Placental Pathology, Perinatal Death, Neonatal Outcome, and Neurological Development: A Systematic Review

Abstract

BackgroundThe placenta plays a crucial role during pregnancy for growth and development of the fetus. Less than optimal placental performance may result in morbidity or even mortality of both mother and fetus. Awareness among pediatricians, however, of the benefit of placental findings for neonatal care, is limited.ObjectivesTo provide a systematic overview of the relation between placental lesions and neonatal outcome.Data sourcesPubmed database, reference lists of selected publications and important research groups in the field.Study appraisal and synthesis methodsWe systematically searched the Pubmed database for literature on the relation between placental lesions and fetal and neonatal mortality, neonatal morbidity and neurological outcome. We conducted three separate searches starting with a search for placental pathology and fetal and neonatal mortality, followed by placental pathology and neonatal morbidity, and finally placental pathology and neurological development. We limited our search to full-text articles published in English from January 1995 to October 2013. We refined our search results by selecting the appropriate articles from the ones found during the initial searches. The first selection was based on the title, the second on the abstract, and the third on the full article. The quality of the selected articles was determined by using the Newcastle-Ottawa Quality Assessment Scale.ResultsPlacental lesions are one of the main causes of fetal death, where placental lesions consistent with maternal vascular underperfusion are most important. Several neonatal problems are also associated with placental lesions, whereby ascending intrauterine infection (with a fetal component) and fetal thrombotic vasculopathy constitute the greatest problem.ConclusionsThe placenta plays a key role in fetal and neonatal mortality, morbidity, and outcome. Pediatricians should make an effort to obtain the results of placental examinations.

A clinicopathological study of episomal papillomavirus infection of the human placenta and pregnancy complications

“…The syncytiotrophoblast is the main functional cellular component of the placenta and active inflammation interferes with its function and impinges on pregnancy success. 35 Idiopathic chronic inflammation has also been reported in 20% of preterm pre-eclampsia cases, 36 and we identified pre-eclampsia in 31% (11/35) of HPV-LHV cases in this cohort. All cases of pre-eclampsia (20/20) were infected with a high-risk HPV type.…”

“…HPV DNA was detected using the GenPoint HPV DNA Probe cocktail (identifies 13 high-risk HPV types: 16,18,31,33,35,39,45,51,52,56,58,59, and 68) and the GenPoint Tyramide Signal Amplification system according to the manufacturer's instructions with one modification (the biotinyl tyramide solution was added to each slide for five instead of 15 min) (Dako, Glostrup, Denmark). Cells were imaged using light microscopy.…”

Joint Effect of Maternal Plasma Homocysteine and Prepregnancy Obesity on Child Blood Pressure: A Prospective Birth Cohort Study

“…Accordingly, it has been proposed that elevated Hcy concentration causes endothelial dysfunction; thus, women who have hyperhomocysteinemia may be likely to experience endothelial dysfunction in the placental vasculature, 13,43 which may also have an effect on offspring cardiometabolic health via intrauterine mechanisms. 44 Elevated Hcy is known to be a modifiable risk factor due to the involvement of vitamin B12 and folate in the transmethylation to methionine. Most times, the use of B12 supplements can return Hcy to an appropriate levels, and may also foster a reduction in related adverse outcomes.…”

Placenta with Old, Diffuse Infarction that Was Difficult to Differentiate from a Placental Tumor

“…Placental lesions, including placental infarction, are associated with fetal and neonatal mortality, morbidity, and outcomes 1 . Placental infarction is a main cause of maternal vascular underperfusion 1 ; however, partial placental infarction is common but of minimal clinical significance 2 .…”

“…Placental infarction is a main cause of maternal vascular underperfusion 1 ; however, partial placental infarction is common but of minimal clinical significance 2 . When infarction occurs early, centrally, or extensively, it is strongly associated with pregnancy-induced hypertension, fetal growth restriction, and even fetal death 3 .…”