Circumvallate placenta and abnormal cord insertion as risk factors for intrauterine growth restriction and preterm birth: a case report

AbstractObjectivesCircumvallate placenta is a rare abnormality of placental shape. Current data indicates that a circumvallate placenta can be a risk factor for severe adverse obstetric and neonatal outcomes such as antepartum bleeding, premature delivery, oligohydramnios, intrauterine growth restriction and placental abruption. An unusual insertion of the umbilical cord can cause a reduction of perfusion and can also lead to pregnancy complications. However, the clinical significance of these pathoanatomical findings often remains unclear.Case presentationWe report a case of a 22-year-old third gravida nullipara in 28+2 pregnancy weeks with a pathological cardiotocography (CTG) and a growth restricted fetus with oligohydramnios and pathological umbilical blood flow. Due to recurrent decelerations of fetal heart rate the baby was delivered via cesarean section. The examination of the placenta showed a circumvallate placenta and fixated umbilical cord mimicking a battledore insertion.ConclusionsIt can be concluded that circumvallate placenta may predispose to severe obstetric complications. Women with circumvallate placenta and abnormal cord insertion probably benefit from stringent follow ups in a specialized perinatal center. Histopathological examination of the placenta can be a diagnostic tool in women with recurrent obstetric complications.

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152 Impact of chorionic somatomammotropin RNA interference on uterine blood flow and placental glucose uptake in the absence of intrauterine growth restriction

Journal of Animal Science ◽

10.1093/jas/skaa278.220 ◽

2020 ◽

Vol 98 (Supplement_4) ◽

pp. 121-121

Author(s):

Amelia R Tanner ◽

Asghar Ali ◽

Quinton A Winger ◽

Paul J Rozance ◽

Russell V Anthony

Keyword(s):

Rna Interference ◽

Glucose Uptake ◽

Intrauterine Growth Restriction ◽

Growth Restriction ◽

Intrauterine Growth ◽

Blood Flows ◽

Umbilical Blood ◽

Exact Function ◽

Chorionic Somatomammotropin ◽

The Impact

Abstract Chorionic somatomammotropin (CSH) is one of the most abundant hormones produced by the sheep placenta, yet the exact function of CSH has been elusive. Previously we reported the use of in vivo RNA interference (RNAi) to assess the impact of CSH deficiency on placental and fetal growth in sheep. Near-term (135 dGA), there are two distinct CSH RNAi phenotypes: 1) pregnancies with intrauterine growth restriction (IUGR), and 2) pregnancies with normal fetal and placental weights. This study describes physiological changes in the latter phenotype. To generate the CSH RNAi pregnancies, the trophectoderm of hatched blastocysts (9 dGA) were infected with lentiviral-constructs expressing either a scrambled control (NTS) or CSH-specific shRNA (CSH RNAi), prior to transfer into synchronized recipient ewes. At 120 dGA, 6 NTS and 6 CSH RNAi pregnancies were fitted with maternal and fetal catheters. Uterine and umbilical blood flows were measured utilizing the 3H2O transplacental diffusion technique at 132 dGA, and nutrient uptakes were calculated by the Fick principle. Resulting data were analyzed by Student’s t-test and significance was set at P ≤ 0.05. CSH RNAi tended (P ≤ 0.10) to reduce placentome weight with no effect on fetal weight. Absolute (ml/min) and relative (ml/min/kg fetus) uterine blood flows were reduced (P ≤ 0.05) in CSH RNAi pregnancies, but umbilical flows were not impacted. The uterine artery-to-vein glucose gradient (mmol/l) was significantly (P ≤ 0.05) increased, whereas the gradients for taurine and glycine were reduced (P ≤ 0.05). Uteroplacental glucose uptake (mmol/min/kg placenta) was increased 27% (P ≤ 0.05), whereas umbilical glucose uptake (mmol/min/kg fetus) was reduced 13%. This cohort demonstrates that even in the absence of IUGR, CSH deficiency has significant physiological ramifications, and the investigation of CSH RNAi pregnancies exhibiting both IUGR and non-IUGR phenotypes may help determine the direct effects of CSH and its potential impact on fetal programming. Supported by NIH R01 HD093701.

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CSH RNA Interference Reduces Global Nutrient Uptake and Umbilical Blood Flow Resulting in Intrauterine Growth Restriction

International Journal of Molecular Sciences ◽

10.3390/ijms22158150 ◽

2021 ◽

Vol 22 (15) ◽

pp. 8150

Author(s):

Amelia R. Tanner ◽

Cameron S. Lynch ◽

Victoria C. Kennedy ◽

Asghar Ali ◽

Quinton A. Winger ◽

...

Keyword(s):

Blood Flow ◽

Rna Interference ◽

Nutrient Uptake ◽

Intrauterine Growth Restriction ◽

Growth Restriction ◽

Intrauterine Growth ◽

Umbilical Blood ◽

Uterine Growth ◽

Umbilical Blood Flow ◽

Placental Hormone

Deficiency of the placental hormone chorionic somatomammotropin (CSH) can lead to the development of intrauterine growth restriction (IUGR). To gain insight into the physiological consequences of CSH RNA interference (RNAi), the trophectoderm of hatched blastocysts (nine days of gestational age; dGA) was infected with a lentivirus expressing either a scrambled control or CSH-specific shRNA, prior to transfer into synchronized recipient sheep. At 90 dGA, umbilical hemodynamics and fetal measurements were assessed by Doppler ultrasonography. At 120 dGA, pregnancies were fitted with vascular catheters to undergo steady-state metabolic studies with the 3H2O transplacental diffusion technique at 130 dGA. Nutrient uptake rates were determined and tissues were subsequently harvested at necropsy. CSH RNAi reduced (p ≤ 0.05) both fetal and uterine weights as well as umbilical blood flow (mL/min). This ultimately resulted in reduced (p ≤ 0.01) umbilical IGF1 concentrations, as well as reduced umbilical nutrient uptakes (p ≤ 0.05) in CSH RNAi pregnancies. CSH RNAi also reduced (p ≤ 0.05) uterine nutrient uptakes as well as uteroplacental glucose utilization. These data suggest that CSH is necessary to facilitate adequate blood flow for the uptake of oxygen, oxidative substrates, and hormones essential to support fetal and uterine growth.

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Caffeine Metabolites in Umbilical Cord Blood, Cytochrome P-450 1A2 Activity, and Intrauterine Growth Restriction

American Journal of Epidemiology ◽

10.1093/aje/kwj125 ◽

2006 ◽

Vol 163 (11) ◽

pp. 1035-1041 ◽

Cited By ~ 53

Author(s):

Laura M. Grosso ◽

Elizabeth W. Triche ◽

Kathleen Belanger ◽

Neal L. Benowitz ◽

Theodore R. Holford ◽

...

Keyword(s):

Cord Blood ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Intrauterine Growth Restriction ◽

Growth Restriction ◽

Intrauterine Growth ◽

Cytochrome P 450

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IMPACT OF CHORIONIC SOMATOMAMMOTROPIN RNA INTERFERENCE ON UTERINE BLOOD FLOW AND PLACENTAL GLUCOSE UPTAKE IN THE ABSENCE OF INTRAUTERINE GROWTH RESTRICTION

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.00223.2020 ◽

2020 ◽

Author(s):

Amelia R. Tanner ◽

Cameron S. Lynch ◽

Asghar Ali ◽

Quinton A. Winger ◽

Paul J. Rozance ◽

...

Keyword(s):

Rna Interference ◽

Glucose Uptake ◽

Intrauterine Growth Restriction ◽

Growth Restriction ◽

Intrauterine Growth ◽

Blood Flows ◽

Fick Principle ◽

Umbilical Blood ◽

Exact Function ◽

Chorionic Somatomammotropin

Chorionic Somatomammotropin (CSH) is one of the most abundantly produced placental hormones, yet its exact function remains elusive. Near-term (135 dGA), CSH RNA interference (RNAi) results in two distinct phenotypes: 1) pregnancies with intrauterine growth restriction (IUGR), and 2) pregnancies with normal fetal and placental weights. Here we report the physiological changes in CSH RNAi pregnancies without IUGR. The trophectoderm of hatched blastocysts (9 dGA) were infected with lentiviral-constructs expressing either a scrambled control (Control RNAi) or CSH-specific shRNA (CSH RNAi), prior to transfer into synchronized recipient ewes. At 126 dGA, Control RNAi (n = 6) and CSH RNAi (n = 6) pregnancies were fitted with maternal and fetal catheters. Uterine and umbilical blood flows were measured at 132 dGA and nutrient uptakes were calculated by the Fick principle. Control RNAi and CSH RNAi pregnancies were compared by analysis of variance, and significance was set at P ≤ 0.05. Absolute (ml/min) and relative (ml/min/kg fetus) uterine blood flows were reduced (P ≤ 0.05) in CSH RNAi pregnancies, but umbilical flows were not impacted. The uterine artery-to-vein glucose gradient (mmol/l) was significantly (P ≤ 0.05) increased. The uteroplacental glucose uptake (μmol/min/kg placenta) was increased (P ≤ 0.05), whereas umbilical glucose uptake (μmol/min/kg fetus) was reduced. Our results demonstrate that CSH RNAi has significant physiological ramifications, even in the absence of IUGR, and comparing CSH RNAi pregnancies exhibiting both IUGR and non-IUGR phenotypes may help determine the direct effects of CSH and its potential impact on fetal development.

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