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Dankó I, Kelemen E, Tankó A, Cserni G. Placental Pathology and Its Associations With Clinical Signs in Different Subtypes of Fetal Growth Restriction. Pediatr Dev Pathol 2023; 26:437-446. [PMID: 37334814 DOI: 10.1177/10935266231179587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
OBJECTIVE We evaluated placental alterations in different subtypes of fetal growth restriction (FGR) to determine any clinical associations. METHODS FGR placentas classified according to the Amsterdam criteria were correlated with clinical findings. Percentage of intact terminal villi and villous capillarization ratio were calculated in each specimen. Correlations of placental histopathology and perinatal outcomes were studied. 61 FGR cases were studied. RESULTS Early-onset-FGR was more often associated with preeclampsia and recurrence than late-onset-FGR; placentas from early-onset-FGR often had diffuse maternal (or fetal) vascular malperfusion and villitis of unknown etiology. Decreased percentage of intact terminal villi was associated with pathologic CTG. Decreased villous capillarization was associated with early-onset-FGR and birth weight below the second percentile. Avascular villi and infarction were more common when femoral length/abdominal circumference ratio was >0.26, and perinatal outcome was poor in this group. CONCLUSION In early-onset-FGR and preeclamptic FGR, altered vascularization of villi may have a key role in pathogenesis, and recurrent FGR is associated with villitis of unknown etiology. There is an association between femoral length/abdominal circumference ratio >0.26 and histopathological alterations of placenta in FGR pregnancies. There are no significant differences in the percentage of intact terminal villi between different FGR subtypes by onset or recurrency.
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Affiliation(s)
- István Dankó
- Department of Obstetrics and Gynecology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Edit Kelemen
- Perinatal Intensive Centre, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - András Tankó
- Department of Obstetrics and Gynecology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Gábor Cserni
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
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Surekha MV, Suneetha N, Balakrishna N, Putcha UK, Satyanarayana K, Geddam JJB, Sreenu P, Tulja B, Mamidi RS, Rutter GA, Meur G. Impact of COVID-19 during pregnancy on placental pathology, maternal and neonatal outcome - A cross-sectional study on anemic term pregnant women from a tertiary care hospital in southern India. Front Endocrinol (Lausanne) 2023; 14:1092104. [PMID: 37025411 PMCID: PMC10070875 DOI: 10.3389/fendo.2023.1092104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/03/2023] [Indexed: 04/08/2023] Open
Abstract
Background SARS-CoV-2 infection during pregnancy may cause adverse maternal, neonatal and placental outcomes. While tissue hypoxia is often reported in COVID-19 patients, pregnant women with anemia are suspected to be more prone to placental hypoxia-related injuries. Methods This hospital-based cross-sectional study was conducted between August-November 2021, during COVID-19 second wave in India. Term pregnant women (N=212) admitted to hospital for delivery were enrolled consecutively. Since hospital admission mandated negative RT-PCR test for SARS-CoV-2 virus, none had active infection. Data on socio-demography, COVID-19 history, maternal, obstetric, and neonatal outcomes were recorded. Pre-delivery maternal and post-delivery cord blood samples were tested for hematological parameters and SARS-CoV-2 IgG. Placentae were studied for histology. Results Of 212 women, 122 (58%) were seropositive for SARS-CoV-2 IgG, but none reported COVID-19 history; 134 (63.2%) were anemic. In seropositive women, hemoglobin (p=0.04), total WBC (p=0.009), lymphocytes (p=0.005) and neutrophils (p=0.02) were significantly higher, while ferritin was high, but not significant and neutrophils to lymphocytes (p=0.12) and platelets to lymphocytes ratios (p=0.03) were lower. Neonatal outcomes were similar. All RBC parameters and serum ferritin were significantly lower in anemic mothers but not in cord blood, except RDW that was significantly higher in both, maternal (p=0.007) and cord (p=0.008) blood from seropositive anemic group compared to other groups. Placental histology showed significant increase in villous hypervascularity (p=0.000), dilated villous capillaries (p=0.000), and syncytiotrophoblasts (p=0.02) in seropositive group, typically suggesting placental hypoxia. Maternal anemia was not associated with any histological parameters. Univariate and multivariate logistic regression analyses of placental histopathological adverse outcomes showed strong association with SARS-CoV-2 seropositivity but not with maternal anemia. When adjusted for several covariates, including anemia, SARS-CoV-2 seropositivity emerged as independent risk factor for severe chorangiosis (AOR 8.74, 95% CI 3.51-21.76, p<0.000), dilated blood vessels (AOR 12.74, 95% CI 5.46-29.75, p<0.000), syncytiotrophoblasts (AOR 2.86, 95% CI 1.36-5.99, p=0.005) and villus agglutination (AOR 9.27, 95% CI 3.68-23.32, p<0.000). Conclusion Asymptomatic COVID-19 during pregnancy seemed to be associated with various abnormal placental histopathologic changes related to placental hypoxia independent of maternal anemia status. Our data supports an independent role of SARS-CoV-2 in causing placental hypoxia in pregnant women.
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Affiliation(s)
- M. V. Surekha
- Pathology and Microbiology Division, Indian Council of Medical Research-National Institute of Nutrition, Hyderabad, India
| | - N. Suneetha
- Obstetrics & Gynecology Department, Government Area Hospital, Nampally, Hyderabad, India
| | - N. Balakrishna
- Department of Statistics, Apollo Hospitals Educational and Research Foundation (AHERF), Hyderabad, India
| | - Uday Kumar Putcha
- Pathology and Microbiology Division, Indian Council of Medical Research-National Institute of Nutrition, Hyderabad, India
| | - K. Satyanarayana
- Pathology and Microbiology Division, Indian Council of Medical Research-National Institute of Nutrition, Hyderabad, India
| | - J. J. Babu Geddam
- Clinical Epidemiology Division, Indian Council of Medical Research-National Institute of Nutrition, Hyderabad, India
| | - Pagidoju Sreenu
- Clinical Epidemiology Division, Indian Council of Medical Research-National Institute of Nutrition, Hyderabad, India
| | - B. Tulja
- Clinical Epidemiology Division, Indian Council of Medical Research-National Institute of Nutrition, Hyderabad, India
| | - Raja Sriswan Mamidi
- Clinical Division, Indian Council of Medical Research-National Institute of Nutrition, Hyderabad, India
| | - Guy A. Rutter
- Centre of Research of Centre Hospitalier de l'Université de Montréal (CRCHUM), Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Section of Cell Biology and Functional Genomics, Imperial College London, London, United Kingdom
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Gargi Meur
- Cell Biology Division, Indian Council of Medical Research-National Institute of Nutrition, Hyderabad, India
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Vafaei H, Karimi Z, Akbarzadeh-Jahromi M, Asadian F. Association of placental chorangiosis with pregnancy complication and prenatal outcome: a case-control study. BMC Pregnancy Childbirth 2021; 21:99. [PMID: 33516193 PMCID: PMC7847032 DOI: 10.1186/s12884-021-03576-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 01/20/2021] [Indexed: 11/22/2022] Open
Abstract
Background Chorangiosis is a vascular change involving the terminal chorionic villi in the placenta. It results from longstanding, low-grade hypoxia in the placental tissue, and is associated with such conditions as intrauterine growth restriction (IUGR), diabetes, and gestational hypertension in pregnancy. Chorangiosis rarely occurs in normal pregnancies. However, its prevalence is 5–7% of all placentas from infants admitted to newborn intensive care units. The present study was aimed at determining the association of chorangiosis with pregnancy complications and perinatal outcomes. Methods In this case-control study, 308 chorangiosis cases were compared with 308 controls (with other diagnoses in pathology) in terms of maternal, placental, prenatal, and neonatal characteristics derived from the medical records of participants retrospectively. R and SPSS version 22 software tools were used, and the statistical significance level was considered 0.05 for all the tests. Results Preeclampsia, diabetes mellitus, maternal hemoglobin, maternal hematocrit, C/S, oligohydramnios, fetal anomaly, dead neonates, NICU admissions were significantly higher in the chorangiosis group OR = 1.6, 3.98, 1.68, 1.92, 2.1, 4.47, 4.22, 2.9, 2.46, respectively (p-value< 0.05 for all). Amniotic fluid index, birth weight, cord PH amount, 1st, and 5th Apgar score was lower in the chorangiosis group OR = 0.31, 1, 0.097, 0.83, 0.85, respectively (p-value< 0.05 for all). Moreover, fundal placenta, retro placental hemorrhage, perivillous fibrin deposition, calcification, and acute chorioamnionitis were higher in the chorangiosis group OR = 2.1, 11.8, 19.96, 4.05, and 6.38 respectively, (p-value< 0.05). There was a high agreement between the two pathologists, and the power of the study was estimated at 99%. Conclusion Although chorangiosis is an uncommon condition, it is associated with a higher incidence of perinatal and neonatal morbidity and mortality. Therefore, it should be considered an important clinical sign of adverse pregnancy outcomes and should be reported in the pathology evaluation.
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Affiliation(s)
- Homeira Vafaei
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Obstetrics & Gynecology department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zinat Karimi
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Obstetrics & Gynecology department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojgan Akbarzadeh-Jahromi
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. .,Pathology Department, School of Medicine, Shiraz University of Medical Sciences, Postal code/ P.O. Box: 34786-71946, Shiraz, Iran.
| | - Fatemeh Asadian
- Department of Medical Laboratory Sciences, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Istrate-Ofiţeru AM, Berceanu C, Berceanu S, Busuioc CJ, Roşu GC, Diţescu D, Grosu F, Voicu NL. The influence of gestational diabetes mellitus (GDM) and gestational hypertension (GH) on placental morphological changes. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2020; 61:371-384. [PMID: 33544789 PMCID: PMC7864320 DOI: 10.47162/rjme.61.2.07] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Gestational diabetes mellitus (GDM) and gestational hypertension (GH) are some of the most common medical conditions associated with pregnancy. These can be correlated with placental morphopathological changes and implicitly can influence good fetal development. The age and weight of the mother can be correlated directly proportionally with those of the fetus but also with histoarchitecture and placental vascularization. The placental appearance associated with GDM and GH reveals macroscopic features, such as calcifications, fibrin deposits and placental infarcts, but the most relevant pathological features are the microscopic ones, highlighted by the classical staining techniques: Hematoxylin-Eosin (HE), Periodic Acid-Schiff (PAS)-Hematoxylin and Masson's trichrome (MT), but also by immunohistochemical technique with the help of the anti-cluster of differentiation 34 (CD34) antibody that labeled the capital endothelium in the structure of the placental terminal villi and thus we were able to quantify the vascular density according to the associated medical pathology. The microscopic changes identified were represented by intravillous and extravillous fibrin depositions, massive placental infarctions caused by vascular suppression due to various causes, such as thrombosis, but also placental calcifications. All these macroscopic and microscopic morphopathological changes, together with the clinical data of the mother and the newborn, we have demonstrated that they are interconnected and that they can vary depending on the pathology, GH or GDM.
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Affiliation(s)
- Anca Maria Istrate-Ofiţeru
- Department of Histology, University of Medicine and Pharmacy of Craiova, Romania; ; Department of Histology, Victor Papilian Faculty of Medicine, Lucian Blaga University of Sibiu, Romania;
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Moran M, Zombori G, Ryan J, Downey P, McAuliffe F. Is there a role for 3 dimensional power Doppler placental ultrasound and computerised assessment of calcification in post-term pregnancies? Radiography (Lond) 2016. [DOI: 10.1016/j.radi.2016.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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A prospective study of villous capillary lesions in complicated pregnancies. J Pregnancy 2014; 2014:193925. [PMID: 25506430 PMCID: PMC4260367 DOI: 10.1155/2014/193925] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 11/11/2014] [Accepted: 11/12/2014] [Indexed: 11/18/2022] Open
Abstract
The vascularity of placental tissue is dependent on various factors of which fetomaternal hypoxia plays a major role. Hypoxia can be of different types and each type influences the vascularity of the villi, especially terminal villi, in its own way. In this study, we attempted to identify villous vascular changes in a group of term placentae from mothers with diseases complicating pregnancy. Chorangiosis was the most frequently identified lesion while chorangioma was found in only 2 cases. There were no cases of chorangiomatosis. A few cases had normal villous vasculature. Maternal diseases have a major role in disrupting the placental vasculogenesis and angiogenesis by creating a hypoxic environment that may affect the fetus adversely. Hence, such conditions need to be identified early in pregnancy and managed appropriately as it is possible to maintain a normal vasculature and prevent neonatal mortality and morbidity if prompt intervention is done.
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Wikström Shemer E, Thorsell M, Östlund E, Blomgren B, Marschall HU. Stereological assessment of placental morphology in intrahepatic cholestasis of pregnancy. Placenta 2012; 33:914-8. [PMID: 23020907 DOI: 10.1016/j.placenta.2012.08.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 08/27/2012] [Accepted: 08/29/2012] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To apply stereology for the detection of possibly morphological abnormalities in placentas of women with intrahepatic cholestasis of pregnancy (ICP). STUDY DESIGN Prospective case-control study of placentas from untreated and UDCA-treated ICP, respectively, and normal pregnancies, examined for morphological differences by systematic random sampling generated by computerized stereology methodology. MAIN OUTCOME MEASURES Volume of placenta, surface area of terminal villi and capillaries, volume fraction of collagen, number of syncytial knots, and chorangiosis. RESULTS Surface area of terminal villi and capillaries, and number of syncytial knots were higher in placentas from all ICP, as compared to controls (p < 0.01). A reduction of collagen was found in placentas from UDCA-treated ICP, both in comparison to placentas from untreated ICP and controls (p < 0.05). CONCLUSION ICP affects the placenta morphologically as shown by increased terminal villous and capillary surface area, and number of syncytial knots.
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Affiliation(s)
- E Wikström Shemer
- Department of Obstetrics and Gynaecology, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
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Suzuki K, Itoh H, Kimura S, Sugihara K, Yaguchi C, Kobayashi Y, Hirai K, Takeuchi K, Sugimura M, Kanayama N. Chorangiosis and placental oxygenation. Congenit Anom (Kyoto) 2009; 49:71-6. [PMID: 19489958 DOI: 10.1111/j.1741-4520.2009.00226.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Chorangiosis is a vascular hyperplasia in the terminal chorionic villi, usually diagnosed histologically using the criteria of Altshuler. Its true etiology has not been fully identified, but chorangiosis has been proposed to result from a longstanding, rather low-grade hypoxia in the placental tissue. To clarify a possible association of placental oxygenation status with the development of chorangiosis, we measured placental tissue oxygen index (TOI) values using near-infrared spectroscopy (NIRS) before delivery and retrospectively compared them to the detection of placental chorangiosis, in a total of 47 (46 singleton and one set of dichorionic diamniotic twins) pregnant women. Small for gestational age (SGA) and/or maternal complications were observed in all cases of placental chorangiosis. Placental TOI values were significantly elevated in cases of chorangiosis. This indicates high oxygen saturation in the intervillous spaces because placental TOI values are expected to represent the oxygenation of maternal blood in the placental tissue. A possible preceding low efficiency of oxygen transfer to the fetal circulation in the villi might not only augment the oxygen saturation of maternal blood in intervillous spaces, but also cause rather low oxygenation in the capillaries of the villi and result in chorangiosis.
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Affiliation(s)
- Kazunao Suzuki
- Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Chorangiosis: The potential role of smoking and air pollution. Pathol Res Pract 2009; 205:75-81. [DOI: 10.1016/j.prp.2008.05.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Revised: 02/29/2008] [Accepted: 05/26/2008] [Indexed: 11/21/2022]
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Abstract
Placental pathology continues to be an underutilized, undertaught, and inadequately handled surgical subspecialty. The requests for placental pathology are soaring, due partly to demands from obstetricians and to the litigious environment in which they practice, and to improved obstetrical care leading to pregnancies in medically challenging situations. Evaluation of the placenta requires a good understanding of the questions and issues concerning both the fetus/infant and the mother. Information from placental pathology can be critical in early neonatal care and in reproductive planning for the family, and it can provide risk assessment for neurologic outcome of the infant. A comfortable interaction among the obstetric staff, mothers, and pathologists often obviates need for legal intervention in unexpected pregnancy outcomes. Some critical pathologic features that involve maternal and fetal management are illustrated herein. A template for gross examination and a few critical histopathologic diagnostic features with clincopathologic correlation are included.
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Affiliation(s)
- Drucilla J Roberts
- Department of Pathology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02115, USA.
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Abstract
The vascular lesions in the placenta form a heterogeneous group of possibly interrelated alterations. Gestational age distribution is different for chorangioma, chorangiosis, and chorangiomatosis; the pathogenesis is unclear, and histological features, especially those of chorangiosis and chorangiomatosis, frequently overlap. Chorangiomatosis shows intermediate features between chorangiosis and chorangioma. In this lesion, particularly when multifocal, the presence of small capillaries is similar to chorangiosis, but the gestational age is different from both chorangiosis and chorangioma. We present three cases of chorangiosis examined during one-year routine pathological analysis of placental tissue and report the histological, histochemical, and immunohistochemical features. Furthermore, we go into the difficulty of discerning the villous capillary lesions and the utility of this division, and describe the clinical effects of these lesions on fetal outcome.
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Affiliation(s)
- Adele Caldarella
- Dipartimento di Patologia Umana e Oncologia, Università degli Studi di Firenze, Firenze, Italia.
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