Shallow Placentation: A Distinct Category of Placental Lesions

2021 ◽  
Author(s):  
Jerzy Stanek
Keyword(s):  
Umbilical Cord ◽  
Neonatal Intensive Care ◽  
Gestational Hypertension ◽  
Basal Plate ◽  
Hypoxic Injury ◽  
Risk Pregnancy ◽  
Amsterdam Criteria ◽  
Group 2 ◽  
Extravillous Trophoblasts ◽  
Group 1

Objective Shallow placental implantation (SPI) features placental maldistribution of extravillous trophoblasts and includes excessive amount of extravillous trophoblasts, chorionic microcysts in the membranes and chorionic disc, and decidual clusters of multinucleate trophoblasts. The histological lesions were previously and individually reported in association with various clinical and placental abnormalities. This retrospective statistical analysis of a large placental database from high-risk pregnancy statistically compares placentas with and without a composite group of features of SPI. Study Design Twenty-four independent abnormal clinical and 44 other than SPI placental phenotypes were compared between 4,930 placentas without (group 1) and 1,283 placentas with one or more histological features of SPI (composite SPI group; group 2). Placentas were received for pathology examination at a discretion of obstetricians. Placental lesion terminology was consistent with the Amsterdam criteria, with addition of other lesions described more recently. Results Cases of group 2 featured statistically and significantly (p < 0.001after Bonferroni's correction) more common than group 1 on the following measures: gestational hypertension, preeclampsia, oligohydramnios, polyhydramnios, abnormal Dopplers, induction of labor, cesarean section, perinatal mortality, fetal growth restriction, stay in neonatal intensive care unit (NICU), congenital malformation, deep meconium penetration, intravillous hemorrhage, villous infarction, membrane laminar necrosis, fetal blood erythroblastosis, decidual arteriopathy (hypertrophic and atherosis), chronic hypoxic injury (uterine and postuterine), intervillous thrombus, segmental and global fetal vascular malperfusion, various umbilical cord abnormalities, and basal plate myometrial fibers. Conclusion SPI placentas were statistically and significantly associated with 48% abnormal independent clinical and 51% independent abnormal placental phenotypes such as acute and chronic hypoxic lesions, fetal vascular malperfusion, umbilical cord abnormalities, and basal plate myometrial fibers among others. Therefore, SPI should be regarded as a category of placental lesions related to maternal vascular malperfusion and the “Great Obstetrical Syndromes.” Key Points

scholarly journals Availability of Donor Milk for Very Preterm Infants Decreased the Risk of Necrotizing Enterocolitis without Adversely Impacting Growth or Rates of Breastfeeding

Nutrients ◽  
2019 ◽  
Vol 11 (8) ◽  
pp. 1895 ◽  
Author(s):  
Débora Cañizo Vázquez ◽  
Sandra Salas García ◽  
Montserrat Izquierdo Renau ◽  
Isabel Iglesias-Platas
Keyword(s):  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Neonatal Intensive Care ◽  
Late Onset ◽  
Donor Milk ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Breastfeeding Rates ◽  
Group 2 ◽  
Group 1

Human milk contains non-nutritional factors that promote intestinal maturation and protect against infectious and inflammatory conditions. In the Neonatal Intensive Care Unit (NICU) setting, donor milk (DM) is recommended when availability of own mother’s milk (OMM) is not enough. Our aim was to compare the incidence of necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) in very preterm infants (VPI) after the introduction of DM. Growth and breastfeeding rates were examined as secondary outcomes. Single center, observational and retrospective cohort study comparing 227 VPI admitted to our neonatal unit before (Group 1, n = 99) and after (Group 2, n = 128) DM introduction. Enteral nutrition was started earlier after DM availability (2.6 ± 1.1 vs. 2.1 ± 1 days, p = 0.001). Incidence of NEC decreased in group 2 (9.1% vs. 3.4%, p = 0.055), especially in those born between 28 and 32 weeks (5.4 vs. 0.0%, p = 0.044). Surgical NEC was also less frequent. Suffering NEC was 4 times more likely in group 1 (multivariate analysis). Availability of DM did not impact breastfeeding rates or preterm growth. Our findings support the protective role of DM against NEC, particularly in non-extreme VPI, a group less frequently included in clinical guidelines and research studies on the use of DM.

Effect of Chlorhexidine Cleansing of Umbilical Cord for Prevention of Infection

2018 ◽  
Vol 4 (2) ◽  
pp. 35-39
Author(s):  
Md Khairuzzaman ◽  
MA Mannan ◽  
Abdul Matin ◽  
Mst Monjuman Ara Sarker ◽  
Nihar Ranjan Sarker ◽  
...  
Keyword(s):  
Umbilical Cord ◽  
Controlled Trial ◽  
Care Group ◽  
Cord Care ◽  
Randomized Controlled ◽  
Group 3 ◽  
Group 2 ◽  
To Receive ◽  
Level Hospital ◽  
Group 1

Background: Chlorhexidine cleansing of the cord can reduce neonatal mortality among newborns.Objective: The aim of study was to determine the effect of cord cleansing with chlorhexidine in reduction of umbilical infection among newborns in hospital settings.Methodology: This randomized controlled trial was carried out between April 2013 to July 2014 and 510 newborns were randomly assigned within a tertiary level hospital in Bangladesh to receive 1 of 3 cord care regimens single cord cleansing with 4% chlorhexidine(Group-1), multiple cord cleansing with 4% chlorhexidine (Group-2)  and clean and dry cord care (Group-3 : control).Results: The risk of umbilical cord infection (omphalitis) was significantly reduced in both the single (Relative risk [RR] 0.15 [95% CI] 0.008-0.93) and multiple chlorhexidine cleansing group (RR 0.37 [95% CI] 0.04- 0.99) compared to the dry cord care group.  The risk of omphalitis was not significantly different between multiple and single chlorhexidine cleansing group (RR 3.14 [0.13-76.54]). Conclusion: Chlorhexidine significantly reduce the risk of umbilical infection in both single and multiple cord cleansing neonates.Bangladesh Journal of Infectious Diseases 2017;4(2):35-39

Carbapenem-Resistant Klebsiella pneumoniae Outbreak in a Neonatal Intensive Care Unit: Risk Factors for Mortality

2020 ◽  
Author(s):  
Meltem Bor ◽  
Ozkan Ilhan
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Congenital Anomalies ◽  
Neonatal Intensive Care ◽  
Carbapenem Resistant ◽  
Group 2 ◽  
Antifungal Use ◽  
Group 1

Abstract Aim The aim of our study was to determine the factors associated with mortality in neonates with carbapenem-resistant Klebsiella pneumoniae (CRKP). Material and methods This retrospective, single-center study was conducted in the Neonatal Intensive Care Unit of Harran University Faculty of Medicine between January 2017 and July 2018 who had CRKP growth in their blood, urine or cerebrospinal fluid cultures. The discharged group was designated as the control group (Group 1), whereas the group that faced mortality was classified as the case group (Group 2). The demographic data, clinical findings and laboratory and microbiological results of the two groups were compared to identify risk factors. Results A total of 58 patients (36 in Group 1 and 22 in Group 2) exhibited CRKP growth during the study period. Low birth weight (p = 0.039), previous antifungal (p = 0.002) or amikacin use (p = 0.040), congenital anomalies (p = 0.002), total parenteral nutrition (TPN) administration (p = 0.002), surgery (p = 0.035), thrombocytopenia (p = 0.007), low platelet mass index (p = 0.011), elevated C-reactive protein (p = 0.004), high carbapenem minimum inhibitory concentration (MIC) (p = 0.029) and high amikacin MIC (p = 0.019) were associated with mortality. In a multivariate regression analysis, previous antifungal use (p = 0.028), congenital anomalies (p = 0.032) and TPN use (p = 0.013) were independent factors in predicting mortality. Conclusion Previous antifungal use, congenital anomalies and TPN use were found to be independent risk factors for mortality in neonates with CRKP infection.

scholarly journals Inflammatory changes in the placenta in ischemic-cervical insufficiency

2021 ◽  
Vol 20 (3) ◽  
pp. 33-37
Author(s):  
V. F. Dolgushina ◽  
E. S. Alikhanova ◽  
M. V. Astashkina ◽  
L. A. Smolnikova
Keyword(s):  
Pregnant Women ◽  
Umbilical Cord ◽  
Sampling Method ◽  
Fetal Membranes ◽  
Cervical Insufficiency ◽  
Continuous Sampling ◽  
Ascending Infection ◽  
Group 2 ◽  
Inflammatory Changes ◽  
Group 1

Introduction. The high frequency of inflammatory changin the placenta in isthmic-cervical insufficiency may be primarily associated with an ascending infection as a result of a violation of the barrier function of the cervix, however, premature remodeling of the cervix may also be secondary due to an already existing process. The study of the features of the spread of the infectious process and thnature of the inflammatory reaction in various structures of the placenta and fetal membranes can contribute to the understanding of pathogenetic mechanisms of preterm birth in isthmic-crvical insufficiency. Aim of the study — to evaluate the frequency and structure of inflammatory changes in the placenta in women with isthmic-cervical insufficiency. Materials and methods. A prospective cohort study was conduct, which included 154 pregnant women taken by the continuous sampling method. All patients were divided into two groups: group 1 consisted of 100 pregnant women with isthmic-cervical insufficiency, group 2 — pregnant women without isthmic-cervical insufficiency. All women after childbirth underwent a pathomorphological examination of the afterbirth. Results and discussion. In women with isthmic-cervical insufficiency, inflamatory changes in the placenta were detected in 71% (71) of cases, which was significantly more frequent compared to group 2 — 38.9% (21). Membranitis was significantly more frequent in isthmic-cervical insufficiency, amounting to 16% (16) versus 3.7% (2) comparison group (OR=4.32, 95% СI=1.03-18.09, p=0.023). Chorioamnionitis was 6 times more common in the afterbirth in women of group 1, accounting for 12% (12), versus 1.9% (1) in group 2 (OR=6.48, 95% CI=0.87-48.51, p=0.031). Involvement of the umbilical cord in the inflammatory process occurred only in pregnant women with isthmic-cervical insufficiency: funiculitis was combined with membranitis in 4% (4) of cases (p=0.137), the combination of funiculitis with choriomnionitis was detcted in 7% (7) of women p=0.047). Conclusion. The frequencof detection of inflammatory changes in the placenta in ICN was 71% (71). In the structure of inflammatory changes of the afterbirth in patients with ICN, the defeat of the fetal membranes prevails, which may indicate a predominatly ascending path of infection in this pathology. Damage membranes prevails, which may indicate a predominatly ascending path of infection in this pathology. Damage to the umbilical cord in ICN can occur both wth total inflammation of all structures of the placenta, and directly through the fetal membranes, without involving the chorion in the process.

scholarly journals Chlorhexidine Cleansing of the Umbilical Cord for Prevention of Umbilical Infection: A Hospital based Study in Bangladesh

2018 ◽  
Vol 42 (1) ◽  
pp. 4-8
Author(s):  
M Khairuzzaman ◽  
MA Rouf ◽  
MMA Sarker ◽  
I Hossain ◽  
A Matin ◽  
...  
Keyword(s):  
Umbilical Cord ◽  
Bacterial Colonization ◽  
Care Group ◽  
Risk Of Infection ◽  
Cord Care ◽  
Group 3 ◽  
Group 2 ◽  
To Receive ◽  
Level Hospital ◽  
Group 1

Background: The umbilical cord is an important site for bacterial colonization. A possible consequence of bacterial colonization is cord stump infection, a factor that can greatly increase morbidity and mortality for infants in developing countries. Chlorhexidine cleansing of the cord can reduce neonatal mortality among newborns infants in low-resource settings with high risk of infection. This objective of this study was to determine the effect of cord cleansing with chlorhexidine in reduction of umbilical infection among newborns in hospital settings.Methodology: Between April 2013 to July 2014, 510 newborns were randomly assigned within a tertiary level hospital in Bangladesh to receive 1 of 3 cord care regimens: single cord cleansing with 4% chlorhexidine(Group-1), multiple cord cleansing with 4% chlorhexidine (Group-2) and clean and dry cord care (Group-3 : control).Results: The risk of umbilical cord infection (omphalitis) was significantly reduced in both the single (Relative risk [RR] 0.15 [95% CI] 0.008-0.93) and multiple chlorhexidine cleansing group (RR 0.37 [95% CI] 0.04- 0.99) compared to the dry cord care group. The risk of omphalitis was not significantly different between multiple and single chlorhexidine cleansing group (RR 3.14 [0.13-76.54]).Conclusion: 4% chlorhexidine significantly reduce the risk of umbilical infection in both single and multiple cord cleansing groups as compared to clean and dry cord care group.Bangladesh J Child Health 2018; VOL 42 (1) :4-8

scholarly journals Psoriasis and Pregnancy: Retrospective Evaluation of 47 Pregnancies in a Tertiary Center

2018 ◽  
pp. 1 ◽  
Author(s):  
Efsun Tanacan ◽  
Atakan Tanacan ◽  
Erdem Fadiloglu ◽  
Canan Unal ◽  
Mehmet Sinan Beksac
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Maternal Age ◽  
Neonatal Intensive Care ◽  
Chronic Plaque Psoriasis ◽  
Gestational Week ◽  
Group 2 ◽  
Minute Apgar Score ◽  
Group 1

<p><strong>Objective:</strong> To evaluate the impact of psoriasis on pregnancy outcomes.</p><p><strong>Study Design:</strong> Data of pregnant women with chronic plaque psoriasis who were followed up at Ha­cet­­tepe University Hospital between January 1, 2010 and December 31, 2017 were evaluated. Pregnant women with singleton pregnancies who had chronic plaque psoriasis were included in the study. Patients were divided into two groups based on the clinical course of psoriasis: group 1 (improvement/disease-stable), and group 2 (deterioration). Median maternal age, gravida, parity, gestational week at birth, birthweight, 5th minute APGAR score together with the rates of cesarean section, neonatal intensive care unit admission and pregnancy complications (spontaneous abortion, preterm delivery, fetal growth restriction and preeclampsia) were compared between the groups.</p><p><strong>Results:</strong> There were 29 (61.7%) patients in group 1 and 18 (38.3%) patients in group 2. Mean values for maternal age, gravida and parity were comparable between the groups (p values were 0.32, 0.09 and 0.17, respectively). Median values for gestational week at birth (39.2 vs 36.1, p =0.002), birthweight (3200 vs 2310, p =0.002) and 5th minute APGAR score (9 vs 7, p &lt;0.001) were statistically significantly lower in group 2. Cesarean section (33.3% vs 71.4%, p =0.02), neonatal intensive care unit admission (11.1% vs 64.3%, p &lt;0.001) and pregnancy complication rates (p =0.003) were statistically significantly higher in group 2. Frequencies of spontaneous abortion, preterm delivery, fetal growth restriction and preeclampsia were 6.9%, 10.3%, 3.4% and 3.4% in group 1, and 22.2%, 27.8%, 16.7% and 16.7% in group 2, respectively.</p><p><strong>Conclusion:</strong> Deterioration of psoriasis in pregnancy was associated with adverse obstetric outcome.</p>

scholarly journals The use of dinoprostone at third trimester in pregnant women with oligohydramnios

2021 ◽  
Vol 38 (4) ◽  
pp. 604-607
Author(s):  
Mehmet GÜÇLÜ ◽  
Nur DOKUZEYLÜL GÜNGÖR ◽  
Tuğba GÜRBÜZ ◽  
Arzu YURCİ
Keyword(s):  
Amniotic Fluid ◽  
Pregnant Women ◽  
Neonatal Intensive Care ◽  
Delivery Rate ◽  
Labour Induction ◽  
Third Trimester ◽  
Amniotic Fluid Index ◽  
Group 2 ◽  
Four Quadrant ◽  
Group 1

The aim of this study was comparing the efficacy of dinoprostone administration for labour induction in pregnant women with oligohydramnios and in pregnant women with normal amniotic fluid volume at third trimester. This retrospective study included 187 pregnant women between January 2015-December 2020. Four quadrant technique was used to determine amniotic fluid index. The cases in the study were divided into two groups as Group:1(the ones with oligohydramnios) and Group:2 (the ones with normal amniotic volume) Age ,gravida, parity ,gestational week according to the last date of menstruation, Bishop score ,dilatation ,hours elapsed after the first contraction, hours elapsed after active contraction, labour entry time (hour) , time elapsed until delivery (hour) , birth weight, Apgar score 0th minute and 5th minute and their distribution between the groups showed similarity (p> 0.05). The values of amniotic fluid index (AFI) (p <0.001) and effacement (p = 0.012) were found to be significantly higher in Group 2 compared to the values of the cases in the Group 1 (p <0.05). It was found in the analysis that the findings of premature rupture of membrane (PROM), oxytocin augmentation need, tachysystole, vaginal delivery rate, caesarean delivery rate, meconium stained amnion rate, neonatal intensive care unit (NICU) need, postpartum hemorrhage, and transfusion need (p = 0.394) were similar between two groups (p> 0.05). We can state that dinoprostone can be used safely and effectively to induce labor in third trimester pregnancies both with normal AFI and oligohydramnios.

scholarly journals Combined Human Umbilical Cord-Derived Stem Cell and Hyperbaric Oxygen Therapy Effectively Preserved the Neurological Function and Brain Architecture in Rat After Acute Intracerebral Hemorrhage

2020 ◽  
Author(s):  
Hon-Kan Yip ◽  
Kun-Chen Lin ◽  
Pei-Hsun Sung ◽  
John Y. Chiang ◽  
Tsung-Cheng Yin ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Umbilical Cord ◽  
Hyperbaric Oxygen ◽  
Neurological Function ◽  
Control Group ◽  
Human Umbilical Cord ◽  
Acute Intracerebral Hemorrhage ◽  
Group 5 ◽  
Group 2 ◽  
Group 1

Abstract Background: This study tested the hypothesis that combined therapy with human umbilical cord-derived mesenchymal stem cells (HUCDMSCs) and hyperbaric oxygen (HBO) was superior to either one on preserving neurological function and reducing brain-hemorrhagic volume (BHV) in rat after acute intracerebral hemorrhage (ICH) induced by intracranial injection of collagenase. Methods and Results: Adult-male SD rats (n=30) were equally divided into group 1 (sham-operated control), group 2 (ICH), group 3 (ICH + HUCDMSCs/1.2x106 cells/intravenous injection at 3h and days 1/2 after ICH), group 4 (ICH + HBO/at 3h and days 1/2 after ICH) and group 5 (ICH + HUCDMSCs-HBO), and euthanized by day 28 after ICH. By day 1, the neurological function was significantly impaired in groups 2 to 5 than in group 1 (p<0.001), but it did not differ among groups 2 to 5. By days 7/4/28, the integrity of neurological function was highest in group 1, lowest in group 2 and significantly progressively improved from groups 3 to 5 (all p<0.001). By day 28, the BHV was lowest in group 1, highest in group 2 and significantly lower in group 5 than in groups 3/4 (all p<0.0001). The protein expressions of inflammation (HMGB1/TLR-2/TLR-4/MyD88/TRAF6/p-NF-κB/IFN-γ/IL-1ß/TNF-α), oxidative-stress/autophagy (NOX-1/NOX-2/oxidized protein/ratio of LC3BII/LC3BI) and apoptosis (cleaved-capspase3/PARP), and cellular expressions of inflammation (CD14+, F4/80+) in brain tissues exhibited an identical pattern, whereas cellular levels of angiogenesis (CD31+/vWF+/small-vessel number) and number of neurons (NeuN+) exhibited an opposite pattern of BHV among the groups (all p<0.0001). Conclusion: combined HUCDMSC-HBO therapy offered better outcomes after rat ICH.

Procalcitonin Level at 24 Hours of Age May be Predictive for Transient Tachypnea of the Newborn

2020 ◽  
Vol 15 (06) ◽  
pp. 307-311
Author(s):  
Nuriye Tarakcı ◽  
Hüseyin Altunhan ◽  
Eyüp Sarı ◽  
Mehmet Uyar
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Distress ◽  
Bacterial Pneumonia ◽  
Neonatal Intensive Care ◽  
Initial Study ◽  
Procalcitonin Level ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Objective It is an important problem to differentiate transient tachypnea of the newborn (TTN) from bacterial pneumonia or other conditions in patients admitted to Neonatal Intensive Care Unit. The aim of this study was to evaluate the predictive value of procalcitonin (PCT) for TTN. Methods A total of 52 infants were contained in the study. The patients were divided into three groups. Group 1 consisted of patients with pronounced grunting at more than 2 hours postnatal age (n = 16). Group 2 consisted of patients whose grunt was reduced or gone at 2 hours postnatal age but in whom tachypnea persisted until 24 hours postnatal age (n = 18). Group 3 consisted of patients with minimal or no respiratory distress at 24 hours postnatal age (n = 18). In all groups, PCT concentrations were determined at birth and 24 hours postnatal age. Results PCT concentrations at birth were significantly higher in Group 1 than other groups, but there was no difference between Groups 2 and 3. PCT concentrations at 24 hours postnatal age were significantly higher in Groups 1 and 2 than Group 3. No difference was found between Group 1 and Group 2 at 24 hours postnatal age. All PCT concentrations in Group 3 were significantly lower than other groups. PCT thresholds for the diagnosis of TTN were 0.44 ng/mL at birth (sensitivity 58%, specificity 50%) and 5.11 ng/mL at 24 hours postnatal age (sensitivity 79.4%, specificity 89.1%). Conclusion Serial PCT measurements at birth and postnatal 24 hours may be helpful in differentiating between pneumonia and TTN. Further researches are needed to confirm this initial study.

scholarly journals Effect of oral administration of probiotics on intestinal colonization with drug-resistant bacteria in preterm infants

2017 ◽  
Vol 57 (2) ◽  
pp. 91
Author(s):  
Abdullah Kurt ◽  
Deniz Anuk Ince ◽  
Ayşe Ecevit ◽  
Özlem Kurt Azap ◽  
Zafer Ecevit ◽  
...  
Keyword(s):  
Oral Administration ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Lactobacillus Reuteri ◽  
Resistant Bacteria ◽  
Intestinal Colonization ◽  
Antibiotic Resistant ◽  
Drug Resistant Bacteria ◽  
Group 2 ◽  
Group 1

Background Oral administration of probiotics in newborn preterm infants has been shown to be helpful, especially ın reducıng the incidence of necrotizing enterocolitis and overall mortality rates.Objective To evaluate the effect of probıotıc supplementation on ıntestınal colonization by antibiotic-resistant microorganisms in preterm infants receiving antibiotics in a neonatal intensive care unit (NICU).Methods The prospective, randomized trial was performed ın preterm infants who were hospitalized in the NICU at Baskent University Ankara Hospital between January 2011 and February 2012. A total of 51 infants were enrolled and randomly assigned to one of two groups: Group 1 (n=27) received probiotic therapy and Group 2 (n=24) did not receive probiotics. The probiotic used was Lactobacillus reuteri (Biogaia® AB, Sweden).  Subjects underwent weekly nasal swab and stool cultures for a maxımum of 6 weeks, and at the tıme of dıscharge ıf thıs was prıor to 6 weeks. All posıtıve cultures were further tested for culture-specıfıc ıdentıfıcatıon and antıbıotıc suceptibility.Results  A total of 607 cultures were evaluated. Posıtıve cultures were found ın 37.9% from Group 1 and 35.2% from Group 2. Intestınal colonızatıon by antıbıotıc-resıstant bacterıa dıd not sıgnıfıcantly dıffer between groups (P>0.05).                                                                                                                          Conclusions Oral supplementation with probiotics do not prevent the intestınal colonization of antibiotic-resistant microorganisms in preterm NICU patıents who receıved antıbıotıc treatment.

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