Immunopathology of the Placenta

Fox, H.; Sebire, Neil J

doi:10.1016/b978-1-4160-2592-4.50018-7

Cited by 22 publications

(28 citation statements)

References 159 publications

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“…Previous smaller studies of the placental pathology associated with adherent myometrial fibers and placenta accreta have identified similar findings including uteroplacental vascular abnormalities, 8 placental infarction, and hemosiderosis, 9 and both acute and chronic inflammation in the myometrium adjacent to areas of placenta accrete. 10 However, this is the largest and most systematic study, to our knowledge, to examine the placental pathologic features associated with MAP.…”

Section: Discussionmentioning

confidence: 99%

“…Existing small studies have described the associated placenta findings in cases of accreta or adherent basal plate myometrium to include uteroplacental vascular abnormalities, 8 decidual hemosiderosis and infarction, 9 and acute and chronic inflammation. 10 The objective of this study was to thoroughly review the placental pathologic findings, especially implantation site pathology, in a large, well-defined MAP cohort to identify potential pathogenic mechanisms for the development of MAP.…”

Section: Introductionmentioning

confidence: 99%

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Placental Pathologic Associations With Morbidly Adherent Placenta

2017

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Background The pathology that underlies morbidly adherent placenta (MAP) is poorly understood. The objective of this study was to describe the placental pathology, especially implantation site pathology, associated with MAP. Methods This was a single institution, retrospective case-control study design examining placentas of patients who delivered between January 2008 and September 2013. MAP cases were defined by the need for clinical intervention at delivery beyond spontaneous placental delivery or simple manual extraction of the placenta. Controls consisted of patients with placentas sent for examination due to a history of maternal malignancy with no clinical suspicion of accreta. Placental pathologic findings of maternal vascular underperfusion (MVU), acute inflammation, chronic inflammation, fetal vascular obstruction, and hemorrhage were recorded and compared using bivariable and multivariable analyses. Results Three categories of pathologic changes were seen more commonly in MAP placentas (N = 101) than control placentas (N = 110): chronic basal inflammation, villous changes of MVU, and retromembranous and subchorionic/intervillous hemorrhage. In multivariable analyses adjusted for confounders, basal chronic villitis (aOR 5.6, 1.73-18.18), plasma cell deciduitis (aOR 2.63, 1.08-6.39), increased syncytial knots (aOR 3.92, 1.57-9.75), villous agglutination (aOR 24.85, 2.78-221.75), increased perivillous fibrin (aOR 5.08, 1.49-17.34), and the presence of subchorionic/intervillous thrombi (aOR 4.01, 1.63-9.86) remained associated with MAP. Conclusions MAP is highly associated with evidence of intraparenchymal placental hemorrhage, villous changes of MVU, and a lymphoplasmacytic infiltrate at the implantation site. The contribution of this basal chronic inflammatory infiltrate to MAP requires further investigation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Placental Pathologic Associations With Morbidly Adherent Placenta

2017

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“…The PR features, unlike normal placenta, include a homogeneous villous maturation (ie, all microscopic fields look similar) and diffuse villous hypervascularity encompassing not only all cases of diffuse chorangiosis but also other diffusely hypervascular placentas with more than 5 capillary profiles per chorionic villus [16]; thus, the condition does not always meet the Altshuler rule of tens [5]. The villous hypervascularity is therefore not equivalent to chorangiosis, as the threshold for villous hypervascularity is lower.…”

Section: Discussionmentioning

confidence: 99%

“…Not surprisingly, clinical umbilical cord compromise and/or focal placental lesions of decreased fetal blood flow (Table 1), because they are frequently random pregnancy accidents, did not correlate with diffuse placental hypoxia, although they can produce a focal PU, so-called stasis-induced thrombotic vasculopathy, with clusters of avascular and fibrotic chorionic villi [34–37]. Congenital malformations, notorious for the frequent absence of abnormal placental findings [16,24], were understandably more common in the CG. Only severe congenital malformations forming mass lesions that interfered with blood return from the placenta can produce placental stasis-induced thrombotic vasculopathy, but not diffuse PU [25], which was, however, not a topic of this analysis.…”

Section: Discussionmentioning

confidence: 99%

Utility of Diagnosing Various Histological Patterns of Diffuse Chronic Hypoxic Placental Injury

Stanek

2012

Pediatr Dev Pathol

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To examine the clinicopathologic correlations of three histological patterns of diffuse chronic hypoxic placental injury (preuterine [PR], uterine [UH], and postuterine [PU]), a retrospective statistical analysis of a large 14year placental database was performed. Of 5097 placentas between 20 and 43 weeks of gestation examined consecutively, 4413 did not feature histological chronic placental hypoxia, while 684 did. In the latter, maternal hypertensive disorders, diabetes mellitus, abnormal cardiotocography and Dopplers, cesarean sections, inductions of labor, and fetal growth restriction, as well as other placental hypoxic lesions and decidual arteriolopathy, were statistically significantly more common than in the remaining placental material. Two hundred eighty-nine PR cases featured the most advanced gestational age and meconium staining; 237 UH cases featured severe preeclampsia, decidual arteriolopathy, villous infarction, membrane laminar necrosis, microscopic chorionic pseudocysts, excessive extravillous trophoblasts, and maternal floor multinucleate trophoblastic giant cells; and 158 PU cases featured the lowest placental weight and the highest prevalence of abnormal Dopplers, umbilical cord compromise, fetal growth restriction, cesarean section rate, and complicated 3rd stage of labor. The specificity of chronic hypoxic patterns of placental injury was much higher than the sensitivity, with the highest specificity for an excessive amount of extravillous trophoblasts. Diagnosing various hypoxic patterns of placental injury by histology may help to clarify the etiopathogenesis of a significant proportion of complications of pregnancy and abnormal fetal or neonatal outcomes. The patterns should help to retrospectively diagnose placental hypoxia, even in clinically unsuspected cases.

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“…Approximately 1 out of every 533 pregnancies, according to the American College of Obstetricians and Gynecologists (ACOG) experience placenta accrete, percreta or increta [3]. The difference between percreta, increta or accreta which are the pathological types used to describe placental invasion, is determined by how deep the placental villi invade into the uterine wall [4] [5] [6].…”

Section: Introductionmentioning

confidence: 99%

Detecting Accuracy of Three Dimensional Power Doppler (3DPD) Vascular Indices for Prenatal Diagnosis of Morbidly Adherent Placenta in Patients with Placenta Previa

Abdelhamid¹,

Aly²,

Ghaly³

et al. 2020

OJOG

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Objective: The study's objective was to assess the accuracy of using prenatal 3-dimensional power Doppler analysis of vascular placental indices to accurately diagnose morbidly adherent placenta objectively. Background: Traditionally, 2D ultrasound was used for the diagnosis of a suspected morbidly adherent placenta (MAP) previa. More objective techniques like 3D power Doppler haven't been well studied. Study Design: A prospective cohort study is designed for women with gestational age between 28 and 32 weeks with suspected placenta previa. Patients were examined by 2D ultrasound which was used in management decisions. 3D Power Doppler's VI, FI and VFI were measured during the same examination after manual tracing of placenta; data were blinded to obstetricians. Histopathology was performed to confirm MAP. Results: Our results showed that the 3D power Doppler VI ≥ 16 predicted the diagnosis of MAP with 100% sensitivity, 100% specificity which is better than those of 2D ultrasound. While VI > 33.1 measured by 3D Doppler predicted severe MAP with a sensitivity of 73.9% and specificity of 86.4%, which was superior to 2D ultrasound. Conclusion: In patients with placenta previa, the 3D Doppler's vascular index accurately predicts MAP. Furthermore, vascular and vascular flow indices of 3D Doppler were more predictive of severe cases of MAP compared to 2D ultrasound.

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Immunopathology of the Placenta

Cited by 22 publications

References 159 publications

Placental Pathologic Associations With Morbidly Adherent Placenta

Placental Pathologic Associations With Morbidly Adherent Placenta

Utility of Diagnosing Various Histological Patterns of Diffuse Chronic Hypoxic Placental Injury

Detecting Accuracy of Three Dimensional Power Doppler (3DPD) Vascular Indices for Prenatal Diagnosis of Morbidly Adherent Placenta in Patients with Placenta Previa

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