Placental findings are not associated with neurodevelopmental outcome in neonates with hypoxic-ischemic encephalopathy – an 11-year single-center experience

Objectives Although neonates with moderate to severe hypoxic ischemic encephalopathy (HIE) receive therapeutic hypothermia (TH), 40–50% die or have significant neurological disability. The aim of this study is to analyse the association of placental pathology and neurodevelopmental outcome in cooled neonates with HIE at 18–24 months of age. Methods Retrospective analysis of prospectively collected data on 120 neonates registered in the Swiss National Asphyxia and Cooling Register born between 2007 and 2017. This descriptive study examines the frequency and range of pathologic findings in placentas of neonates with HIE. Placenta pathology was available of 69/120 neonates, whose results are summarized as placental findings. As neonates with HIE staged Sarnat score 1 (21/69) did not routinely undergo follow-up assessments and of six neonates staged Sarnat Score 2/3 no follow-up assessments were available, 42/48 (88%) neonates remain to assess the association between placental findings and outcome. Results Of the 42/48 (88%) neonates with available follow up 29% (12/42) neonates died. Major placenta abnormalities occurred in 48% (20/42). Major placenta abnormality was neither associated with outcome at 18–24 months of age (OR 1.75 [95% CI 0.50–6.36, p=0.381]), nor with death by 2 years of age (OR 1.96 [95% CI 0.53–7.78, p=0.320]). Conclusions In this study cohort there could not be shown an association between the placenta findings and the neurodevelopmental outcome at 18–24 months of age.

Pathological Study of Stillbirths Placentas at Muhimbili National Hospital, Tanzania

Introduction/Objective Stillbirth is defined as fetal death that occurs at gestational age of ≥28 weeks. In our setting clinical assessment is the only method used to determine cause of stillbirths, with no reported proportion of unknown clinical diagnosis. Studies showed that unknown cause of stillbirths can be reduced by examination of placenta. Causal identification aids in the mourning process and identifying recurrence risks. The study aimed to describe pathological changes in the placentas of stillbirths which have risk to cause fetal death Methods A descriptive cross-sectional study done for the period of 6 months, it involved examination of 80 placentas of stillbirths born at gestational age of ≥ 28 weeks, placentas were fixed in 10% neutral buffered formalin for 8–12 hours. Grossing and interpretation of placenta pathology was according to Amsterdam Placental Workshop Group Consensus Statement. Results Out of 80 stillbirths, 32(40%) had unknown clinical diagnosis. Majority of stillbirth placentas 71(91%) found with either one or combined pathologies with the risk to cause stillbirth. Maternal vascular malperfusion was the commonest pathology and was significantly associated with preterm stillbirths. Maternal floor infarction, a placenta pathology with risk to cause fetal death and high risk of recurrence was among the pathologies found, was seen in 4(5%) of stillbirth placentas. Conclusion Findings in this study clearly indicated the importance of pathological examination of placenta in determining cause of stillbirth. Placenta examination in stillbirths can identify more pathology related to stillbirths than clinical assessment alone.

THE ROLE OF PLACENTAL DISORDERS AMONG RISK FACTORS IN THE FORMATION OF ISOLATED HYPOSPADIAS

Aim of the study. The incidence of hypospadias increased by 2-3 times within the last 50 years. Changes in the frequency occurred mostly due to the gain of the distal isolated forms. The etiology of the majority of cases of the isolated hypospadias isn’t clear. The study of the origin hypospadias is at a stage of the search and assessment of the value of risk factors. The multifactorial pathology is supposed to be caused by changes in an organism of the mother, a placenta and environment factors. Our research is devoted to the assessment of placental factors in the formation of hypospadias. Material and Methods. We have performed a retrospective questionnaire among parents of 99 children with the isolated forms of hypospadias. The special attention was paid to the collecting of the family anamnesis, including data on diseases of reproductive organs, both at parents and at the immediate family in the male line and also data on a occupation, addictions (smoking) of parents. Information was also collected about the peculiarities of the course of the prenatal period and the outcome of childbirth. On the basis of the obtained data, an assessment of the influence of various “parental” factors on the formation of the isolated hypospadias forms in their sons is given. Results. In 4 out of 99 cases, the origin of isolated hypospadias has been caused by genetic deviations. Primary diseases of reproductive organs in parents have been noted as follow: in fathers in 18 of 95 cases, and in mothers in 12 cases. Most often the placenta pathology in the first trimester of pregnancy was shown by the threat of a spontaneous miscarriage (in 35 cases from 95). Placental disturbances during all pregnancy were accompanied by premature births in 25 cases. In 22 cases placental disorders were shown by a fetus arrest of development. Conclusions. In our research placental disturbances were the most frequent risk factors in the formation of the isolated hypospadias.