CD34 immunostain increases the sensitivity of placental diagnosis of fetal vascular malperfusion in stillbirth

Stanek, Jerzy; Abdaljaleel, Maram

doi:10.1016/j.placenta.2019.02.001

Cited by 26 publications

(36 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…31 Clusters of sclerotic villi or fibromuscular sclerosis of stem arteries are subtypes of fetal vascular malperfusion potentially associated with high vascular resistance of stem villi with resulting abnormal Dopplers 1,42 which may further compromise the fetus, the placental features thereof should be sought after delivery in such pregnancies as high-grade fetal vascular malperfusion may explain poorer than expected outcome. 28 As histological features of fetal vascular malperfusion may not be obvious on routine H&E staining, immunohistochemistry for CD34 (for clusters of hypocellular villi or villi with endothelial fragmentation), 43 histochemistry for iron (for lobular/segmental hemosiderosis), 33 and additional sampling may be indicated in placentas associated with known fetal malformations but seemingly normal hematoxylin eosin placental histology.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Patterns of Placental Injury in Congenital Anomalies in Second Half of Pregnancy

Stanek

2019

Pediatr Dev Pathol

Self Cite

View full text Add to dashboard Cite

Background Placental pathology in fetal congenital anomalies in second half of pregnancy is largely unknown. Methods Twenty-six clinical and 45 independent placental phenotypes from pregnancies ≥20 weeks of gestation with congenital anomalies divided into 4 groups were retrospectively compared with analysis of variance or χ 2 with 3 degrees of freedom and with Bonferroni correction for multiple comparisons: group 1 : 112 cases with heart malformations (with or without chromosomal anomalies), group 2 : 41 cases with abnormal karyotypes and anomalies other than heart malformations, group 3 : 87 cases with intrathoracic or intraabdominal mass-forming anomalies (mostly congenital diaphragmatic hernias and adenomatoid airway malformation), and group 4 : 291 miscellaneous cases with mostly skeletal, renal, and central nervous system anomalies not fulfilling the criteria of inclusion into groups 1 to 3. Results Eight of 26 clinical (30.8%) and 16 of 45 (35.5%) placental phenotypes varied statistically significantly among the 4 groups ( P < .05), of those, 7 (26.9%) and 4 (8.9%), respectively, remained statistically significant after Bonferroni correction ( P Bonferroni ≤ .002). Those placental phenotypes were placental weight, chorionic disc chorionic microcysts, fetal vascular ectasia, and luminal vascular abnormalities of chorionic villi. Conclusions Fetal anomalies in second half of pregnancy feature abnormal clinical phenotypes much more frequently than abnormal placental phenotypes. Chromosomal abnormalities with or without heart malformations tend to feature villous edema, and erythroblastosis of fetal blood, likely due to fetal heart failure. Mass-forming fetal anomalies feature placental histological lesions of shallow placental implantation, diffuse chronic hypoxic patterns of placental injury, and lesions of fetal vascular malperfusion, likely stasis-induced.

show abstract

Section: Discussionmentioning

confidence: 99%

“…In mass-forming lesions, features of chronic in utero hypoxia, shallow placental implantation, or fetal vascular malperfusion may be associated with poorer prognosis 26 with a higher risk of central nervous system thrombosis. 43…”

Section: Discussionmentioning

confidence: 99%

Patterns of Placental Injury in Congenital Anomalies in Second Half of Pregnancy

Stanek

2019

Pediatr Dev Pathol

Self Cite

View full text Add to dashboard Cite

show abstract

“…All gross abnormalities were sampled and in addition at least 2 sections of membrane roll and the umbilical cord and 2 paracentral sections of grossly unremarkable placenta were taken. Formalin-fixed and paraffin-embedded sections were stained with HE and were reviewed by the author using the same diagnostic criteria as in previous publications [1,22,23,24,25,26,27,28,29,30].…”

Section: Methodsmentioning

confidence: 99%

“…1). Recently we reported that recognizing segmental villous mineralization [21] and/or endothelial fragmentation by CD34 immunohistochemistry [22] can also detect SFVM in cases not diagnosable on HE stained placental sections (Fig. 2).…”

Section: Introductionmentioning

confidence: 96%

“…As the associations of SFVM (particularly low grade) and global FVM without segmental changes, and the impact of FVM grade on short-term perinatal complications, are not well documented, the aim of this retrospective analysis is to compare the relation of the grade of segmental and global FVM to early clinical outcome and other abnormal placental findings. In addition, it is not clear whether the recently reported techniques (segmental endothelial fragmentation, hypovascularity, and villous mineralization) [21,22,23,24,25,26] can identify cases with the same potential of perinatal complications as cases with totally sclerotic chorionic villi seen on HE sections only. For the purpose of this study, the FVM Amsterdam criteria were modified and expanded by including those stains.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Grading placental fetal vascular malperfusion and short-term perinatal outcome

Stanek¹

2020

pjp

Self Cite

View full text Add to dashboard Cite

This retrospective analysis was performed to seek possible associations of the global fetal vascular malperfusion (GFVM) and grade of segmental fetal vascular malperfusion (SFVM) with early perinatal outcome. Clinical associations of 538 consecutive cases of placental fetal vascular malperfusion (FVM), including 374 cases of SFVM (group 1: 308 low-grade, group 2: 66 high-grade), and 65 cases of GFVM without segmental villous changes (group 3), were statistically compared. Histological SFVM was graded on HE (Subgroups 1A and 2A) and on CD34 or histochemistry stains (segmental endothelial fragmentation, segmental hypovascularity and/or mineralization) (subgroups 1B and 2B). The short term neonatal outcome as evaluated by NICU stay and neurological complications was statistically significantly more frequently complicated in association with high-grade SFVM than in low-grade SFVM and GFVM in general, and equally frequently in high-grade SFVM diagnosed on HE slides only and on CD34 immunostain and/or mineralization histochemistry only (about 61% of cases each). High-grade SFVM portends a more complicated short-term perinatal outcome than low-grade SFVM or GFVM. CD34 immunohistochemistry and/or mineralization histochemistry diagnosed/upgraded high-grade SFVM has the same short-term prognostic significance as high-grade SFVM diagnosed on HE only, thus increasing the sensitivity of placental examination for FVM by these methods.

show abstract

Cesarean section per se is not a risk factor for non‐anatomical placenta creta

Stanek

2022

Intl J Gynecology & Obste

Self Cite

View full text Add to dashboard Cite

Retained placentas complicate approximately 3% of all deliveries, 1 with only a proportion of them featuring lesions of histological placenta creta (PC) spectrum, i.e. accreta, increta, and percreta.Placenta accreta was first reported in 1927, with the term PC later introduced. Prenatal ultrasonography for PC diagnosis was used as the primary method for diagnosing morbidly adherent placenta, 2 sometimes supplemented by magnetic resonance imaging. 3 More than 90% of PCs now occur in women with a history of cesarean deliveries or placenta previa; other risk factors include other uterine surgeries, use of assisted reproduction technologies, preterm delivery, advanced maternal age in developed countries, in utero hypoxia, and maternal conditions such as gestational hypertensive disease and maternal vascular malperfusion. 4,5 Only a half of PC cases are suspected before delivery; however, outcomes of expected versus

show abstract

CD34 immunostain increases the sensitivity of placental diagnosis of fetal vascular malperfusion in stillbirth

Cited by 26 publications

References 45 publications

Patterns of Placental Injury in Congenital Anomalies in Second Half of Pregnancy

Patterns of Placental Injury in Congenital Anomalies in Second Half of Pregnancy

Grading placental fetal vascular malperfusion and short-term perinatal outcome

Cesarean section per se is not a risk factor for non‐anatomical placenta creta

Contact Info

Product

Resources

About