Placental lesions associated with oligohydramnios in fetal growth restricted (FGR) pregnancies

Spinillo, Arsenio; Cesari, Stefania; Bariselli, Silvia; Tzialla, Chryssoula; Gardella, Barbara; Silini, Enrico Maria

doi:10.1016/j.placenta.2015.02.007

Cited by 19 publications

(16 citation statements)

References 25 publications

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“…17 In the present study, on gross examination 90.0 % cases had discoid shaped and 10.0 % cases had oval shaped placenta which was consistent with study of Hamdany MZ, in which discoid shape was seen in all cases of oligohydramnios.…”

Section: Discussionsupporting

confidence: 91%

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Morphological changes in placenta in cases of oligohydramnios

Gupta

Musharaf

Singh

et al. 2018

Int J Reprod Contracept Obstet Gynecol

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Background: There are gross and microscopic changes in placenta and umbilical cord in complicated pregnancies. The objective of this study was to study pathological (gross and microscopic) changes in placenta, membrane and umbilical cord in cases with oligohydramnios and to study relationship between changes in placenta, membranes and umbilical cord with severity of oligohydramnios.Methods: A total of 50 patients were selected and their placentas were collected after delivery and sent to pathology department in 10 % formalin for histopathological examination. Patients were divided into three groups and the results were compared. Statistical calculations were performed using the SPSS 16.0. In order to detect differences between subjects students t-test was used for continuous variables, while, for categorical variables, the X2 test was used. A p-value of less than 0.05 was considered statistically significant.Results: Atotal of 50 patients were studied for a period of one year and following observations were made, discoid shape placenta in 45 (90.0%), oval in 5 (10.0%), central attachment of umbilical cord in 16 cases (32.0%), eccentric in 33 (66.0%), marginal in 1 (2.0%) case following variables were compared and p value detected, placental maximum diameter (p <0.0001),placental minimum diameters (p = 0.041), mean of cord length (p <0.0001) placental weight (p = 0.273), placental thickness (p = 0.253), acute chorioamnionitis (p <0.0001), chronic chorioamnionitis (p<0.0001), focal squamous metaplasia (p <0.0001), bacterial colonies in subamnion (p <0.0001), meconium staining (p <0.0001), amnion nodosum (p < 0.0001), intra amniotic haemorrhage (p = 0.090), membranous deciduitis with chorioamnionitis (p = 0.081), focal haematoma (p = 0.010), acute inflammatory infiltrate in Wharton’s jelly (p = 0.012), single umbilical artery (p =0.010), intervillous fibrin deposition (p <0.0001), calcification (p<0.0001), chorangiosis (p <0.0001), syncytial knots (p <0.0001), avascular villi (p = 0.011), villous edema (p = 0.090) and infarct (p = 0.090).Conclusions: There are alterations in placental morphology associated with oligohydramnios hence placenta should be examined, which may be useful in predicting perinatal morbidity and mortality.

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Section: Discussionsupporting

confidence: 91%

“…18,10,17,22,23 Villous edema (p value = 0.090) and infarct (p value = 0.090) consistent with Spinillo A et al, 2015 in which infarct (early) was found in 15.6 % cases in mild, 13.6% cases in moderate and 11.2% cases in severe oligohydramnios group (p value = 0.25) was found insignificant.…”

supporting

confidence: 81%

Morphological changes in placenta in cases of oligohydramnios

Gupta

Musharaf

Singh

et al. 2018

Int J Reprod Contracept Obstet Gynecol

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“…The incidence of oligohydramnios secondary to placental insufficiency in severe preeclampsia ranges from 20% to 50%. 44 , 45 , 46 Once osmotic diuresis, secondary to a high fetal blood urea level, is often present in pregnant women on dialysis, we speculate that only patients with inadequate placental blood flow will not develop polyhydramnios. 47…”

Section: Discussionmentioning

confidence: 91%

Risk Factors for Adverse Fetal Outcome in Hemodialysis Pregnant Women

Luders

Titan

Kahhale

et al. 2018

Kidney International Reports

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IntroductionPregnancy in women on dialysis is associated with a higher risk of adverse events, and the best care for this population remains to be established.MethodsIn this series, we aimed to identify factors associated with the risk of adverse fetal outcomes among 93 pregnancies in women on hemodialysis. Dialysis dose was initially assigned according to the presence of residual diuresis, body weight, and years on dialysis. Subsequent adjustments on dialysis dose were performed according to several parameters.ResultsThe overall successful delivery rate was 89.2%, with a dialysis regimen of 2.6 ± 0.7 h/d, 15.4 ± 4.0 h/wk, and mean weekly standard urea Kt/V of 3.3 ± 0.6. In the logistic models, preeclampsia, lupus, primigravida, and average midweek blood urea nitrogen (BUN) level were positively related to the risk of a composite outcome of perinatal death or extreme prematurity, whereas polyhydramnios was inversely related to it. In multivariable linear regression, preeclampsia, polyhydramnios, primigravida, average midweek BUN, and residual diuresis remained significantly and independently related to fetal weight, which is a surrogate marker of fetal outcome. An average midweek BUN of 35 mg/dl was the best value for discriminating the composite outcome, and BUN ≥35 mg/dl was associated with a significant difference in a Kaplan-Meier curve (P = 0.01).ConclusionOur results showed that a good fetal outcome could be reached and that preeclampsia, lupus, primigravida, residual diuresis, polyhydramnios, and hemodialysis dose were important variables associated with this outcome. In addition, we suggested that a midweek BUN <35 mg/dl might be used as a target for adjusting dialysis dose until hard data were generated.

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“…There are reports of amniotic necrosis by meconium, and the relationship between meconium staining of membranes and reduction of the amniotic fluid volume, 14 suggesting a correlation between amniotic necrosis and amniotic fluid volume abnormalities. 15 In conclusion, we opine that oxidative DNA damage of the amniotic epithelium occurs by decomposition products of blood cells in cases of subchorionic hematomas and pathological DCH. The amniotic fluid containing iron easily penetrates the chorion due to necrosis of the amniotic epithelium and hemosiderin is diffusely deposited therein.…”

Section: Discussionmentioning

confidence: 78%

“…Thus, it is possible that disorders of amniotic epithelial cells caused by decomposition products of blood cells induce the abnormal distribution of amniotic fluid or occult rupture of membranes, causing oligohydramnios. There are reports of amniotic necrosis by meconium, and the relationship between meconium staining of membranes and reduction of the amniotic fluid volume, suggesting a correlation between amniotic necrosis and amniotic fluid volume abnormalities …”

Section: Discussionmentioning

confidence: 99%

Amniotic epithelial cells damage by oxidative stress in cases of diffuse chorioamniotic hemosiderosis

Iizuka

Ono

Masumoto

et al. 2019

J of Obstet and Gynaecol

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The amniotic membrane plays an important role in the physiological maintenance and protection of the embryo. Indeed, dysfunction of the amniotic membrane is thought to have an adverse effect on the continuation of pregnancy. In this report, we examined the pathological changes in the amniotic epithelium in three cases of diffuse chorioamniotic hemosiderosis (DCH) and investigated the cause of necrosis of the amniotic epithelial cells and its relationship with oligohydramnios. Diffuse chorioamniotic hemosiderosis was confirmed in all three cases. More extensive amniotic epithelial necrosis led to more severe hemosiderosis. Immunostaining for 8‐hydroxy‐2′‐deoxyguanosine, a marker of oxidative stress, was positive in the amniotic epithelial cells. We speculate that oxidative DNA damage of the amniotic epithelium occurs by decomposition products of blood cells in cases accompanying subchorionic hematomas and pathological DCH. Furthermore, disorder of the amniotic epithelium may disrupt the balance of the amniotic fluid volume and cause oligohydramnios.

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Placental lesions associated with oligohydramnios in fetal growth restricted (FGR) pregnancies

Cited by 19 publications

References 25 publications

Morphological changes in placenta in cases of oligohydramnios

Morphological changes in placenta in cases of oligohydramnios

Risk Factors for Adverse Fetal Outcome in Hemodialysis Pregnant Women

Amniotic epithelial cells damage by oxidative stress in cases of diffuse chorioamniotic hemosiderosis

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