Life After Amsterdam: Placental Pathology Consensus Recommendations and Beyond

Slack, Jonathan C; Parra‐Herran, Carlos

doi:10.1016/j.path.2022.02.001

Cited by 14 publications

(5 citation statements)

References 95 publications

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“…Histopathology suggests that neutrophilic inflammation of the placental tissue caused by an ascending bacterial infection is the gold standard for the diagnosis of acute chorioamnionitis [ 3 ]. Neutrophils of maternal origin spread from the decidua, invade the chorion and amnion, and enter the amniotic cavity [ 4 , 5 ]. Fetal infection is the most advanced and dangerous stage of ascending intrauterine infection [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Laboratory markers to identify acute histological chorioamnionitis in febrile parturients undergoing epidural analgesia: a retrospective study

Xu,

Fan,

Zhang

et al. 2023

BMC Pregnancy Childbirth

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Background This study aimed to investigate the effect of the pathological staging of acute histological chorioamnionitis (HCA) on laboratory indicators and to conduct further studies to reassess the threshold values used by clinicians to identify acute HCA in febrile parturients undergoing epidural analgesia. Methods A retrospective study of febrile mothers receiving epidural analgesia at Nanjing Maternal and Child Health Care Hospital from January 1, 2018 to December 31, 2018. The participants were grouped by the progression of acute HCA, and the laboratory parameters were compared between groups. The ability of C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and monocyte-leukocyte ratio (M%), alone or in combination, to identify acute HCA in febrile parturients undergoing epidural analgesia was assessed using logistic regression and ROC curves. Results The area under the curve (AUC) of the best logistic regression model predicting HCA climbed to 0.706 (CRP + MLR). Maternal CRP, NLR, and MLR significantly and progressively increased with the progression of acute HCA (p < 0.0001). Based on the ROC curves, the following thresholds were selected to define increased laboratory indicators for identifying acute HCA: CRP ≥ 6.90 mg/L, NLR ≥ 11.93, and MLR ≥ 0.57. In addition, the AUC of the best logistic regression model predicting HCA ≥ stage 2 was 0.710, so these inflammatory markers were more precise in predicting HCA ≥ stage 2. Conclusion Increased CRP (≥ 6.90 mg/L), NLR (≥ 11.93), and MLR (≥ 0.57) may help clinicians to identify early potential acute HCA in febrile parturients receiving epidural analgesia and to monitor progression to optimize clinical treatment options. Trial registration The study was registered in the Chinese Clinical Trial Registry on November 24, 2021 (http://www.chictr.org.cn, ChiCTR2100053554).

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Section: Introductionmentioning

confidence: 99%

Laboratory markers to identify acute histological chorioamnionitis in febrile parturients undergoing epidural analgesia: a retrospective study

Xu,

Fan,

Zhang

et al. 2023

BMC Pregnancy Childbirth

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“…According to the Amsterdam Placental Workshop Group Consensus Statement on Sampling and Definitions, placentitis is universally used to describe the most common pathologic lesions found in the placenta [62]. Placental inflammatory histopathological features are considered similar to those of other pregnancy-related viral RNA infections [63].…”

Section: Route Of Sars-cov-2 During Pregnancy and Its Consequencesmentioning

confidence: 99%

SARS-CoV-2 Footprints in the Placenta: What We Know after Three Years of the Pandemic

Tosto

Meyyazhagan

Alqasem

et al. 2023

JPM

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As the COVID-19 pandemic continues into its third year, there is accumulating evidence on the consequences of maternal infection. Emerging data indicate increased obstetrics risks, including maternal complications, preterm births, impaired intrauterine fetal growth, hypertensive disorders, stillbirth, gestational diabetes, and a risk of developmental defects in neonates. Overall, controversial concerns still exist regarding the potential for vertical transmission. Histopathological examination of the placenta can represent a useful instrument for investigation and can contribute significant information regarding the possible immunohistopathological mechanisms involved in developing unfavorable perinatal outcomes. Based on current evidence, SARS-CoV-2 infection can affect placental tissue by inducing several specific changes. The level of placental involvement is considered one of the determining factors for unfavorable outcomes during pregnancy due to inflammation and vascular injuries contributing to complex cascade immunological and biological events; however, available evidence does not indicate a strong and absolute correlation between maternal infection, placental lesions, and obstetric outcomes. As existing studies are still limited, we further explore the placenta at three different levels, using histology, immunohistochemistry, and molecular genetics to understand the epidemiological and virological changes observed in the ongoing pandemic.

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“…The current practice of placental pathology is based on the international consensus classification, the so-called Amsterdam criteria [5], which include acute amniotic fluid infection and chronic placental lesions (maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM), and inflammatory lesions featuring chronic villitis, chronic lymphoplasmacytic deciduitis, and chronic histiocytic intervillositis (CHI)).…”

Section: Sars-cov-2 Infection and Chronic Placental Pathologymentioning

confidence: 99%

“…MVM is known to be associated with systemic maternal disorders, particularly hypertensive disorders (PE, pregnancy-induced hypertension, and HELLP) [5]. PE is a serious complication of pregnancy that is diagnosed when gestational hypertension is accompanied by new-onset proteinuria.…”

Section: Sars-cov-2 Infection and Chronic Placental Pathologymentioning

confidence: 99%

SARS-CoV-2 Infection in Late Pregnancy and Childbirth from the Perspective of Perinatal Pathology

Debelenko

2023

JDB

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This review focuses on SARS-CoV-2 infection in placental and fetal tissues. Viremia is rare in infected pregnant women, and the virus is seldom amplified from placental tissues. Definite and probable placental infection requires the demonstration of viral RNA or proteins using in situ hybridization (ISH) and immunohistochemistry (IHC). Small subsets (1.0–7.9%, median 2.8%) of placentas of SARS-CoV-2-positive women showed definite infection accompanied by a characteristic histopathology named SARS-CoV-2 placentitis (SP). The conventionally accepted histopathological criteria for SP include the triad of intervillositis, perivillous fibrin deposition, and trophoblast necrosis. SP was shown to be independent of the clinical severity of the infection, but associated with stillbirth in cases where destructive lesions affecting more than 75% of the placental tissue resulted in placental insufficiency and severe fetal hypoxic–ischemic injury. An association between maternal thrombophilia and SP was shown in a subset of cases, suggesting a synergy of the infection and deficient coagulation cascade as one of the mechanisms of the pathologic accumulation of fibrin in affected placentas. The virus was amplified from fetal tissues in approximately 40% of SP cases, but definite fetal involvement demonstrated using ISH or IHC is exceptionally rare. The placental pathology in SARS-CoV-2-positive women also includes chronic lesions associated with placental malperfusion in the absence of definite or probable placental infection. The direct viral causation of the vascular malperfusion of the placenta in COVID-19 is debatable, and common predispositions (hypertension, diabetes, and obesity) may play a role.

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Life After Amsterdam: Placental Pathology Consensus Recommendations and Beyond

Cited by 14 publications

References 95 publications

Laboratory markers to identify acute histological chorioamnionitis in febrile parturients undergoing epidural analgesia: a retrospective study

Laboratory markers to identify acute histological chorioamnionitis in febrile parturients undergoing epidural analgesia: a retrospective study

SARS-CoV-2 Footprints in the Placenta: What We Know after Three Years of the Pandemic

SARS-CoV-2 Infection in Late Pregnancy and Childbirth from the Perspective of Perinatal Pathology

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