No abstract

Objective We evaluated the extent to which histologic lesions bearing a diagnosis of abruption conform to a diagnosis based on established clinical criteria. We further examined the profile of chronic and acute histologic lesions associated with clinical abruption. Methods Data from the New Jersey-Placental Abruption Study – a multi-center, case-control study – were utilized to compare the clinical and histologic criteria for abruption. The study was based on 162 women with clinically diagnosed abruption and 173 controls. We examined the concordance between clinical indicators for abruption with those of a histopathological diagnosis. The clinical criteria for a diagnosis of abruption included (i) evidence of retroplacental clot(s); (ii) abruption diagnosed on prenatal ultrasound; or (iii) vaginal bleeding accompanied by nonreassuring fetal status or uterine hypertonicity. The pathological criteria for abruption diagnosis included hematoma, fibrin deposition, compressed villi, and hemosiderin-laden histiocytes in cases with older hematomas. Acute lesions included chorioamnionitis, funisitis, acute deciduitis, meconium stained membranes, villous stromal hemorrhage, and villous edema. Chronic lesions included chronic deciduitis, decidual necrosis, decidual vasculopathy, placental infarctions, villous maldevelopment (delayed or accelerated maturation), hemosiderin deposition, intervillous thrombus, and chronic villitis. Results Of clinically diagnosed cases, the sensitivity and specificity for a histologic confirmation of abruption were 30.2% and 100%, respectively. Presence of retroplacental clots remained the single most common finding (77.1%) among clinically diagnosed cases. Among the acute lesions, chorioamnionitis and funisitis were associated with abruption. The only chronic histologic lesion associated with abruption was placental infarctions. Conclusions The concordance between clinical and pathologic criteria for abruption diagnosis is poor. The criteria for diagnosing a clinical abruption should include sonographic visualization of abruption, evidence of retroplacental clots, or vaginal bleeding accompanied by nonreassuring fetal status or uterine hypertonicity.

Objective-We evaluated the extent to which histologic lesions bearing a diagnosis of abruption conform to a diagnosis based on established clinical criteria. We further examined the profile of chronic and acute histologic lesions associated with clinical abruption.Methods-Data from the New Jersey-Placental Abruption Study -a multi-center, case-control study -were utilized to compare the clinical and histologic criteria for abruption. The study was based on 162 women with clinically diagnosed abruption and 173 controls. We examined the concordance between clinical indicators for abruption with those of a histopathological diagnosis. The clinical criteria for a diagnosis of abruption included (i) evidence of retroplacental clot(s); (ii) abruption diagnosed on prenatal ultrasound; or (iii) vaginal bleeding accompanied by nonreassuring fetal status or uterine hypertonicity. The pathological criteria for abruption diagnosis included hematoma, fibrin deposition, compressed villi, and hemosiderin-laden histiocytes in cases with older hematomas. Acute lesions included chorioamnionitis, funisitis, acute deciduitis, meconium stained membranes, villous stromal hemorrhage, and villous edema. Chronic lesions included chronic deciduitis, decidual necrosis, decidual vasculopathy, placental infarctions, villous maldevelopment (delayed or accelerated maturation), hemosiderin deposition, intervillous thrombus, and chronic villitis.Results-Of clinically diagnosed cases, the sensitivity and specificity for a histologic confirmation of abruption were 30.2% and 100%, respectively. Presence of retroplacental clots remained the single most common finding (77.1%) among clinically diagnosed cases. Among the acute lesions, chorioamnionitis and funisitis were associated with abruption. The only chronic histologic lesion associated with abruption was placental infarctions. Conclusions-The concordance between clinical and pathologic criteria for abruption diagnosis is poor. The criteria for diagnosing a clinical abruption should include sonographic visualization of Correspondence and reprint requests: Cande

Objective-To evaluate the effect of maternal cigarette smoking on placental histology in women with abruption.Study design-Data were derived from the New Jersey-Placental Abruption Study (NJ-PAS)-an ongoing, case-control study, conducted since August 2002 in two large hospitals in NJ. Abruption cases were identified based on a clinical diagnosis. Histological evaluations were performed by two perinatal pathologists who were blinded to the abruption status. Maternal smoking during pregnancy was determined based on patient's self report. Among abruption cases, histological findings were compared between smokers and non-smokers, and the association expressed as odds ratio (OR) with 95% confidence interval (CI). All analyses were adjusted for potential confounders.Results-A total of 189 abruption cases were available for analysis, of which 10.6% (n=20) were smokers. Intervillous thrombus was more common in women who smoked (20%) than in nonsmokers (3.0%) (OR 17.5, 95% CI 3.1, 99.4). However, placental infarcts were seen less frequently among smokers than non-smokers (10.0% vs 32.5%; OR 0.2, 95% CI 0.1, 0.8).Conclusion-These findings suggest that different pathologic mechanisms may be responsible for the histologic findings between smokers and non-smokers diagnosed with placental abruption. KeywordsPlacental abruption; smoking; villous fibrosis; intervillous thrombus; microinfarcts; trophoblast knotting Placental abruption complicates approximately 1% of all pregnancies, 1, 2 with an increase in its incidence over time. 3 This condition is associated with significant maternal morbidity and Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. The association of maternal smoking with placental abruption has been well documented with studies reporting relative risks of 1.4 to 2.5. 9-11 Cigarette use is associated with a 2.5 fold increase in severe abruption resulting in fetal death. 9 The risk of abruption increases with the number of cigarettes smoked per day, 11 with a threshold effect at approximately 10 cigarettes per day after which the risk remains constant. 12 NIH Public AccessStudies focusing on smoking-related placental abruption pathology are sparse. These studies allude to the mechanism of abruption in smokers that is initiated by decidual necrosis at the margin of the placenta. 13, 14 Maternal smoking has been shown to decrease placental blood flow. 15 This effect may be mediated through changes in production of vasoactive substances, such as prostacyclin and nitric oxide, 16 or endothelial cell damage. 17The sequence of events in the placentas of smokers leading t...

Placental mesenchymal dysplasia is a rare condition characterized by enlarged multicystic placenta with anechoic regions on ultrasound. Gross examination shows grapelike vesicles which mimics molar pregnancy. Microscopic findings shows large edematous villi with cistern formation interspersed with normal villi. The absence of trophoblastic proliferation and trophobastic inclusions differentiates it from molar pregnancy. We report a new case of placental mesenchymal dysplasia. A 31-year-old G2P1 presented with preterm vaginal bleeding at 24 5/7 weeks of gestation. Ultrasound findings show cystic placenta and placenta previa. She went into preterm labor and delivered a female baby with no dysmorphic features but later suffered from complications of prematurity. Pathologically, the placenta showed multiple grapelike cystic vesicles with unremarkable chorionic vessels. Microscopically, enlarged edematous villi with cistern formation were noted. Trophoblastic proliferation or inclusions were not seen.