Placental Implantation Disorders

Jauniaux, Eric; Moffett, Ashley; Burton, Graham J.

doi:10.1016/j.ogc.2019.10.002

Cited by 57 publications

(59 citation statements)

References 83 publications

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“…17 Abnormal placentation was also associated with IVF and prior cesarean section. 18 The conclusion might be biased because the rates of pregnancy conceived by IVF (66.7%) and pregnancy in women with a prior cesarean section (24.6%) were high in their study. In our study, those rates were 29.5% and 11.5%, respectively, and only one woman with a prior cesarean section had placenta previa.…”

Section: Discussionmentioning

confidence: 84%

Association of a unicornuate uterus with adverse obstetric outcomes: A retrospective cohort study

Liu

Deng

et al. 2021

J of Obstet and Gynaecol

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Objective: To estimate the association of unicornuate uterus (UU) with adverse obstetric outcomes. Methods: Using data from 26 737 singleton childbirths from a tertiary hospital from 1999 to 2019, we identified 44 births from women with a UU. A total of 367 births from women with a normal uterus were randomly selected as controls. The outcome measures were preterm birth (PTB), breech presentation, and cesarean delivery. The subdivisions of PTB and indications for cesarean delivery were described. Results: The presence of UU was associated with an increased risk of PTB (adjusted risk ratio [aRR], 2.3; 95% confidence interval [CI], 1.1-4.9), breech presentation (aRR, 6.2; 95% CI, 2.9-13.2), and cesarean delivery (aRR, 2.1; 95% CI, 1.8-2.7). For women with a UU, most PTBs (7/9) were moderate to late PTBs, and approximately half of the PTBs (4/9) were iatrogenic due to preeclampsia (PE). Breech presentation, PE, and prior surgery for rudimentary horn resection were UU-related indications for cesarean delivery. Conclusions: Women with a UU have a higher risk of PTB, breech presentation, and cesarean delivery. Understanding of the subdivisions of PTBs and indications for cesarean delivery might help clinicians when counseling women with pregnancy complicated by a UU.

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Section: Discussionmentioning

confidence: 84%

Association of a unicornuate uterus with adverse obstetric outcomes: A retrospective cohort study

Liu

Deng

et al. 2021

J of Obstet and Gynaecol

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“…Severe conceptus misorientation in the Mtrr gt mouse line may show some relationship to velamentous umbilical cord insertion in humans. This condition is when the umbilical cord is misaligned and inserts into the chorioamniotic membranes at the edge of the placenta (Jauniaux et al, 2020) leading to reduced vascularisation of the placenta (Yampolsky et al, 2009). Its occurrence is associated with congenital heart disease and adverse perinatal outcomes including preterm birth and low birth weight (Raisanen et al, 2012;Ebbing et al, 2013;Brouillet et al, 2014;Albalawi et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Disruption of folate metabolism causes poor alignment and spacing of mouse conceptuses for multiple generations

Menelaou

Rakoczy

et al. 2021

Preprint

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Abnormal uptake or metabolism of folate increases risk of human pregnancy complications, though the mechanism is unclear. Here, we explore how defective folate metabolism influences early development by analysing mice with an Mtrrgt hypomorphic mutation. MTRR is necessary for methyl group utilisation from the folate cycle, and the Mtrrgt allele disrupts this process. We show that the spectrum of phenotypes previously observed in Mtrrgt/gt conceptuses at embryonic day (E) 10.5 is apparent from E8.5 including developmental delay, congenital malformations, and placental phenotypes (e.g., eccentric chorioallantoic attachment). Notably, we report misalignment of some Mtrrgt conceptuses within their implantation sites from E6.5. The degree of skewed growth occurs across a continuum, with eccentric chorioallantoic attachment now re-characterised as a severe form of conceptus misalignment. Additionally, some Mtrrgt/gt conceptuses display twinning. Therefore, we implicate folate metabolism in blastocyst orientation and spacing at implantation. Embryo development is influenced by skewed growth since developmental delay and heart malformations (but not neural tube defects) associate with severe misalignment of Mtrrgt/gt conceptuses. Patterning of trophoblast lineage markers is largely unaffected in skewed Mtrrgt/gt conceptuses at E8.5 indicating trophoblast differentiation was normal when misaligned. Typically, the uterus guides conceptus orientation. Accordingly, we manipulate the maternal Mtrr genotype and assess conceptus alignment. Mtrr+/gt, and Mtrrgt/gt mothers, plus Mtrr+/+ mothers, exhibit misaligned conceptuses at E6.5. While progesterone and/or BMP2 signalling required for decidualisation might be disrupted, normal gross decidual morphology, patterning, and blood perfusion is evident regardless of conceptus alignment, arguing against a uterine defect. Given the important finding that Mtrr+/+ mothers also display conceptus misalignment, a grandparental effect is explored. Multigenerational phenotype inheritance is characteristic of the Mtrrgt model, though the mechanism remains unclear. Genetic pedigree analysis reveals that severe skewing associates with the Mtrr genotype of either maternal grandparent. Moreover, misalignment is independent of the uterus and instead is attributed to an embryonic mechanism based on blastocyst transfer experiments. Overall, our data indicates that abnormal folate metabolism influences conceptus orientation over multiple generations with implications for subsequent development. Our study casts light on the complex role of folate metabolism during development beyond a direct maternal effect.

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“…Complications related to the placenta are among the more serious consequences of previous CS (10). Women with previous CS are more likely to have placenta previa and placental implantation, leading to severe postpartum hemorrhage and even hysterectomy (11,12). The reason that placenta previa occurs easily in a scarred uterus is unclear (13).…”

Section: Principal Findings Of the Studymentioning

confidence: 99%

Previous mode of delivery affects subsequent pregnancy outcomes: a Chinese birth register study

Chen¹,

Gao²,

Liu³

et al. 2021

Ann Transl Med

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Background: With the comprehensive implementation of the second child policy in China, the proportion of multiparous women has increased dramatically in the past few years. As nearly half of them have a history of previous cesarean delivery, there is widespread concern regarding complications of their pregnancy. Methods:The aim of this study was to evaluate the effect of the previous delivery mode on subsequent pregnancy outcomes in the real world based on data from a Chinese birth registry. Birth registry data from July 1, 2016 to June 30, 2017 among a Chinese population were collected and analyzed retrospectively. This study included 14 representative hospitals from 10 provinces of China. All delivery data were collected by an internet-based system using a birth registration platform. The study enrolled 36,355 multiparas. Information extracted for analysis included basic demographic characteristics, previous delivery mode, current delivery mode, major maternal complications, and neonatal outcomes. Pregnancy outcomes of women with previous cesarean delivery (PCS group, n=14,774) were compared with the outcomes of women with previous vaginal delivery (PVD group, n=21,581).Results: There were statistically significant differences in the major pregnancy outcomes between the PCS group and the PVD group. The PCS group had a higher incidence of cesarean section (CS), placenta previa, postpartum hemorrhage, uterus rupture, hysterectomy, gestational diabetes, gestational hypertension, delivery before 37 weeks of gestation, low birth weight, and Apgar Score at 5 min ≤3.Conclusions: Women with previous cesarean delivery had poorer pregnancy outcomes than women with previous vaginal delivery. Avoiding unnecessary CS, especially in primiparas is essential to improving maternal and neonatal outcomes in later pregnancies.

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Placental Implantation Disorders

Cited by 57 publications

References 83 publications

Association of a unicornuate uterus with adverse obstetric outcomes: A retrospective cohort study

Association of a unicornuate uterus with adverse obstetric outcomes: A retrospective cohort study

Disruption of folate metabolism causes poor alignment and spacing of mouse conceptuses for multiple generations

Previous mode of delivery affects subsequent pregnancy outcomes: a Chinese birth register study

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