Disorders of Placental Circulation and the Fetal Brain

Redline, Raymond W.

doi:10.1016/j.clp.2009.06.003

Cited by 54 publications

(38 citation statements)

References 57 publications

(56 reference statements)

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“…Se ha sugerido que la epinefrina puede modular la eritropoyesis y estimular la liberación de los glóbulos rojos nucleados (23). La hipoxemia fetal aguda produce liberación de glóbulos rojos nucleados y linfocitosis en menos de dos horas, sin relación con la eritropoyesis (24,25).…”

Section: Discussionunclassified

Glóbulos rojos nucleados y estado metabólico en recién nacidos con estado fetal no reactivo intraparto

Mejia-Montilla

Santos-Bolívar

Torres-Cepeda

et al. 2017

CES Med

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ResumenObjetivo: comparar el conteo de los glóbulos rojos nucleados en sangre de cordón umbilical y estado metabólico en recién nacidos con estado fetal no reactivo intraparto. Métodos: se eligieron pacientes de bajo riesgo con frecuencia cardiaca fetal normal al momento del ingreso para la atención del parto. Se determinó el conteo de glóbulos rojos nucleados, pH y déficit de base de la arteria y vena umbilical de recién nacidos con (grupo A) o sin diagnóstico (grupo B) de estado fetal no reactivo por cardiotocografía. Resultados: de las 200 muestras seleccionadas, 9,5 % pertenecían a recién nacidos con diagnóstico de estado fetal no reactivo debido a cambios en la cardiotocografía. Los valores promedio de pH y déficit de base de la arteria y vena umbilical fueron significativamente más altos en los recién nacidos del grupo A que en los recién nacidos del grupo B (p < 0,05). El conteo de glóbulos rojos nucleados en los recién nacidos con estado fetal no reactivo fue 11,47 ± 4,93 x 100 leucocitos y en los recién nacidos sin estado fetal no reactivo fue de 5,71 ± 1,21 x 100 leucocitos (p < 0,05). No se encontró una correlación significativa entre el conteo de glóbulos rojos nucleados y los valores de pH y déficit de base en la sangre de la arteria y vena umbilical en el grupo de recién nacidos con y sin estado fetal no reactivo. Conclusión: los recién nacidos con estado fetal no reactivo intraparto tienen conteos más elevados de glóbulos rojos nucleados comparado con aquellos sin alteraciones.Palabras claves: Glóbulos rojos nucleados, Recién nacido, Déficit de base, Estado fetal no reactivo. AbstractObjective: To relate umbilical nucleated red blood cells count and metabolic status in newborns with intrapartum non-reassuring fetal state. Materials and method: All low-risk pregnant women with a normal fetal heart rate at admission to labor and delivery were eligible for participation. Nucleated red blood cells, pH, and base deficit of umbilical artery and vein newborn with (group A) or without diagnosis (Group B) of non-reassuring fetal state by cardiotocography. Results: Of 200 samples selected, 19 (9.5 %) were from newborns with a diagnosis of non-reactive fetal status due to changes in cardiotocography (group A). Mean values of pH and umbilical

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Section: Discussionunclassified

Glóbulos rojos nucleados y estado metabólico en recién nacidos con estado fetal no reactivo intraparto

Mejia-Montilla

Santos-Bolívar

Torres-Cepeda

et al. 2017

CES Med

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“…Indeed, recent neuroimaging studies of preterm infants with detailed placental histology and neonatal neuroimaging at term equivalent age show histological CHORIO is an independent antenatal risk factor for preterm brain injury (247). Additionally, placental abnormalities are an independent risk factor in the pathogenesis of perinatal stroke (223,224,(248)(249)(250) (221,(254)(255)(256)(257)(258)(259)(260)(261). In the absence of other risk factors, the cytokine milieu of CHORIO can facilitate a hypercoaguable state or cause direct thromboembolism to the fetal brain (260,262).…”

Section: Chorioamnionitismentioning

confidence: 99%

“…Uteroplacental hypoperfusion leads to fetal hypoxia and diminishes fetal nutrition, including impaired removal of metabolic products from circulation (146, 259,265,[268][269][270][271][272]. CHORIO generates substantial inflammation and engenders a placental, fetal systemic, and fetal CNS inflammatory response characterized by a robust and highly dysregulated proinflammatory cytokine and chemokine profile (146, 273-275).…”

Section: Effects Of Chorio On the Maternalplacental-fetal Axismentioning

confidence: 99%

“…The pathophysiology of CHORIO is hallmarked by inflammation and HI, at the maternal-placental interface that directly impacts the fetal microenvironment (259). Uteroplacental hypoperfusion leads to fetal hypoxia and diminishes fetal nutrition, including impaired removal of metabolic products from circulation (146, 259,265,[268][269][270][271][272].…”

Section: Effects Of Chorio On the Maternalplacental-fetal Axismentioning

confidence: 99%

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The Unifying Effects of Maternal-Placental-Fetal Axis Dysregulation on Neurodevelopment Following Infectious and Toxic In Utero Insults

Yellowhair¹,

Oppong²,

Maxwell³

et al. 2017

MRAJ

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Homeostasis during pregnancy and in the in utero environment is essential for prenatal development. Prenatal maturation is hallmarked by an orchestrated and rigorous developmental program characterized by critical cascades in multiple organ systems. During these critical periods of development, however, potential vulnerability to injury exists throughout pregnancy. Indeed, the developing central nervous system (CNS) is extremely vulnerable to environmental insults throughout the entirety of gestation. These insults can adversely affect the developing brain and spinal cord, and permanently alter the neurodevelopmental trajectory. Specifically, in utero insults and dysregulation of the maternal-placentalfetal axis can change molecular, cellular, structural, and functional development of the CNS, culminating in adverse outcomes and neurological disorders throughout postnatal life. In this review, we will discuss common infectious and toxin-induced in utero insults that have recently garnered attention, including Zika virus, prenatal opioid and alcohol exposure, and chorioamnionitis. The goals are to identify common pathophysiological mechanisms, to emphasize the urgent need for new diagnostic tools, and to promote a broader understanding of the diverse array of neurological outcomes presenting in these children throughout their lifespan. With an increasing number of infants exposed to in utero infections and toxins, and the expanding public health awareness of the consequences of Zika infection, the opioid crisis, alcohol consumption during pregnancy, and the frequency of preterm birth in the United States, familiarity with the underlying mechanisms of each of these insults is paramount to improve the diagnosis and treatment for this exceedingly vulnerable patient population.

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“…The most common example is the abrupt placenta, a serious condition in which, the time period taken to develop a retroplacental hematoma is crucial for the macroscopic interpretation of the lesion and is critical to understand fetal complications. When fetal death does not occur, neurological damage is usually frequent [2,3]. Similarly, placental infarctions have consequent fetal complications according to the time of occurrence, location, extension and its progression.…”

mentioning

confidence: 99%

Macroscopic and Histopathological Study of the Placenta - An Essential Resource in Litigation Processes

Nogueira¹,

F²

2015

J Clinic Res Bioeth

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The pathological study of the placenta is of upmost importance in cases of unexplained fetal/perinatal loss and often these carry litigation implications. Integrating pathological findings and the underlying pathophysiological processes, leading to placental lesions, is fundamental for the evaluation of poor fetal and perinatal outcomes and to distinguish from cases of true negligence.Keywords: Placenta; Litigation process; Pathology study; Histopathology Overall PerspectiveUnderstanding the placental function has been crucial for a clinical and well-founded interpretation of pathological alterations associated with poor obstetric outcomes. The anatomopathological study of the placenta allows the investigation of unforeseen cases of fetal/perinatal loss, while further developing our knowledge of some neonatal diseases. The significance of this study is even greater if one considers that about 3/1,000 children will suffer of some sort of cerebral palsy [1][2][3][4]. The increase of litigation processes towards hospitals and obstetricians is a reality and in most cases, the litigant part claims negligence. Setting aside, well documented cases of true negligence, one must consciously and responsibly select cases with pathology associated with a poor obstetric outcome. For this purpose, the study of the placental is fundamental [5]. It is important to note that, the aim of this article is not to describe any epidemiological study of specific cases of placental disorders but, to emphasize that the study of the placenta may reveal undiagnosed or unsuspected pathologies in cases of poor obstetric outcomes that explains and justifies fetal/perinatal loss. Placental pathological features and adverse fetal outcomeImplantation anomalies can lead to velamentous cord insertion with or without vasa previa, to placental accrete and/or to placenta previa and it is well documented its relationship with neurological damage and increased risk of fetal loss [6,7].Placental infarction is a pathological condition of unknown etiology with distinctive features and has been associated with fetal intrauterine growth retardation (IUGR), microcephaly and neurological complications [1,8].Decidual arteriopathy is a type of injury diagnosed only histologically and usually occurs as result of maternal circulatory disorders, such as pre-eclampsia, hypertension, antiphospholipidic syndrome and thrombophilia. It is also associated with placental poor perfusion and low weight, leading to IUGR [6,9]. The period of time that, placental lesions take to evolve and extend, and how they become installed are determining factors for fetal complications. The most common example is the abrupt placenta, a serious condition in which, the time period taken to develop a retroplacental hematoma is crucial for the macroscopic interpretation of the lesion and is critical to understand fetal complications. When fetal death does not occur, neurological damage is usually frequent [2,3]. Similarly, placental infarctions have consequent fetal complications acco...

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Disorders of Placental Circulation and the Fetal Brain

Cited by 54 publications

References 57 publications

Glóbulos rojos nucleados y estado metabólico en recién nacidos con estado fetal no reactivo intraparto

Glóbulos rojos nucleados y estado metabólico en recién nacidos con estado fetal no reactivo intraparto

The Unifying Effects of Maternal-Placental-Fetal Axis Dysregulation on Neurodevelopment Following Infectious and Toxic In Utero Insults

Macroscopic and Histopathological Study of the Placenta - An Essential Resource in Litigation Processes

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