Chronic villitis: Refining the risk ratio of recurrence using a large placental pathology sample

Abstract Objective.—The aim of this study was to determine the association of placental findings with cerebral palsy and related forms of neurologic impairment (NI) following birth at ≥37 weeks gestation (term). Design.—In a retrospective comparison, placentas from 40 term infants with NI ascertained on the basis of clinicopathologic review for medicolegal consultation were compared with placentas from 176 consecutive meconium-stained term infants at low risk for NI. Results.—After stratification for severity, 9 lesions were significantly increased in placentas from infants with NI: 5 lesions generally considered to occur within days of the time of labor and delivery (meconium-associated vascular necrosis, severe fetal chorioamnionitis, chorionic vessel thrombi, increased nucleated red blood cells, and findings consistent with abruptio placenta) and 4 lesions generally believed to have their onset long before labor and delivery (diffuse chronic villitis, extensive avascular villi, diffuse chorioamnionic hemosiderosis, and perivillous fibrin). Findings independently associated with NI by logistic regression in this descriptive study were severe fetal chorioamnionitis (odds ratio [OR], 13.2; 95% confidence interval [CI], 1.2–144); extensive avascular villi (OR, 9.0; 95% CI, 1.6–51); and diffuse chorioamnionic hemosiderosis (OR, 74.8; 95% CI, 6.3–894). The risk of NI increased as a function of the number of lesions present (OR, 10.1; 95% CI, 5.1–20 for each additional lesion), particularly when lesions generally considered to occur near the time of labor and those believed to occur well before labor were found in the same placenta (OR, 94.2; 95% CI, 11.9–747). Conclusions.—These findings suggest that placental pathology can contribute to an understanding of the mechanisms that contribute to NI at term.

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Abstract 16048: Placental Pathology in Pregnancies Complicated by Maternal Cardiac Disease: A Study From the Standardized Outcomes in Reproductive Cardiovascular Care (STORCC) Initiative

Circulation ◽

10.1161/circ.142.suppl_3.16048 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Fred M Wu ◽

Bradley J Quade ◽

Zoe J Schefter ◽

Abigail Moses ◽

Cara L Lachtrupp ◽

...

Keyword(s):

Heart Disease ◽

Vascular Pathology ◽

Placental Pathology ◽

Maternal Characteristics ◽

Flow Restriction ◽

Pathologic Findings ◽

Gestational Age At Delivery ◽

Chronic Villitis ◽

Pathology Reports ◽

Cardiovascular Care

Background: The incidence of pregnancy in women with cardiovascular disease (CVD) has increased, yet there is little known about placental pathology in these women. Objective: To describe placental pathology in pregnancies carried by women with CVD and to compare placental findings between categories of maternal CVD. Methods: We identified live births within the prospective, single-center Standardized Outcomes in Reproductive Cardiovascular Care cohort for which the placenta underwent histopathologic examination. Pathology reports were reviewed by an experienced placental pathologist (BJQ) for prespecified pathologic findings that were then compared against maternal characteristics. Results: 271 placentas (Table 1) were identified from pregnancies associated with maternal congenital heart disease (CHD) (65%), arrhythmia (16%), cardiomyopathy (8%), connective tissue disease (7%), and valvular heart disease (4%). Median maternal age at delivery was 32 years (range 19-49). Median gestational age at delivery was 39 weeks (range 25-41). Anatomic pathology, mostly in the form of small placenta by weight, was most common, affecting 43% of placentas. Vascular pathology, mostly maternal vascular malperfusion or fetal flow restriction, was seen in 41% of placentas. Infectious (acute chorioamnionitis) and inflammatory (chronic villitis) pathology was seen in 23% and 10% of placentas, respectively. Inflammatory pathology was more common in maternal CHD than in other CVD categories (14.9% vs. 2.1%, p=0.001), while anatomic, infectious, and vascular pathology were seen at similar rates across all CVD categories. Conclusion: Pregnancies among women with CVD commonly demonstrate abnormal placental findings, especially anatomic and vascular pathology. Chronic villitis was more common in women with CHD compared to other types of CVD. Otherwise, the incidence of specific pathology findings did not differ significantly based on maternal characteristics.

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Impact of SARS-CoV-2 on the clinical outcomes and placental pathology of pregnant women and their infants: A Systematic Review

Heliyon ◽

10.1016/j.heliyon.2021.e06393 ◽

2021 ◽

pp. e06393

Author(s):

Irina Oltean ◽

Jason Tran ◽

Sarah Lawrence ◽

Brittany Ann Ruschkowski ◽

Na Zeng ◽

...

Keyword(s):

Systematic Review ◽

Pregnant Women ◽

Clinical Outcomes ◽

Placental Pathology

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Distribution and Severity of Placental Lesions Caused by the Chlamydia abortus 1B Vaccine Strain in Vaccinated Ewes

Pathogens ◽

10.3390/pathogens10050543 ◽

2021 ◽

Vol 10 (5) ◽

pp. 543

Author(s):

Sergio Gastón Caspe ◽

Javier Palarea-Albaladejo ◽

Clare Underwood ◽

Morag Livingstone ◽

Sean Ranjan Wattegedera ◽

...

Keyword(s):

Disease Outbreaks ◽

Principal Component ◽

Placental Pathology ◽

Wild Type ◽

Cell Infiltrate ◽

Chlamydia Abortus ◽

Vaccine Type ◽

The Difference ◽

Enzootic Abortion Of Ewes

Chlamydia abortus infects livestock species worldwide and is the cause of enzootic abortion of ewes (EAE). In Europe, control of the disease is achieved using a live vaccine based on C. abortus 1B strain. Although the vaccine has been useful for controlling disease outbreaks, abortion events due to the vaccine have been reported. Recently, placental pathology resulting from a vaccine type strain (vt) infection has been reported and shown to be similar to that resulting from a natural wild-type (wt) infection. The aim of this study was to extend these observations by comparing the distribution and severity of the lesions, the composition of the predominating cell infiltrate, the amount of bacteria present and the role of the blood supply in infection. A novel system for grading the histological and pathological features present was developed and the resulting multi-parameter data were statistically transformed for exploration and visualisation through a tailored principal component analysis (PCA) to evaluate the difference between them. The analysis provided no evidence of meaningful differences between vt and wt strains in terms of the measured pathological parameters. The study also contributes a novel methodology for analysing the progression of infection in the placenta for other abortifacient pathogens.

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Placental pathology in an unsuspected case of mucolipidosis type II with secondary hyperparathyroidism in a premature infant

Molecular Genetics and Metabolism Reports ◽

10.1016/j.ymgmr.2021.100747 ◽

2021 ◽

Vol 27 ◽

pp. 100747

Author(s):

Parith Wongkittichote ◽

Garland Michael Upchurch ◽

Louis P. Dehner ◽

Timothy Wood ◽

Jorge L. Granadillo

Keyword(s):

Secondary Hyperparathyroidism ◽

Premature Infant ◽

Type Ii ◽

Placental Pathology ◽

Mucolipidosis Type

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New-onset type 2 diabetes in heart failure: impact of heart failure and death versus ischemic events – a Danish nationwide cohort study

European Heart Journal ◽

10.1093/ehjci/ehaa946.1145 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

B Zareini ◽

P.B Blanche ◽

A.H Holt ◽

M.M Malik ◽

D.P Rajan ◽

...

Keyword(s):

Heart Failure ◽

Type 2 Diabetes ◽

Risk Ratio ◽

Real Life ◽

Ischemic Event ◽

Increased Risk ◽

The Absolute ◽

Ischemic Events ◽

New Onset

Abstract Background Development of type 2 diabetes (T2D) is common in patients with heart failure (HF), but knowledge of future cardiovascular events is lacking. Purpose We compared risk of heart failure hospitalization (HFH) or death versus ischemic events in real-life HF patients with new-onset T2D, prevalent T2D and no T2D. Methods Using the Danish nationwide registers, we identified all patients with HF between 1998–2016. The patients were separated in two different HF cohorts based on the status of T2D. One cohort consisted of HF patients with either prevalent or absent T2D at the time of HF diagnosis. The other cohort consisted of HF patients, who developed new-onset T2D, included at time of diagnosis. The two HF cohorts were analyzed separately. Outcomes for both cohorts were analyzed as time-to-first event as either an ischemic event (i.e. composite outcome of fatal and non-fatal myocardial infarction, stroke, and peripheral artery disease), HFH, or event-free death (not related to HFH or the ischemic event). For each cohort, we estimated the five-year absolute risk of ischemic event, HFH and event-free death, along with five-year risk ratio of HFH or event-free death versus ischemic events. Effects among subgroups were investigated by stratifying both cohorts based on age, gender and comorbidities present at inclusion. Results A total of 139,264 HF patients were included between 1998 and 2016, of which 29,078 (21%) patients had prevalent T2D at baseline. A total of 11,819 (8%) developed new-onset T2D and were included in the second cohort. The median duration of time between HF diagnosis and new-onset T2D diagnosis was: 4.1 years (IQR:1.5; 5.8). The absolute five-year risk of an ischemic event in patients with new-onset T2D, prevalent T2D and no T2D was: 17.9% (95% confidence interval (CI): 17.2; 18.6), 26.1% (95% CI: 25.6; 26.7), and 18.8% (95% CI:18.6; 19.0). Corresponding estimates for HFH were: 31.5% (95% CI: 30.6; 32.3), 33.6% (95% CI: 33.0; 34.2), and 30,7% (95% CI: 30.5; 31.0). The absolute five-year risk of event-free death among patients with new-onset T2D, prevalent T2D and no T2D was: 20.9% (95% CI: 20.2; 21.7), 18.9% (95% CI:18.4; 19.3), and 18.6% (95% CI: 18.4; 18.8) (see Figure). The five-year risk ratio of experiencing HFH or event-free death versus an ischemic event was: 2.9 (95% CI: 2.8; 3.1), 2.0 (95% CI:2.0; 2.1), and 2.6 (95% CI: 2.6; 2.7) for patients with new-onset T2D, prevalent T2D and no T2D, respectively. Similar results of absolute and relative risk were present across all subgroups. Conclusion In our population of HF patients, 8% developed new-onset diabetes. Development of T2D in patients with HF increases the risk of HFH and mortality three-fold. The increased risk of new-onset T2D is higher than the importance of prevalent T2D in patients with HF. Funding Acknowledgement Type of funding source: None

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Effectiveness of Epidemic Preventive Policies and Hospital Strategies in Combating COVID-19 Outbreak in Taiwan

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18073456 ◽

2021 ◽

Vol 18 (7) ◽

pp. 3456

Author(s):

Ting Wan Tan ◽

Han Ling Tan ◽

Man Na Chang ◽

Wen Shu Lin ◽

Chih Ming Chang

Keyword(s):

Mortality Rate ◽

Incidence Rate ◽

Risk Ratio ◽

Early Stage ◽

Control Measures ◽

Polymerase Chain Reaction Test ◽

Effective Control ◽

Nasopharyngeal Swab ◽

Preventive Strategies ◽

Epidemic Control

(1) Background: The implementation of effective control measures in a timely fashion is crucial to control the epidemic outbreak of COVID-19. In this study, we aimed to analyze the control measures implemented during the COVID-19 outbreak, as well as evaluating the responses and outcomes at different phases for epidemic control in Taiwan. (2) Methods: This case study reviewed responses to COVID-19 and the effectiveness of a range of control measures implemented for epidemic control in Taiwan and assessed all laboratory-confirmed cases between 11 January until 20 December 2020, inclusive of these dates. The confirmation of COVID-19 infection was defined as the positive result of a reverse-transcriptase–polymerase-chain-reaction test taken from a nasopharyngeal swab. Test results were reported by the Taiwan Centers for Disease Control. The incidence rate, mortality rate, and testing rate were compiled, and the risk ratio was provided to gain insights into the effectiveness of prevention measures. (3) Results and Discussion: This study presents retrospective data on the COVID-19 incidence rate in Taiwan, combined with the vital preventive control measures, in a timeline of the early stage of the epidemic that occurred in Taiwan. The implementation of multiple strategy control measures and the assistance of technologies to control the COVID-19 epidemic in Taiwan led to a relatively slower trend in the outbreak compared to the neighboring countries. In Taiwan, 766 confirmed patients were included, comprised of 88.1% imported cases and 7.2% local transmission cases, within the studied period. The incidence rate of COVID-19 in Taiwan during the studied period was 32 per million people, with a mortality rate of 0.3 per million people. Our analysis showed a significantly raised incidence risk ratio in the countries of interest in comparison to Taiwan during the study period; in the range of 1.9 to 947.5. The outbreak was brought under control through epidemic policies and hospital strategies implemented by the Taiwan Government. (4) Conclusion: Taiwan’s preventive strategies resulted in a drastically lower risk for Taiwan nationals of contracting COVID-19 when new pharmaceutical drug or vaccines were not yet available. The preventive strategies employed by Taiwan could serve as a guide and reference for future epidemic control strategies.

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Extensive Perivillous Fibrin and Intervillous Histiocytosis in a SARS-CoV-2 Infected Placenta From an Uninfected Newborn: A Case Report Including Immunohistochemical Profiling

Pediatric and Developmental Pathology ◽

10.1177/10935266211025122 ◽

2021 ◽

pp. 109352662110251

Author(s):

James Roberts ◽

Jeanette D Cheng ◽

Elizabeth Moore ◽

Carla Ransom ◽

Minhui Ma ◽

...

Keyword(s):

Risk Factors ◽

Case Report ◽

Gestational Age ◽

Small For Gestational Age ◽

Immunohistochemical Staining ◽

Placental Pathology ◽

Fibrin Deposition ◽

Placental Infection ◽

Fetal Infection

Placental infection by SARS-CoV-2 with various pathologic alterations reported. Inflammatory findings, such as extensive perivillous fibrin deposition and intervillous histiocytosis, have been postulated as risk factors for fetal infection by SARS-CoV-2. We describe the placental findings in a case of a 31-year-old mother with SARS-CoV-2 infection who delivered a preterm female neonate who tested negative for SAR-CoV2 infection. Placental examination demonstrated a small for gestational age placenta with extensive intervillous histiocytosis, syncytiotrophoblast karyorrhexis, and diffuse intervillous fibrin deposition. Immunohistochemical staining demonstrated infection of the syncytiotrophoblasts by SARS-CoV-2 inversely related to the presence of intervillous histiocytes and fibrin deposition. Our case demonstrates that despite extensive placental pathology, no fetal transmission of SARS-CoV-2 occurred, as well as postulates a relationship between placental infection, inflammation, and fibrin deposition.

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Reflections illuminate antenatal detection of placental pathology

EBioMedicine ◽

10.1016/j.ebiom.2021.103404 ◽

2021 ◽

Vol 68 ◽

pp. 103404

Author(s):

Joseph J. Smolich ◽

Jonathan P. Mynard

Keyword(s):

Placental Pathology ◽

Antenatal Detection

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Life-course trajectories of weight and their impact on the incidence of type 2 diabetes

Scientific Reports ◽

10.1038/s41598-021-91910-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Diego Yacamán-Méndez ◽

Ylva Trolle-Lagerros ◽

Minhao Zhou ◽

Antonio Monteiro Ponce de Leon ◽

Hrafnhildur Gudjonsdottir ◽

...

Keyword(s):

Type 2 Diabetes ◽

Life Course ◽

Risk Ratio ◽

Absolute Risk ◽

Early Adulthood ◽

Normal Weight ◽

Overweight And Obesity ◽

Increased Risk ◽

Incident Cases

AbstractAlthough exposure to overweight and obesity at different ages is associated to a higher risk of type 2 diabetes, the effect of different patterns of exposure through life remains unclear. We aimed to characterize life-course trajectories of weight categories and estimate their impact on the incidence of type 2 diabetes. We categorized the weight of 7203 participants as lean, normal or overweight at five time-points from ages 7–55 using retrospective data. Participants were followed for an average of 19 years for the development of type 2 diabetes. We used latent class analysis to describe distinctive trajectories and estimated the risk ratio, absolute risk difference and population attributable fraction (PAF) associated to different trajectories using Poisson regression. We found five distinctive life-course trajectories. Using the stable-normal weight trajectory as reference, the stable overweight, lean increasing weight, overweight from early adulthood and overweight from late adulthood trajectories were associated to higher risk of type 2 diabetes. The estimated risk ratios and absolute risk differences were statistically significant for all trajectories, except for the risk ratio of the lean increasing trajectory group among men. Of the 981 incident cases of type 2 diabetes, 47.4% among women and 42.9% among men were attributable to exposure to any life-course trajectory different from stable normal weight. Most of the risk was attributable to trajectories including overweight or obesity at any point of life (36.8% of the cases among women and 36.7% among men). The overweight from early adulthood trajectory had the highest impact (PAF: 23.2% for woman and 28.5% for men). We described five distinctive life-course trajectories of weight that were associated to increased risk of type 2 diabetes over 19 years of follow-up. The variability of the effect of exposure to overweight and obesity on the risk of developing type 2 diabetes was largely explained by exposure to the different life-course trajectories of weight.

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