scholarly journals Acute Villitis and Intravascular Microorganisms in Fetal Vessels: A Case Report and Literature Review of an Unusual Histopathological Finding

2021 ◽  
pp. 109352662199333
Author(s):  
Brenda F Narice ◽  
Martyna Trzeszcz ◽  
Marta Cohen ◽  
Dilly O Anumba
Keyword(s):  
Unusual Case ◽  
Perinatal Outcomes ◽  
Intrauterine Infection ◽  
Pathological Examination ◽  
Histopathological Analysis ◽  
Fetal Demise ◽  
Focus Of Infection ◽  
Emergency Hysterectomy ◽  
Adverse Perinatal Outcomes ◽  
Fetal Vessels

Optimal management of intrauterine infection to avoid serious adverse perinatal outcomes entails prompt administration of antibiotics and consideration of early delivery of the fetus to remove the focus of infection. We report an unusual case of preterm chorioamnionitis which did not improve with sensitive antibiotics, or delivery of the fetus, and ultimately required an emergency hysterectomy to save the mother’s life. Interestingly, subsequent histopathological analysis of the post-hysterectomy specimen did not reveal myometrial necrosis or infectious microorganisms. The placental pathological examination, on the other hand, showed evidence of necrotising chorioamnionitis accompanied by a rarely reported lesion: acute villitis with abundant intravascular Escherichia coli, a finding which is strongly associated with fetal demise and adverse maternal outcomes.

scholarly journals Diagnosis of Neonatal Herpes Simplex Infection from the Placenta

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Amanda E. Smith ◽  
Amy McKenney ◽  
Laura Rabinowitz ◽  
Anirudha Das
Keyword(s):  
Herpes Simplex ◽  
Intrauterine Infection ◽  
High Rate ◽  
Pathological Examination ◽  
Neonatal Herpes ◽  
Fetal Demise ◽  
First Case ◽  
Simplex Infection ◽  
Neonatal Herpes Simplex ◽  
Simplex Virus

Due to a high rate of fetal demise and premature birth in intrauterine HSV infection, the outcome in neonates is usually adverse. A female preterm infant with a gestational age of 25 1/7 weeks with expected early clinical course tested positive for neonatal herpes simplex virus (HSV) 2 after the neonatologist was informed of positive immunohistochemistry for the virus on the fifth day of life by the pathologist. Pathological examination of the placenta had revealed subacute necrotizing inflammation with stromal cell necrosis suggestive of intrauterine infection, possibly ascending due to prolonged rupture of membranes. To the best of our knowledge, this is the first case wherein placental pathology indicated exposure to HSV in utero before the infant presented with signs or symptoms of neonatal HSV resulting in a favorable outcome for the infant. Due to the variability of presentation of intrauterine HSV infection, pathological examination of the placenta in the first 2–5 days of life in premature infants can provide clues to the diagnosis of neonatal HSV which may significantly impact the outcome.

scholarly journals Placental pathology in COVID-19

2020 ◽  
Author(s):  
Elisheva D Shanes ◽  
Leena B Mithal ◽  
Sebastian Otero ◽  
Hooman A Azad ◽  
Emily S Miller ◽  
...  
Keyword(s):  
Perinatal Outcomes ◽  
Third Trimester ◽  
Fetal Demise ◽  
Intrauterine Fetal Demise ◽  
History Of ◽  
Retroplacental Hematoma ◽  
Adverse Perinatal Outcomes ◽  
Acute And Chronic Inflammation ◽  
Histopathologic Findings ◽  
Historical Controls

Objectives: To describe histopathologic findings in the placentas of women with COVID-19 during pregnancy. Methods: Pregnant women with COVID-19 delivering between March 18, 2020 and May 5, 2020 were identified. Placentas were examined and compared to historical controls and women with placental evaluation for a history of melanoma. Results: 16 placentas from patients with SARS-CoV-2 were examined (15 with live birth in the 3rd trimester 1 delivered in the 2nd trimester after intrauterine fetal demise). Compared to controls, third trimester placentas were significantly more likely to show at least one feature of maternal vascular malperfusion (MVM), including abnormal or injured maternal vessels, as well as delayed villous maturation, chorangiosis, and intervillous thrombi. Rates of acute and chronic inflammation were not increased. The placenta from the patient with intrauterine fetal demise showed villous edema and a retroplacental hematoma. Conclusions: Relative to controls, COVID-19 placentas show increased prevalence of features of maternal vascular malperfusion (MVM), a pattern of placental injury reflecting abnormalities in oxygenation within the intervillous space associated with adverse perinatal outcomes. Only 1 COVID-19 patient was hypertensive despite the association of MVM with hypertensive disorders and preeclampsia. These changes may reflect a systemic inflammatory or hypercoagulable state influencing placental physiology.

scholarly journals Fetal thrombotic vasculopathy: A case report and literature review

2016 ◽  
Vol 62 (7) ◽  
pp. 687-690 ◽  
Author(s):  
Ana Berquo Peleja ◽  
Silvio Martinelli ◽  
Renata Lopes Ribeiro ◽  
Roberto Eduardo Bittar ◽  
Regina Schultz ◽  
...  
Keyword(s):  
Case Report ◽  
Fetal Death ◽  
Perinatal Outcomes ◽  
Pathological Examination ◽  
Biophysical Profile ◽  
Practice Method ◽  
The Subject ◽  
Adverse Perinatal Outcomes ◽  
The Impact ◽  
Fetal Thrombotic Vasculopathy

Summary Introduction: Fetal thrombotic vasculopathy is a recently described placental alteration with varying degrees of involvement and often associated with adverse perinatal outcomes. The diagnosis is made histologically and therefore is postnatal, which makes it a challenge in clinical practice. Method: Case report and review of literature on the subject. Results: The present case refers to a pregnant woman presenting fetal growth restriction, with poor obstetrical past, and sent late to our service. Even with weekly assessments of fetal vitality (fetal biophysical profile and Doppler velocimetry) and prenatal care, the patient progressed with fetal death at 36 weeks and 1 day. There was no association with inherited and acquired thrombophilia. Pathological examination of the placenta revealed fetal thrombotic vasculopathy. Conclusion: The fetal thrombotic vasculopathy may be associated with adverse perinatal outcomes including fetal death, but much remains to be studied regarding its pathogenesis. Diagnosis during pregnancy is not possible and there is still no proven treatment for this condition. Future studies are needed so that strategies can be developed to minimize the impact of fetal thrombotic vasculopathy.

scholarly journals Placental Pathology in COVID-19

2020 ◽  
Vol 154 (1) ◽  
pp. 23-32 ◽  
Author(s):  
Elisheva D Shanes ◽  
Leena B Mithal ◽  
Sebastian Otero ◽  
Hooman A Azad ◽  
Emily S Miller ◽  
...  
Keyword(s):  
Perinatal Outcomes ◽  
Third Trimester ◽  
Fetal Demise ◽  
Intrauterine Fetal Demise ◽  
History Of ◽  
Retroplacental Hematoma ◽  
Adverse Perinatal Outcomes ◽  
Acute And Chronic Inflammation ◽  
Histopathologic Findings ◽  
Historical Controls

Abstract Objectives To describe histopathologic findings in the placentas of women with coronavirus disease 2019 (COVID-19) during pregnancy. Methods Pregnant women with COVID-19 delivering between March 18, 2020, and May 5, 2020, were identified. Placentas were examined and compared to historical controls and women with placental evaluation for a history of melanoma. Results Sixteen placentas from patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were examined (15 with live birth in the third trimester, 1 delivered in the second trimester after intrauterine fetal demise). Compared to controls, third trimester placentas were significantly more likely to show at least one feature of maternal vascular malperfusion (MVM), particularly abnormal or injured maternal vessels, and intervillous thrombi. Rates of acute and chronic inflammation were not increased. The placenta from the patient with intrauterine fetal demise showed villous edema and a retroplacental hematoma. Conclusions Relative to controls, COVID-19 placentas show increased prevalence of decidual arteriopathy and other features of MVM, a pattern of placental injury reflecting abnormalities in oxygenation within the intervillous space associated with adverse perinatal outcomes. Only 1 COVID-19 patient was hypertensive despite the association of MVM with hypertensive disorders and preeclampsia. These changes may reflect a systemic inflammatory or hypercoagulable state influencing placental physiology.

Triphasic umbilical artery waveform: association with severe fetal growth restriction, fetal demise, and extreme velamentous cord insertion

2014 ◽  
Vol 3 (2) ◽  
Author(s):  
Burton Rochelson ◽  
Tharwat Stewart Boulis ◽  
Hima Tam Tam ◽  
Morris Edelman
Keyword(s):  
Umbilical Artery ◽  
Perinatal Outcomes ◽  
Positive Component ◽  
Vascular Abnormality ◽  
Fetal Demise ◽  
Diastolic Velocity ◽  
Chorionic Plate ◽  
Adverse Perinatal Outcomes ◽  
Premorbid State ◽  
Velamentous Cord Insertion

AbstractExtreme Doppler abnormalities of the umbilical artery such as absent or reversed end diastolic velocity are associated with adverse perinatal outcomes. We present a case of a triphasic umbilical artery waveform identified at 24 weeks. The fetus was severely growth restricted with an estimated fetal weight of 314 g. A week later, fetal demise occurred. Placental pathology revealed a placental weight of 83 g, an extensive maternal floor infarction, and an extreme velamentous cord insertion 7 cm from the edge of the placental disc, with vessels entering at opposite poles of the placental disc and a single anastomotic bridging vessel on the chorionic plate connecting these two vascular poles. A triphasic umbilical artery waveform may be associated with a premorbid state and severe placental vascular abnormality. We hypothesize that the third and positive component in late diastole is present due to forward flow across the communicating bridging vessel into the contralateral entering vessel.

scholarly journals Prediction of perinatal outcomes in pregnant women with fetal growth retardation

2021 ◽  
Vol 20 (4) ◽  
pp. 4-11
Author(s):  
V. F. Dolgushina ◽  
N. K. Vereina ◽  
Ju. V. Fartunina ◽  
T. V. Nadvikova
Keyword(s):  
Pregnant Women ◽  
Fetal Growth ◽  
Growth Retardation ◽  
Perinatal Outcome ◽  
Perinatal Outcomes ◽  
Intrauterine Infection ◽  
First Trimester ◽  
Fetal Growth Retardation ◽  
Adverse Perinatal Outcomes ◽  
Group 2

Introduction. An important problem of modern obstetrics is the development and improvement of methods for predicting fetal growth retardation (FGR) and pregnancy outcomes in this pathology, since there are no proven effective treatments for FGR. Purpose of the study — to develop prediction criteria for newborn hypotrophy and cumulative adverse perinatal outcome in pregnant women with FGR. Objective. To identify key predictive factors for adverse perinatal outcomes in pregnancy complicated by FGR. Material and methods. A case-control, cohort-based study was conducted that included 155 pregnant women with FGR, who were divided into two groups after delivery: Group 1 included 90 patients with neonatal hypotrophy and Group 2 included 65 patients without neonatal hypotrophy. A comprehensive analysis of clinical and anamnestic, laboratory and instrumental data, peculiarities of the course of pregnancy and perinatal outcomes was performed. FGR was determined on the basis of ultrasound fetometry. Results. Factors associated with neonatal hypotrophy and unfavorable perinatal outcome were: impaired blood flow in the uterine arteries and/or umbilical artery, early preeclampsia and scarcity of water. Protective factors were antibacterial therapy for intrauterine infection, administration of low-molecular-weight heparin in the first trimester, and acetylsalicylic acid starting from the 12th to 16th weeks of gestation. Conclusion. The most promising measures in the prevention of FGR and adverse perinatal outcomes in this pathology may be timely prescription of antithrombotic correction and treatment of genital infections.

scholarly journals Pregnancy Outcomes and SARS-CoV-2 Infection: The Spanish Obstetric Emergency Group Study

Viruses ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 853
Author(s):  
Sara Cruz Melguizo ◽  
María Luisa de la Cruz Conty ◽  
Paola Carmona Payán ◽  
Alejandra Abascal-Saiz ◽  
Pilar Pintando Recarte ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Perinatal Outcomes ◽  
Preterm Births ◽  
Hypertensive Disorder ◽  
Obstetric Emergency ◽  
Increased Risk ◽  
Emergency Group ◽  
Adverse Perinatal Outcomes ◽  
Maternal Disease ◽  
The Relationship

Pregnant women who are infected with SARS-CoV-2 are at an increased risk of adverse perinatal outcomes. With this study, we aimed to better understand the relationship between maternal infection and perinatal outcomes, especially preterm births, and the underlying medical and interventionist factors. This was a prospective observational study carried out in 78 centers (Spanish Obstetric Emergency Group) with a cohort of 1347 SARS-CoV-2 PCR-positive pregnant women registered consecutively between 26 February and 5 November 2020, and a concurrent sample of PCR-negative mothers. The patients’ information was collected from their medical records, and the association of SARS-CoV-2 and perinatal outcomes was evaluated by univariable and multivariate analyses. The data from 1347 SARS-CoV-2-positive pregnancies were compared with those from 1607 SARS-CoV-2-negative pregnancies. Differences were observed between both groups in premature rupture of membranes (15.5% vs. 11.1%, p < 0.001); venous thrombotic events (1.5% vs. 0.2%, p < 0.001); and severe pre-eclampsia incidence (40.6 vs. 15.6%, p = 0.001), which could have been overestimated in the infected cohort due to the shared analytical signs between this hypertensive disorder and COVID-19. In addition, more preterm deliveries were observed in infected patients (11.1% vs. 5.8%, p < 0.001) mainly due to an increase in iatrogenic preterm births. The prematurity in SARS-CoV-2-affected pregnancies results from a predisposition to end the pregnancy because of maternal disease (pneumonia and pre-eclampsia, with or without COVID-19 symptoms).

scholarly journals Fetal movement counting is associated with the reduction of delayed maternal reaction after perceiving decreased fetal movements: a prospective study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shigeki Koshida ◽  
Shinsuke Tokoro ◽  
Daisuke Katsura ◽  
Shunichiro Tsuji ◽  
Takashi Murakami ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Maternal Behavior ◽  
Multivariable Analysis ◽  
Perinatal Outcomes ◽  
Fetal Movement ◽  
Post Intervention ◽  
Fetal Movements ◽  
Adverse Perinatal Outcomes ◽  
The Impact ◽  
Maternal Reaction

AbstractMaternal perception of decreased fetal movement is associated with adverse perinatal outcomes. Although there have been several studies on interventions related to the fetal movements count, most focused on adverse perinatal outcomes, and little is known about the impact of the fetal movement count on maternal behavior after the perception of decreased fetal movement. We investigated the impact of the daily fetal movement count on maternal behavior after the perception of decreased fetal movement and on the stillbirth rate in this prospective population-based study. Pregnant women in Shiga prefecture of Japan were asked to count the time of 10 fetal movements from 34 weeks of gestation. We analyzed 101 stillbirths after the intervention compared to 121 stillbirths before the intervention. In multivariable analysis, maternal delayed visit to a health care provider after the perception of decreased fetal movement significantly reduced after the intervention (aOR 0.31, 95% CI 0.11–0.83). Our regional stillbirth rates in the pre-intervention and post-intervention periods were 3.06 and 2.70 per 1000 births, respectively. Informing pregnant women about the fetal movement count was associated with a reduction in delayed maternal reaction after the perception of decreased fetal movement, which might reduce stillbirths.

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