders, the composition of the MDT and the relevance of an indispensable pathologist physician at the time of Cesarean hysterectomy involved in the selection of best samples with the purpose of avoiding the possibility of losing undiagnosed cases with litigation implications. Conclusions show that the prenatal diagnosis of PAS disorders is possible so decreasing the risk of mortality and morbidity of pregnant women. Screening in the second trimester of pregnancy for PAS disorders becomes mandatory as the number of births by Cesarean section is expected to rise past three-fold until 2030. The professional expertise of the pathologist physician could be enriched by immunohistochemical staining in all suspected cases of placental invasion in myometrium wall.
Collapse
Affiliation(s)
- Ruxandra Viorica Stănculescu
- Department of Obstetrics and Gynecology, Doctoral School, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; ;
| | - Elvira Brătilă
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Obstetrics and Gynecology, Prof. Dr. Panait Sîrbu Clinical Hospital, Bucharest, Romania
| | - Demetra Gabriela Socolov
- Department of Obstetrics and Gynecology, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania; Department of Obstetrics and Gynecology, Cuza Vodă Clinical Hospital, Iaşi, Romania
| | - Manuela Cristina Russu
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Obstetrics and Gynecology, Ion Cantacuzino Clinical Hospital, Bucharest, Romania
| | - Vasilica Bauşic
- Department of Cellular and Molecular Biology, and Histology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Raluca Chirculescu
- Department of Pathology, Filantropia Clinical Hospital, Bucharest, Romania
| | - Ciprian Andrei Coroleucă
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Obstetrics and Gynecology, Prof. Dr. Panait Sîrbu Clinical Hospital, Bucharest, Romania
| | - Anda Ioana Pristavu
- Department of Obstetrics and Gynecology, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania; Department of Obstetrics and Gynecology, Cuza Vodă Clinical Hospital, Iaşi, Romania
| | - Ramona Elena Dragomir
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Obstetrics and Gynecology, Polizu Clinical Hospital, Bucharest, Romania
| | - Petru Papuc
- Department of Pathology, Sf. Pantelimon Clinical Hospital, Bucharest, Romania
| | - Antoanela Tanca
- Department of Cellular and Molecular Biology, and Histology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alexandra Irma Gabriela Bauşic
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Obstetrics and Gynecology, Prof. Dr. Panait Sîrbu Clinical Hospital, Bucharest, Romania
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Pietro L, Guida JPDS, Nobrega GDM, Antolini-Tavares A, Costa ML. Placental Findings in Preterm and Term Preeclampsia: An Integrative Review of the Literature. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:560-569. [PMID: 34461666 PMCID: PMC10301774 DOI: 10.1055/s-0041-1730292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Preeclampsia (PE) is a pregnancy complication associated with increased maternal and perinatal morbidity and mortality. The disease presents with recent onset hypertension (after 20 weeks of gestation) and proteinuria, and can progress to multiple organ dysfunction, with worse outcomes among early onset preeclampsia (EOP) cases (< 34 weeks). The placenta is considered the root cause of PE; it represents the interface between the mother and the fetus, and acts as a macromembrane between the two circulations, due to its villous and vascular structures. Therefore, in pathological conditions, macroscopic and microscopic evaluation can provide clinically useful information that can confirm diagnosis and enlighten about outcomes and future therapeutic benefit. OBJECTIVE To perform an integrative review of the literature on pathological placental findings associated to preeclampsia (comparing EOP and late onset preeclampsia [LOP]) and its impacts on clinical manifestations. RESULTS Cases of EOP presented worse maternal and perinatal outcomes, and pathophysiological and anatomopathological findings were different between EOP and LOP placentas, with less placental perfusion, greater placental pathological changes with less villous volume (villous hypoplasia), greater amount of trophoblastic debris, syncytial nodules, microcalcification, villous infarcts, decidual arteriolopathy in EOP placentas when compared with LOP placentas. Clinically, the use of low doses of aspirin has been shown to be effective in preventing PE, as well as magnesium sulfate in preventing seizures in cases of severe features. CONCLUSION The anatomopathological characteristics between EOP and LOP are significantly different, with large morphological changes in cases of EOP, such as hypoxia, villous infarctions, and hypoplasia, among others, most likely as an attempt to ascertain adequate blood flow to the fetus. Therefore, a better understanding of the basic macroscopic examination and histological patterns of the injury is important to help justify outcomes and to determine cases more prone to recurrence and long-term consequences.
Collapse
Affiliation(s)
- Luciana Pietro
- Institute of Health Sciences, Universidade Paulista, Campinas, SP, Brazil.,Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | | | | | | | - Maria Laura Costa
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil
| |
Collapse
|