Peculiar blood flow profiles among placental chorionic villous vessels of an abnormally thick placenta in a case of systemic lupus erythematosus characterized using microvascular imaging

Abstract

We present a patient with systemic lupus erythematosus receiving long-term steroid therapy, who had myometrial thinning, markedly thickened placenta, and fetal growth restriction (FGR). Blood flow profiles of the myometrium, decidua and placental villous vessels (VV) were described using superb microvascular imaging (SMI) at 35 weeks' gestation. Images showed no decidual blood flow underneath the placenta sitting on a thin myometrium and sparse VV distribution and non-visualization of peripheral VV flow. Emergency cesarean hysterectomy was performed at 36 weeks. Histological findings showed missing decidua on the thin myometrium, which indicated placenta accreta spectrum, and massive perivillous fibrin deposition and increased numbers of syncytial knots in the placenta. We speculated that the thick placenta and peculiar VV flow profiles resulted from congestion of the intervillous space and intervillous underperfusion/low intraplacental oxygenation, respectively, resulting in FGR. Superb microvascular imaging is useful for diagnosing placenta accreta spectrum and understanding the pathophysiology of thick placenta and FGR.

Diffuse myometrium thinning and placenta accreta spectrum in a patient with systemic lupus erythematosus (SLE): a case report and review of the literature

“…The relationship between SLE during pregnancy and abnormal myometrium with PAS has been reported in Asian countries for ten years [ 2 – 7 ]. There were 12 reports (7 English and 5 Japanese articles), and 14 patients were identified, including our patient.…”

“…There were 12 reports (7 English and 5 Japanese articles), and 14 patients were identified, including our patient. Interestingly, all patients were from Asian counties (Japan [ 3 , 4 , 7 ]), South Korea [ 2 , 6 ] Vietnam [ 5 ]. Here, we reviewed eight patients from 6 English articles, including our patients with SLE during pregnancy with uterine wall thinning and PAS (Table 1 ).…”

“…We should note the structural relationship of placental invasion to the uterine wall by ultrasonography in SLE patients from the beginning of pregnancy. Inoue et al [ 7 ]. reported placenta thickening and missing decidual blood flow detected by superb microvascular imaging of ultrasonography that led to a diagnosis of PAS before labor.…”

“…SLE in pregnancy induces various obstetric complications, such as miscarriage, premature delivery, and preeclampsia [ 1 ]. There have been reported placenta accreta spectrum (PAS) cases in pregnant women with SLE over the last ten years [ 2 – 7 ]. These cases were complicated with uterine wall thinning, which led to a rupture of the uterus and hysterectomies.…”

Integration approach to study placental vessels in preeclampsia

“…В настоящее время представлено немало научных работ, посвященных иммуногистохимическому и морфометрическому исследованию плацент, однако остаются не до конца изученными состояние сосудов опорных ворсин и их роль в развитии ПЭ [2,14,17,18]. Имеются единичные работы, в которых дается морфометрическая характеристика облитерационного процесса в артериолах стволовых ворсин, а также предпринимаются попытки объяснить нарушения регуляторных процессов, приводящих к формированию гипертрофии мышечной стенки и суженного просвета артериол [5,10,16,19].…”