Corpus luteum number and the maternal renin-angiotensin-aldosterone system as determinants of utero-placental (vascular) development: the Rotterdam Periconceptional Cohort

Background Pregnancies with > 1 corpus luteum (CL) display a hyperdynamic circulation and an increased risk of small-for-gestational age deliveries. Among the factors released by the CL is prorenin, the inactive precursor of renin. Since the renin-angiotensin-aldosterone system (RAAS) is involved in early hemodynamic pregnancy adaptation, we linked both CL number and first-trimester concentrations of prorenin (as an indicator of RAAS activity) and the aldosterone/renin ratio (as an indicator of angiotensin-independent aldosterone effectiveness) to non-invasive markers of utero-placental (vascular) development, measured longitudinally from the first trimester onwards. Methods A total of 201 women, who conceived naturally or after in-vitro fertilization treatment (with 0 (n = 8), 1 (n = 143), or > 1 (n = 51) CL), were selected from the Rotterdam Periconceptional Cohort. Maternal RAAS components were determined at 11 weeks gestation. Placental volume and utero-placental vascular volume were measured from transvaginal 3D ultrasound scans at 7, 9 and 11 weeks gestation, pulsatility and resistance indices of the uterine arteries were assessed by pulsed wave Doppler ultrasounds at 7, 9, 11, 13, 22 and 32 weeks gestation. At birth placental weight was obtained using standardized procedures. Results Pregnancies without a CL show lower uterine artery indices throughout gestation than 1 CL and > 1 CL pregnancies, while parameters of placental development are comparable among the CL groups. After adjustment for patient- and treatment-related factors, first-trimester prorenin concentrations are positively associated with uterine artery pulsatility and resistance indices (β 0.06, 95% CI 0.01;0.12, p = 0.04 and β 0.10, 95% CI 0.01;0.20, p = 0.04, respectively), while high prorenin concentrations are negatively associated with first-trimester utero-placental vascular volume (β -0.23, 95% CI -0.44;-0.02, p = 0.04) and placental weight (β -93.8, 95%CI -160.3;-27.4, p = 0.006). In contrast, the aldosterone/renin ratio is positively associated with first-trimester placental volume (β 0.12, 95% CI 0.01;0.24, p = 0.04). Conclusions The absence of a CL, resulting in low prorenin concentrations, associates with low uterine artery pulsatility and resistance, while high prorenin concentrations associate with a low utero-placental vascular volume and weight. These data support a scenario in which excess prorenin, by upregulating angiotensin II, increases uterine resistance, thereby preventing normal placental (vascular) development, and increasing the risk of small-for-gestational age deliveries. Simultaneously, high aldosterone concentrations, by ensuring volume expansion, exert the opposite.

Evaluation of Serial 2-D Sonographic Placental Volumetry and Umbilical Arterial Doppler and Their Correlation with Uterine Arterial Doppler in Predicting Adverse Fetomaternal Outcomes – An Observational Study from a Tertiary Care Centre in Pune, India

BACKGROUND An important part of human placental development is the extensive modification of maternal vasculature by trophoblasts. Fetal growth retardation (FGR) and preeclampsia (PE) are associated with deficient trophoblastic invasion and modification of the uterine spiral arteries leading to small-caliber vessels of high resistance which impairs placental blood flow, creating a hypoxic environment and subsequent oxidative stress. FGR and pre-eclampsia are important causes of maternal and perinatal morbidity and mortality and it is important to identify such ‘at risk’ pregnancies during routine antenatal care. Ultrasonography (USG) and colour-Doppler are readily available tools that may be used for identifying such ‘at risk’ pregnancies. The purpose of this study was to evaluate the accuracy of 2-D sonographic placental volumetry, umbilical arterial doppler and uterine arterial doppler in predicting adverse fetomaternal outcomes and compare the accuracy of these three tests with each other in terms of sensitivity and specificity. METHODS A total of 100 women were randomly selected from the antenatal clinics, and were subject to serial ultrasounds at 12 - 16 weeks, 20 - 24 weeks, and 28 - 32 weeks. The 2-D sonographic placental volume, umbilical and uterine arterial resistivity index (RI), and pulsatility index (PI) were measured. The pregnancies were followed up till delivery and the measurements were plotted against the actual placental weight and development of FGR and/or pre-eclampsia. RESULTS In pregnancies with FGR or pre-eclampsia, the placental volumes were low, and correspondingly the uterine and umbilical arterial RI and PI were high (increased impedance) as compared to the normal pregnancies. For the prediction of adverse outcomes, a receiver operating curve (ROC) analysis showed that placental volume and umbilical artery RI and PI had high sensitivity in the 1st-trimester, and high specificity in the 2nd-trimester. CONCLUSIONS 2-D sonographic placental volumetry and umbilical arterial Doppler studies may be used as 1st-trimester screening tools to predict adverse fetomaternal outcomes. These patients may be subjected to more intensive follow-up to minimize maternal and perinatal morbidity and mortality. KEYWORDS Doppler Ultrasonography; Fetal Growth Retardation; Placenta; Pre-eclampsia; Umbilical Arteries; Uterine Artery

STUDY OF MORPHOLOGY AND HISTOLOGY OF PLACENTA AND ITS CORRELATION WITH MATERNAL PARAMETERS AND BIRTH WEIGHT OF NEWBORN IN ANAEMIC MOTHERS

The aim of this study was to determine whether maternal anaemia [Hb <11gm/dl]would affect the morphology and histology of placenta and and correlate it with maternal parameters and birth weight of newborn and compare this with that of non-anaemic mothers. It was a cross-sectional comparative study carried out at the maternity ward and anatomy department of NSCB MEDICAL COLLEGE JABALPUR. Background & Method: Background & Method: The study was carried out on 100 placentae, mothers and their babies. The placenta was collected from Obstetrics and Gynaecology, Department of NSCB Medical College, Jabalpur. Out of 100 placentae 50 from anaemic and 50 from NON anaemic mothers. As soon as the placenta was delivered, the umblical cord was cut it was put into formal saline. It was kept in a tray, to the membranes were trimmed off cord was cut about 10 cm from the insertion. The blood clots adherent to maternal surface were picked up. Morphological parameters like placental weight, volume. diameter, thickness, no of cotyledons were measured .Any abnormality like calcification, accessory lobe, haematoma, etc were noted. histological slides were made and stained with H and stain and Masson’s Trichrome stain. Result: A Macroscopic study of the placenta revealed placental weight, placental volume, diameter, placental thickness were more than non anaemic group and number of cotyledons were less in study group. Mean placental weight in study group was 474gm and in control group was 425 (p<0.05). Mean placental volume in study group & control group were 393.23and352 ml respectively (p<0.05). Mean number of cotyledons were 13.24and 16 in study & control group significant[p<0.05] and mean diameter 18.30cms and17.05cms in study and control group. Mean placental thickness 2.4cms in study and 2.1 in control group respectively. There was an accessory lobe present in one patient of anaemic group. All morphometric parameters of placenta weight, volume, diameter, thickness were increased ,no of cotyledons were reduced .Histological findings were placental tissues shows intense congestion of septal capillaries.In the present study age, parity, height, weight, built, doesn’t found to be related with morphology of placenta. Maternal blood Hb found to be +vely correlated with weight, volume, diameter, thickness and –vely correlated with no of cotyledons and birth weight of baby. Conclusion: From the study it is concluded anaemia in pregnancy affects morphology and histology of placenta and it is correlated with various maternal parameters and birth weight of baby. Keywords: morphology, histology, placenta, anaemia, birth weight & mothers.

STUDY OF MORPHOLOGY AND HISTOLOGY OF PLACENTA IN HYPERSENSITIVE MOTHERS

Background: Hypertensive pregnancy may be responsible for vascular damage, enhanced systemic inflammation and insulin resistance in the placenta as oxygen and nutrient transfer is impaired and oxidative stress is generated affecting the placental growth and development. Placental growth pattern in hypertensive pregnancies shows a variable pattern owing to placental insufficiency. Method: The study was carried out on 80 sets placentae, mothers and their babies. The placentae were collected from Obstetrics & Gynecology Department of NSCB Medical College Jabalpur. Out of 80 placentae, 40 were from normal pregnant mothers and 40 from pregnancies complicated by PIH in previously normotensive women, serial number of placentae, mother and baby were same. placentae were collected soon after the normal vaginal delivery or caesarian section along with 10 cm long stump of umbilical cord. Aims and objectives: The aim of this study was to determine whether maternal PIH would affect the morphology and histology of placenta and compare this with that of normotensive mothers. It was a cross-sectional comparative study carried out at the maternity ward and anatomy department of NSCB Medical College, Jabalpur. Result: A Macroscopic study of the placenta revealed placental weight, placental volume, diameter, placental thickness and number of cotyledons were less in study group. Mean placental weight in study group was 336gm and in control group was 425 (p<0.05). Mean placental volume in study group & control group were 236and352 ml respectively (p<0.05). Mean number of cotyledons were 14.7and 16 in study & control group respectively but not significant and mean diameter15.6 cms and17.05cms in study and control group. But in the present study placental thickness was not significant (p<0.539). There was a single umbilical artery present in one patient in PIH group. All morphometric parameters of placenta weight, volume, diameter, thickness, no. of cotyledons were reduced. Histological findings were cytotrophoblastic cellular proliferation, syncitial knot formation, fibrin plaque formation. In 20 percent cases, villi were hypovascular. The hypovascular villi have abundance of syncitial knots, usually lack vasculosyncitial membrane and increased stromal collagen. Conclusion: PIH adversely affect both morphology and histology of placenta. Keywords: morphology, histology, placenta, hypersensitive & mothers.