Placental pathology and pregnancy outcomes in donor and non-donor oocyte in vitro fertilization pregnancies

Perni, Sriram C.; Predanić, Mladen; Cho, Jennifer E; Baergen, Rebecca N.

doi:10.1515/jpm.2005.004

Cited by 73 publications

(22 citation statements)

References 10 publications

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“…In one study, the frequency of chronic deciduitis was 42% (14/33) in egg donation pregnancies, and 1.6% (1/60) in the controls (p=0.001) 100 . However, in a subsequent study, the frequency was 2.8% after oocyte donation vs. 1.8% in non-oocyte donor IVF (p=0.03) 101 .…”

Section: Chronic Deciduitismentioning

confidence: 95%

Chronic inflammation of the placenta: definition, classification, pathogenesis, and clinical significance

Kim

Romero

Chaemsaithong

et al. 2015

American Journal of Obstetrics and Gynecology

420

308

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Chronic inflammatory lesions of the placenta are characterized by the infiltration of the organ by lymphocytes, plasma cells and/or macrophages, and may result from infections (viral, bacterial, parasitic) or be of immune origin (maternal anti-fetal rejection). The three major lesions are villitis (when the inflammatory process affects the villous tree), chronic chorioamnionitis (which affects the chorioamniotic membranes), and chronic deciduitis (which involves the decidua basalis). Maternal cellular invasion is a common feature of the lesions. Villitis of unknown etiology (VUE) is a destructive villous inflammatory lesion characterized by the infiltration of maternal T cells (CD8+ cytotoxic T cells) into chorionic villi. Migration of maternal T cells into the villi is driven by the production of T cell chemokines in the affected villi. Activation of macrophages in the villi has been implicated in the destruction of the villous architecture. VUE has been reported in association with preterm and term fetal growth restriction, preeclampsia, fetal death and preterm labor. Infants whose placentas have VUE are at risk for death and abnormal neurodevelopmental outcome at the age of 2. Chronic chorioamnionitis is the most common lesion in late spontaneous preterm birth and is characterized by the infiltration of maternal CD8+ T cells into the chorioamniotic membranes. These cytotoxic T cells can induce trophoblast apoptosis and damage the fetal membranes. The lesion is frequently accompanied by villitis of unknown etiology and evidence of maternal anti-fetal antibodies and deposition of complement in the umbilical vein. Chronic deciduitis consists of the presence of lymphocytes or plasma cells in the basal plate of the placenta. This lesion is more common in pregnancies resulting from egg donation and has been reported in a subset of patients with premature labor. Chronic placental inflammatory lesions are now considered to represent maternal anti-fetal rejection and this process can be associated with the development of a novel form of fetal systemic inflammatory response syndrome characterized by an elevation of the fetal plasma T cell chemokine (CXCL10). The evidence that maternal anti-fetal rejection may underlie the pathogenesis of many chronic inflammatory lesions of the placenta is reviewed. This article includes figures and histologic examples of all chronic inflammatory lesions of the placenta.

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Section: Chronic Deciduitismentioning

confidence: 95%

Chronic inflammation of the placenta: definition, classification, pathogenesis, and clinical significance

Kim

Romero

Chaemsaithong

et al. 2015

American Journal of Obstetrics and Gynecology

420

308

View full text Add to dashboard Cite

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“…VUE is characterised by patchy villous infiltration by chronic inflammatory cells, mainly histiocytes and lymphocytes, especially in basal/maternal floor villi, in the absence of an identifiable infective cause. It is postulated that VUE represents an abnormal maternofetal immune reaction, with consequently increased risk of VUE recurrence [73,74,75,76,77]. VUE is approximately twice as common and more diffuse in multigravidity [78], and it has a higher than expected concordance in twin pregnancies [79].…”

Section: Other Placental Histological Lesions Associated With Fgrmentioning

confidence: 99%

Placental Pathology in Early-Onset and Late-Onset Fetal Growth Restriction

2014

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Several histopathological features are found more frequently in placentas from pregnancies complicated by fetal growth restriction (FGR), including villous infarction, maternal vascular changes and villous morphological alterations, although around one quarter of placentas associated with FGR lack any morphological abnormality on routine examination. Since similar changes may also affect clinically uncomplicated pregnancies, the positive predictive value of such findings for pathological FGR in an unselected case remains low. However, the pattern of placental pathologies varies with clinical subgroup. The combination of placental bed and parenchymal lesions in FGR with abnormal uterine artery Doppler velocimetry is essentially identical to preterm pre-eclampsia (PET), and there is an association between FGR with abnormal umbilical artery Doppler findings and lesions of fetal stem arteries and terminal villous hypovascularity. Conversely, placentas from pregnancies complicated by PET or FGR presenting at or near term have a significantly lower frequency of histological abnormalities compared to early-onset disease and absence of a distinctive biochemical profile. The histological placental findings in FGR are therefore varied, from morphologically unremarkable through to severe uteroplacental vasculopathy, with no single pathological feature associated with high sensitivity or specificity. Severe early-onset FGR, overlapping with severe early-onset PET, is mainly associated with features of impaired maternal uteroplacental perfusion secondary to defective extravillous trophoblast invasion, and its consequences. Late-onset FGR probably represents a more heterogeneous group with less characteristic histological changes. Future research using histopathological assessment of aggregated data from multiple studies into larger datasets with centralised pathology review will allow delineation of distinctive clinicopathological associations and further understanding of pathophysiology.

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“…Chronic deciduitis was reported to be linked to several obstetric and neonatal complications such as preterm labor (41%) and neonatal periventricular leukomalacia/cerebral palsy (20%) following adjustment for birthweight and multiple gestation. Moreover, infertile women undergoing intrauterine transfer of embryos derived of donor oocytes had higher prevalence of chronic deciduitis than those derived of autologous oocytes, suggesting that this local inflammatory condition may represent chronic rejection of maternal immune system to the conceptus . The expression level of several genes including IGJ, IGLL1, CXCL13, CD27, CXCL9, ICOS, and KLRC1 is increased in the placental tissue with chronic deciduitis compared with those without inflammation.…”

Section: Association Between Ce and Reproductive Failurementioning

confidence: 99%

Chronic Endometritis: Potential Cause of Infertility and Obstetric and Neonatal Complications

Kitaya

Matsubayashi

Yamaguchi

et al. 2015

American J Rep Immunol

187

136

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Chronic endometritis (CE) is a local inflammatory disease characterized by unusual plasmacyte infiltration in the endometrial stromal areas. CE has been neglected in gynecologic practice, as it is a less symptomatic benign disease that requires demanding and time-consuming histopathologic examinations for the definite diagnosis. Recent studies, however, suggest the association of CE with infertility and obstetric and neonatal complications. In this review article, we aimed to update the knowledge on epidemiology, etiology, and pathogenesis of CE as well as discuss its clinical management from diagnosis to treatment.

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Placental pathology and pregnancy outcomes in donor and non-donor oocyte in vitro fertilization pregnancies

Abstract: Pathologic evidence of an immune-mediated process is much more pronounced in donor oocyte IVF pregnancies compared to non-donor cycles. Clinical implications of these findings have yet to be determined.

Cited by 73 publications

References 10 publications

Chronic inflammation of the placenta: definition, classification, pathogenesis, and clinical significance

Chronic inflammation of the placenta: definition, classification, pathogenesis, and clinical significance

Placental Pathology in Early-Onset and Late-Onset Fetal Growth Restriction

Chronic Endometritis: Potential Cause of Infertility and Obstetric and Neonatal Complications

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