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Carreon CK, Ravishankar S, Parast MM, Castro EC, Baergen RN, Bonasoni MP, Cady FM, Comstock JM, Ernst LM, Kostadinov S, Linn RL, Poulin A, Sarita-Reyes CD, Zhang J, Roberts DJ. Releasing Placentas to Families: A Unified Recommendation From the Perinatal Committee of the Society for Pediatric Pathology. Arch Pathol Lab Med 2023; 147:515-517. [PMID: 37130191 DOI: 10.5858/arpa.2022-0425-le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 05/04/2023]
Affiliation(s)
- Chrystalle Katte Carreon
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sanjita Ravishankar
- Department of Pathology, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Mana M Parast
- Department of Pathology, University of California San Diego, San Diego
| | - Eumenia C Castro
- Department of Pathology and Immunology, Texas Children's Hospital and Baylor College of Medicine, Houston
| | - Rebecca N Baergen
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Maria Paola Bonasoni
- Pathology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Jessica M Comstock
- Division of Pediatric Pathology, University of Utah and Primary Children's Hospital, Salt Lake City
| | - Linda M Ernst
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, Illinois
- Department of Pathology, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Stefan Kostadinov
- Department of Pathology, Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania
| | - Rebecca L Linn
- Division of Anatomic Pathology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Alysa Poulin
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Carmen D Sarita-Reyes
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Jie Zhang
- Department of Pathology, Le Bonheur Children's Hospital, Memphis, Tennessee
- Department of Pathology, University of Tennessee Health Science Center, Memphis
| | - Drucilla J Roberts
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston
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Roberts DJ, Baergen RN, Boyd TK, Carreon CK, Duncan VE, Ernst LM, Faye-Petersen OM, Folkins AK, Hecht JL, Heerema-McKenney A, Heller DS, Linn RL, Polizzano C, Ravishankar S, Redline RW, Salafia CM, Torous VF, Castro EC. Neonatologist responsibility to ensure placentas are received for pathologic examination-response to comment on criteria for placental examination for obstetric and neonatal providers. Am J Obstet Gynecol 2023:S0002-9378(23)00067-4. [PMID: 36731816 DOI: 10.1016/j.ajog.2023.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 01/24/2023] [Indexed: 02/03/2023]
Affiliation(s)
- Drucilla J Roberts
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St. WRN 219, Boston, MA 02114.
| | - Rebecca N Baergen
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY
| | - Theonia K Boyd
- Department of Pathology, Texas Children's Hospital, Houston, TX
| | | | - Virginia E Duncan
- Division of Women's Health, Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL
| | - Linda M Ernst
- Department of Pathology, NorthShore University Health System, Evanstan, IL
| | - Ona M Faye-Petersen
- Departments of Pathology and Obstetrics and Gynecology, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL
| | - Ann K Folkins
- Department of Pathology, Stanford University and Stanford Healthcare, Stanford, CA
| | - Jonathon L Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | | | - Debra S Heller
- Department of Pathology, Rutgers New Jersey Medical School, Newark, NJ
| | - Rebecca L Linn
- Department of Pathology, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Sanjita Ravishankar
- Case Western Reserve University School of Medicine, Clevelend, OH; Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Raymond W Redline
- Departments of Pathology and Reproductive Biology, Case Western Reserve University School of Medicine, Cleveland, OH; University Hospitals Cleveland Medical Center, Cleveland, OH
| | | | - Vanda F Torous
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Eumenia C Castro
- Department of Pathology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
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Roberts DJ, Baergen RN, Boyd TK, Carreon CK, Duncan VE, Ernst LM, Faye-Petersen OM, Folkins AK, Hecht JL, Heerema-McKenney A, Heller DS, Linn RL, Polizzano C, Ravishankar S, Redline RW, Salafia CM, Torous VF, Castro EC. Criteria for placental examination for obstetrical and neonatal providers. Am J Obstet Gynecol 2022; 228:497-508.e4. [PMID: 36549567 DOI: 10.1016/j.ajog.2022.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/28/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
Pathologic examination of the placenta can provide insight into likely (and unlikely) causes of antepartum and intrapartum events, diagnoses with urgent clinical relevance, prognostic information for mother and infant, support for practice evaluation and improvement, and insight into advancing the sciences of obstetrics and neonatology. Although it is true that not all placentas require pathologic examination (although alternative opinions have been expressed), prioritization of placentas for pathologic examination should be based on vetted indications such as maternal comorbidities or pregnancy complications in which placental pathology is thought to be useful for maternal or infant care, understanding pathophysiology, or practice modifications. Herein we provide placental triage criteria for the obstetrical and neonatal provider based on publications and expert opinion of 16 placental pathologists and a pathologists' assistant, formulated using a modified Delphi approach. These criteria include indications in which placental pathology has clinical relevance, such as pregnancy loss, maternal infection, suspected abruption, fetal growth restriction, preterm birth, nonreassuring fetal heart testing requiring urgent delivery, preeclampsia with severe features, or neonates with early evidence of multiorgan system failure including neurologic compromise. We encourage a focused gross examination by the provider or an attendant at delivery for all placentas and provide guidance for this examination. We recommend that any placenta that is abnormal on gross examination undergo a complete pathology examination. In addition, we suggest practice criteria for placental pathology services, including a list of critical values to be used by the relevant provider. We hope that these sets of triage indications, criteria, and practice suggestions will facilitate appropriate submission of placentas for pathologic examination and improve its relevance to clinical care.
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Affiliation(s)
- Drucilla J Roberts
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX.
| | - Rebecca N Baergen
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Theonia K Boyd
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Chrystalle Katte Carreon
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Virginia E Duncan
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Linda M Ernst
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Ona M Faye-Petersen
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Ann K Folkins
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Jonathon L Hecht
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Amy Heerema-McKenney
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Debra S Heller
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Rebecca L Linn
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Carolyn Polizzano
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Sanjita Ravishankar
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Raymond W Redline
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Carolyn M Salafia
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Vanda F Torous
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
| | - Eumenia C Castro
- Massachusetts General Hospital Department of Pathology and Harvard Medical School, Boston, MA; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Texas Children's Hospital Department of Pathology, Houston, TX; Boston's Children's Hospital Department of Pathology and Harvard Medical School, Boston, MA; University of Alabama at Birmingham Department of Pathology, Division of Women's Health, Birmingham, AL; NorthShore University Health System, Department of Pathology, Evanston, IL; Heersink School of Medicine, University of Alabama at Birmingham, Departments of Pathology and Obstetrics and Gynecology, Birmingham, AL; Stanford Healthcare Department of Pathology and Stanford University, Stanford, CA; Beth Israel Deaconess Medical Center Department of Pathology and Harvard Medical School, Boston, MA; Cleveland Clinic, Cleveland, OH; Rutgers-New Jersey Medical School, Newark, NJ; Children's Hospital of Philadelphia, Department of Pathology, Philadelphia, PA; MidState Medical Center Department of Pathology, Meriden, CT; Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center Department of Pathology, Cleveland, OH; Case Western Reserve University School of Medicine Departments of Pathology and Reproductive Biology and University Hospitals Cleveland Medical Center, Cleveland, OH; Placental Analytics LLC, New Rochelle, NY; Texas Children's Hospital and Baylor College of Medicine, Department of Pathology, Houston, TX
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Smithgall MC, Murphy EA, Schatz-Siemers N, Matrai C, Tu J, Baergen RN, Yang YJ. Placental pathology in women vaccinated and unvaccinated against SARS-CoV-2. Am J Obstet Gynecol 2022; 227:782-784. [PMID: 35777431 PMCID: PMC9236917 DOI: 10.1016/j.ajog.2022.06.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/03/2022] [Accepted: 06/23/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Marie C Smithgall
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical Center/New York-Presbyterian Hospital, Weill Cornell Medicine, 1300 York Ave, F-701, New York, NY 10065
| | - Elisabeth A Murphy
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical Center/New York-Presbyterian Hospital, Weill Cornell Medicine, 1300 York Ave, F-701, New York, NY 10065
| | - Nina Schatz-Siemers
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical Center/New York-Presbyterian Hospital, Weill Cornell Medicine, 1300 York Ave, F-701, New York, NY 10065
| | - Cathleen Matrai
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical Center/New York-Presbyterian Hospital, Weill Cornell Medicine, 1300 York Ave, F-701, New York, NY 10065
| | - Jiangling Tu
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical Center/New York-Presbyterian Hospital, Weill Cornell Medicine, 1300 York Ave, F-701, New York, NY 10065
| | - Rebecca N Baergen
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical Center/New York-Presbyterian Hospital, Weill Cornell Medicine, 1300 York Ave, F-701, New York, NY 10065
| | - Yawei J Yang
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical Center/New York-Presbyterian Hospital, Weill Cornell Medicine, 1300 York Ave, F-701, New York, NY 10065.
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5
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Smithgall MC, Murphy EA, Rand S, Sukhu A, Singh S, Schatz-Siemers N, Matrai C, Tu J, Salvatore CM, Prabhu M, Permar S, Riley LE, Robinson BD, Baergen RN, Yang YJ. Placental pathology, neonatal birth weight, and Apgar score in acute and distant SARS-CoV-2 infection. J Clin Transl Res 2022; 8:351-359. [PMID: 36518545 PMCID: PMC9741934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Most research on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy has been on acute infections with limited data on the effect of distant infection. AIM We examined placental pathology and neonatal outcomes in distant SARS-CoV-2 infection earlier in pregnancy compared to acute infections late in pregnancy/at birth and to non-SARS-CoV-2 infected patients with other placental pathologies/clinical presentations. METHODS Placentas birthed to unvaccinated patients with SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) testing and serology testing results from time of delivery were included in this study. A total of 514 singleton placentas between April 18, 2020, and July 26, 2021, were included: 77 acute SARS-CoV-2 infection (RT-PCR positive and serology negative); 222 distant SARS-CoV-2 infection (RT-PCR negative but serology IgG-positive); and 215 non-SARS-Cov-2 infected (RT-PCR negative, serology negative, and history negative) with other placental pathologies: preeclampsia/hypertension, intrauterine growth restriction (IUGR), diabetes, chorioamnionitis, and meconium. Placental pathology findings, Apgar scores, and neonatal birth weights were compared. RESULTS Placentas from the acute group had significantly more villous agglutination (10.4%, P = 0.015) and eosinophilic T-cell vasculitis (5.2%, P = 0.004) compared to placentas from the distant group (2.7% and 0%) and non-SARS-CoV-2 placentas (1.9% and 0.9%). One acute case showed SARS-CoV-2 placentitis and resulted in preterm delivery at 25 weeks. Both the preeclampsia/hypertension and the IUGR groups showed significantly more maternal vascular malperfusion findings compared to the acute (6.5%, 6.5% and 1.3%) and distant (7.7%, 7.7%, and 3.2%) groups. Fetal vascular malperfusion findings such as thrombosis of fetal vessels (17.4% P = 0.042) and intramural fibrin deposition (21.7% P = 0.026) were significantly higher in the IUGR group compared to acute (7.8%; 2.6%) and distant (3.6%; 8.1%) infection. Many neonates born to patients infected with SARS-CoV-2 had birth weights outside of 95% confidence range of observed birth weights. There was no association of Apgar scores with infection status or placental pathology. CONCLUSION Acute and distant SARS-CoV-2 infections present differing placental pathology. RELEVANCE FOR PATIENTS SARS-CoV-2 infection during pregnancy has demonstrable effects on the placenta with potential significant impacts for maternal and fetal health. Prevention of maternal SARS-CoV-2 infection, primarily through vaccination, remains the best mitigation strategy to prevent sequelae of maternal SARS-CoV-2 infection.
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Affiliation(s)
- Marie C. Smithgall
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10065, United States
| | - Elisabeth A. Murphy
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10065, United States
| | - Sophie Rand
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10065, United States
| | - Ashley Sukhu
- New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY 10065, United States
| | - Sunidhi Singh
- Weill Medical College, Weill Cornell Medicine, New York, NY 10065, United States
| | - Nina Schatz-Siemers
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10065, United States
| | - Cathleen Matrai
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10065, United States
| | - Jiangling Tu
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10065, United States
| | | | - Malavika Prabhu
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY 10065, United States
| | - Sallie Permar
- Department of Pediatrics, Weill Cornell Medicine, New York, NY 10065, United States
| | - Laura E. Riley
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY 10065, United States
| | - Brian D. Robinson
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10065, United States
| | - Rebecca N. Baergen
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10065, United States
| | - Yawei J. Yang
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10065, United States
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6
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Argueta LB, Lacko LA, Bram Y, Tada T, Carrau L, Rendeiro AF, Zhang T, Uhl S, Lubor BC, Chandar V, Gil C, Zhang W, Dodson BJ, Bastiaans J, Prabhu M, Houghton S, Redmond D, Salvatore CM, Yang YJ, Elemento O, Baergen RN, tenOever BR, Landau NR, Chen S, Schwartz RE, Stuhlmann H. Inflammatory responses in the placenta upon SARS-CoV-2 infection late in pregnancy. iScience 2022; 25:104223. [PMID: 35434541 PMCID: PMC8996470 DOI: 10.1016/j.isci.2022.104223] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/25/2022] [Accepted: 04/05/2022] [Indexed: 02/06/2023] Open
Abstract
The effect of SARS-CoV-2 infection on placental function is not well understood. Analysis of placentas from women who tested positive at delivery showed SARS-CoV-2 genomic and subgenomic RNA in 22 out of 52 placentas. Placentas from two mothers with symptomatic COVID-19 whose pregnancies resulted in adverse outcomes for the fetuses contained high levels of viral Alpha variant RNA. The RNA was localized to the trophoblasts that cover the fetal chorionic villi in direct contact with maternal blood. The intervillous spaces and villi were infiltrated with maternal macrophages and T cells. Transcriptome analysis showed an increased expression of chemokines and pathways associated with viral infection and inflammation. Infection of placental cultures with live SARS-CoV-2 and spike protein-pseudotyped lentivirus showed infection of syncytiotrophoblast and, in rare cases, endothelial cells mediated by ACE2 and Neuropilin-1. Viruses with Alpha, Beta, and Delta variant spikes infected the placental cultures at significantly greater levels.
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Affiliation(s)
- Lissenya B. Argueta
- Department of Cell and Developmental Biology, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, USA
| | - Lauretta A. Lacko
- Department of Surgery, Weill Cornell Medicine, New York, NY 10065, USA
| | - Yaron Bram
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Takuya Tada
- Department of Microbiology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Lucia Carrau
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - André Figueiredo Rendeiro
- Institute for Computational Biomedicine, Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY 10065, USA,Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Tuo Zhang
- Genomics Resources Facility, Weill Cornell Medicine, New York, NY 10065, USA
| | - Skyler Uhl
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Brienne C. Lubor
- Department of Cell and Developmental Biology, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, USA
| | - Vasuretha Chandar
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Cristianel Gil
- Department of Surgery, Weill Cornell Medicine, New York, NY 10065, USA
| | - Wei Zhang
- Genomics Resources Facility, Weill Cornell Medicine, New York, NY 10065, USA
| | - Brittany J. Dodson
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Jeroen Bastiaans
- Department of Cell and Developmental Biology, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, USA
| | - Malavika Prabhu
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Sean Houghton
- Division of Regenerative Medicine, Ansary Stem Cell Institute, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - David Redmond
- Division of Regenerative Medicine, Ansary Stem Cell Institute, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Christine M. Salvatore
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Weill Cornell Medicine, New York, NY 10065, USA
| | - Yawei J. Yang
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Olivier Elemento
- Institute for Computational Biomedicine, Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY 10065, USA,Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Rebecca N. Baergen
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10065, USA
| | - Benjamin R. tenOever
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Nathaniel R. Landau
- Department of Microbiology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Shuibing Chen
- Department of Surgery, Weill Cornell Medicine, New York, NY 10065, USA,Corresponding author
| | - Robert E. Schwartz
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York, NY 10065, USA,Corresponding author
| | - Heidi Stuhlmann
- Department of Cell and Developmental Biology, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, USA,Department of Pediatrics, Weill Cornell Medicine, New York, NY 10065, USA,Corresponding author
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7
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Murdock TA, Varghese A, Xing D, Schoolmeester JK, Alexander C, Baergen RN, Dahoud W, Hopkins MR, Askin F, Vang R. Bizarre Chorionic-type Trophoblast in Second-trimester and Third-trimester Placentas: Clinicopathologic Characterization of a Placental Pseudoneoplastic Lesion. Am J Surg Pathol 2022; 46:258-267. [PMID: 34799484 DOI: 10.1097/pas.0000000000001838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Bizarre (atypical/symplastic) cells have been described in various gynecologic normal tissues and benign neoplasms. This type of bizarre cytologic change is usually an incidental finding and is regarded as a benign process. We describe 17 cases of bizarre chorionic-type trophoblast in second-trimester and third-trimester placentas that created concern for an underlying/undersampled or incipient intraplacental trophoblastic neoplasm, predominantly found in intervillous trophoblastic islands (11/17), placental septae (6/17), chorionic plate (1/17), and/or the chorion layer of fetal membranes (2/17). The bizarre trophoblastic cells exhibited sheet-like or nested architecture, had a multifocal/patchy distribution, and/or were present as individual cells within hyaline stroma; they were characterized by large nuclei with smudgy chromatin and occasional intranuclear pseudoinclusions. The degree of atypia was classified as mild (0/17), moderate (3/17), or severe (14/17). Mitotic figures and necrosis were not identified. A dual immunohistochemical stain for trophoblast (hydroxyl-delta-5-steroid dehydrogenase) and a proliferation marker (Ki-67), performed in 15 cases, demonstrated 0% to very low proliferative activity within the bizarre trophoblast (0% to 2% [10/15], 3% to 8% [5/15]). Immunohistochemical stains for fumarate hydratase showed intact/retained expression in the bizarre cells in 7 of 7 cases. Clinical follow-up ranged from 1 to 45 months, and all patients were alive and well without subsequent evidence of a gestational trophoblastic or other neoplasms. We conclude that bizarre chorionic-type trophoblast in second-trimester or third-trimester placentas have the potential to mimic an intraplacental trophoblastic neoplasm but are likely a benign degenerative change. This study expands the spectrum of bizarre cells that occur in the gynecologic tract.
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Affiliation(s)
| | - Aaron Varghese
- Gynecology and Obstetrics, The Johns Hopkins Medical Institutions, Baltimore, MD
| | | | | | | | - Rebecca N Baergen
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY
| | | | | | - Frederic Askin
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC
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8
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Glynn SM, Yang YJ, Thomas C, Friedlander RL, Cagino KA, Matthews KC, Riley LE, Baergen RN, Prabhu M. SARS-CoV-2 and Placental Pathology: Malperfusion Patterns Are Dependent on Timing of Infection During Pregnancy. Am J Surg Pathol 2022; 46:51-57. [PMID: 34310367 PMCID: PMC8662940 DOI: 10.1097/pas.0000000000001772] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The extent to which severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection at different points in the pregnancy timeline may affect maternal and fetal outcomes remains unknown. We sought to characterize the impact of SARS-CoV-2 infection proximate and remote from delivery on placental pathology. We performed a secondary analysis of placental pathology from a prospective cohort of universally tested SARS-CoV-2 positive women >20 weeks gestation at 1 institution. Subjects were categorized as having acute or nonacute SARS-CoV-2 based on infection <14 or ≥14 days from delivery admission, respectively, determined by nasopharyngeal swab, symptom history, and serologies, when available. A subset of SARS-CoV-2 negative women represented negative controls. Placental pathology was available for 90/97 (92.8%) of SARS-CoV-2 positive women, of which 26 were from women with acute SARS-CoV-2 infection and 64 were from women with nonacute SARS-CoV-2. Fetal vascular malperfusion lesions were significantly more frequent among the acute SARS-CoV-2 group compared with the nonacute SARS-CoV-2 group (53.8% vs. 18.8%; P=0.002), while frequency of maternal vascular malperfusion lesions did not differ by timing of infection (30.8% vs. 29.7%; P>0.99). When including 188 SARS-CoV-2 negative placentas, significant differences in frequency of fetal vascular malperfusion lesions remained between acute, nonacute and control cases (53.8% vs. 18.8% vs. 13.2%, respectively; P<0.001). No differences were noted in obstetric or neonatal outcomes between acutely and nonacutely infected women. Our findings indicate timing of infection in relation to delivery may alter placental pathology, with potential clinical implications for risk of thromboembolic events and impact on fetal health.
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Affiliation(s)
| | - Yawei J. Yang
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital/Weill Cornell Medicine
| | | | | | | | | | - Laura E. Riley
- Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY
| | - Rebecca N. Baergen
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital/Weill Cornell Medicine
| | - Malavika Prabhu
- Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY
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9
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Argueta LB, Lacko LA, Bram Y, Tada T, Carrau L, Zhang T, Uhl S, Lubor BC, Chandar V, Gil C, Zhang W, Dodson B, Bastiaans J, Prabhu M, Salvatore CM, Yang YJ, Baergen RN, tenOever BR, Landau NR, Chen S, Schwartz RE, Stuhlmann H. SARS-CoV-2 Infects Syncytiotrophoblast and Activates Inflammatory Responses in the Placenta. bioRxiv 2021:2021.06.01.446676. [PMID: 34100019 PMCID: PMC8183016 DOI: 10.1101/2021.06.01.446676] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
SARS-CoV-2 infection during pregnancy leads to an increased risk of adverse pregnancy outcomes. Although the placenta itself can be a target of virus infection, most neonates are virus free and are born healthy or recover quickly. Here, we investigated the impact of SARS-CoV-2 infection on the placenta from a cohort of women who were infected late during pregnancy and had tested nasal swab positive for SARS-CoV-2 by qRT-PCR at delivery. SARS-CoV-2 genomic and subgenomic RNA was detected in 23 out of 54 placentas. Two placentas with high virus content were obtained from mothers who presented with severe COVID-19 and whose pregnancies resulted in adverse outcomes for the fetuses, including intrauterine fetal demise and a preterm delivered baby still in newborn intensive care. Examination of the placental samples with high virus content showed efficient SARS-CoV-2 infection, using RNA in situ hybridization to detect genomic and replicating viral RNA, and immunohistochemistry to detect SARS-CoV-2 nucleocapsid protein. Infection was restricted to syncytiotrophoblast cells that envelope the fetal chorionic villi and are in direct contact with maternal blood. The infected placentas displayed massive infiltration of maternal immune cells including macrophages into intervillous spaces, potentially contributing to inflammation of the tissue. Ex vivo infection of placental cultures with SARS-CoV-2 or with SARS-CoV-2 spike (S) protein pseudotyped lentivirus targeted mostly syncytiotrophoblast and in rare events endothelial cells. Infection was reduced by using blocking antibodies against ACE2 and against Neuropilin 1, suggesting that SARS-CoV-2 may utilize alternative receptors for entry into placental cells.
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Affiliation(s)
- Lissenya B. Argueta
- Department of Cell and Developmental Biology, Weill Cornell Medicine, 1300 York Avenue, New York 10065, NY, USA
| | | | - Yaron Bram
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Takuya Tada
- Department of Microbiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Lucia Carrau
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tuo Zhang
- Genomics Resources Facility, Weill Cornell Medicine, New York, NY, USA
| | - Skyler Uhl
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brienne C. Lubor
- Department of Cell and Developmental Biology, Weill Cornell Medicine, 1300 York Avenue, New York 10065, NY, USA
| | - Vasuretha Chandar
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Cristianel Gil
- Department of Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Wei Zhang
- Genomics Resources Facility, Weill Cornell Medicine, New York, NY, USA
| | - Brittany Dodson
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - Jeroen Bastiaans
- Department of Cell and Developmental Biology, Weill Cornell Medicine, 1300 York Avenue, New York 10065, NY, USA
| | - Malavika Prabhu
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - Christine M. Salvatore
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | - Yawei J. Yang
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA,Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Rebecca N. Baergen
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Benjamin R. tenOever
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nathaniel R. Landau
- Department of Microbiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Shuibing Chen
- Department of Surgery, Weill Cornell Medicine, New York, NY, USA,Corresponding Authors: Heidi Stuhlmann PhD (lead contact) , Robert Schwartz MD-PhD , Shuibing Chen PhD
| | - Robert E. Schwartz
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA,Corresponding Authors: Heidi Stuhlmann PhD (lead contact) , Robert Schwartz MD-PhD , Shuibing Chen PhD
| | - Heidi Stuhlmann
- Department of Cell and Developmental Biology, Weill Cornell Medicine, 1300 York Avenue, New York 10065, NY, USA,Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA,Corresponding Authors: Heidi Stuhlmann PhD (lead contact) , Robert Schwartz MD-PhD , Shuibing Chen PhD
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10
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Prabhu M, Cagino K, Matthews KC, Friedlander RL, Glynn SM, Kubiak JM, Yang YJ, Zhao Z, Baergen RN, DiPace JI, Razavi AS, Skupski DW, Snyder JR, Singh HK, Kalish RB, Oxford CM, Riley LE. Pregnancy and postpartum outcomes in a universally tested population for SARS-CoV-2 in New York City: a prospective cohort study. BJOG 2020; 127:1548-1556. [PMID: 32633022 PMCID: PMC7361728 DOI: 10.1111/1471-0528.16403] [Citation(s) in RCA: 166] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To describe differences in outcomes between pregnant women with and without coronavirus dsease 2019 (COVID-19). DESIGN Prospective cohort study of pregnant women consecutively admitted for delivery, and universally tested via nasopharyngeal (NP) swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using reverse transcription-polymerase chain reaction. All infants of mothers with COVID-19 underwent SARS-CoV-2 testing. SETTING Three New York City hospitals. POPULATION Pregnant women >20 weeks of gestation admitted for delivery. METHODS Data were stratified by SARS-CoV-2 result and symptomatic status, and were summarised using parametric and nonparametric tests. MAIN OUTCOME MEASURES Prevalence and outcomes of maternal COVID-19, obstetric outcomes, neonatal SARS-CoV-2, placental pathology. RESULTS Of 675 women admitted for delivery, 10.4% were positive for SARS-CoV-2, of whom 78.6% were asymptomatic. We observed differences in sociodemographics and comorbidities among women with symptomatic COVID-10 versus asymptomatic COVID-19 versus no COVID-19. Caesarean delivery rates were 46.7% in symptomatic COVID-19, 45.5% in asymptomatic COVID-19 and 30.9% in women without COVID-19 (P = 0.044). Postpartum complications (fever, hypoxia, readmission) occurred in 12.9% of women with COVID-19 versus 4.5% of women without COVID-19 (P < 0.001). No woman required mechanical ventilation, and no maternal deaths occurred. Among 71 infants tested, none were positive for SARS-CoV-2. Placental pathology demonstrated increased frequency of fetal vascular malperfusion, indicative of thrombi in fetal vessels, in women with COVID-19 versus women without COVID-19 (48.3% versus 11.3%, P < 0.001). CONCLUSION Among pregnant women with COVID-19 at delivery, we observed increased caesarean delivery rates and increased frequency of maternal complications in the postpartum period. Additionally, intraplacental thrombi may have maternal and fetal implications for COVID-19 remote from delivery. TWEETABLE ABSTRACT COVID-19 at delivery: more caesarean deliveries, postpartum complications and intraplacental thrombi.
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Affiliation(s)
- M Prabhu
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - K Cagino
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - K C Matthews
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, NY, USA
| | | | - S M Glynn
- Weill Cornell Medicine, New York, NY, USA
| | - J M Kubiak
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Y J Yang
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Z Zhao
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - R N Baergen
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - J I DiPace
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - A S Razavi
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, NY, USA.,Department of Obstetrics & Gynecology, New York Presbyterian Queens, Queens, NY, USA
| | - D W Skupski
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, NY, USA.,Department of Obstetrics & Gynecology, New York Presbyterian Queens, Queens, NY, USA
| | - J R Snyder
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, NY, USA.,Departments of Obstetrics & Gynecology, New York Presbyterian Lower Manhattan Hospital, New York, NY, USA
| | - H K Singh
- Division of Infectious Diseases, Weill Cornell Medicine, New York Presbyterian Lower Manhattan Hospital, New York, NY, USA
| | - R B Kalish
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - C M Oxford
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - L E Riley
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, NY, USA
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11
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Abstract
INTRODUCTION Proper placental gross examination requires weighing the placental disc trimmed of fetal membranes and the umbilical cord. However, untrimmed placental weights are often reported, both in cases submitted for consultation and in publications. Thus, determining the contribution of membranes and cords to untrimmed placental weights would be helpful in estimating the true trimmed weight of placentas. We sought to report the average weights of membranes and cord in term placentas and to correlate these weights with common placental pathologies. METHODS A total of 500 consecutive placentas delivered between 36 and 42 weeks gestational age were subjected to a modified grossing protocol, in which the weight of the trimmed and untrimmed placentas, fetal membranes, and umbilical cords were recorded. Acute chorioamnionitis, meconium, maternal vascular malperfusion, and fetal vascular malperfusion were included as pathologic correlates. Clinical data such as the presence of fetal hydrops, intrauterine growth restriction, intrauterine fetal demise, and maternal diabetes were also recorded. RESULTS The mean weights of the trimmed placenta, fetal membranes, and umbilical cords were 442 g (180-805 g), 47.2 g (16-108 g), and 37.9 g (9-126 g), respectively. The fetal membranes and umbilical cord weights contributed a mean of 16% to the total untrimmed placental weight. Meconium was associated with heavier fetal membranes. Fetal vascular malperfusion was associated with longer umbilical cord and thus also with heavier umbilical cords. Maternal vascular malperfusion and intrauterine growth restriction were associated with lighter placentas. DISCUSSION The trimmed placental disc weight may be estimated by subtracting 16% (ie, weight of the fetal membranes and umbilical cord) from the untrimmed placental weight, or alternatively by subtracting the mean weight of the membranes and umbilical cord. It is important to consider the effects of meconium, fetal and maternal vascular malperfusion, and intrauterine growth restriction on membrane and cord weights when estimating the trimmed placental disc weight.
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Affiliation(s)
- Lucy X Ma
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Daniel Levitan
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York.,Department of Pathology, SUNY Downstate, Brooklyn, New York
| | - Rebecca N Baergen
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
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12
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13
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Abstract
This study describes the pathology and clinical information on 20 placentas whose mother tested positive for the novel Coronovirus (2019-nCoV) cases. Ten of the 20 cases showed some evidence of fetal vascular malperfusion or fetal vascular thrombosis. The significance of these findings is unclear and needs further study.
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Affiliation(s)
- Rebecca N Baergen
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Debra S Heller
- Department of Pathology, Immunology & Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, New Jersey
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Mulvey JJ, Magro CM, Ma LX, Nuovo GJ, Baergen RN. WITHDRAWN: A mechanistic analysis placental intravascular thrombus formation in COVID-19 patients. Ann Diagn Pathol 2020; 46:151529. [PMID: 32361635 PMCID: PMC7195270 DOI: 10.1016/j.anndiagpath.2020.151529] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 02/06/2023]
Affiliation(s)
- J Justin Mulvey
- Department of Laboratory Medicine, Memorial Sloan-Kettering Cancer Center, United States of America
| | - Cynthia M Magro
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, United States of America
| | - Lucy X Ma
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, United States of America
| | - Gerard J Nuovo
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America; Discovery Life Sciences, Powell, OH, United States of America
| | - Rebecca N Baergen
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, United States of America
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15
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Mulvey JJ, Magro CM, Ma LX, Nuovo GJ, Baergen RN. Analysis of complement deposition and viral RNA in placentas of COVID-19 patients. Ann Diagn Pathol 2020; 46:151530. [PMID: 32387855 PMCID: PMC7182529 DOI: 10.1016/j.anndiagpath.2020.151530] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 01/08/2023]
Abstract
COVID-19, the disease caused by the novel Coronavirus, SARS-CoV-2, is increasingly being recognized as a systemic thrombotic and microvascular injury syndrome that may have its roots in complement activation. We had the opportunity to study the placental pathology of five full-term births to COVID-19 patients. All five exhibited histology indicative of fetal vascular malperfusion characterized by focal avascular villi and thrombi in larger fetal vessels. Vascular complement deposition in the placentas was not abnormal, and staining for viral RNA and viral spike protein was negative. While all cases resulted in healthy, term deliveries, these findings indicate the systemic nature of COVID-19 infection. The finding of vascular thrombosis without complement deposition may reflect the systemic nature of COVID-19's procoagulant effects unrelated to systemic complement activation. This paper explores thrombosis in the placentas COVID-19-positive patients at our hospital Potential prothrombotic mechanisms are explored. Direct infection of the placentas is ruled out as a cause.
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Affiliation(s)
- J Justin Mulvey
- Department of Laboratory Medicine, Memorial Sloan-Kettering Cancer Center, United States of America
| | - Cynthia M Magro
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, United States of America
| | - Lucy X Ma
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, United States of America
| | - Gerard J Nuovo
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America; Discovery Life Sciences, Powell, OH, United States of America
| | - Rebecca N Baergen
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, United States of America.
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Baergen RN. Kurt Benirschke, MD (1924-2018): Pioneer in Perinatal and Placental Pathology. Pediatr Dev Pathol 2019; 22:399-405. [PMID: 31003591 DOI: 10.1177/1093526619843723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Kurt Benirschke, noted pathologist and animal conservationist, passed away on September 10, 2018 at the age of 94. Kurt Benirschke is a legendary figure in perinatal pathology and was likely the first pathologist to have a genuine interest in the placenta. With Shirley Driscoll, he wrote the first textbook on placental pathology-The Pathology of the Human Placenta published in 1967. Dr Benirschke combined interests in both human and animal biology-not only was he a noted pathologist and geneticist, but he had expertise in the reproduction of humans and many mammalian species. During his career, he advanced comparative pathology of placentation, and due to his work on the preservation of endangered species, he likely saved a number of species from extinction. He also became internationally known for his creation of the "frozen zoo" collecting embryos and tissues of numerous endangered species. I have been privileged to be among his many friends and colleagues who were awed by the breadth of his extensive knowledge, his humility, and his sense of humor. Benirschke's life and career, which is reviewed here, should be an inspiration to the Pediatric and Developmental Pathology readership.
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Affiliation(s)
- Rebecca N Baergen
- Surgical Pathology, Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, Weill Cornell Medicine, New York, New York
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Matrai CE, Rand JH, Baergen RN. Absence of Distinct Immunohistochemical Distribution of Annexin A5, C3b, C4d, and C5b-9 in Placentas From Patients With Antiphospholipid Antibodies, Preeclampsia, and Systemic Lupus Erythematosus. Pediatr Dev Pathol 2019; 22:431-439. [PMID: 30922166 DOI: 10.1177/1093526619836025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION In pregnancy, the presence of preeclampsia (PEC), systemic lupus erythematosus (SLE), and/or antiphospholipid antibody syndrome (APLS) is characterized by poor obstetric outcomes, with potential adverse effects for both mother and fetus. Although the histopathologic changes observed in these entities have been well established, the pathogenic mediators associated with tissue injury are poorly understood. METHODS Forty placentas were evaluated, including 10 patients with preeclampsia, 9 with SLE, 11 with APLS, and 10 disease-free controls. Each case was subjected to a panel of immunohistochemical markers including C3b, C4d, Annexin A5, and C5b-9. Staining was graded on intensity and distribution. RESULTS C4d staining was distinctly different among disease groups and controls. Moreover, 6/10 PEC cases, 3/9 SLE cases, and 4/11 APLS cases showed at least focal staining for C4d. All controls were negative. Annexin A5 (AnxA5) staining showed intrinsic variability in all disease groups, while 10/10 controls showed diffuse, strong staining (2+ or 3+). C3b staining was heterogeneous among groups. DISCUSSION Previously, antiphospholipid antibody (aPLA)-associated pregnancy complications have been thought to be a consequence of a unique aPLA-mediated pathogenic mechanism. However, the immunohistochemical similarity (increased complement and decreased AnxA5 staining) observed in placentas from patients with APLS, PEC, and SLE suggests that aPLA-associated pregnancy complications may reflect a more general autoimmune mechanism.
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Affiliation(s)
- Cathleen E Matrai
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, New York
| | - Jacob H Rand
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, New York
| | - Rebecca N Baergen
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, New York
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18
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Abstract
INTRODUCTION Chorangiosis is a proliferation of capillaries in terminal chorionic villi and is considered to be a marker for hypoxia and poor clinical outcome. Not all cases with hypervascular villi meet the generally accepted diagnostic criteria as reported by Altshuler. Our aim was to evaluate cases with villous hypervascularity that do not meet the diagnosis of chorangiosis, in which increased vascularity was present in a significant portion of the villous tissue but was not a diffuse process, which we call focal chorangiosis, to ascertain whether there were clinical or pathologic associations. MATERIALS AND METHODS A total of 175 placentas with the finding of focal chorangiosis and 176 maternal age- and gestational age-matched controls were evaluated retrospectively. We defined focal chorangiosis as villous hypervascularity that did not meet criteria for a diagnosis of chorangiosis, but in which there was involvement of at least 50% of villi on at least 2 of 3 slides of placental tissue or involvement of all the villi on 1 slide. In these focal areas, the criteria of 10 capillaries in each of 10 villi in ten 10× microscopic fields were required. RESULTS We found that focal chorangiosis is associated with a decrease in Apgar scores, increased placental weight, fetal vascular thrombosis (fetal vascular malperfusion), umbilical cord abnormalities, increased fetal nucleated red blood cells, villous dysmaturity, and increased rate of vaginal delivery. DISCUSSION Many of these associations are shared with chorangiosis as traditionally defined, suggesting that focal chorangiosis is a significant finding that should be reported.
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Affiliation(s)
- Diana K Sung
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Rebecca N Baergen
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
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Massimiani M, Lacko LA, Burke Swanson CS, Salvi S, Argueta LB, Moresi S, Ferrazzani S, Gelber SE, Baergen RN, Toschi N, Campagnolo L, Stuhlmann H. Increased circulating levels of Epidermal Growth Factor-like Domain 7 in pregnant women affected by preeclampsia. Transl Res 2019; 207:19-29. [PMID: 30620888 PMCID: PMC6486846 DOI: 10.1016/j.trsl.2018.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/30/2018] [Accepted: 12/19/2018] [Indexed: 11/23/2022]
Abstract
Proper placental development is crucial to establish a successful pregnancy. Defective placentation is the major cause of several pregnancy complications, including preeclampsia (PE). We have previously demonstrated that the secreted factor Epidermal Growth Factor-like Domain 7 (EGFL7) is expressed in trophoblast cells of the human placenta and that it regulates trophoblast migration and invasion, suggesting a role in placental development. In the present study, we demonstrate that circulating levels of EGFL7 are undetectable in nonpregnant women, increase during pregnancy and decline toward term. Close to term, circulating levels of EGFL7 are significantly higher in patients affected by PE when compared to normal pregnancies. Consistent with these results, villus explant cultures obtained from placentas affected by PE display increased release of EGFL7 in the culture medium when compared to those from normal placentas. Our results suggest that increased release of placenta-derived EGFL7 and increased circulating levels of EGFL7 are associated with the clinical manifestation of PE.
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Affiliation(s)
- Micol Massimiani
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Lauretta A Lacko
- Department of Cell and Developmental Biology, Weill Cornell Medical College, New York, New York
| | - Clare S Burke Swanson
- Department of Cell and Developmental Biology, Weill Cornell Medical College, New York, New York
| | - Silvia Salvi
- Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lissenya B Argueta
- Department of Cell and Developmental Biology, Weill Cornell Medical College, New York, New York
| | - Sascia Moresi
- Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sergio Ferrazzani
- Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Shari E Gelber
- Department of ObGyn, Weill Cornell Medical College, New York, New York
| | - Rebecca N Baergen
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York
| | - Nicola Toschi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy; Department of Radiology, "Athinoula A. Martinos" Center for Biomedical Imaging, and Harvard Medical School, Boston, Massachusetts
| | - Luisa Campagnolo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - Heidi Stuhlmann
- Department of Cell and Developmental Biology, Weill Cornell Medical College, New York, New York.
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Grossman TB, Heller DS, Baergen RN. Isolated acute funisitis in the absence of acute chorioamnionitis: What does it mean? Placenta 2018; 75:42-44. [PMID: 30712665 DOI: 10.1016/j.placenta.2018.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/20/2018] [Accepted: 12/04/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Acute funisitis (AF) is most commonly associated with acute chorioamnionitis (AC) and ascending infection. The significance of cases of AF without associated AC or isolated funisitis (IF) is unknown. Our objective was to evaluate clinical and pathologic features of IF and to determine its significance. STUDY DESIGN This was a retrospective review of placentas of patients delivering at our institution from 1997 to 2017. Placentas with the diagnosis of IF comprised the study population and placentas without either AF or AC served as controls. RESULTS There were 156 cases and 181 controls identified. Maternal age, gestational age, birthweight and mode of delivery were similar in both groups. 132 (84.6%) of cases of IF had meconium, with 62 (47.0%) having meconium only in the membranes, 36 (27.3%) in the membranes and cord and 34 (25.6%) in the membranes and cord with associated myonecrosis. 72 (38.7%) of controls had microscopically identified meconium, with only one (1.4%) showing meconium in the cord. None had myonecrosis (p < .001). There was also a significantly higher rate of intrauterine fetal demise (IUFD) in the IF group (p = .027). but the rate of suspected Intrauterine growth restriction (IUGR) was significantly greater in the controls (p = .014). CONCLUSION IF is highly associated with the presence of meconium discharge and meconium-associated myonecrosis of umbilical vessels. The inflammation in IF may be the result of damage to the muscle fibers of the cord due to meconium but additional studies are necessary to understand the significance of these findings.
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Affiliation(s)
- Tracy B Grossman
- Weill Cornell Medical College, Department of Obstetrics & Gynecology, 525 E 68th St, New York, NY, 10065, USA.
| | - Debra S Heller
- Rutgers New Jersey Medical School, Department of Pathology, Immunology and Laboratory Medicine, 185 South Orange Ave-UH E158, Newark, NJ, 07103, USA.
| | - Rebecca N Baergen
- Weill Cornell Medical College, Department of Pathology and Laboratory Medicine, 520 E 70th St, New York, NY, 10065, USA.
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21
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Abstract
The placenta is a fetal organ, composed of fetal DNA and as such reflects the fetal phenotype. The placenta consists of an umbilical cord, fetal membranes (amnion and chorion), and the placental disc which in turn is comprised of villous tissue. Both maternal and fetal disorders have placental sequelae and placental abnormalities can affect both maternal and fetal well-being. As such, placentas are often helpful in future maternal and neonatal healthcare. Thus, examination of the placenta is important for both mother and infant. On this basis, a list of indications for placental examinations has been created by a multidisciplinary group of pathologists, maternal-fetal-medicine specialists, and neonatologists that, if followed, will ensure that the vast majority of placentas that ultimately show any significant pathology will be examined (Arch Pathol Lab Med, 121, 1997, 449-76). This list include fetal, maternal, and placental indications. This chapter will discuss those indications as well as give a brief overview of macroscopic placental examination and procedure.
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Affiliation(s)
- Rebecca N Baergen
- Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
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22
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Pereira N, Elias RT, Gunnala V, Baergen RN. Sonographic, Hysteroscopic, and Histopathological Findings of a Placental Site Nodule. J Minim Invasive Gynecol 2017; 24:891-892. [PMID: 28196775 DOI: 10.1016/j.jmig.2017.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 02/03/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Nigel Pereira
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY.
| | - Rony T Elias
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY
| | - Vinay Gunnala
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY
| | - Rebecca N Baergen
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
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23
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Abstract
Decidual vasculopathy (DV) is a general term for a number of lesions involving uteroplacental vessels. It is often seen in preeclamptic placentas and indicates a disorder of uteroplacental malperfusion and is associated with placental ischemia and infarction. Although some have advocated submitting special sections in order to better document DV, it is unclear which placental sections have the highest yield in demonstrating these abnormal vessels. Seventy-six consecutive cases of decidual vasculopathy were identified and evaluated for location of DV, as well as presence of other lesions of ischemic change, infarcts, and retroplacental hematomas. Sections reviewed were the membrane roll (MR), full thickness (FT) sections of the placental disc, and sections specifically of the basal plate (BP). DV was found in the MR in 67.1% of cases, in FT sections in 32.9%, and in the BP in 25.0% of cases ( P value = .004). DV was exclusive to the MR in 53.9%, the FT in 14.5%, and the BP in 9.2%. DV was present in 2 locations in 19.7% and in all 3 locations in 2.6%. The presence of DV in any location (MR, FT, and BP) was associated with placental ischemic change but not specifically with infarcts or retroplacental hematomas. The specific location of DV showed no difference in the presence of placental lesions. Our findings indicate DV is often present in 1 location and is associated with lesions of malperfusion. It is recommended that when clinically indicated, additional sections are submitted to demonstrate decidual vasculopathy.
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Affiliation(s)
- Joanna Sy Chan
- 1 Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Debra S Heller
- 2 Department of Pathology and Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Rebecca N Baergen
- 3 Department of Pathology and Laboratory Medicine, Weill-Cornell Medical College, New York, USA
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Abstract
Intrauterine passage of meconium is common, occurring in approximately 10-15% of term births. Uncommonly, long-standing meconium exposure is associated with umbilical vascular myonecrosis, but few studies have evaluated specific clinical and pathologic features. This is a retrospective study of 481 term placentas: 139 with meconium-associated myonecrosis, 139 with meconium in fetal membranes, only 62 with meconium in the cord without myonecrosis, and 139 controls without meconium. We studied clinical factors, including clinical evidence of meconium discharge, fetal distress, APGAR scores, intrauterine growth restriction (IUGR), and intrauterine fetal demise (IUFD), and histologic factors, including acute chorioamnionitis, umbilical cord complications, uteroplacental malperfusion, fetal thrombosis, chorangiosis, and fetal nucleated red blood cells. Meconium myonecrosis was significantly associated with clinical meconium, fetal distress, IUGR, IUFD, acute chorioamnionitis, cord complications, fetal thrombosis, chorangiosis, and nucleated red blood cells when compared to controls (P < 0.05). Compared to cases with meconium in the membranes only, clinical meconium, fetal distress, IUGR, chorioamnionitis, thrombosis, chorangiosis, and nucleated red blood cells remained significant. Compared to cases with meconium in the cord without myonecrosis, only chorioamnionitis retained significance. In conclusion, myonecrosis was associated with adverse clinical outcome and placental lesions associated with hypoxia. Chorioamnionitis was significantly more common in all meconium groups compared to controls. As myonecrosis is an important lesion, a clinical history of meconium should trigger a meticulous search for meconium and specifically myonecrosis.
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Affiliation(s)
- Adela Cimic
- 525 East 68th Street, Starr Pavilion 10th Floor, New York, NY 10065, USA
| | - Rebecca N Baergen
- 525 East 68th Street, Starr Pavilion 10th Floor, New York, NY 10065, USA
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25
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Weel IC, Baergen RN, Romão-Veiga M, Borges VT, Ribeiro VR, Witkin SS, Bannwart-Castro C, Peraçoli JC, De Oliveira L, Peraçoli MT. Association between Placental Lesions, Cytokines and Angiogenic Factors in Pregnant Women with Preeclampsia. PLoS One 2016; 11:e0157584. [PMID: 27315098 PMCID: PMC4912084 DOI: 10.1371/journal.pone.0157584] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 06/01/2016] [Indexed: 11/29/2022] Open
Abstract
Preeclampsia (PE) is considered the leading cause of maternal and perinatal morbidity and mortality. The placenta seems to play an essential role in this disease, probably due to factors involved in its formation and development. The present study aimed to investigate the association between placental lesions, cytokines and angiogenic factors in pregnant women with preeclampsia (PE). We evaluated 20 normotensive pregnant women, 40 with early-onset PE and 80 with late-onset PE. Placental samples were analyzed for histopathology, immunohistochemistry and determination of granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin-10 (IL-10), transforming growth factor-beta 1 (TGF-β1), tumor necrosis factor-alpha (TNF-α), placental growth factor (PlGF), vascular endothelial growth factor (VEGF), fms-like tyrosine-kinase-1 (Flt-1) and endoglin (Eng) levels. Higher percentages of increased syncytial knots and increased perivillous fibrin deposits, and greater levels of TNF-α, TGF-β1and Flt-1 were detected in placentas from early-onset PE. Levels of IL-10, VEGF and PlGF were decreased in PE versus normotensive placentas. Both the TNF-α/IL-10 and sFlt-1/PlGF ratios were higher in placental homogenate of early-onset PE than late-onset PE and control groups. The more severe lesions and the imbalance between TNF-α/IL-10 and PlGF/sFlt-1 in placentas from early-onset PE allows differentiation of early and late-onset PE and suggests higher placental impairment in early-onset PE.
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Affiliation(s)
- Ingrid C. Weel
- Department of Gynaecology and Obstetrics, Botucatu Medical School, São Paulo State University, 18618–970, Botucatu, São Paulo, Brazil
| | - Rebecca N. Baergen
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College – New York Presbyterian Hospital, New York, United States of America
| | - Mariana Romão-Veiga
- Department of Gynaecology and Obstetrics, Botucatu Medical School, São Paulo State University, 18618–970, Botucatu, São Paulo, Brazil
| | - Vera T. Borges
- Department of Gynaecology and Obstetrics, Botucatu Medical School, São Paulo State University, 18618–970, Botucatu, São Paulo, Brazil
| | - Vanessa R. Ribeiro
- Department of Microbiology and Immunology, Institute of Biosciences, São Paulo State University, 18618–970, Botucatu, São Paulo, Brazil
| | - Steven S. Witkin
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, United States of America
| | - Camila Bannwart-Castro
- Department of Gynaecology and Obstetrics, Botucatu Medical School, São Paulo State University, 18618–970, Botucatu, São Paulo, Brazil
| | - Jose C. Peraçoli
- Department of Gynaecology and Obstetrics, Botucatu Medical School, São Paulo State University, 18618–970, Botucatu, São Paulo, Brazil
| | - Leandro De Oliveira
- Department of Gynaecology and Obstetrics, Botucatu Medical School, São Paulo State University, 18618–970, Botucatu, São Paulo, Brazil
| | - Maria T. Peraçoli
- Department of Microbiology and Immunology, Institute of Biosciences, São Paulo State University, 18618–970, Botucatu, São Paulo, Brazil
- * E-mail:
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26
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Abstract
Placentas have been often considered medical waste in hospitals. This view is particularly held by the patients themselves, who may not understand the importance of placental examination. Hospitals have been receiving requests for placental release to patients and need to be prepared to handle these requests. Therefore, a survey was conducted to explore the experiences and practices of perinatal pathologists with respect to placental release. Utilizing SurveyMonkey, we emailed a survey to 192 practicing perinatal pathologists in the United States and Canada. Questions were asked about policies in force at their particular institution, conditions of release, and the purpose of release, ie, what the disposition of the placenta was after release to the family. Thirty-six responses were received; 22 (61.1%) of respondents did allow release of placentas, and those who did not release usually reported that they had not received requests for release. In most cases, specific policies were in place, with multiple departments within the hospital having input on the creation of the policy. Parental signature was required in most cases. The most common reason for patient request was to bury the placenta, although some placental release was for consumption and/or encapsulation. Although there are no specific religious requirements for use or burial of the placenta after delivery, there are many cultural reasons for requests. Hospitals and specific providers need to be aware of this interest and have a specific policy in place so that they are prepared when a request is received.
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Affiliation(s)
- Rebecca N Baergen
- 1 Department of Pathology, New York Presbyterian Hospital-Weill-Cornell Medical Center, New York, NY, USA
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27
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Abstract
Problems and abnormalities of the umbilical cord play a significant role in perinatal morbidity and mortality. Because the umbilical cord is the lifeline of the fetus, any disruption of blood flow through the umbilical vessels can lead to severe fetal consequences.
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Affiliation(s)
- Rebecca N Baergen
- Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital, Weill Cornell Medical Center, Surgical Pathology, Starr 1002, 520 East 70th Street, New York, NY 10065, USA.
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28
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Affiliation(s)
- Rebecca N Baergen
- Professor of Pathology and Laboratory Medicine, Chief of Perinatal and Obstetric Pathology, New York-Presbyterian Hospital, Weill-Cornell Medical Center, 520 East 70th Street, Starr 1002, New York, NY 10065, USA.
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29
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Abstract
Umbilical cord complications (UCC), such as true knots (TK), velamentous (VEL) insertion, marginal umbilical cord (MUC) insertion, umbilical cord entanglement (UCE) (both nuchal and non-nuchal), excessively long umbilical cord (ELUC), and excessively twisted umbilical cord (ETUC), can lead to decreased UC blood flow and have been associated with adverse fetal outcome and intrauterine fetal demise (IUFD). Few large series exist that correlate UCC with specific pathologic findings of the placenta. We present the largest series of UCC at this time. Eight hundred forty-one 3rd-trimester placentas with UCC were identified, as well as 858 randomly selected gestational age-matched placentas with grossly unremarkable UC. Lesions associated with circulatory stasis and thrombosis, including villous capillary congestion (VC), umbilical vessel distension (UVD), chorionic plate vessel distension (CPD), umbilical vessel thrombosis (UVT), fetal vascular thrombosis (FVT), intimal fibrin cushions (IFC), and avascular villi (AV), were noted, as well as other pathologic lesions. Data were analyzed by analysis of variance and Fisher exact tests, with P < 0.05 statistically significant. Umbilical cord complications as a group was associated with a significant increase in placental circulatory stasis lesions. Lesions associated with hypoxia, namely nucleated red blood cells and chorangiosis, were also increased. Finally, the presence of any UCC was significantly associated with IUFD. We also found that multiple UCC are associated with nonreassuring fetal heart rate and chorangiosis but that the presence of a single UCC was not. This indicates that UCC may lead to intrauterine hypoxia and subsequent adverse fetal outcome and that multiple UCC may be cumulative in effect.
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Affiliation(s)
- Joanna S Y Chan
- Department of Pathology & Laboratory Medicine, New York Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA.
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30
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Abstract
Hypertensive disease (HD) during pregnancy includes chronic hypertension (HTN), gestational hypertension (GH), and preeclampsia/eclampsia (PEC). Differences between types of HD have not been well studied. Clinicopathologic features were compared between the HD groups and controls. HD was associated with lower Apgar scores, intrauterine growth restriction, IUGR, and delivery at an earlier gestational age (GA). IUGR was less common in the GH group, gestational age was lowest in the PEC. As expected, HD is associated with placental lesions of malperfusion, younger GA, and increased incidence of IUGR and controls showed less chronic and more "acute" lesions (ACA, MEC). Finally, comparisons of the HD groups showed differences only in GA and IUGR in the GH group as compared to the HTN and PEC groups. This suggests that GH may be associated with less severe clinical disease while showing similar pathologic features.
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Affiliation(s)
- Katherine F Maloney
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College - New York Presbyterian Hospital, New York, New York, USA
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Jain S, Ward MM, O'Loughlin J, Boeck M, Wiener N, Chuang E, Cigler T, Moore A, Donovan D, Lam C, Cobham MV, Schneider S, Christos P, Baergen RN, Swistel A, Lane ME, Mittal V, Rafii S, Vahdat LT. Incremental increase in VEGFR1⁺ hematopoietic progenitor cells and VEGFR2⁺ endothelial progenitor cells predicts relapse and lack of tumor response in breast cancer patients. Breast Cancer Res Treat 2011; 132:235-42. [PMID: 22160642 DOI: 10.1007/s10549-011-1906-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2011] [Accepted: 11/29/2011] [Indexed: 12/21/2022]
Abstract
Animal models have demonstrated the critical role of bone marrow-derived VEGFR1(+) hematopoietic progenitor cells (HPCs) and VEGFR2(+) endothelial progenitor cells (EPCs) in metastatic progression. We explored whether these cells could predict relapse and response in breast cancer (BC) patients. One hundred and thirty-two patients with stages 1-4 BC were enrolled on 2 studies. Circulating CD45(+)/CD34(+)/VEGFR1(+) HPCs and CD45(dim)/CD133(+)/VEGFR2(+) EPCs were assessed from peripheral blood mononuclear cells using flow cytometry. Changes in HPCs and EPCs were analyzed in (1) patients without overt disease that relapsed and (2) metastatic patients according to response by RECIST. At study entry, 102 patients were without evidence of disease and 30 patients had metastatic BC. Seven patients without evidence of BC by exam, labs, and imaging developed recurrence while on study. Median HPC/ml (range) increased from 645.8 (23.5-1,914) to 2,899 (1,176-37,336), P = 0.016, followed by an increase in median EPC/ml from 21.3 (4.7-42.5) to 94.7 (28.2-201.3), P = 0.016, prior to clinical relapse. In metastatic patients with progressive disease, median HPC/ml increased from 1,696 (10-16,470) to 5,124 (374-77,605), P = 0.0009, and median EPC/ml increased from 26 (0-560) to 71 (0-615) prior to progression, P = 0.10. In patients with responding disease, median HPC/ml decreased from 6,147 (912-85,070) to 633 (47-18,065), P = 0.05, and EPC/ml decreased from 46 (0-197) to 23 (0-105), P = 0.41, at response. There were no significant changes in these cells over time in patients with stable disease. Circulating bone marrow-derived HPCs and EPCs predict relapse and disease progression in BC patients.
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Affiliation(s)
- Sarika Jain
- Department of Medicine, Weill Cornell Medical College, Iris Cantor Breast Center, 425 East 61 St, 8th floor, New York, NY 10065, USA
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Jain S, Ward MM, O'Loughlin J, Boeck MA, Wiener N, Chuang E, Cigler T, Moore A, Donovan D, Lam C, Cobham MV, Schneider SE, Christos P, Baergen RN, Lane ME, Mittal V, Rafii S, Vahdat LT. Abstract 4720: Incremental increase in VEGFR1+ and VEGFR2+ hemangiogenic progenitor cells predict relapse and tumor response in breast cancer (BC) patients. Cancer Res 2011. [DOI: 10.1158/1538-7445.am2011-4720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: BC can relapse years after initial diagnosis. In animal models, bone marrow (BM)-derived VEGFR1+ cells define the premetatastic niche and VEGFR2+ cells are critical for the transition from micro- to macrometastatic disease. We sought to define the temporal relationship of these circulating hemangiogenic progenitor cells in a cohort of BC patients (pts) that developed recurrent disease and whether quantitative changes in these cells could predict response to therapy in pts with established metastases.
Methods: 125 pts with Stages I to IV BC enrolled in 2 studies. In Study #1 circulating VEGFR1+ (CD45+/CD34+/VEGFR1+) hematopoietic progenitor cells (HPCs) and VEGFR2+ (CD45dim/CD133+/ VEGFR2+) endothelial progenitor cells (EPCs) of adjuvant patients were assessed at baseline (BL), every 3 months (mo) for the first year, then every 6 mo. Stage IV pts had levels measured at BL (defined as when initiating new treatment (tx)), with subsequent 1 mo interval blood draws and accompanied by a clinical evaluation. Tx could include chemo-, hormone or biologic therapy. In Study #2, these cells were examined monthly in pts without overt evidence of BC. HPCs/EPCs were quantified from peripheral blood mononuclear cells using flow cytometry with commercially available antibodies. Statistical analysis is by Wilcoxon signed-rank test.
Results: Data from both studies were combined to analyze 1) pts without overt BC who relapse and 2) stage IV pts according to response. Seven pts without evidence of BC based on physical exam, labs, and imaging developed recurrence while on study. In all 7 pts, there was a median (med) increase of 1,111% in HPCs preceding overt relapse (range 283% to 5800%). Med HPCs at BL 0.65/ul (range 0.02 to 1.22/ul) increased to 2.90/ul prior to relapse (range 1.18 to 34.94/ul), p=0.016. In 5 of 7 relapsed pts a 433% increase in EPCs occurred as HPCs decreased: med EPCs at BL 0.03/ul (range 0.015 to 0.21/ul) and at relapse 0.16/ul (range 0.03 to 0.27/ul). This pattern was not seen in non-relapsed pts.
In 22 stage IV pts, HPCs and EPCs were evaluated over the course of 40 tx. For the 20 tx (16 pts) in which progression of disease (POD) was the outcome, HPCs increased prior to POD (median 7.45/ul, range 0.37 to 77.6/ul) from BL (med 1.70/ul, range 0.01 to 16.47/ul), p=0.001. Similarly, EPCs increased at relapse (med 0.07/ul, range 0 to 0.62/ul) from BL (med 0.03/ul, range 0 to 0.21/ul), p=0.04. For the 12 tx (11 pts) with disease responding to systemic tx, there was a reduction in HPCs (BL med 6.15/ul, range 0.91 to 85.1/ul) to a 3 mo time point (med 0.63/ul, range 0.05 to 18.1/ul), p=0.05. A trend was noted in med EPCs (0.05/ul at BL to 0.02/ul at 3 mo), p=0.37. There was no change in HPCs/EPCs in 8 tx (6 pts) with stable disease.
Conclusion: BM-derived progenitor cells are important in the metastatic cascade and may represent a novel biomarker in following disease status and a new target for therapy.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 4720. doi:10.1158/1538-7445.AM2011-4720
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Affiliation(s)
- Sarika Jain
- 1Weill Medical School of Cornell University, New York, NY
| | | | | | | | - Naomi Wiener
- 1Weill Medical School of Cornell University, New York, NY
| | - Ellen Chuang
- 1Weill Medical School of Cornell University, New York, NY
| | - Tessa Cigler
- 1Weill Medical School of Cornell University, New York, NY
| | - Anne Moore
- 1Weill Medical School of Cornell University, New York, NY
| | - Diana Donovan
- 1Weill Medical School of Cornell University, New York, NY
| | - Christina Lam
- 1Weill Medical School of Cornell University, New York, NY
| | | | | | - Paul Christos
- 1Weill Medical School of Cornell University, New York, NY
| | | | | | - Vivek Mittal
- 1Weill Medical School of Cornell University, New York, NY
| | - Shahin Rafii
- 1Weill Medical School of Cornell University, New York, NY
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Fishman SG, Pelaez LM, Baergen RN, Carroll SJ. Parvovirus-mediated fetal cardiomyopathy with atrioventricular nodal disease. Pediatr Cardiol 2011; 32:84-6. [PMID: 20936534 DOI: 10.1007/s00246-010-9803-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 09/18/2010] [Indexed: 11/30/2022]
Abstract
Acute parvovirus B19 infection (API) in pregnancy has been associated with fetal anemia and hydrops fetalis. Direct myocardial damage from API in a fetus and an infant has been described. This report presents a case of fetal second-degree heart block and cardiomyopathy secondary to API. A 19-year-old G4P1112 (gravida 4 para 2 with 1 term delivery, 1 preterm delivery, 1 termination, and 2 living children) was referred at 20 weeks gestation for fetal bradycardia. A 2:1 atrioventricular block was identified by fetal echocardiography at 23 weeks. Hydrops developed at 25 weeks. Amniocentesis and percutaneous umbilical blood sampling demonstrated API. At 31 weeks, the patient presented with preterm labor and delivered a viable female infant, who died of poor cardiac function and arrhythmia on the first day of life. In addition to fetal anemia and hydrops fetalis, API in pregnancy may cause direct fetal myocardial damage and conduction system disease.
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Affiliation(s)
- Shira G Fishman
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, 525 East 68th Street, Box 122, New York, NY 10065, USA.
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Abstract
OBJECTIVE To evaluate differences in placental lesions in twin pregnancies with and without mid-trimester sonographic cervical shortening. METHODS Two groups of women were identified: those with twin gestations and a cervical length <or=2.5 cm measured between 16 and 24 weeks of gestation and those with twin gestations and without evidence of cervical shortening. The placental pathology was then retrospectively reviewed. The placental lesions were categorized as either acute or chronic inflammatory lesions, lesions of malperfusion or coagulopathic lesions. RESULTS A total of 704 patients with twin gestations were identified. There was significantly more acute chorioamnionitis in patients with cervical shortening but no differences in the frequency of other placental lesions. CONCLUSION Placentas with acute inflammatory lesions are significantly more frequent in twin gestations with mid-trimester cervical shortening.
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Affiliation(s)
- Linda M Peláez
- Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY 10065, USA.
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Abstract
Syncytiotrophoblastic knots or syncytial knots are aggregates of syncytial nuclei at the surface of terminal villi. In the term placenta, most syncytial knots are thought to be artifacts from tangential sectioning while the minority are syncytial sprouts, bridges, or apoptotic knots. Syncytial knots are consistently present, increasing with increasing gestational age, and can be used to evaluate villous maturity. Increased syncytial knots are associated with conditions of uteroplacental malperfusion and are important in placental examination. Although 30% of terminal villi with syncytial knots at term are often reported, no reference values have been developed for the percentage of villi with syncytial knots at different gestational ages. We counted the percentage of chorionic villi with syncytial knots at different gestational ages from 20 to 40 weeks using cases with no history of malperfusion or clinical conditions known to be associated with malperfusion. We provide normal reference data for the average percentage of syncytial knots for gestational ages ranging from 20 to 40 weeks. There was a significant positive correlation of gestational age with percentage of villi with syncytial knots. Term placentas (37-40 weeks) showed an average of 28% syncytial knots. A drop-off to a mean of 22.5% was noted at 36 weeks; at 26 to 33 weeks, syncytial knots varied from 10.8% to 14.7%; between 20 and 25 weeks, syncytial knots ranged between 5.2% and 9.l%. These reference data can facilitate histologic assessment of normal placental maturation as well as evaluation of placental morphology in placental malperfusion.
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Affiliation(s)
- Kristina Loukeris
- Department of Pathology, New York Presbyterian Hospital-Weill Medical College of Cornell University, 525 East 68th Street, New York, NY 10021, USA
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Baergen RN, Castillo MM, Mario-Singh B, Stehly AJ, Benirschke K. Embolism of Fetal Brain Tissue to the Lungs and the Placenta. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/15513819709168355] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pelaez L, Chasen ST, Baergen RN. 97: Low pregnancy associated plasma protein-A (PAPP-A) in combination with elevated alpha feto-protein (AFP): relationship to the placenta. Am J Obstet Gynecol 2009. [DOI: 10.1016/j.ajog.2009.10.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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38
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Heller DS, Faye-Petersen O, Baergen RN, Kaplan C. Handling of perinatal specimens: a Society for Pediatric Pathology practice committee survey. Pediatr Dev Pathol 2009; 12:307-8. [PMID: 19799505 DOI: 10.2350/09-03-0625.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Debra S. Heller
- Department of Pathology and Laboratory Medicine of UMDNJ-New Jersey Medical School, Newark, NJ, USA
| | - Ona Faye-Petersen
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rebecca N. Baergen
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, Cornell, NY, USA
| | - Cynthia Kaplan
- Department of Pathology and Laboratory Medicine, Stony Brook University School of Medicine, Stony Brook, NY, USA
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Pelaez L, Chasen ST, Baergen RN. 302: Relationship between first trimester maternal serum PAPP-A levels and placental lesions in twin gestations. Am J Obstet Gynecol 2008. [DOI: 10.1016/j.ajog.2008.09.330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Placental site trophoblastic tumor is a neoplasm of extravillous intermediate trophoblast at the implantation site, preceded in the majority of cases by a female gestational event. Our pilot investigation suggested that the development of this tumor might require a paternally derived X chromosome and the absence of a Y chromosome. Twenty cases of placental site trophoblastic tumor were included in this study. Genotyping at 15 polymorphic loci and one sex determination locus was performed by multiplex PCR followed by capillary electrophoresis. X chromosome polymorphisms were determined by PCR amplification of exon 1 of the human androgen receptor gene using primers flanking the polymorphic CAG repeats within this region. Genotyping at 15 polymorphic loci was informative and paternal alleles were present in all tumors, confirming the trophoblastic origin of the tumors. The presence of an X chromosome and the absence of a Y chromosome were observed in all tumors. Among 13 cases in which analysis of the X chromosome polymorphism was informative, all but one demonstrated at least two X alleles and seven cases showed one identifiable paternal X allele. These results confirm a unique pathogenetic mechanism in placental site trophoblastic tumor, involving an exclusion of the Y chromosome from the genome and, therefore, a tumor arising from the trophectoderm of a female conceptus. As epigenetic regulations of imprinting during X chromosome inactivation are of significant biological implications, placental site trophoblastic tumor may provide an important model for studying the sex chromosome biology and the proliferative advantage conferred by the paternal X chromosome.
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Affiliation(s)
- Pei Hui
- Department of Pathology, Yale University, New Haven, CT 06520-8023, USA.
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Abstract
Prostaglandin levels vary during pregnancy, mostly under the control of the inducible enzyme cyclooxygenase-2 (COX-2). The expression of COX-2 has been associated with ischemic events in the heart and brain, but its direct effect on human placental perfusion has not been previously examined. The purpose of this study was to investigate whether a functional polymorphism in the COX-2 gene that controls enzyme expression levels is associated with placental histopathologic lesions. Maternal and neonatal DNA from twin gestations were analyzed by a polymerase chain reaction-based assay for a single G to C nucleotide polymorphism at position -765 in the COX-2 gene promoter. Placental histopathology was evaluated in 6 major categories: meconium, malperfusion, inflammation, umbilical cord problems, villitis, and thrombosis. There was no significant association between placental histopathologic findings and polymorphisms of the COX-2 gene in the mother. In the fetus, carriage of the COX-2 C allele, which is correlated with decreased COX-2 gene expression, was negatively associated with lesions of placental ischemia/malperfusion (P = 0.02). Placental ischemic lesions were positively associated with intrauterine growth restriction (IUGR; P < 0.001). No other group of histopathologic lesions was associated with fetal polymorphisms in the COX-2 gene or with IUGR. Thus, a fetal polymorphism in the COX-2 gene influences the occurrence of placental malperfusion and ischemia, which may be of sufficient severity to promote or allow the development of IUGR.
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Affiliation(s)
- Alexandros D Polydorides
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, New York, New York, USA.
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Abstract
The placenta not only "records" and reflects the intrauterine environment, it also provides valuable information on the cause and timing of many adverse events and conditions. The placenta may be useful in several ways. It may be the cause of injury due to an inherent abnormality, it may "malfunction" because of disease processes that are not primarily placental in origin, or it may merely reflect an abnormal intrauterine environment. Not only may the etiology of the injury be ascertained from placental examination, but also a time frame during which the abnormal condition has been operating. Acute lesions may be associated with sudden catastrophic events, whereas other, more chronic lesions lead to decreased placental reserves. Markedly depleted reserves will render the infant susceptible to other, sometimes more acute, events and thus are also associated with significant injury or even death.
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Affiliation(s)
- Rebecca N Baergen
- New York Presbyterian Hospital, Weill-Cornell Medical Center, Department of Pathology, Starr 1002, 520 East 70th Street, New York, NY 10021, USA.
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Poppas DP, Hochsztein AA, Baergen RN, Loyd E, Chen J, Felsen D. Nerve sparing ventral clitoroplasty preserves dorsal nerves in congenital adrenal hyperplasia. J Urol 2007; 178:1802-6; discussion 1806. [PMID: 17707008 DOI: 10.1016/j.juro.2007.03.186] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Indexed: 11/25/2022]
Abstract
PURPOSE Masculinization of the female genitalia observed in patients with classic congenital adrenal hyperplasia often results in clitorimegaly. Reduction clitoroplasty is the most widely practiced corrective surgery for clitorimegaly, yet reservations about surgical intervention exist based on fears of nerve destruction during surgical removal of excess erectile tissue. In this study, we modified the reduction clitoroplasty and examined excised erectile tissue for the presence of dorsal nerves. MATERIALS AND METHODS We describe the development of the nerve sparing ventral clitoroplasty. Nerves were examined in situ using optical coherence technology. In addition, erectile tissue removed from 27 female patients with congenital adrenal hyperplasia was examined immunohistochemically for the presence of nerves by staining for neurofilament. Nerves outside of the tunica albuginea were counted and measured. Tissue from 2 adult females was also examined by immunohistochemistry. RESULTS Optical coherence technology visualized dorsal nerves in 3 patients with congenital adrenal hyperplasia (size 600 to 800 microm). In 4 of 27 patients undergoing nerve sparing ventral clitoroplasty, no dorsal nerve branches were visualized in excised erectile tissue. In another 18 patients 10 or fewer nerve branches were found. In patients who underwent nerve sparing ventral clitoroplasty 92% of dorsal nerves detected were 90 microm or less. In contrast, 88% of dorsal nerves found in the 2 adult specimens were 120 microm or greater. The maximum nerve fiber size observed in patient specimens was significantly smaller than the maximum nerve fiber size observed in control specimens. CONCLUSIONS Scarcity of large dorsal nerves in histological specimens excised using nerve sparing ventral clitoroplasty likely reflects their preservation within the congenital adrenal hyperplasia patients. This preservation is vital to future somatosensory and motor function of the clitoris.
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Affiliation(s)
- Dix P Poppas
- Department of Urology, New York Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA
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Abstract
As the umbilical cord is the lifeline of the fetus, obstruction or disruption of blood flow through the umbilical vessels can lead to severe fetal compromise. Obstruction is usually mechanical in nature and is associated with compression of the umbilical cord and umbilical vessels. Disruption of umbilical or fetal vessels is usually traumatic in origin. These conditions have in common a loss of blood flow to the fetus and an association with adverse perinatal outcome.
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Affiliation(s)
- Rebecca N Baergen
- Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, New New York, New York 10021, USA.
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Shamonki JM, Salmon JE, Hyjek E, Baergen RN. Excessive complement activation is associated with placental injury in patients with antiphospholipid antibodies. Am J Obstet Gynecol 2007; 196:167.e1-5. [PMID: 17306667 PMCID: PMC2248299 DOI: 10.1016/j.ajog.2006.10.879] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Revised: 07/31/2006] [Accepted: 10/21/2006] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Studies that use a murine model of antiphospholipid syndrome have demonstrated a critical role for complement activation that leads to fetal and placental injury in the presence of antiphospholipid antibodies (APAs). We examined the placentas of patients with APAs to demonstrate a similar association with tissue injury in humans. STUDY DESIGN Immunohistochemical analyses with the use of antibodies to the complement products C4d, C3b, and C5b-9 were performed on paraffin-embedded tissue sections of placentas from 47 patients with APAs and 23 normal control patients. RESULTS We found evidence of increased complement deposition in the trophoblast cytoplasm (C4d and C3b), trophoblastic cell and basement membrane (C4d), and extravillous trophoblasts (C4d) of patients with APAs, compared with control patients. We report a correlation between placental pathologic features and complement deposition (C4d) in the trophoblastic cytoplasm, cell membrane, and basement membrane. CONCLUSION These findings are consistent with murine studies that implicate complement as a critical factor in the fetal tissue injury observed in antiphospholipid syndrome.
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Affiliation(s)
- Jaime M Shamonki
- Department of Pathology, New York Presbyterian Hospital-Weill Medical College, Cornell University, New York, NY 10021, USA
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46
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Chasen S, Trentacoste S, Jean-Pierre C, Baergen RN. Placental pathology and PPROM: Singleton vs. twins. Am J Obstet Gynecol 2006. [DOI: 10.1016/j.ajog.2006.10.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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47
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Trentacoste S, Chasen S, Jean-Pierre C, Baergen RN. PPROM in twins: Correlation of outcomes with placental pathology. Am J Obstet Gynecol 2006. [DOI: 10.1016/j.ajog.2006.10.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
We present a patient with a placenta previa in which we failed to manage conservatively with methotrexate and uterine embolization. The patient was diagnosed in the second trimester as having a possible placenta previa-increta,and underwent a repeat classical cesarean delivery at 32 weeks of gestation due to significant antepartum vaginal bleeding. Following abdominal closure,the uterine vessels were embolized with the Gel-Foam by interventional radiology. The placenta previa was left in-situ and patient was discharged home in stable condition in five days. The patient reported on the 44th postoperative day with heavy vaginal bleeding. A total abdominal hysterectomy was performed due to an unstable patient's hemodynamic condition in association with fluid resuscitation and multiple blood transfusions. The pathologic findings revealed a 675 g uterus with placenta previa-percreta with extension of chorionic villi to the serosal layer. Our case demonstrates a need for careful selection of patients with placenta previa and suspected accreta/increta/percreta that would be suitable candidates for conservative medical management. Patients who opt for conservative medical management should be informed about the possibility of catastrophic bleeding associated with a retained placenta, that would ultimately require blood transfusions and hysterectomy.
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Affiliation(s)
- Guoyang Luo
- Weill Medical College of Cornell University, New York, NY 10021, USA
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Schatz F, Krikun G, Baergen RN, Critchley HOD, Kuczynski E, Lockwood CJ. Intercellular adhesion molecule-1 expression in human endometrium: implications for long term progestin only contraception. Reprod Biol Endocrinol 2006; 4:2. [PMID: 16445864 PMCID: PMC1403781 DOI: 10.1186/1477-7827-4-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2005] [Accepted: 01/30/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neutrophils infiltrate the endometrium pre-menstrually and after long-term progestin only-contraceptive (LTPOC) treatment. Trafficking of neutrophils involves endothelial cell-expressed intercellular adhesion molecule (ICAM-1). Previous studies observed that ICAM-1 was immunolocalized to the endothelium of endometrial specimens across the menstrual cycle, but disagreed as to whether extra-endothelial cell types express ICAM-1 and whether ICAM-1 expression varies across the menstrual cycle. METHODS Endometrial biopsies were obtained from women across the menstrual cycle and from those on LTPOC treatment (either Mirena or Norplant). The biopsies were formalin-fixed and paraffin-embedded with subsequent immunohistochemical staining for ICAM-1. RESULTS The current study found prominent ICAM-1 staining in the endometrial endothelium that was of equivalent intensity in different blood vessel types irrespective of the steroidal or inflammatory endometrial milieu across the menstrual cycle and during LTPOC therapy. Unlike the endothelial cells, the glands were negative and the stromal cells were weakly positive for ICAM immunostaining. CONCLUSION The results of the current study suggest that altered expression of ICAM-1 by endothelial cells does not account for the influx of neutrophils into the premenstrual and LTPOC-derived endometrium. Such neutrophil infiltration may depend on altered expression of neutrophil chemoattractants.
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Affiliation(s)
- Frederick Schatz
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven CT, USA
| | - Graciela Krikun
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven CT, USA
| | - Rebecca N Baergen
- Department of Pathology, Weil-Cornell Medical Center, New York NY, USA
| | | | - Edward Kuczynski
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven CT, USA
| | - Charles J Lockwood
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven CT, USA
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Greer BE, Bundy BN, Ozols RF, Fowler JM, Clarke-Pearson D, Burger RA, Mannel R, DeGeest K, Hartenbach EM, Baergen RN, Copeland LJ. Implications of second-look laparotomy in the context of optimally resected stage III ovarian cancer: a non-randomized comparison using an explanatory analysis: a Gynecologic Oncology Group study. Gynecol Oncol 2005; 99:71-9. [PMID: 16039699 DOI: 10.1016/j.ygyno.2005.05.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2004] [Revised: 05/05/2005] [Accepted: 05/11/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVE A non-randomized comparison of outcome in women undergoing second-look laparotomy (SLL) or clinical follow-up, after receiving six cycles of combination chemotherapy with paclitaxel plus either cisplatin or carboplatin, for optimally resected stage III ovarian cancer. METHODS Prior to chemotherapy randomization, patients chose whether or not to undergo SLL; this was a stratification factor to insure balance of treatment assignment. Any subsequent therapy was physician-directed. Explanatory analysis replaced intent-to-treat because of a higher likelihood of detecting SLL effect in the presence of noncompliance. RESULTS There were 393 patients (median age: 54) who Elected SLL and 399 (median age: 59) who Elected No SLL. The former group was more likely to have gross residual disease at initial surgery than the latter group (69% versus 60%, respectively). In the Elected SLL group, 59 (15%) patients subsequently refused surgery, in nine (2%) surgery was contraindicated, and 31 (8%) relapsed or died prior to the procedure. Cancer was found in 46% of 294 (75%) patients undergoing SLL. Since early failures (prior to SLL) do not address benefit, such patients (SLL: 32; No SLL: 33), defined as progression-free survival (PFS) < 6 months, were excluded from analysis. The adjusted relative risk of progression is 0.89 (95% confidence interval: 0.75, 1.07); the difference in median PFS is 1.0 month (SLL: 23.9 months; No SLL: 22.9 months). The survival rate curves are superimposable. CONCLUSION In the context of a non-randomized comparison, the performance of a SLL was not associated with longer survival.
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Affiliation(s)
- Benjamin E Greer
- Division of Gynecologic Oncology, University of Washington, Fred Hutchinson Cancer Research Center, Puget Sound Oncology Consortium LF-287, 1100 Fairview Avenue N., Seattle, WA 98109, USA.
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