Umbilical cord compromise versus other clinical conditions predisposing to placental fetal vascular malperfusion

Stanek, Jerzy

doi:10.1016/j.placenta.2022.07.016

Cited by 12 publications

(8 citation statements)

References 22 publications

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“…Our current material obtained in the Children's Hospital contained few hypertensive conditions of pregnancy, diabetes mellitus, infections, chronic FHR abnormalities, genetic thrombophilia, FGR, and oligohydramnios, i.e. the conditions known to be associated with FVM [28][29][30], but less frequently in our material than in UC compression [31]. Foetal growth restriction was reported to be associated with maternal background morbidities during pregnancy [32], representing a chronic repeated insult while "new" FGR cases (those following an appropriate for gestational age pregnancy) were characterized by a higher rate of FVM lesions and lower birth rate, probably representing "an accident" in placentation [33].…”

Section: Discussionmentioning

confidence: 98%

Placental recent/on-going foetal vascular malperfusion with endothelial fragmentation is diagnostically equivalent to established distal villous lesions of foetal vascular malperfusion

Stanek

2022

pjp

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CD34 immunostaining increases the sensitivity of placental diagnosis of foetal vascular malperfusion (FVM). This comparative retrospective study was performed to find out whether recent distal FVM lesions diagnosed with CD34 are diagnostically equivalent to remote FVM lesions diagnosed with haematoxylin-eosin (H&E). Clinical and placental phenotypes of 562 placentas from ≥ 20-week, high-risk pregnancies were analysed: Group 1-158 placentas with remote distal villous FVM (by H&E only), Group 2-142 placentas showing clustered endothelial fragmentation by CD34 immunostaining, 98 of them also with H&E distal FVM lesions (on-going, temporal heterogeneity), and Group 3-262 placentas without distal villous FVM. In Group 1, gestational age was the shortest, postnatal mortality most frequent, placental weight the smallest, and intra villous haemorrhage, erythroblasts in foetal blood, hypertrophic decidual arteriopathy, and foetal vascular thrombi most common. In Group 2, placental infarction, post-uterine pattern of chronic placental injury, and excessive extra villous trophoblasts of chorionic disc were most common (p < 0.05). In this cohort of foetuses/neonates dominated by congenital malformations, distal villous FVM was the most common pattern of placental injury, and those diagnosed by CD34 and by H&E are diagnostically/prognostically equivalent. CD34 immunostaining is therefore a powerful tool in the diagnosis of distal villous FVM.

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Section: Discussionmentioning

confidence: 98%

Placental recent/on-going foetal vascular malperfusion with endothelial fragmentation is diagnostically equivalent to established distal villous lesions of foetal vascular malperfusion

Stanek

2022

pjp

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“…In our wide‐spectrum (gestational ages from 24th to 40th week) study population, numerous histopathologic alterations were identified in PE placentae, but the two entities of EO‐PE and LO‐PE were different in some respects: EO‐PE cases were characterized by diffuse DVH, AVM, certain decidual arteriopathies (i.e., signs of MVM), and large foci of AV, while LO‐PE cases had significantly increased infarcted areas and chorionic plate/stem vessel thrombosis compared to EO‐PE. DVH and avascular villi—accurately differentiated from infarcted areas—could be an evidence of pathological placentation in EO‐PE, while stem vessel thrombosis in the background of LO‐PE could be considered as consequence of different forms of umbilical cord pathology, and as a placental change associated with fetal cardiac failure, anemia, or fetal hypercoaguability 22 : in our study population, the presence of these entities could be found in the background of all of the LO‐PE cases (22 cases had thrombosis in the umbilical cord vessels, five cases had fetal cardiac failure, and two cases had fetal anemia, none of these backgrounds were found in the EO‐PE group).…”

Section: Discussionmentioning

confidence: 99%

Placental pathology of preeclampsia from a clinical point of view: Correlation between placental histopathology, clinical signs of preeclampsia and neonatal outcome

Dankó

Tankó

Kelemen

et al. 2023

J of Obstet and Gynaecol

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Aim To evaluate the associations between placental histopathology (signs of maternal and fetal vascular malperfusion, delayed villous maturation, villitis of unknown etiology) and subtypes of preeclampsia by onset, clinical aspects of the disease and neonatal outcome. Methods Placental slides from preeclamptic pregnancies were retrospectively reviewed according to a uniform scheme. Information regarding obstetrical anamnesis, clinical data and perinatal outcome was collected from charts, and statistical analysis was performed in order to demonstrate associations between microscopic placental alterations and different aspects of preeclampsia. Results A total of 49 cases were studied. Diffuse signs of maternal vascular malperfusion and avascular villi were more common in early‐onset‐preeclampsia associated with worse prognosis. Preeclampsia with fetal growth restriction had more often diffuse signs of maternal and fetal vascular malperfusion and villitis of unknown etiology. Recurring preeclampsia was associated with more common perivasculitis. Umbilical and uterine artery Doppler indices were associated with medial hypertrophy and/or acute atherosis of maternal decidual vessels. Large foci of avascular villi correlated with extent of maternal 24‐h‐proteinuria which itself correlated with outcome of preeclampsia. Rate of capillarisation of villi was significantly lower in case of hypertension requiring a three‐drug combination of antihypertensive medications versus hypertension treated with one or two drugs, preeclampsia with growth restriction, and stillbirth versus live birth. Conclusions Early‐ versus late‐onset‐preeclampsia showed a markedly different profile of histopathological features and perinatal outcome, reflecting their distinguished pathogenesis and prognosis; preeclampsia complicated with fetal growth restriction also had distinctive features. Qualitative and quantitative changes define placental pathology of preeclampsia.

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“…However, UC abnormalities have been demonstrated to play a much larger role in the development of FVM than other clinical conditions (hypertensive conditions of pregnancy, diabetes mellitus, infections). 34 Additionally, placental vascular lesions (maternal vascular malperfusion and FVM) are inherently more difficult to reproducibly diagnose and grade than inflammatory lesions (villitis of unknown etiology and acute chorioamnionitis). 18 In summary, SUA is a specific cord anomaly predisposing to remote, advanced, and recent FVM, with a pathogenesis partially different from that of stasis induced FVM, likely because of the inherent conditions associated with SUA.…”

Section: Discussionmentioning

confidence: 99%

Single Umbilical Artery Umbilical Cord Is Associated With High-Grade Distal Fetal Vascular Malperfusion

Stanek

2023

Pediatr Dev Pathol

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Purpose and Context: Umbilical cord abnormalities with clinical signs of cord compromise are frequently associated with fetal vascular malperfusion (FVM). Single umbilical artery (SUA) has been reported to be associated with high-grade FVM in fetal growth restriction but not in an unselected population; our study aimed to address this issue. Methods: Clinical and placental phenotypes of 55 consecutive placentas with SUA (Group 1) were compared with those of 655 placentas with 3-vessel umbilical cord (Group 2) from patients who were in the second half of their pregnancy. The placentas were histologically examined using hematoxylin and eosin (H&E) staining and CD 34 immunostaining. Key Results: Several umbilical cord phenotypes and high-grade distal FVM, based on H&E staining and endothelial fragmentation by CD34 were significantly more common in Group 1, whereas decidual clusters of multinucleate trophoblasts were more common in Group 2. Notably, H&E staining or CD34 immunostaining evaluated separately showed that high-grade distal FVM was more common in Group 1 than in Group 2, but the difference was not statistically significant. Conclusions: SUA predisposes to remote, advanced, and recent high-grade distal villous FVM, with a pathogenesis partly different from that of stasis-induced FVM, likely related to fetal anomalies associated with SUA.

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Umbilical cord compromise versus other clinical conditions predisposing to placental fetal vascular malperfusion

Cited by 12 publications

References 22 publications

Placental recent/on-going foetal vascular malperfusion with endothelial fragmentation is diagnostically equivalent to established distal villous lesions of foetal vascular malperfusion

Placental recent/on-going foetal vascular malperfusion with endothelial fragmentation is diagnostically equivalent to established distal villous lesions of foetal vascular malperfusion

Placental pathology of preeclampsia from a clinical point of view: Correlation between placental histopathology, clinical signs of preeclampsia and neonatal outcome

Single Umbilical Artery Umbilical Cord Is Associated With High-Grade Distal Fetal Vascular Malperfusion

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