Increased prevalence of high grade placental pathology with first trimester SARS-CoV-2 infection

Whether HPV is causative of pregnancy complications is uncertain. E6 and E7 affect functions underling preeclampsia (PET) in cultured trophoblasts, but whether E6 and E7 is produced in the placenta is uncertain. Here, we investigated whether E6/E7 was expressed in the placentae from pregnancies with PET, other pregnancy complications (fetal growth restriction (FGR) and diabetes mellitus), and uncomplicated pregnancies. Placental tissues collected from two geographical locations were subjected to RNAscope analyses of high- and low- risk E6/E7, and individual HPV types identified using an HPV array. High-risk E6/E7 expression was increased in both PET cohorts, (81% and 86% of patients positive for high-risk HPV DNA compared to 13% of control patients). Various HPV types were identified. Although HPV 18 was the most frequent in all cohorts, the majority of individuals had multiple HPV types (55% of the PET compared to 25% of the control cohort). Further evidence that E6 and E7 is present early when placental pathology underlying preeclampsia is established, is provided with the finding of high-risk E6/E7 in the first-trimester placenta anchoring trophoblast. In conclusion, E6/E7 expression and multiple HPV types were frequent in placentae from preeclampsia-complicated pregnancies.

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Prediction of placental pathology during the second trimester of pregnancy using a new risk assessment scale and fetal cardiotocography

Voprosy ginekologii akušerstva i perinatologii ◽

10.20953/1726-1678-2020-5-36-43 ◽

2020 ◽

Vol 19 (5) ◽

pp. 36-43

Author(s):

R.S. Zamaleeva ◽

◽

N.A. Cherepanova ◽

A.V. Frizina ◽

E.Yu. Yupatov ◽

...

Keyword(s):

Risk Assessment ◽

At Risk ◽

Gestational Hypertension ◽

Neonatal Morbidity ◽

First Trimester ◽

Normal Pregnancy ◽

Assessment Scale ◽

Second Trimester ◽

Placental Pathology ◽

Perinatal Complications

Objective. Рreclinical prognosis of placental pathology (PP) during the second trimester of pregnancy using a new risk assessment scale and fetal cardiotocography (CTG). Patients and methods. This retrospective study included 264 patients who had undergone risk assessment during the first trimester of pregnancy using the conventional scale followed by reassessment on weeks 12–15 using the new scale. There were 102 women with PP and 162 women with normal pregnancy and delivery. We also performed prospective analysis of CTG results obtained during the second trimester. Results. The calculation of the risk for perinatal complications during the first trimester using the conventional scale demonstrated that 31% of women had PP. After recalculating the risks in the beginning of the second trimester, we found that 90% of women had PP; there was a threefold increase in the accuracy of prognosis. Women with pathological variants of CTG and risk of PP were 1.34 times more likely to have delayed fetal growth, 1.8 times more likely to develop preeclampsia, 2.6 times more likely to have preterm birth, 1.2 times more likely to have gestational hypertension, and 1.75 times more likely to have neonatal morbidity compared to women at risk of PP, but with normal CTG variants during the second trimester. Conclusion. Combination of the new risk assessment scale and CTG during the second trimester helps to identify women at risk of gestational pathology and to find and optimal tactics of their management. Key words: CTG, placental pathology, placental insufficiency, risk scale

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Placental Pathology in Maternal Ornithine Transcarbamylase Deficiency

Pediatric and Developmental Pathology ◽

10.1177/10935266211055286 ◽

2021 ◽

pp. 109352662110552

Author(s):

Angela R. Seasely ◽

Rachel G. Sinkey ◽

Sarah Joy Dean ◽

Maria Descartes ◽

Virginia E. Duncan

Keyword(s):

Urea Cycle ◽

Endothelial Damage ◽

Urea Cycle Disorder ◽

Ornithine Transcarbamylase ◽

High Grade ◽

Placental Pathology ◽

Male Fetus ◽

Metabolic States ◽

Otc Deficiency ◽

High Index Of Suspicion

Introduction Ornithine transcarbamylase (OTC) deficiency is the most common urea cycle disorder, inherited in an X-linked manner. Males are severely affected. Female phenotypes vary from asymptomatic to severe, and symptoms may be triggered by high metabolic states like childbirth. Literature on OTC deficiency in pregnancy and placental pathology is limited. Methods Pathology records were searched at a single referral center from 2000–2020 and identified three placental cases from two mothers heterozygous for OTC deficiency. Placental pathology and maternal and neonatal history were reviewed in detail. Results The placenta from one symptomatic mother carrying an affected male fetus showed widespread high-grade fetal vascular malperfusion (FVM) lesions of varying age. These lesions were not seen in the two placentas from the asymptomatic mother. Discussion In cases of symptomatic maternal OTC deficiency, our findings highlight the need for placental examination. Since thrombotic events in the placenta have the potential to associate with fetal and neonatal endothelial damage, a high index of suspicion for neonatal thrombosis may be warranted.

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Placental pathology, first-trimester biomarkers and adverse pregnancy outcomes

Journal of Perinatology ◽

10.1038/jp.2013.176 ◽

2014 ◽

Vol 34 (3) ◽

pp. 186-191 ◽

Cited By ~ 38

Author(s):

A O Odibo ◽

K R Patel ◽

A Spitalnik ◽

L Odibo ◽

P Huettner

Keyword(s):

Pregnancy Outcomes ◽

First Trimester ◽

Adverse Pregnancy Outcomes ◽

Placental Pathology ◽

Adverse Pregnancy

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92: Placental pathology, first-trimester biomarkers, and adverse pregnancy outcomes (APO)

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2012.10.257 ◽

2013 ◽

Vol 208 (1) ◽

pp. S53-S54

Author(s):

Amanda Spitalnik ◽

Kalyani Patel ◽

Linda Odibo ◽

Phyllis Huettner ◽

Anthony Odibo

Keyword(s):

Pregnancy Outcomes ◽

First Trimester ◽

Adverse Pregnancy Outcomes ◽

Placental Pathology ◽

Adverse Pregnancy

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Risk Factors Associated with Non-Cardiac Congenital Anomalies of Fetus Admitted in Chittagong Medical College Hospital

Cardiovascular Journal ◽

10.3329/cardio.v13i1.50563 ◽

2020 ◽

Vol 13 (1) ◽

pp. 40-45

Author(s):

Jahanara Akhter ◽

Suman Nazmul Hosain ◽

Zakia Mamataz ◽

Sulekha Bhattacharjee ◽

Chowdhury Sharmila Barua

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Congenital Anomaly ◽

Congenital Anomalies ◽

Cleft Lip ◽

First Trimester ◽

Obstetrics And Gynecology ◽

High Grade ◽

High Grade Fever ◽

The Mean

Background: Congenital anomalies make an important contribution to infant mortality and they remain a leading cause of death in many countries of the world. Many babies also died in our country due to congenital anomalies. Methods: This retrospective cross-sectional study was conducted at the Departments of Obstetrics and Gynecology of CMCH between October 2016 to March 2017. Objective of the study was to find out the risk factors of non-cardiac congenital anomaly of fetus. The study population of those women who delivered a baby with different non-cardiac congenital anomalies admitted in Departments of Obstetrics and Gynecology of CMCH. Results: The mean maternal age was found 26.6±5.6 years and the mean paternal age was found 35.8±7.9 years. 28 (28.0%) patients had hydrocephalus, 25 (25.0%) had Anencephaly, 7 (7.0%) had Omphalocele, 7 (7.0%) had Hydrops fetalis, 6 (6.0%) had cleft lip, 6 (6.0%) had cleft palate, 4 (4.0%) had cleft lip and cleft palate. 20 (20.0%) patients had consanguinity, history of high-grade fever with rash in first trimester was 12 (12.0%). 16(16.0%) was diabetes mellitus. Majority (63.0%) patients belonged to gestational age 16-28 weeks. The mean gestational age was found 29.5±7.1 weeks with ranged from 16 to 42 weeks. Majority (89.0%) were singleton pregnancy. 60% reveal congenital anomaly in USG. Conclusion: Risk factors of non-cardiac congenital anomalies were consanguinity, maternal obesity, high grade fever with rash in first trimester due to viral infection, diabetes mellitus (uncontrolled), uncontrolled gestational diabetes mellitus, previous birth defect, inadequate intake of folic acid in first trimester, blood group Rh negative, male baby. Hydrocephalus and anencephaly were the most common congenital anomalies. Cardiovasc. j. 2020; 13(1): 40-45

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Vitelline Vessel Remnant-Derived Funisitis Is a Sensitive and Specific Predictor of Histological Evidence of Amniotic Fluid Infection

Pediatric and Developmental Pathology ◽

10.1177/10935266211033271 ◽

2021 ◽

pp. 109352662110332

Author(s):

John Kemuel De Guzman ◽

Weiming Yu ◽

Lawrence de Koning ◽

Christopher Horn ◽

James R Wright

Keyword(s):

Amniotic Fluid ◽

Strong Association ◽

High Grade ◽

Placental Pathology ◽

Third Trimester ◽

Neutrophilic Inflammation ◽

Histological Evidence ◽

The Third ◽

Umbilical Cords ◽

Fetal Response

Background 4-11% of umbilical cords contain vitelline vessel remnants (VVRs). A recent study has described neutrophilic inflammation arising from VVRs and suggested an association with amniotic fluid infection (AFI). Methods During routine placental pathology sign-out over a six month period, we identified 70 cords with VVRs. HE-stained sections were re-examined for “VVR-derived funisitis,” which was classified as low or high grade/stage based upon whether neutrophils were present only in Wharton’s jelly near the VVRs or whether neutrophils were also present near the cord’s amniotic surface. The same placentas were also examined for histologic evidence of AFI (maternal response = acute chorionitis or chorioamnionitis vs. fetal response = chorionic vasculitis, umbilical vasculitis, or funisitis vs. both). Results Neutrophilic inflammation arising from VVRs was present in 54.3% (38/70); 15 and 23 lesions were low and high grade/stage, respectively. “VVR-derived funisitis” was strongly associated with histological evidence of AFI elsewhere in the placenta. Its overall sensitivity and specificity were 0.94 and 0.88; when VVR-derived funisitis was high grade/stage or diagnosed in the third trimester, specificity rose to 1.0. Conclusion “VVR-derived funisitis” has a strong association with histological evidence of AFI.

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Formulating a Meaningful and Comprehensive Placental Phenotypic Classification

Pediatric and Developmental Pathology ◽

10.1177/10935266211008444 ◽

2021 ◽

pp. 109352662110084

Author(s):

Alexa A Freedman ◽

Lauren S Keenan-Devlin ◽

Ann Borders ◽

Gregory E Miller ◽

Linda M Ernst

Keyword(s):

Preterm Birth ◽

Birth Outcomes ◽

Gestational Age ◽

Web Application ◽

Acute Inflammation ◽

Low Grade ◽

Adverse Birth Outcomes ◽

High Grade ◽

Placental Pathology ◽

Pathology Reports

Introduction While many placental lesions have been identified and defined, the significance of multiple overlapping lesions has not been addressed. The purpose of our analysis was to evaluate overlapping patterns of placental pathology and determine meaningful phenotypes associated with adverse birth outcomes. Methods Placental pathology reports were obtained from a single hospital between 2009 and 2018. Placental lesions were grouped into four major categories: acute inflammation (AI), chronic inflammation (CI), maternal vascular malperfusion (MVM), and fetal vascular malperfusion (FVM). Within each category, lesions were classified as not present, low grade or high grade. Combinations of pathologies were evaluated in relation to preterm birth (<37 weeks) and small for gestational age (SGA) infant (birthweight <10th percentile). Results During the study period, 19,027 placentas were reviewed by pathologists. Results from interaction models indicate that MVM and MVM in combination with CI and/or FVM are associated with the greatest odds of SGA infant and PTB. When incorporating grade, we identified 21 phenotype groups, each with characteristic associations with the SGA infant and patterns of PTB. Discussion We have developed a comprehensive and meaningful placental phenotype that incorporates severity and multiplicity of placental lesions. We have also developed a web application to facilitate phenotype determination ( https://placentaexpression.shinyapps.io/phenotype ).

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The Incidence of Dichorionic Diamniotic Twin Pregnancy After Single Blastocyst Embryo Transfer and Zygosity: 8 Years of Single-Center Experience

Twin Research and Human Genetics ◽

10.1017/thg.2020.5 ◽

2020 ◽

Vol 23 (1) ◽

pp. 51-54 ◽

Cited By ~ 1

Author(s):

Hiroko Konno ◽

Takeshi Murakoshi ◽

Kiyonori Miura ◽

Hideaki Masuzaki

Keyword(s):

Embryo Transfer ◽

Twin Pregnancy ◽

Hormone Replacement ◽

First Trimester ◽

Frozen Embryo Transfer ◽

The Other ◽

Placental Pathology ◽

Monochorionic Twin ◽

Single Center Experience ◽

Twin Pregnancies

AbstractDichorionic diamniotic (DCDA) twin pregnancies after single blastocyst embryo transfer have been reported recently, although a blastocyst ovum is generally believed to divide into monochorionic twin pregnancy. We investigated the incidence of DCDA twin pregnancy after single blastocyst embryo transfer and their zygosity. This prospective cohort study included 655 consecutive twin pregnancies that were managed from 2006 to 2014 at our institution. Chorionicity and amnionicity were determined using first-trimester ultrasonography and/or placental pathology. Zygosity was analyzed if the cases were DCDA twins after single blastocyst embryo transfer. Among 655 twin pregnancies, there were 348 DCDA cases, 295 monochorionic diamniotic (MCDA) cases and 12 monochorionic monoamniotic cases. Single blastocyst embryo transfer was performed in 43 cases. Six out of the 43 (14%) cases involved DCDA twin pregnancies and the other 37 cases involved MCDA twin pregnancies. Three DCDA twins born after single blastocyst embryo transfer, wherein frozen embryo transfer (FET) was performed in the natural cycle, were dizygotic, and the other three cases, wherein FET with hormone replacement therapy was performed, were monozygotic. DCDA twin pregnancy occurred in 14% (7% for monozygotic and 7% for dizygotic) of twin pregnancies after single blastocyst embryo transfer cases.

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Brain and Placental Pathology in Fetal COL4A1 Related Disease

Pediatric and Developmental Pathology ◽

10.1177/1093526620984083 ◽

2021 ◽

pp. 109352662098408

Author(s):

Patrick Shannon ◽

Courtney Hum ◽

Tony Parks ◽

GM Schauer ◽

David Chitayat ◽

...

Keyword(s):

Brain Injury ◽

Ventricular Zone ◽

Fetal Brain ◽

Small Vessel ◽

Low Grade ◽

High Grade ◽

Placental Pathology ◽

Cell Degeneration ◽

Genetic Sequencing ◽

Related Disease

Introduction Although fetal brain injury due to COL4A1 gene mutation is well documented, fetal central nervous system (CNS) and placental histopathology lack description. We report CNS and placental pathology in fetal cases with symptomatic COL4A1 mutation. Methods We retrieved four autopsy cases of COL4A1 related disease, confirmed by genetic sequencing after fetal brain injury was detected. Results One case was a midgestation fetus with residua of ventricular zone hemorrhage and normal placental villi. Three cases were 30-32 week gestation fetuses: two demonstrated CNS small vessel thrombosis, with CNS injury. Both demonstrated high grade placental fetal vascular malperfusion (FVM). One additionally showed villous dysmorphism, the other demonstrated mild villous immaturity. The fetus whose placenta demonstrated high grade FVM was growth restricted. A fourth fetus demonstrated schizencephaly with a CNS arteriopathy with smooth muscle cell degeneration and cerebral infarcts; the placenta demonstrated severe villous dysmorphism and low grade FVM. Discussion These cases confirm that small vessel disease is important in producing intracranial pathology in COL4A1mutation. We report an arteriopathy distinct from microvascular thrombosis and demonstrate that placental pathology is common in fetal COL4A1 related disease. This tentatively suggests that placental pathology may contribute to CNS abnormalities by affecting circulatory sufficiency.

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