A Clinicopathological Aspect of Chorionic Villous Hemorrhage Leading to Formation of Intervillous Thrombosis

Soma, Hiroaki; Watanabe, Yoshiaki; Osawa, Hiroyuki; Hata, Toshio

doi:10.1055/s-2007-996046

Cited by 4 publications

(1 citation statement)

References 8 publications

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“…4 Although IVT is not commonly associated with significant maternal or fetal morbidity, Soma et al reported secondary compli-cations. 5 They cited a cesarean section rate of 29.8% and found an incidence of abruptio placentae in 5.0% of pregnancies; 2.3% of the fetuses exhibited intrauterine growth restriction. The pathogenesis of IVT remains unclear; however, numerous investigators suspect that the leakage of fetal components (blood cells or trophoblastic cells) into the maternal circulation is a consequence of IVH.…”

Section: Discussionmentioning

confidence: 99%

Fetal DNA Levels in Maternal Blood Correlated with Fetal Prognosis in a Case of Intervillous Hematoma

Murakami

Shimada²,

Maeda³

et al. 2003

Am J Perinatol

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Several methods for detection of fetal components in maternal blood have been reported. However, few have proven clinically useful for determining the treatment in cases of placental injuries. Here, we report a case of extensive intervillous hematoma diagnosed at 25 weeks of gestation with severe intrauterine growth restriction and oligohydramnios. Marked elevation of fetal DNA levels was observed in maternal blood. Fetal DNA levels decreased after 27 weeks of gestation, concurrent with recovery of fetal growth. We conservatively managed this case until 30 weeks of gestation, when a male infant was delivered. He weighed 508 g and displayed Apgar scores of 7 at 1 minute and 9 at 5 minutes. Histological examination of the placenta revealed intervillous thrombosis without infarction or inflammatory changes. In this case, decreasing fetal DNA levels in maternal plasma correlated with recovery of fetal growth and provided useful information for fetal management as well as insight into the pathogenesis of placental injuries.

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Section: Discussionmentioning

confidence: 99%

Fetal DNA Levels in Maternal Blood Correlated with Fetal Prognosis in a Case of Intervillous Hematoma

Murakami

Shimada²,

Maeda³

et al. 2003

Am J Perinatol

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Changed expression of heat shock proteins in various pathological findings in placentas with intrauterine fetal growth restriction

Wataba

Saito

Takeuchi

et al. 2004

Med Electron Microsc

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Heat shock proteins (HSPs) are activated in the cells of most organisms in response to sublethal heat shock and other stressors. It has been reported that HSP27, HSP60, HSP70, and HSP90 are expressed in normal human placenta, and it was thought that these HSPs play a role in the demonstration of cell viability and function. In this study, we performed an immunohistochemical (IHC) study of these HSPs for 27 placentas that had complicated intrauterine fetal growth restriction (IUGR) and compared the IHC findings with the pathological findings. To quantify HSP27, HSP60, HSP70, and HSP90, immunoreacted cells in the chorionic villi, syncytiotrophoblasts (ST), and cytotrophoblasts (CT) were counted. In thrombus, excessive syncytial knots, and avascular villi, the expression of HSPs was higher in the pathological sections compared to control in both ST and CT. In contrast, all HSPs decreased in both ST and CT around the infarction region. The data suggested that chorionic villi cells locally responded to some stresses, e.g., hypoxia and increase or decrease in the expression of HSPs. Although the villous cells around the infarction histologically appear viable, they may have received lethal damage, and as a result the expression of HSPs was decreased. These results are expected to improve our understanding of the pathological findings of IUGR in placentas, including the quality, damage, and function of the chorionic villi.

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The influence of maternal cigarette smoking on placental pathology in pregnancies complicated by abruption

Kaminsky

Ananth

Prasad

et al. 2007

American Journal of Obstetrics and Gynecology

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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...

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A Clinicopathological Aspect of Chorionic Villous Hemorrhage Leading to Formation of Intervillous Thrombosis

Cited by 4 publications

References 8 publications

Fetal DNA Levels in Maternal Blood Correlated with Fetal Prognosis in a Case of Intervillous Hematoma

Fetal DNA Levels in Maternal Blood Correlated with Fetal Prognosis in a Case of Intervillous Hematoma

Changed expression of heat shock proteins in various pathological findings in placentas with intrauterine fetal growth restriction

The influence of maternal cigarette smoking on placental pathology in pregnancies complicated by abruption

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