Placental Abnormalities Associated With Childbirth

Wright, Robert F.; Macindoe, Christopher; Green, Patricia

doi:10.1177/1925362119851113

Cited by 3 publications

(4 citation statements)

References 39 publications

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“…This might be explained by the deteriorated maternal condition resulting in vessel compression and cessation of blood flow, as well as fetal perfusion. lastly, the combination of all these effects could lead to fetal asphyxia and death ( 78 , 79 ). In line with this, history of ANC visits, urinary tract infection, being anemic, previous history of cesarean section, gestational hypertension, and diabetes were known modifiable risk factors for both maternal health conditions (i.e., Maternal complication of pregnancy and complications of the placenta, cord, and membranes) ( 30 , 80 , 81 ).…”

Section: Discussionmentioning

confidence: 99%

Determinants of stillbirth among reviewed perinatal deaths in Ethiopia

et al. 2022

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BackgroundThe global burden of stillbirth has declined over time. However, the problem is still prominent in South Asian and Sub-Saharan African countries. Ethiopia is one of the top stillbirth-reporting countries worldwide. Despite several measures taken to reduce the burden of stillbirth; the pace of decline was not as good as the post-neonatal death. Thus, this study is aimed at identifying potential factors related to stillbirth in Ethiopia based on nationally reviewed perinatal deathsMethodThe national perinatal death surveillance data were used for this study. A total of 3,814 reviewed perinatal death were included in the study. Two model families,namely generalized estimating equation, and alternating logistic regression models from marginal model family were employed to investigate the risk factors of stillbirth. The alternating logistic regression model was selected as the best fit for the final analysis.ResultAmong reviewed perinatal deaths nearly forty percent (37.4%) were stillbirths. The findings from the multivariate analysis demonstrated that the place of birth (in transit and at home), cause of death (infection, and congenital and chromosomal abnormalities), maternal health condition (women with complications of pregnancy, placenta, and cord), delay one (delay in deciding to seek care) and delay three (delay in receiving adequate care) were associated with an increased risk of having a stillbirth. On the other hand, maternal education (women with primary and above education level) and the type of health facility (women who were treated in secondary and tertiary health care) were associated with a decreased risk of having a stillbirth.ConclusionThe study identified that both individual (place of delivery, cause of death, maternal health condition, maternal education, and delay one) and facility level (type of health facility and delay three) factors contributed to stillbirth outcome. Therefore, policies that are aimed at encouraging institutional delivery, improving health seeking behavior, and strengthening facility-level readiness should be devised to reduce the high burden of stillbirth in Ethiopia.

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Section: Discussionmentioning

confidence: 99%

Determinants of stillbirth among reviewed perinatal deaths in Ethiopia

et al. 2022

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“…Vascular alterations of the umbilical cord, among other placental or maternal vascular pathologies such as chorioamnionitis, hypertension or preeclampsia [42][43][44] can affect foetal oxygenation during pregnancy. Foetal hypoxia results in anaerobic metabolism in which organic acids such as lactate and ketoacids are produced, leading to metabolic or mixed acidosis.…”

Section: Foetal Programming: How Vascular Alterations In the Umbilica...mentioning

confidence: 99%

Considering the Effects and Maternofoetal Implications of Vascular Disorders and the Umbilical Cord

et al. 2022

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The umbilical cord is a critical anatomical structure connecting the placenta with the foetus, fulfilling multiple functions during pregnancy and hence influencing foetal development, programming and survival. Histologically, the umbilical cord is composed of three blood vessels: two arteries and one vein, integrated in a mucous connective tissue (Wharton’s jelly) upholstered by a layer of amniotic coating. Vascular alterations in the umbilical cord or damage in this tissue because of other vascular disorders during pregnancy are worryingly related with detrimental maternofoetal consequences. In the present work, we will describe the main vascular alterations presented in the umbilical cord, both in the arteries (Single umbilical artery, hypoplastic umbilical artery or aneurysms in umbilical arteries) and the vein (Vascular thrombosis, aneurysms or varicose veins in the umbilical vein), together with other possible complications (Velamentous insertion, vasa praevia, hypercoiled or hypocoiled cord, angiomyxoma and haematomas). Likewise, the effect of the main obstetric vascular disorders like hypertensive disorders of pregnancy (specially pre-eclampsia) and chronic venous disease on the umbilical cord will also be summarized herein.

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“…[1][2][3] Apart from maternal (hypertensive disorders of pregnancy, diabetes mellitus, infection), and fetal (fetal growth restriction, fetal structural abnormalities, umbilical cord abnormalities) conditions, placental (maternal and fetal vascular malperfusion, inflammation) abnormalities are commonly known to cause stillbirth. [4][5][6][7][8][9][10] Although having a history of abnormal pregnancy is considered a strong risk factor for stillbirth, 11,12 one study 2 reported that one third of the stillbirths occurred in women who had an apparently healthy pregnancy. Because they are related to labor and delivery problems, intrapartum stillbirths usually have no antenatal risk factors.…”

Section: Introductionmentioning

confidence: 99%

“…Stillbirth defined as fetal death in utero at ≥20 weeks of gestation accounts for approximately 60% of all perinatal deaths; however, its cause remains unknown in 25%–60% of all cases 1–3 . Apart from maternal (hypertensive disorders of pregnancy, diabetes mellitus, infection), and fetal (fetal growth restriction, fetal structural abnormalities, umbilical cord abnormalities) conditions, placental (maternal and fetal vascular malperfusion, inflammation) abnormalities are commonly known to cause stillbirth 4–10 . Although having a history of abnormal pregnancy is considered a strong risk factor for stillbirth, 11,12 one study 2 reported that one third of the stillbirths occurred in women who had an apparently healthy pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Placental CD34 immunohistochemistry in fetal vascular malperfusion in stillbirth

Stanek

Drach

2022

J of Obstet and Gynaecol

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Aim To assess the use of CD34 immunostaining in diagnosing of fetal vascular malperfusion (FVM) in stillborns. Methods We examined 25 independent clinical (pregnancy and fetal outcomes) and 48 placental phenotypes in 100 placentas of consecutive stillborns at ≥20 weeks of gestation. Group 1 comprised 34 cases with no distal villous FVM; Group 2 comprised 36 placentas with clustered distal villous FVM (sclerotic villi, hypovascularity, stromal vascular karyorrhexis, and/or mineralization) determined using hematoxylin–eosin staining not upgraded by CD34 immunostaining, and Group 3 comprised 30 placentas with FVM diagnosed or upgraded by CD34 immunostaining (distal villous endothelial fragmentation and/or villous hypovascularity). Results Diffuse villous lesions of fetal retention with various degrees were present in approximately 50% of the cases in all groups; however, histological evaluation for FVM was still possible in most stillborns. Abnormal clinical phenotypes were significantly less frequent than abnormal placental phenotypes of FVM (8.6% vs. 24%, respectively). Chronic hypoxic placental injury patterns, fetal blood erythroblastosis, some features of shallow placental implantation, and muscular FVM lesions were most common in Group 2. Only decidual arteriopathy (hypertrophic and or hyaline necrosis/atherosis) was most frequent in Group 3. Conclusion Most distal FVM lesions can be observed on hematoxylin–eosin placental slides only several days following the inciting event. CD34 immunostaining can reveal recent distal villous lesions of FVM featuring segmental villous endothelial fragmentation for de novo diagnosis or for upgrading FVM. Routine CD34 immunostaining has demonstrated FVM to be the major pattern of placental injury in stillborns.

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Placental Abnormalities Associated With Childbirth

Cited by 3 publications

References 39 publications

Determinants of stillbirth among reviewed perinatal deaths in Ethiopia

Determinants of stillbirth among reviewed perinatal deaths in Ethiopia

Considering the Effects and Maternofoetal Implications of Vascular Disorders and the Umbilical Cord

Placental CD34 immunohistochemistry in fetal vascular malperfusion in stillbirth

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