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

Circulation ◽  
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.

Perinatal Pulmonary Hemorrhage: A Retrospective Autopsy Case Series

2020 ◽  
Vol 23 (4) ◽  
pp. 267-273
Author(s):  
Indu Agarwal ◽  
Linda M Ernst
Keyword(s):  
Pulmonary Hypoplasia ◽  
Case Series ◽  
Pulmonary Hemorrhage ◽  
Vascular Pathology ◽  
Placental Pathology ◽  
Autopsy Case ◽  
Inclusion Criteria ◽  
High Prevalence ◽  
Hematoxylin And Eosin ◽  
Pathology Reports

Perinatal pulmonary hemorrhage (PH) is a condition characterized by blood loss via the respiratory tract with an approximate incidence of 0.1% in all newborns. The histologic characteristics of the lung in PH are not well characterized, and we hypothesized that pulmonary maldevelopment such as pulmonary hypoplasia may contribute to PH. In addition, we sought to find any correlations with placental pathology. Retrospective study of fetal and neonatal autopsies with diagnosis of PH was performed between the years from 2009 to 2015. Autopsy reports, placental pathology reports, and hematoxylin and eosin sections of the lung were reviewed. Of the 17 cases which were identified meeting inclusion criteria, PH ranged from mild (<5% in each lung) to severe (>75% in both lungs). PH involved >50% of both lungs in 6 cases. Pulmonary hypoplasia was designated in 7 of 17 (41.17%) cases with PH. Pulmonary hypoplasia and/or persistence of intra-acinar arterioles was seen in 13 of 17 (76.4%) cases. No specific placental pathology was seen universally in the cases of PH, but either maternal or fetal vascular malperfusion was noted in 14 of 17 (82%) cases. Our data suggest a high prevalence of pulmonary maldevelopment, such as pulmonary hypoplasia and persistence of intra-acinar arterioles, in cases with PH. Although no specific placental pathology is seen in PH, maternal and fetal vascular pathology is common.

Placental Lesions Associated With Cerebral Palsy and Neurologic Impairment Following Term Birth

2000 ◽  
Vol 124 (12) ◽  
pp. 1785-1791 ◽  
Author(s):  
Raymond W. Redline ◽  
Mary Ann O'Riordan
Keyword(s):  
Cerebral Palsy ◽  
Labor And Delivery ◽  
Placental Pathology ◽  
Term Infants ◽  
Additional Lesion ◽  
Nucleated Red Blood Cells ◽  
Neurologic Impairment ◽  
Retrospective Comparison ◽  
Abruptio Placenta ◽  
Chronic Villitis

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.

Intrapartum prediction of birth weight with a simplified algorithmic approach derived from maternal characteristics

2019 ◽  
Vol 47 (6) ◽  
pp. 643-650
Author(s):  
Piengbulan Yapan ◽  
Chirameth Promchirachote ◽  
Chutima Yaiyiam ◽  
Suraiya Rahman ◽  
Julaporn Pooliam ◽  
...  
Keyword(s):  
Birth Weight ◽  
Female Gender ◽  
Abdominal Circumference ◽  
Maternal Characteristics ◽  
Abdominal Palpation ◽  
Gestational Age At Delivery ◽  
Vertex Presentation ◽  
Mid Upper Arm Circumference ◽  
Pregnancy Weight ◽  
Best Fit

Abstract Objective To derive and validate a population-specific multivariate approach for birth weight (BW) prediction based on quantitative intrapartum assessment of maternal characteristics by means of an algorithmic method in low-risk women. Methods The derivation part (n = 200) prospectively explored 10 variables to create the best-fit algorithms (70% correct estimates within ±10% of actual BW) for prediction of BW at term; vertex presentation with engagement. The algorithm was then cross validated with samples of unrelated cases (n = 280) to compare the accuracy with the routine abdominal palpation method. Results The best-fit algorithms were parity-specific. The derived simplified algorithms were (1) BW (g) = 100 [(0.42 × symphysis-fundal height (SFH; cm)) + gestational age at delivery (GA; weeks) − 25] in nulliparous, and (2) BW (g) = 100 [(0.42 × SFH (cm)) + GA − 23] in multiparous. Cross validation showed an overall 69.3% accuracy within ±10% of actual BW, which exceeded routine abdominal palpation (60.4%) (P = 0.019). The algorithmic BW prediction was significantly more accurate than routine abdominal palpation in women with the following characteristics: BW 2500–4000 g, multiparous, pre-pregnancy weight <50 kg, current weight <60 kg, height <155 cm, body mass index (BMI) <18.5 kg/m2, cervical dilatation 3–5 cm, station <0, intact membranes, SFH 30–39 cm, maternal abdominal circumference (mAC) <90 cm, mid-upper arm circumference (MUAC) <25 cm and female gender of the neonates (P < 0.05). Conclusion An overall accuracy of term BW prediction by our simplified algorithms exceeded that of routine abdominal palpation.

scholarly journals Biological indicators of the in-utero environment and their association with birth weight for gestational age

2011 ◽  
Vol 2 (5) ◽  
pp. 280-290 ◽  
Author(s):  
N. M. Talge ◽  
C. Holzman ◽  
P. K. Senagore ◽  
M. Klebanoff ◽  
R. Fisher
Keyword(s):  
Birth Weight ◽  
Health Outcomes ◽  
Gestational Age ◽  
Biological Indicators ◽  
Maternal Serum ◽  
Vascular Pathology ◽  
Health Study ◽  
Large For Gestational Age ◽  
Placental Pathology ◽  
Maternal Serum Screening

Birth weight for gestational age (BW/GA) has been associated with a risk of adverse health outcomes. Biological indices of pregnancy complications, maternal mid-pregnancy serum biomarkers and placental pathology may shed light on these associations, but at present, they are most often examined as single entities and offer little insight about overlap. In addition, these indices are typically assessed in relation to the extremes of the BW/GA distribution, leaving open the question of how they relate to the entire BW/GA distribution. Addressing issues such as these may help elucidate why postnatal health outcomes vary across the BW/GA continuum. In this study, we focused on a subset of women who participated in the Pregnancy Outcomes and Community Health Study (n = 1371). We examined BW/GA (i.e. gestational age and sex-referenced z-scores) in relation to obstetric complications, second trimester maternal serum screening results and histologic evidence of placental pathology along with maternal demographics, anthropometrics and substance use. In adjusted models, mean reductions in BW/GA z-scores were associated with preeclampsia (β = −0.70, 95% CI −1.04, −0.36), high maternal serum alpha fetoprotein (β = −0.28, 95% CI −0.43, −0.13), unconjugated estriol (β = −0.31/0.5 multiples of the median decrease, 95% CI −0.41, −0.21) and high levels of maternal obstructive vascular pathology in the placenta (β = −0.46, 95% CI −0.67, −0.25). The findings were similar when preterm infants, small-for-gestational age or large-for-gestational age infants were excluded. More research is needed to examine how the factors studied here might directly mediate or mark risk when evaluating the associations between BW/GA and postnatal health outcomes.

scholarly journals Expanding the impact of a longstanding Canadian cardiac registry through data linkage: challenges and opportunities

2018 ◽  
Vol 3 (3) ◽  
Author(s):  
Danielle A Southern ◽  
Matthew T James ◽  
Stephen B Wilton ◽  
Lawrence DeKoning ◽  
Hude Quan ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Data Linkage ◽  
Point Of Care ◽  
Clinical Information ◽  
Inception Cohort ◽  
Treatment Information ◽  
Challenges And Opportunities ◽  
The Impact ◽  
Cardiovascular Care

The Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) began as a province-wide inception cohort of all adult Alberta residents undergoing cardiac catheterization for ischemic heart disease. As of September 2017, clinical information has been collected by APPROACH on over 240,000 adult Alberta residents.  Use of the APPROACH platform has also expanded across Canada and now facilitates the measurement and reporting of cardiovascular care across more than 18 major cardiovascular centres in 8 provinces. Strengths of the APPROACH initiative include the prospective collection of detailed clinical, procedural, and treatment information, measured at point-of-care.  While this aspect of APPROACH provides data users with several advantages over of use of typical administrative data, the ability to link APPROACH with data from multiple other sources has provided several unique opportunities to measure cardiovascular care and outcomes. This paper describes applied examples of work that has leveraged the potential of linking several external datasets with the APPROACH registry.

scholarly journals Cardiovascular disease manifestations in Chernobyl liquidators: 25 years later. Clinico-analytical review

2012 ◽  
Vol 11 (3) ◽  
pp. 62-69 ◽  
Author(s):  
I. L. Telkova
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Vascular Pathology ◽  
Radiation Doses ◽  
Cardiovascular Monitoring ◽  
Early Diagnostics ◽  
Analytical Review ◽  
Atherosclerosis Development ◽  
Low Radiation Doses

Aim. To analyse the results of clinical cardiovascular disease (CVD) monitoring and the specifics of CVD manifestations in Chernobyl liquidators, who were exposed to “low” radiation doses 25 years ago. Material and methods. In total, 402 Chernobyl liquidators were examined. One hundred eighty five individuals have been followed up for 15 years (1994-2009) and underwent primary and repeat cardiologic examination, such as coronary artery (CA) angiography, endomyocardial biopsy, computed spiral tomography of CA, peripheral artery ultrasound, and the assessment of hormone levels, carbohydrate metabolism, and cardiovascular function. Results. At the first stage of cardiovascular monitoring (1995-1999), the most prevalent forms of CVD among Chernobyl liquidators were arterial hypertension, AH (70,3%) and/or coronary microvascular coronary heart disease, MVCHD (58,9%). Ten-fifteen years later, the prevalence of AH had not changed substantially. The prevalence of atherosclerotic coronary heart disease (ACHD) had increased, partly due to CA atherosclerosis development in patients with earlier diagnosed MVCHD. Severity, manifestations, and outcomes of CVD in Chernobyl liquidators were dependent on a range of factors, such as age, duration and doses of radiation exposure, and subsequent lifestyle and work characteristics. Conclusion. Stabilisation of AH pathomorphosis and prevention of atherosclerotic progression of MVCHD were associated with early diagnostics of vascular pathology and effective CVD prevention.

scholarly journals Establishment of a cardiac telehealth program to support cardiovascular diagnosis and care in a remote, resource-poor setting in Uganda

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255918
Author(s):  
Alyssa DeWyer ◽  
Amy Scheel ◽  
Jenipher Kamarembo ◽  
Rose Akech ◽  
Allan Asiimwe ◽  
...  
Keyword(s):  
Heart Disease ◽  
Clinical Care ◽  
Age Groups ◽  
Healthcare Sector ◽  
Standards Of Care ◽  
Northern Uganda ◽  
Heart Institute ◽  
Common Diagnosis ◽  
The Impact ◽  
Cardiovascular Care

Introduction To address workforce shortages and expand access to care, we developed a telemedicine program incorporating existing infrastructure for delivery of cardiovascular care in Gulu, Northern Uganda. Our study had three objectives: 1) assess feasibility and clinical impact 2) evaluate patient/parent satisfaction and 3) estimate costs. Methods All cardiology clinic visits during a two-year study period were included. All patients received an electrocardiogram and echocardiogram performed by a local nurse in Gulu which were stored and transmitted to the Uganda Heart Institute in the capital of Kampala for remote consultation by a cardiologist. Results were relayed to patients/families following cardiologist interpretation. The following telemedicine process was utilized: 1) clinical intake by nurse in Gulu; 2) ECG and echocardiography acquisition in Gulu; 3) echocardiography transmission to the Uganda Heart Institute in Kampala, Uganda; 4) remote telemedicine consultation by cardiologists in Kampala; and 5) communication of results to patients/families in Gulu. Clinical care and technical aspects were tracked. Diagnoses and recommendations were analyzed by age groups (0–5 years, 6–21 years, 22–50 years and > 50 years). A mixed methods approach involving interviews and surveys was used to assess patient satisfaction. Healthcare sector costs of telemedicine-based cardiovascular care were estimated using time-driven activity-based costing. Results Normal studies made up 47%, 55%, 76% and 45% of 1,324 patients in the four age groups from youngest to oldest. Valvular heart disease (predominantly rheumatic heart disease) was the most common diagnosis in the older three age groups. Medications were prescribed to 31%, 31%, 24%, and 48% of patients in the four age groups. The median time for consultation was 7 days. A thematic analysis of focus group transcripts displayed an overall acceptance and appreciation for telemedicine, citing cost- and time-saving benefits. The cost of telemedicine was $29.48/visit. Conclusions Our data show that transmission and interpretation of echocardiograms from a remote clinic in northern Uganda is feasible, serves a population with a high burden of heart disease, has a significant impact on patient care, is favorably received by patients, and can be delivered at low cost. Further study is needed to better assess the impact relative to existing standards of care and cost effectiveness.

Seasonal Variation of Chronic Villitis of Unknown Etiology

2019 ◽  
Vol 23 (4) ◽  
pp. 253-259
Author(s):  
Alexa A Freedman ◽  
Jeffery A Goldstein ◽  
Gregory E Miller ◽  
Ann Borders ◽  
Lauren Keenan-Devlin ◽  
...  
Keyword(s):  
Seasonal Variation ◽  
Inflammatory Lesion ◽  
Unknown Etiology ◽  
Low Grade ◽  
Text Search ◽  
Standardized Protocol ◽  
Prevalence Estimates ◽  
Chronic Villitis ◽  
Pathology Reports ◽  
Estimate Prevalence

Introduction Chronic villitis of unknown etiology (VUE) is a chronic inflammatory lesion of the placenta. VUE is hypothesized to result from an alloimmune response or as response to an unidentified infection. Lack of a seasonal trend is thought to support VUE as an alloimmune response, though data on seasonal VUE trends are limited. Methods Data were obtained from a hospital in Chicago, Illinois, from 2011–2016. Placentas sent to pathology were reviewed using a standardized protocol, and VUE cases were identified based on an automated text search of pathology records. We used monthly VUE prevalence estimates to investigate the annual trend, and we used Poisson regression to evaluate seasonal variation in the number of VUE cases. Results There were 79 825 deliveries within the study period. Pathologists evaluated 12 074 placentas and identified 2873 cases of VUE. Regression results indicate that the risk of VUE is 16% to 17% higher in the fall and winter as compared to the summer (fall relative risk [RR]: 1.17, 95% confidence interval [CI]: 1.06–1.29; winter RR: 1.16, 95% CI: 1.05–1.29). Discussion Our results suggest that there may be seasonal variation in VUE prevalence, particularly for low-grade VUE. Future studies should evaluate seasonal variation in a representative sample rather than relying on pathology reports to estimate prevalence.

In a Genomic Era, Placental Pathology Still Holds the Key in the Nondysmorphic Stillbirth

2017 ◽  
Vol 21 (3) ◽  
pp. 308-318 ◽  
Author(s):  
Jamie Campbell ◽  
Kristy Armstrong ◽  
Nithiya Palaniappan ◽  
Eddy Maher ◽  
Mary Glancy ◽  
...  
Keyword(s):  
Microarray Analysis ◽  
Normal Population ◽  
Demographic Data ◽  
Placental Pathology ◽  
Genetic Test Results ◽  
Diagnostic Confusion ◽  
Pathology Reports ◽  
Fluorescent Polymerase Chain Reaction ◽  
Stillborn Infant ◽  
Microarray Analyses

Objective To explore the relative utility of genetic testing in contrast to placental pathology in explaining causation of death in the structurally normal stillborn population. Methods A retrospective review of a structurally normal stillborn infant cohort in South East Scotland between 2011 and 2015, defined by death at or after 24 weeks of gestation. We reviewed pathology reports and collected demographic data on cases. This information was collated with genetic test results (quantitative fluorescent polymerase chain reaction and microarray analysis) and placental pathology to create a database for analysis. Primary Results Within the structurally normal population (n = 131), there were 125 genetic tests performed and 11 abnormal results. Sixty-six microarray analyses were performed, and 2 (3%) of the results were thought likely to reflect cause of stillbirth (1 case of incomplete trisomy 4 and 1 case of deletion of chromosome Xp in a female). Analysis was significantly limited in 2 cases as parental samples were not available. The placental pathology was available in a total of 129 cases; significant findings were identified in 100 cases; 79 (61%) showed changes that were considered to have caused death (including cord “accidents”), and a further 21 (16%) showed findings likely to influence the management of subsequent pregnancies. Conclusions We reaffirm the utility of placental examination in the investigation of stillbirth. In cases of nondysmorphic stillbirth where placental pathology does not explain the cause of stillbirth, microarray analysis of fetal DNA can add further diagnostic information in 3% of cases but can add further diagnostic confusion, and it is important that parental bloods are taken to minimize this risk.

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