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Thompson BB, Holzer PH, Kliman HJ. Placental Pathology Findings in Unexplained Pregnancy Losses. Reprod Sci 2024; 31:488-504. [PMID: 37725247 PMCID: PMC10827979 DOI: 10.1007/s43032-023-01344-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/28/2023] [Indexed: 09/21/2023]
Abstract
There are approximately 5 million pregnancies per year in the USA, with 1 million ending in miscarriage (a loss occurring prior to 20 weeks of gestation) and over 20,000 ending in stillbirth at or beyond 20 weeks of gestation. As many as 50% of these losses are unexplained. Our objective was to evaluate the effect of expanding the placental pathology diagnostic categories to include the explicit categories of (1) dysmorphic chorionic villi and (2) small placenta in examining previously unexplained losses. Using a clinical database of 1256 previously unexplained losses at 6-43 weeks of gestation, the most prevalent abnormality associated with each loss was determined through examination of its placental pathology slides. Of 1256 cases analyzed from 922 patients, there were 878 (69.9%) miscarriages and 378 (30.1%) antepartum stillbirths. We determined the pathologic diagnoses for 1150/1256 (91.6%) of the entire series, 777/878 (88.5%) of the miscarriages (< 20 weeks' gestation), and 373/378 (98.7%) of the stillbirths (≥ 20 weeks' gestation). The most common pathologic feature observed in unexplained miscarriages was dysmorphic chorionic villi (757 cases; 86.2%), a marker associated with genetic abnormalities. The most common pathologic feature observed in unexplained stillbirths was a small placenta (128 cases; 33.9%). Our classification system reinforced the utility of placental examination for elucidating potential mechanisms behind pregnancy loss. The improved rate of diagnosis appeared to be the result of filling a gap in previous pregnancy loss classification systems via inclusion of the categories of dysmorphic chorionic villi and small placenta.
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Affiliation(s)
- Beatrix B Thompson
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
- Harvard Medical School, Boston, MA, USA
| | - Parker H Holzer
- Department of Statistics & Data Science, Yale University, New Haven, CT, USA
- Spiff Incorporated, Sandy, UT, USA
| | - Harvey J Kliman
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.
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León RL, Li KT, Brown BP. A retrospective segmentation analysis of placental volume by magnetic resonance imaging from first trimester to term gestation. Pediatr Radiol 2018; 48:1936-1944. [PMID: 30027370 DOI: 10.1007/s00247-018-4213-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 06/08/2018] [Accepted: 07/12/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Abnormalities of the placenta affect 5-7% of pregnancies. Because disturbances in fetal growth are often preceded by dysfunction of the placenta or attenuation of its normal expansion, placental health warrants careful surveillance. There are limited normative data available for placental volume by MRI. OBJECTIVE To determine normative ranges of placental volume by MRI throughout gestation. MATERIALS AND METHODS In this cross-sectional retrospective analysis, we reviewed MRI examinations of pregnant females obtained between 2002 and 2017 at a single institution. We performed semi-automated segmentation of the placenta in images obtained in patients with no radiologic evidence of maternal or fetal pathology, using the Philips Intellispace Tumor Tracking Tool. RESULTS Placental segmentation was performed in 112 women and had a high degree of interrater reliability (single-measure intraclass correlation coefficient =0.978 with 95% confidence interval [CI] 0.956, 0.989; P<0.001). Normative data on placental volume by MRI increased nonlinearly from 6 weeks to 39 weeks of gestation, with wider variability of placental volume at higher gestational age (GA). We fit placental volumetric data to a polynomial curve of third order described as placental volume = -0.02*GA3 + 1.6*GA2 - 13.3*GA + 8.3. Placental volume showed positive correlation with estimated fetal weight (P=0.03) and birth weight (P=0.05). CONCLUSION This study provides normative placental volume by MRI from early first trimester to term gestation. Deviations in placental volume from normal might prove to be an imaging biomarker of adverse fetal health and neonatal outcome, and further studies are needed to more fully understand this metric. Assessment of placental volume should be considered in all routine fetal MRI examinations.
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Affiliation(s)
- Rachel L León
- Department of Pediatrics, Division of Neonatology, Riley Hospital for Children, Indiana University School of Medicine, 699 Riley Hospital Drive RR 208, Indianapolis, IN, 46202, USA.
| | - Kevin T Li
- Department of Radiology and Imaging Sciences, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Brandon P Brown
- Department of Radiology and Imaging Sciences, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
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Lelovas P, Efthimiadou EK, Mantziaras G, Siskos N, Kordas G, Kostomitsopoulos N. In vivo toxicity study of quatro stimuli nanocontainers in pregnant rats: Gestation, parturition and offspring evaluation. Regul Toxicol Pharmacol 2018; 98:161-167. [PMID: 30056247 PMCID: PMC7116984 DOI: 10.1016/j.yrtph.2018.07.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 11/25/2022]
Abstract
The aim of the present study was to investigate the impact of intravenous administration of newly fabricated nanocontainers (NCs) on the last third of pregnancy in rats. Fifteen pregnant 3-month-old Wistar rats were separated into 3 groups. On the 15th and 17th day of pregnancy all animals received an intravenous administration of 1 ml of 15 mg of NCs (Group A), 1 ml of 5 mg NCs (Group B) while Control group received 1 ml of 0.9% NaCl. On the 14th and 17th of pregnancy ultrasonography was performed and the parameters evaluated were the width of placenta, the length and width of the embryonic sac, the foetus length and the heart rate. On parturition the number of pups per dam was evaluated. Half of the pups were euthanised the day after parturition and their liver and kidney was histologically evaluated and for the rest of the pups the body growth curve was evaluated until the age of 14 week. At the end of the 14th week the remaining pups were euthanised and their liver and kidney was histologically evaluated. At weaning the dams were euthanised and their liver and kidney was histologically evaluated. Ultrasonography: Baseline measurements of the width of placenta, the length and width of embryonic sac, the foetus length and the heart rate on the 14th day of pregnancy, revealed no statistical significant differences between groups. Comparison of the same values on the 17th day of pregnancy after 2 intravenous administrations of NCs showed no statistical significant effect on the respective parameters. The administration of NCs had no impact on the mean number of pups per dam. Additionally, no impact of the NCs on the body weights of the pups was observed on the 1st day after parturition. Moreover, comparisons between groups, for both sexes showed no difference on growth rate. During the histological evaluation no inflammatory, degenerative or neoplastic lesions were observed as far as the newborn, adult offspring and dams were concerned. According to our results no toxic impact of the low and high doses of the NCs was observed on the parameters selected to be evaluated. Nanocontainers toxicity study. Toxicological study on pregnant rats, foetuses and offspring. Ultrasonographic evaluation. Histological evaluation.
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Affiliation(s)
- P Lelovas
- Clinical, Experimental Surgery, & Translational Research, Biomedical Research Foundation Academy of Athens (BRFAA), Athens, 115 27, Greece.
| | - E K Efthimiadou
- Laboratory for Sol-Gel, Institute of Nanoscience and Nanotechnology, NCSR "Demokritos", 153 10, Ag.Paraskevi Attikis, Greece; Laboratory of Inorganic Chemistry, Chemistry Department, National and Kapodistrian University of Athens, Panepistimioupolis, Zografou, 157 71, Greece
| | - G Mantziaras
- Clinical, Experimental Surgery, & Translational Research, Biomedical Research Foundation Academy of Athens (BRFAA), Athens, 115 27, Greece
| | - N Siskos
- Clinical, Experimental Surgery, & Translational Research, Biomedical Research Foundation Academy of Athens (BRFAA), Athens, 115 27, Greece
| | - G Kordas
- Laboratory for Sol-Gel, Institute of Nanoscience and Nanotechnology, NCSR "Demokritos", 153 10, Ag.Paraskevi Attikis, Greece
| | - N Kostomitsopoulos
- Clinical, Experimental Surgery, & Translational Research, Biomedical Research Foundation Academy of Athens (BRFAA), Athens, 115 27, Greece
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Sonek J, Krantz D, Carmichael J, Downing C, Jessup K, Haidar Z, Ho S, Hallahan T, Kliman HJ, McKenna D. First-trimester screening for early and late preeclampsia using maternal characteristics, biomarkers, and estimated placental volume. Am J Obstet Gynecol 2018; 218:126.e1-126.e13. [PMID: 29097177 DOI: 10.1016/j.ajog.2017.10.024] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 10/10/2017] [Accepted: 10/20/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Preeclampsia is a major cause of perinatal morbidity and mortality. First-trimester screening has been shown to be effective in selecting patients at an increased risk for preeclampsia in some studies. OBJECTIVE We sought to evaluate the feasibility of screening for preeclampsia in the first trimester based on maternal characteristics, medical history, biomarkers, and placental volume. STUDY DESIGN This is a prospective observational nonintervention cohort study in an unselected US population. Patients who presented for an ultrasound examination between 11-13+6 weeks' gestation were included. The following parameters were assessed and were used to calculate the risk of preeclampsia: maternal characteristics (demographic, anthropometric, and medical history), maternal biomarkers (mean arterial pressure, uterine artery pulsatility index, placental growth factor, pregnancy-associated plasma protein A, and maternal serum alpha-fetoprotein), and estimated placental volume. After delivery, medical records were searched for the diagnosis of preeclampsia. Detection rates for early-onset preeclampsia (<34 weeks' gestation) and later-onset preeclampsia (≥34 weeks' gestation) for 5% and 10% false-positive rates using various combinations of markers were calculated. RESULTS We screened 1288 patients of whom 1068 (82.99%) were available for analysis. In all, 46 (4.3%) developed preeclampsia, with 13 (1.22%) having early-onset preeclampsia and 33 (3.09%) having late-onset preeclampsia. Using maternal characteristics, serum biomarkers, and uterine artery pulsatility index, the detection rate of early-onset preeclampsia for either 5% or 10% false-positive rate was 85%. With the same protocol, the detection rates for preeclampsia with delivery <37 weeks were 52% and 60% for 5% and 10% false-positive rates, respectively. Based on maternal characteristics, the detection rates for late-onset preeclampsia were 15% and 48% for 5% and 10%, while for preeclampsia at ≥37 weeks' gestation the detection rates were 24% and 43%, respectively. The detection rates for late-onset preeclampsia and preeclampsia with delivery at >37 weeks' gestation were not improved by the addition of biomarkers. CONCLUSION Screening for preeclampsia at 11-13+6 weeks' gestation using maternal characteristics and biomarkers is associated with a high detection rate for a low false-positive rate. Screening for late-onset preeclampsia yields a much poorer performance. In this study the utility of estimated placental volume and mean arterial pressure was limited but larger studies are needed to ultimately determine the effectiveness of these markers.
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Affiliation(s)
- Jiri Sonek
- Fetal Medicine Foundation USA, Dayton, OH; Wright State University, Dayton, OH.
| | | | | | - Cathy Downing
- Fetal Medicine Foundation USA, Dayton, OH; Wright State University, Dayton, OH
| | | | | | | | | | | | - David McKenna
- Fetal Medicine Foundation USA, Dayton, OH; Wright State University, Dayton, OH
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Bukowski R, Hansen NI, Pinar H, Willinger M, Reddy UM, Parker CB, Silver RM, Dudley DJ, Stoll BJ, Saade GR, Koch MA, Hogue C, Varner MW, Conway DL, Coustan D, Goldenberg RL. Altered fetal growth, placental abnormalities, and stillbirth. PLoS One 2017; 12:e0182874. [PMID: 28820889 PMCID: PMC5562325 DOI: 10.1371/journal.pone.0182874] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/26/2017] [Indexed: 11/19/2022] Open
Abstract
Background Worldwide, stillbirth is one of the leading causes of death. Altered fetal growth and placental abnormalities are the strongest and most prevalent known risk factors for stillbirth. The aim of this study was to identify patterns of association between placental abnormalities, fetal growth, and stillbirth. Methods and findings Population-based case-control study of all stillbirths and a representative sample of live births in 59 hospitals in 5 geographic areas in the U.S. Fetal growth abnormalities were categorized as small (<10th percentile) and large (>90th percentile) for gestational age at death (stillbirth) or delivery (live birth) using a published algorithm. Placental examination by perinatal pathologists was performed using a standardized protocol. Data were weighted to account for the sampling design. Among 319 singleton stillbirths and 1119 singleton live births at ≥24 weeks at death or delivery respectively, 25 placental findings were investigated. Fifteen findings were significantly associated with stillbirth. Ten of the 15 were also associated with fetal growth abnormalities (single umbilical artery; velamentous insertion; terminal villous immaturity; retroplacental hematoma; parenchymal infarction; intraparenchymal thrombus; avascular villi; placental edema; placental weight; ratio birth weight/placental weight) while 5 of the 15 associated with stillbirth were not associated with fetal growth abnormalities (acute chorioamnionitis of placental membranes; acute chorioamionitis of chorionic plate; chorionic plate vascular degenerative changes; perivillous, intervillous fibrin, fibrinoid deposition; fetal vascular thrombi in the chorionic plate). Five patterns were observed: placental findings associated with (1) stillbirth but not fetal growth abnormalities; (2) fetal growth abnormalities in stillbirths only; (3) fetal growth abnormalities in live births only; (4) fetal growth abnormalities in stillbirths and live births in a similar manner; (5) a different pattern of fetal growth abnormalities in stillbirths and live births. Conclusions The patterns of association between placental abnormalities, fetal growth, and stillbirth provide insights into the mechanism of impaired placental function and stillbirth. They also suggest implications for clinical care, especially for placental findings amenable to prenatal diagnosis using ultrasound that may be associated with term stillbirths.
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Affiliation(s)
- Radek Bukowski
- The University of Texas at Austin Dell Medical School, Austin, Texas, United States of America
- * E-mail:
| | - Nellie I. Hansen
- RTI International, Research Triangle Park, North Carolina, United States of America
| | - Halit Pinar
- Brown University School of Medicine, Providence, Rhode Island, United States of America
| | - Marian Willinger
- The Pregnancy and Perinatology Branch, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Uma M. Reddy
- The Pregnancy and Perinatology Branch, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Corette B. Parker
- RTI International, Research Triangle Park, North Carolina, United States of America
| | - Robert M. Silver
- University of Utah School of Medicine and Intermountain Health Care, Salt Lake City, Utah, United States of America
| | - Donald J. Dudley
- University of Virginia School of Medicine, Charlottesville, Virginia, United States of America
| | - Barbara J. Stoll
- University of Texas Health Science Center Houston, Houston, Texas, United States of America
| | - George R. Saade
- University of Texas Medical Branch at Galveston, Galveston, Texas, United States of America
| | - Matthew A. Koch
- RTI International, Research Triangle Park, North Carolina, United States of America
| | - Carol Hogue
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Michael W. Varner
- University of Utah School of Medicine and Intermountain Health Care, Salt Lake City, Utah, United States of America
| | - Deborah L. Conway
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States of America
| | - Donald Coustan
- Brown University School of Medicine, Providence, Rhode Island, United States of America
| | - Robert L. Goldenberg
- Columbia University Medical Center, New York, New York, United States of America
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Pannopnut P, Kitporntheranunt M, Paritakul P, Kongsomboon K. Correlation of ultrasound estimated placental volume and umbilical cord blood volume in term pregnancy. J Turk Ger Gynecol Assoc 2015; 16:64-7. [PMID: 26097385 DOI: 10.5152/jtgga.2015.15235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/08/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To investigate the correlation between ultrasound measured placental volume and collected umbilical cord blood (UCB) volume in term pregnancy. MATERIAL AND METHODS An observational cross-sectional study of term singleton pregnant women in the labor ward at Maha Chakri Sirindhorn Medical Center was conducted. Placental thickness, height, and width were measured using two-dimensional (2D) ultrasound and calculated for placental volume using the volumetric mathematic model. After the delivery of the baby, UCB was collected and measured for its volume immediately. Then, birth weight, placental weight, and the actual placental volume were analyzed. The Pearson's correlation was used to determine the correlation between each two variables. RESULTS A total of 35 pregnant women were eligible for the study. The mean and standard deviation of estimated placental volume and actual placental volume were 534±180 mL and 575±118 mL, respectively. The median UCB volume was 140 mL (range 98-220 mL). The UCB volume did not have a statistically significant correlation with the estimated placental volume (correlation coefficient 0.15; p=0.37). However, the UCB volume was significantly correlated with the actual placental volume (correlation coefficient 0.62; p<0.001) and birth weight (correlation coefficient 0.38; p=0.02). CONCLUSION The estimated placental volume by 2D ultrasound was not significantly correlated with the UCB volume. Further studies to establish the correlation between the UCB volume and the estimated placental volume using other types of placental imaging may be needed.
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Affiliation(s)
- Papinwit Pannopnut
- Department of Obstetrics and Gynecology, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Maethaphan Kitporntheranunt
- Department of Obstetrics and Gynecology, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Panwara Paritakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Kittipong Kongsomboon
- Department of Preventive and Social Medicine, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
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