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1
Matsuzaki, Shinya, Yutaka Ueda, Satoko Matsuzaki, Hitomi Sakaguchi, Mamoru Kakuda, Misooja Lee, Yuki Takemoto, et al. "Relationship between Abnormal Placenta and Obstetric Outcomes: A Meta-Analysis." Biomedicines 11, no. 6 (May 25, 2023): 1522. http://dx.doi.org/10.3390/biomedicines11061522.
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The placenta has several crucial physiological functions that help maintain a normal pregnancy. Although approximately 2–4% of pregnancies are complicated by abnormal placentas, obstetric outcomes remain understudied. This study aimed to determine the outcomes and prevalence of patients with abnormal placentas by conducting a systematic review of 48 studies published between 1974 and 2022. The cumulative prevalence of circumvallate placenta, succenturiate placenta, multilobed placenta, and placenta membranacea were 1.2%, 1.0%, 0.2%, and 0.004%, respectively. Pregnancies with a circumvallate placenta were associated with an increased rate of emergent cesarean delivery, preterm birth (PTB), and placental abruption compared to those without a circumvallate placenta. The succenturiate lobe of the placenta was associated with a higher rate of emergent cesarean delivery, whereas comparative results were observed in terms of PTB, placental abruption, and placenta previa in comparison to those without a succenturiate lobe of the placenta. A comparator study that examined the outcomes of multilobed placentas found that this data is usually unavailable. Patient-level analysis (n = 15) showed high-rates of abortion (40%), placenta accreta spectrum (40%), and a low term delivery rate (13.3%) in women with placenta membranacea. Although the current evidence is insufficient to draw a robust conclusion, abnormal placentas should be recognized as a high-risk factor for adverse outcomes during pregnancy.
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Duffley, Eleanor, David Grynspan, Hailey Scott, Anthea Lafrenière, Cherley Borba Vieira de Andrade, Enrrico Bloise, and Kristin L. Connor. "Gestational Age, Infection, and Suboptimal Maternal Prepregnancy BMI Independently Associate with Placental Histopathology in a Cohort of Pregnancies without Major Maternal Comorbidities." Journal of Clinical Medicine 13, no. 12 (June 8, 2024): 3378. http://dx.doi.org/10.3390/jcm13123378.
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Background: The placenta undergoes morphological and functional adaptations to adverse exposures during pregnancy. The effects ofsuboptimal maternal body mass index (BMI), preterm birth, and infection on placental histopathological phenotypes are not yet well understood, despite the association between these conditions and poor offspring outcomes. We hypothesized that suboptimal maternal prepregnancy BMI and preterm birth (with and without infection) would associate with altered placental maturity and morphometry, and that altered placental maturity would associate with poor birth outcomes. Methods: Clinical data and human placentae were collected from 96 pregnancies where mothers were underweight, normal weight, overweight, or obese, without other major complications. Placental histopathological characteristics were scored by an anatomical pathologist. Associations between maternal BMI, placental pathology (immaturity and hypermaturity), placental morphometry, and infant outcomes were investigated for term and preterm births with and without infection. Results: Fetal capillary volumetric proportion was decreased, whereas the villous stromal volumetric proportion was increased in placentae from preterm pregnancies with chorioamnionitis compared to preterm placentae without chorioamnionitis. At term and preterm, pregnancies with maternal overweight and obesity had a high percentage increase in proportion of immature placentae compared to normal weight. Placental maturity did not associate with infant birth outcomes. We observed placental hypermaturity and altered placental morphometry among preterm pregnancies with chorioamnionitis, suggestive of altered placental development, which may inform about pregnancies susceptible to preterm birth and infection. Conclusions: Our data increase our understanding of how common metabolic exposures and preterm birth, in the absence of other comorbidities or complications, potentially contribute to poor pregnancy outcomes and developmental programming.
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Nair, Vidhu V., Sobha S. Nair, and Radhamany K. "Study of placental location and pregnancy outcome." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, no. 4 (March 26, 2019): 1393. http://dx.doi.org/10.18203/2320-1770.ijrcog20191187.
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Background: Placental location can be estimated easily using ultrasonogram by 16 weeks. It can be classified based on its location into central and lateral. Central can be anterior or posterior. Lateral can be left lateral or right lateral. Placental location has been attributed to both normal and abnormal pregnancy and neonatal outcomes.Methods: This is a prospective cohort study conducted in the department of Obstetrics and Gynecology which comprised of 450 singleton gestations between 18 and 24 weeks. The primary objective is to determine the association between placental location and pregnancy outcome and secondary objective is to find out the association between placental location and neonatal outcome. The study population was divided into two groups – central and lateral. Results were analyzed using SPSS version 20, Chi square test and independent two sample t-test.Results: The frequency of central placenta was 377 (83.8%) and lateral placenta in 73 (16.2%). Central placentation had an abnormal outcome in 182(48.3%), lateral placentas with abnormal outcome were 44(60.3%). Abnormal maternal outcomes like hypertensive disorders (33.3%), Intra Uterine Growth Restriction (10.2%), Antepartum haemorrhage (25%), Preterm birth (16.3%) were more in lateral placentation. The number of central placentas having NICU admissions were 62(16.4%) and lateral placenta with NICU admissions were 19(26%).Conclusions: There is a significant association between lateral placentation and abnormal pregnancy and neonatal outcomes. Second trimester ultrasound can be used as non-invasive predictor of adverse pregnancy and neonatal outcomes.
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Wortman, Alison, Stephanie Schaefer, Donald McIntire, Jeanne Sheffield, and Diane Twickler. "Complete Placenta Previa: Ultrasound Biometry and Surgical Outcomes." American Journal of Perinatology Reports 08, no. 02 (April 2018): e74-e78. http://dx.doi.org/10.1055/s-0038-1641163.
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Objective To evaluate the relationship between surgical outcomes and ultrasound measurement of placental extension beyond the cervical os in women with placenta previa. Study Design This is a retrospective cohort study of singleton pregnancies with placenta previa undergoing third-trimester ultrasound and delivering at our institution from 2002 through 2011. For study purposes, an investigator measured placental extension, defined as the placental distance from the internal os across the placenta continuing out to the lowest placental edge. If morbidly adherent placentation was suspected, women were excluded. Receiver operating characteristic (ROC) curves were developed for pertinent surgical outcomes, and multivariate analysis was performed to determine the placental extension with the best predictive discriminatory zone. Results In total, 157 women had placenta previa, ultrasound, and delivery data: 86 (55%) had a placental extension of <40 mm, and 71 (45%) had a placental extension of ≥40 mm. Women with placental extension of ≥40 mm had increased surgical time, blood loss > 2,000 mL, blood transfusion, and rate of peripartum hysterectomy. After multivariate analysis, only peripartum hysterectomy and surgical time > 90 minutes remained significant, p ≤ 0.05 and p ≤ 0.01, respectively. Conclusion In women with placenta previa, the placental extension ultrasound measurement of ≥40 mm is a predictor of adverse surgical outcomes.
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Emeka-Ogbugo, Alerechi, Dumle Jane Gbobie, Aloysius Obinna Ikwuka, Mkpe Abbey, Ada Nkemagu Okocha, and Simeon Chijioke Amadi. "Maternal Age as a Determinant of Placental Morphology and Morphometry at Term Pregnancy: A Cross-sectional Study of Selected Hospitals in Rivers State, Southern Nigeria." European Journal of Medical and Health Research 2, no. 4 (July 1, 2024): 33–40. http://dx.doi.org/10.59324/ejmhr.2024.2(4).04.
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The placenta which is a crucial intermediary in maternal-fetal exchanges, undergoes intricate structural changes throughout gestation, culminating in its fully developed form at term. The potential impact of maternal age on pregnancy and fetal outcomes has generated interest. This study aimed to investigate the intricate relationships between maternal age, and placental morphology and morphometry at term pregnancy. This study was a hospital-based, cross-sectional study with a systematic sampling technique, which meticulously collected and examined 250 placentae postpartum. Rigorous cleansing under running water preceded comprehensive assessments and precise measurements. Detailed maternal histories were obtained to facilitate comprehensive contextual analysis. Descriptive statistics (frequency and percentage) were complemented by inferential analyses (ANOVA and Pearson correlation), with significance level set at p<0.05. Among the reviewed placentae (n=250), statistically significant relationships exist between maternal age and some placental parameters. Notably, maternal age exhibited positive associations with placental thickness (p=0.048), placental weight (p=0.014), and the number of cotyledons (p=0.028). However, no statistically significant relationships were identified between maternal age and placental shape (p=0.977) or placental diameter (p=0.070). Maternal age significantly influences pregnancy outcomes. Maternal age affects placental morphometry more than placental morphology.
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Hadali, Ndulila, Dismas Matovelo, Richard Kiritta, Oscar Ottoman, Cosmas Mbulwa, Adolfine Hokororo, and Edgar Ndaboine. "Insights into Placental Pathology: Analyzing Patterns and Fetal Outcomes in 205 Livebirths at Bugando Medical Centre, Mwanza, Tanzania." EAS Journal of Medicine and Surgery 6, no. 03 (February 6, 2024): 80–87. http://dx.doi.org/10.36349/easjms.2024.v06i03.001.
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Background: The placenta facilitates vital nutrient exchange between fetus and mother, offering insights into fetal and maternal health. Despite its significance, research on placental histopathology in Tanzania is scarce. This study investigates placental features, maternal factors, and their impact on fetal outcomes at Bugando Medical Centre from January to May 2022. Methods: This 5-month cohort study included 205 mothers delivering at BMC. Fetal outcomes were evaluated at birth and after seven days, with maternal characteristics recorded at delivery. Participants were from the twenty-eighth week of gestation, excluding those with intrauterine fetal death or multiple pregnancies. Data on placental histology, maternal factors, and fetal outcomes were collected systematically, while statistical analysis employed STATA version 15, utilizing descriptive statistics. Results: In this study of 205 placentas, participants had a median age of 29 years and a mean gestational age of 38 weeks. Histopathological patterns were present in 61% of placentas, with acute inflammation (22%) and maternal vascular malperfusion (20.8%) being most common. Favorable outcomes were observed in 81% of newborns, while 19% experienced poor outcomes, including 1.9% early neonatal deaths. Most placental lesions were mild (53.6%), with severe pathology in 2.9% of cases. Acute inflammation correlated with various admission reasons, especially neonatal sepsis (60%). Maternal vascular lesions were associated with prematurity (63.6%) and birth asphyxia (40%). Chronic inflammation was more prevalent among low-birth-weight infants (18.8%), while very low birth weight was common in cases of maternal vascular lesions (68.8%). Conclusion: The majority of placentas showed normal or mild pathology, associated with positive fetal outcomes. Further research is needed to understand placental changes and their impact on maternal-fetal health.
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Firestein, Morgan R., Harvey J. Kliman, Ayesha Sania, Lucy T. Brink, Parker H. Holzer, Katherine M. Hofmann, Kristin M. Milano, et al. "Trophoblast inclusions and adverse birth outcomes." PLOS ONE 17, no. 3 (March 1, 2022): e0264733. http://dx.doi.org/10.1371/journal.pone.0264733.
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Objective Trophoblast inclusions—cross sections of abnormal trophoblast bilayer infoldings—have previously been associated with aneuploidy, placenta accreta, and prematurity. This study was conducted to establish the relationship between trophoblast inclusions and a range of placental, pregnancy, and birth outcomes in a patient population with high smoking and alcohol exposure. Specifically, we sought to evaluate the association between the presence of trophoblast inclusions and 1) three primary birth outcomes: full-term birth, preterm birth, and stillbirth; 2) gestational age at delivery; and 3) specific placental pathologies. Methods Two slides containing chorionic villi were evaluated from 589 placentas that were collected from Stellenbosch University in Cape Town, South Africa as part of the prospective, multicenter cohort Safe Passage Study of the Prenatal Alcohol and SIDS and Stillbirth Network. The subsample included 307 full-term live births, 212 preterm live births, and 70 stillbirths. Results We found that the odds of identifying at least one trophoblast inclusion across two slides of chorionic villi was significantly higher for placentas from preterm compared to term liveborn deliveries (OR = 1.74; 95% CI: 1.22, 2.49, p = 0.002), with an even greater odds ratio for placentas from stillborn compared to term liveborn deliveries (OR = 4.95; 95% CI: 2.78, 8.80, p < 0.001). Gestational age at delivery was inversely associated with trophoblast inclusion frequency. Trophoblast inclusions were significantly associated with small for gestational age birthweight, induction of labor, villous edema, placental infarction, and inflammation of the chorionic plate. Conclusions The novel associations that we report warrant further investigation in order to understand the complex network of biological mechanisms through which the factors that lead to trophoblast inclusions may influence or reflect the trajectory and health of a pregnancy. Ultimately, this line of research may provide critical insights that could inform both clinical and research applications.
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Ravikumar, G., J. Crasta, J. S. Prabhu, T. Thomas, P. Dwarkanath, A. Thomas, T. S. Sridhar, and A. V. Kurpad. "Eccentric placentae have reduced surface area and are associated with lower birth weight in babies small for gestational age." Journal of Developmental Origins of Health and Disease 9, no. 3 (January 14, 2018): 281–86. http://dx.doi.org/10.1017/s2040174417001076.
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AbstractPlacental structure and function determine birth outcomes. Placental mass does not always correlate with fetal birth weight (BW) in uncomplicated pregnancies which raises the possibility of other variables such as placental shape and cord insertion being the determinants of placental efficiency. In total, 160 women with singleton pregnancy, recruited into a pregnancy cohort were studied. Placental weight (PW) was measured and other data were obtained from clinical records. Birth outcomes were classified as small for gestational age (SGA) and appropriate for gestational age (AGA) based on fetal gender, gestational age (GA) and BW. High-resolution images of the chorionic plate were recorded. The shape of the placenta and the insertion of the cord were measured using eccentricity index (EI) and cord centrality index (CCI). Only placentae with eccentrically inserted cords (n=136) were included. The mean BW and PW were 2942 (±435) g and 414 (±82) g with average GA of 38.6 weeks. The mean CCI and EI was 0.483 (±0.17) and 0.482 (±0.16). Neither of these correlated with placental efficiency. However, EI showed negative correlation with placental surface area and breadth. Upon sub-grouping the cohort into SGA (n=32) and AGA (n=104), the SGA babies with the highest EI (third tertile) had significantly lower BW than those with the least eccentric placentae (first tertile). Although eccentric-shaped placentae were present in both SGA and AGA groups, the effect on BW was observed only in the SGA group.
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Nair, Bindu T., and Uma Raju. "Study of Correlation of Neonatal Outcomes with Gross Abnormalities of Placenta and Umbilical Cord." Journal of Nepal Paediatric Society 37, no. 3 (June 7, 2018): 254–60. http://dx.doi.org/10.3126/jnps.v37i3.17637.
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Introduction: Perinatal outcome of new-borns is greatly influenced by abnormalities of placenta and umbilical cord. In most of the deliveries, whether home or institutional, the placenta and umbilical cords are discarded without examination. Due to paucity of information on abnormalities of placenta and cord, there is hardly any correlation with foetal outcomes. The aim was to study the correlation between the foetal outcome and the different types of abnormalities of placenta and umbilical cord.Materials and Methods: A prospective, cross-sectional, descriptive, randomised study was conducted from January 2016 to December 2016 in a tertiary care hospital in North India. The study was carried out on 1000 term singleton newborns. The placenta and umbilical cords were obtained from both normal and caesarean section deliveries. A proforma was used to gather data from the patients and new-borns. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 20 (SPSS Inc, Chicago, IL, IBM version) along with Microsoft Excel (2010 version).Results: One thousand placentae and umbilical cords were examined of which high placental weight/birth weight ratio, gross anomalies of placenta (infarctions, calcifications and retro placental haematoma), marginal (battledore and velamentous) umbilical cord insertions, long umbilical cords and single umbilical artery were associated with negative foetal outcomes.Conclusions: There was a high incidence of adverse foetal outcome with placental and umbilical cord abnormalities. Education of our health personnel dealing with deliveries on the importance of proper examination of the placenta and umbilical cords should be emphasised and instituted upon.
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Natarajan, Lalitha, and G. UmaMaheswari. "Gestational hyperglycemia on diet and medication: impact on placental pathology and pregnancy outcomes." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, no. 8 (July 26, 2019): 3350. http://dx.doi.org/10.18203/2320-1770.ijrcog20193564.
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Background: To evaluate the placental morphology and perinatal outcome in patients with gestational hyperglycemia on diet and medication.Methods: Placental examinations performed at the Department of Pathology between August 2016 to August 2018 were retrospectively reviewed. Of the received 140 placentas, 35 of gestational diabetes (GDM) and pre gestational diabetes were identified and segregated into hyperglycemia on diet and on medication. The clinical details, placental findings and perinatal outcome of patients in both the groups (gestational hyperglycemia on diet and medication) were collected and analyzed.Results: Among the 35 cases, there were 24 cases of mild gestational hyperglycemia controlled with diet and 11 cases of hyperglycemia on medication (oral hypoglycemic drugs ± insulin).Most of the placentae in both the groups weighed less than tenth centile. The cord abnormalities such as hyper coiling, velamentous /marginal insertion and furcate cord were observed more in women with GDM on diet. There was no significant gross placental lesion in those on medication. Placental histological features most consistently associated with both the groups include, disturbances of villous maturation (DVM), Derangements in uteroplacental / foetoplacental circulation and villous capillary lesions. Small for gestational age and intrauterine foetal death were found in both the groups, but more commonly in patients with hyperglycemia on medication.Conclusions: Villous maturation defects, uteroplacental / foetoplacental malperfusion are the essential placental changes which can result in adverse perinatal outcomes in women with hyperglycemia irrespective of the diabetic control.
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Josowitz, Rebecca, Rebecca Linn, and Jack Rychik. "The Placenta in Congenital Heart Disease: Form, Function and Outcomes." NeoReviews 24, no. 9 (September 1, 2023): e569-e582. http://dx.doi.org/10.1542/neo.24-9-e569.
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The maternal-fetal environment, controlled and modulated by the placenta, plays a critical role in the development and well-being of the fetus, with long-term impact through programming of lifelong health. The fetal cardiovascular system and placenta emerge at the same time embryologically, and thus placental form and function are altered in the presence of congenital heart disease (CHD). In this review, we report on what is known about the placenta from a structural and functional perspective when there is CHD. We describe the various unique pathologic findings as well as the diagnostic imaging tools used to characterize placental function in utero. With growing interest in the placenta, a standardized approach to characterizing placental pathology has emerged. Furthermore, application of ultrasonography techniques and magnetic resonance imaging now allow for insights into placental blood flow and functionality in vivo. An improved understanding of the intriguing relationship between the placenta and the fetal cardiovascular system will provide opportunities to develop novel ways to optimize outcomes. Once better understood, therapeutic modulation of placental function offered during the vulnerable period of fetal plasticity may be one of the most impactful ways to alter the course of CHD and its complications.
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SIMCHENKO, A. V., O. A. ALEXEY, and A. A. KUPRASHVILI. "MITOCHONDRIAL DYSFUNCTION IN THE GENESIS OF PLACENTAL PATHOLOGY: PERINATAL OUTCOMES." MODERN PERINATAL MEDICAL TECHNOLOGIES IN SOLVING THE PROBLEM OF DEMOGRAPHIC SECURITY, no. 17 (December 2024): 357–61. https://doi.org/10.63030/2307-4795/2024.17.p.24.
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The human placenta is a unique organ with a temporary functioning period of about 280 days on average. All changes associated with the physiology of mitochondria, the aging process of the placenta, adaptation to changing conditions or dysfunction of the placenta directly affect the performance of the placenta's functions, as well as the development of the fetus. Modern studies studying the causes of intrauterine growth disorders of the fetus demonstrate the implementation of a chain of mechanisms of placental dysfunction, which leads to a slowdown in fetal growth with a subsequent slowdown in physical development at an early age. The literature review presents modern research in the field of studying the adaptive mechanisms of mitochondria during various periods of gestation and their relationship with neonatal pathology
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Bockoven, Crystal, Roland D. Gastfield, Thomas Victor, Palamadai N. Venkatasubramanian, Alice M. Wyrwicz, and Linda M. Ernst. "Correlation of Placental Magnetic Resonance Imaging With Histopathologic Diagnosis: Detection of Aberrations in Structure and Water Diffusivity." Pediatric and Developmental Pathology 23, no. 4 (December 23, 2019): 260–66. http://dx.doi.org/10.1177/1093526619895438.
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Objective Noninvasive methods to identify placental pathologic conditions are being sought in order to recognize these conditions at an earlier stage leading to improved clinical interventions and perinatal outcomes. The objective of this study was to examine fixed tissue slices of placenta by T2- and diffusion-weighted magnetic resonance imaging (MRI) and correlate the images with placental pathologic findings defined by routine gross and histologic examination. Methods Four formalin-fixed placentas with significant placental pathology (maternal vascular malperfusion, chronic villitis of unknown etiology, and massive perivillous fibrin deposition) and 2 histologically normal placentas were evaluated by high-resolution MRI. Representative placental slices were selected (2 cm long and 10 mm wide) and rehydrated. Imaging was performed on a Bruker Avance 14.1 T microimager. Diffusion-weighted images were acquired from 16 slices using slice thickness 0.5 mm and in-plane resolution approximately 100 µm × 100 µm. T2 maps were obtained from the same slices. T2 relaxation time and apparent diffusion coefficient (ADC) were acquired from representative regions of interest and compared between normal and diseased placentas. Results In T2- and diffusion-weighted images, the placental microstructure differed subjectively between diseased and normal placentas. Furthermore, diseased placentas showed statistically significantly longer mean T2 relaxation times and generally higher mean ADC. Conclusion Diffusion- and T2-weighted MRI can potentially be used to detect significant placental pathology by using T2 relaxation time and ADC as markers of altered placental microstructure.
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Ahenkorah, John, Patience B. Tetteh-Quarcoo, Mercy A. Nuamah, Bethel Kwansa–Bentum, Hanson G. Nuamah, Bismarck Hottor, Emmanuel Korankye, Magdalene Torto, Michael Ntumy, and Fredrick K. Addai. "The Impact ofPlasmodiumInfection on Placental Histomorphology: A Stereological Preliminary Study." Infectious Diseases in Obstetrics and Gynecology 2019 (March 3, 2019): 1–8. http://dx.doi.org/10.1155/2019/2094560.
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Background. Malaria during pregnancy may threaten the mother’s health and cause serious structural damage to the internal architecture of the placenta, which subsequently affects the pregnancy outcome. A better understanding of the impact of malaria parasites on the placenta morphology is crucial for better management of pregnant women and their babies.Aim. To assess by stereology the histomorphology of selected placental structures in placenta malaria compared with normal placentae at term.Method. A total of 10 placentae comprising 5 controls and 5 cases were selected from 50 placentae that were collected at term (38 weeks ± 2 weeks) from the maternal delivery suit of Korle-Bu Teaching Hospital in Accra, Ghana. Blood from the placentae was collected for both rapid diagnostic test and microscopic examinations. Samples collected were examined forPlasmodiumparasites, after which they were classified as study group (Plasmodiumpositive) or control (Plasmodiumnegative). Stereological quantification using systematic uniform random sampling technique with test point and intersection counting of photomicrographs were employed to estimate the mean volume densities of syncytial knots, syncytial necrosis, foetal capillaries, and intervillous spaces of the placentae on a total of 1,600 photomicrographs.Results. Out of the fifty placental samples from the maternal side tested forPlasmodium,six representing 12% were found to be infected with the parasite by both rapid diagnostic test and microscopy. On stereological assessment, the mean volume density of syncytial knots was significantly higher in the placental malaria group compared with the control placentae at term (P = 0.0080), but foetal capillaries (P = 0.7813), intervillous spaces (P = 0.8078), and syncytial necrosis (P = 0.8249) were not significantly different.Conclusion. This preliminary result indicates that placental malaria may cause significant increase in the syncytial knots but not foetal capillaries, intervillous spaces, or syncytial necrosis. This finding signifies early maturation of the placenta and may be crucial in understanding perinatal outcomes.
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DiCaglio, Sara. "Placental beginnings: Reconfiguring placental development and pregnancy loss in feminist theory." Feminist Theory 20, no. 3 (October 23, 2018): 283–98. http://dx.doi.org/10.1177/1464700118804446.
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The placenta has played an important role in feminist theories of subjectivity; however, the placenta of feminist theory has been the fully functional placenta of what is considered a successful full-term pregnancy. Pregnancy loss, a topic that has been generally overlooked within feminist scholarship, is absent from feminist theories of the placenta. This article uses early placental development, particularly development that takes place before the placenta becomes fully functional as an organ for hormone production and interchange, as a space through which to consider theorising subjectivity, reproduction and relation through pregnancy loss. In so doing, I argue that turning our attention to the placenta’s early development, regardless of outcomes, allows us to reimagine the role of process for feminist theories of subjectivity while also making room for a wider array of pregnancy outcomes, reinvigorating our ability to think about relations and models of hospitality that do not end as we might imagine.
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Rahim, Dr Asma Jan Abdul, Dr Anila Aravindan, and Dr Anupama Bondili. "Pregnancy Outcomes in Patients with Placenta Previa Due to Site of Placentation." Scholars International Journal of Obstetrics and Gynecology 6, no. 04 (April 15, 2023): 140–48. http://dx.doi.org/10.36348/sijog.2023.v06i04.002.
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Background: The aim of this research is to evaluate pregnancy outcomes in patients with placenta previa due to the site of placentation. Method: This retrospective study included 105 cases conducted in the OBG department of Al AIN hospital for three years (January 2015 to October 2018). All cases of placenta previa admitted during this period were included in the study. Case records were obtained from the medical record section and carefully analyzed to find out the incidence, various types of placenta previa, its clinical presentation, and its outcome in relation to mode of delivery, birth weight, and maternal and perinatal morbidity. Results: Placental attachment site influenced the outcome of pregnancy. Placental attachment to the anterior wall was associated with shorter gestational age, low birth weight, low Apgar score, higher prenatal bleeding rate, increased postpartum hemorrhage, longer duration of hospitalization, higher blood transfusion and higher hysterectomy rates compared to cases with lateral/posterior wall placenta. Placental attachment at the incision site of previous cesarean section significantly increased the incidence of complete placenta previa compared with placental attachment at a site without incision, but did not significantly influence pregnancy outcomes. Placental attachment to the anterior wall was an independent risk factor for postpartum hemorrhage in patients with placenta previa. Conclusion: The site of placental attachment in patients with placenta previa influences the pregnancy outcome. When the placenta is located on the anterior wall, clinicians should pay attention to the adverse pregnancy outcomes and the possibility of massive postpartum hemorrhage.
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Castillo, Michelle M., Qiuhui Yang, Abril Solis Sigala, Dosia T. McKinney, Min Zhan, Kristen L. Chen, Jason A. Jarzembowski, and Rashmi Sood. "The endothelial protein C receptor plays an essential role in the maintenance of pregnancy." Science Advances 6, no. 45 (November 2020): eabb6196. http://dx.doi.org/10.1126/sciadv.abb6196.
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Placenta-mediated pregnancy complications are a major challenge in the management of maternal-fetal health. Maternal thrombophilia is a suspected risk factor, but the role of thrombotic processes in these complications has remained unclear. Endothelial protein C receptor (EPCR) is an anticoagulant protein highly expressed in the placenta. EPCR autoantibodies and gene variants are associated with poor pregnancy outcomes. In mice, fetal EPCR deficiency results in placental failure and in utero death. We show that inhibition of molecules involved in thrombin generation or in the activation of maternal platelets allows placental development and embryonic survival. Nonetheless, placentae exhibit venous thrombosis in uteroplacental circulation associated with neonatal death. In contrast, maternal EPCR deficiency results in clinical and histological features of placental abruption and is ameliorated with concomitant Par4 deficiency. Our findings unveil a causal link between maternal thrombophilia, uterine hemorrhage, and placental abruption and identify Par4 as a potential target of therapeutic intervention.
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Doctory, N., A. Romano, I. Navon, S. Barbash-Hazan, R. Bardin, and E. Hadar. "Placental Location and Obstetrical-Neonatal Outcomes: A Retrospective Study." Obstetric Anesthesia Digest 43, no. 3 (August 23, 2023): 146–47. http://dx.doi.org/10.1097/01.aoa.0000946400.19840.c3.
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(Int J Gynecol Obstet. 2023;160:641–645) The placenta is vital in pregnancy for nutrient transfer from mother to fetus, and different positions of the placenta can affect pregnancy outcomes. Placental placement can be categorized as anterior, posterior, fundal, or lateral, with anterior placenta being the most common orientation and lateral placenta the least common. Lateral placenta in particular poses some risks because the circulation available to the placenta in this orientation is significantly less; reduced blood flow has been correlated with adverse outcomes such as pre-eclampsia, fetal growth restriction, small for gestational age, and postpartum hemorrhage, among others. This study attempted to understand the association of lateral placental orientation with poor outcomes in pregnancy. The primary outcome for this study was neonatal birth weight, as a continuous measure, and categorized for small for gestational age. Secondary outcomes included maternal and perinatal gestational hypertension, pre-eclampsia, HELLP syndrome, placental abruption, nonreassuring fetal heart rate, oligohydramnios, polyhydramnios, preterm birth, and mode of delivery.
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Leal, Caio Ribeiro Vieira, Rayra Amana Macêdo Maciel, and Mário Dias Corrêa Júnior. "SARS-CoV-2 Infection and Placental Pathology." Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics 43, no. 06 (June 2021): 474–79. http://dx.doi.org/10.1055/s-0041-1730291.
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AbstractPlacental pathophysiology in SARS-CoV-2 infection can help researchers understand more about the infection and its impact on the maternal/neonatal outcomes. This brief review provides an overview about some aspects of the placental pathology in SARS-CoV-2 infection. In total, 11 papers were included. The current literature suggests that there are no specific histopathological characteristics in the placenta related to SARS-CoV-2 infection, but placentas from infected women are more likely to show findings of maternal and/or fetal malperfusion. The most common findings in placentas from infected women were fibrin deposition and intense recruitment of inflammatory infiltrates. The transplacental transmission of this virus is unlikely to occur, probably due to low expression of the receptor for SARS-CoV-2 in placental cell types. Further studies are needed to improve our knowledge about the interaction between the virus and the mother-fetus dyad and the impact on maternal and neonatal/fetal outcomes.
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Faizi, Shaweez, and Muralidhar V. Pai. "Role of Midtrimester Localization of the Placenta in predicting Pregnancy Outcome." International Journal of Infertility & Fetal Medicine 5, no. 3 (2014): 87–91. http://dx.doi.org/10.5005/jp-journals-10016-1087.
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ABSTRACT The localization of the placenta by ultrasound in the second trimester has been hypothesized to have an impact on the pregnancy, in terms of antenatal, intrapartum and postnatal outcome. Objective To evaluate the role of placental location in predicting the pregnancy outcome. Materials and methods It was a prospective observational study conducted between September 2011 and March 2013 at a tertiary care hospital. Placental location, as determined by midtrimester ultrasound in 620 antenatal women, was divided into five groups—anterior, posterior, fundal, lateral and low lying placenta-depending on where > 75% of the placental mass was located. Outcome variables, such as antenatal complications, intrapartum events and neonatal outcome in these women were studied. Results Out of 620 women, 274 (44.1%) had anterior, 169 (27.2%) had posterior, 98 (15.8%) had fundal, 61 (9.8%) had lateral placentae and 18 (2.9%) had placenta previa as per the last scan done at 28 weeks. Pre-eclampsia (27.9%) and antepartum hemorrhage (19.7%) were more common in lateral placenta whereas term prelabor rupture of membranes (11.2%) was more common in fundal placenta and these findings were statistically significant. The incidence of intrauterine growth restriction (IUGR) was also found to be higher in patients with lateral (16.4%) and posteriorly (16%) implanted placenta although there was no statistically significant association. Conclusion Among the various placental sites of implantation, lateral location of the placenta is associated with adverse antenatal outcomes like pre-eclampsia, antepartum hemorrhage and IUGR. How to cite this article Faizi S, Pai MV. Role of Midtrimester Localization of the Placenta in predicting Pregnancy Outcome. Int J Infertil Fetal Med 2014;5(3):87-91.
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Shanes, Elisheva D., Leena B. Mithal, Sebastian Otero, Hooman A. Azad, Emily S. Miller, and Jeffery A. Goldstein. "Placental Pathology in COVID-19." American Journal of Clinical Pathology 154, no. 1 (May 22, 2020): 23–32. http://dx.doi.org/10.1093/ajcp/aqaa089.
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Abstract Objectives To describe histopathologic findings in the placentas of women with coronavirus disease 2019 (COVID-19) during pregnancy. Methods Pregnant women with COVID-19 delivering between March 18, 2020, and May 5, 2020, were identified. Placentas were examined and compared to historical controls and women with placental evaluation for a history of melanoma. Results Sixteen placentas from patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were examined (15 with live birth in the third trimester, 1 delivered in the second trimester after intrauterine fetal demise). Compared to controls, third trimester placentas were significantly more likely to show at least one feature of maternal vascular malperfusion (MVM), particularly abnormal or injured maternal vessels, and intervillous thrombi. Rates of acute and chronic inflammation were not increased. The placenta from the patient with intrauterine fetal demise showed villous edema and a retroplacental hematoma. Conclusions Relative to controls, COVID-19 placentas show increased prevalence of decidual arteriopathy and other features of MVM, a pattern of placental injury reflecting abnormalities in oxygenation within the intervillous space associated with adverse perinatal outcomes. Only 1 COVID-19 patient was hypertensive despite the association of MVM with hypertensive disorders and preeclampsia. These changes may reflect a systemic inflammatory or hypercoagulable state influencing placental physiology.
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Hannigan, Ailish, Peter Kelehan, Keelin O'Donoghue, Amanda Cotter, and Khadijah Ismail. "Abnormal Placental Cord Insertion and Adverse Pregnancy Outcomes: Results from a Prospective Cohort Study." American Journal of Perinatology 34, no. 11 (July 24, 2017): 1152–59. http://dx.doi.org/10.1055/s-0037-1604413.
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Objectives To prospectively measure the distance from the placental cord insertion (PCI) site to the placental margin using digital imaging and to examine the association between abnormal PCI and adverse pregnancy outcomes in singleton pregnancies. Study Design This prospective cohort study examined 1,005 placentas from consecutively delivered singleton pregnancies in a tertiary center. Standardized images of each placenta were taken and digital measurement was performed using ImageJ software. Results The rates of velamentous (insertion into the membrane) and marginal (<2 cm from placental margin) cord insertions in a total of 1,005 singleton pregnancies were 3.6% (n = 36; 95% confidence interval [CI] = 2.5–4.9%) and 6.4% (n = 64; 95% CI = 4.9–8.1%), respectively. Abnormal PCI was found to be more common among smokers compared with non-smokers (22.7 vs. 14.8%, p = 0.04). Abnormal PCI was found to be significantly associated with small for gestational age (adjusted odds ratio [OR]: 1.73; 95% CI: 1.01–2.97, p = 0.047) and low birth weight (adjusted OR: 3.87; 95% CI: 1.72–8.71, p = 0.001). Conclusion Digital imaging analysis using ImageJ software mapped the surface of the placenta and provided objective measurement of PCI site. In this large prospective cohort, abnormal PCIs were significantly associated with an increased risk of small for gestational age and low birth weight.
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Kasparova, A. E., E. D. Khadieva, E. I. Kutefa, V. L. Yanin, E. N. Vasil'kovskaya, L. A. Chegus, N. A. Sazonova, and F. R. Khidirnebieva. "An uncommon case of placental histopathology with antenatal fetal death under new coronavirus infection." Journal of Anatomy and Histopathology 12, no. 2 (July 9, 2023): 99–105. http://dx.doi.org/10.18499/2225-7357-2023-12-2-99-105.
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Since the beginning of the COVID-19 pandemic, there have been a number of studies related to the impact of SARS-CoV-2 on the course of pregnancy and fetus condition. As observed, the placentas of women who have had a new coronavirus infection often contain more villous agglutination and subchorionic thrombi than placentas in SARS-CoV-2-negative women. To date, several isolated publications have reported clinical cases of fetal death in mothers infected with coronavirus infection. The authors have made an assumption on the association of adverse outcomes with placental lesions. The aim of the study was to analyse a clinical case of a moderate-course new coronavirus infection in a pregnant woman at a long gestation period who underwent an antenatal fetal death, and evaluate the features of placental histopathology and their impact on adverse gestational outcomes. Material and methods. The authors have analysed Russian and international research publications from various sources, including eLIBRARY.RU, CyberLeninka, PubMed databases etc. and, considering the data obtained, investigated a clinical case of intrauterine fetal death in a pregnant woman infected with SARS-CoV-2. The placenta was studied in accordance with the clinical recommendations of the Russian Society of Pathologists "Rules for placental pathological and anatomical examination" and the international classification of placental lesions (Amsterdam, 2015). Results. The results obtained support the association between acute diseases of the upper respiratory tract and developing severe hemodynamic disorders in the "mother-placenta-fetus" system in pregnant women infected with SARS-CoV-2. Systemic inflammation associated with new coronavirus infection appears to be one of the mechanisms for developing placental disorders.
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Bui, Minh Tien, Cam Anh Nguyen Le, Khanh Linh Duong, Van Thuan Hoang, and Trung Kien Nguyen. "Transplacental Transmission of SARS-CoV-2: A Narrative Review." Medicina 60, no. 9 (September 18, 2024): 1517. http://dx.doi.org/10.3390/medicina60091517.
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Background and Objectives: The study aims to explore the potential for transplacental transmission of SARS-CoV-2, focusing on its pathophysiology, placental defense mechanisms, and the clinical implications for maternal and neonatal health. Materials and Methods: A comprehensive review of the current literature was conducted, analyzing studies on SARS-CoV-2 infection in pregnancy, the expression of key viral receptors (ACE2 and TMPRSS2) in placental cells, and the immune responses involved in placental defense. The review also examined the clinical outcomes related to maternal and neonatal health, including adverse pregnancy outcomes and neonatal infection. Results: The expression of ACE2 and TMPRSS2 in the placenta supports the biological plausibility of SARS-CoV-2 transplacental transmission. Histopathological findings from the infected placentas reveal inflammation, vascular changes, and the evidence of viral particles in placental tissues. Clinical reports indicate an increased risk of preterm birth, intrauterine growth restriction, and neonatal infection in pregnancies affected by COVID-19. However, the frequency and mechanisms of vertical transmission remain variable across studies, highlighting the need for standardized research protocols. Conclusions: SARS-CoV-2 can potentially infect placental cells, leading to adverse pregnancy outcomes and neonatal infection. While evidence of transplacental transmission has been documented, the risk and mechanisms are not fully understood. Ongoing research is essential to clarify these aspects and inform obstetric care practices to improve maternal and neonatal outcomes during the COVID-19 pandemic.
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Matthews, Jadyn, Brammy Rajakumar, Chrystalle Katte Carreon, and Sarah U. Morton. "Placental–Heart Axis: An Evolutionary Perspective." International Journal of Molecular Sciences 25, no. 20 (October 18, 2024): 11212. http://dx.doi.org/10.3390/ijms252011212.
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To maintain its development, the growing fetus is directly dependent on the placenta, an organ that acts as both a modulator and mediator. As an essential component of pregnancy that is derived from both maternal and fetal tissues, the placenta facilitates the passage of all oxygen and nutrients from the expecting parent to their fetuses. Further, the placenta conveys multiple impacts of the maternal environment to the growing fetus. The timing of placental development parallels that of the fetal cardiovascular system, and placental anomalies are implicated as a potential cause of congenital heart disease. For example, congenital heart disease is more common in pregnancies complicated by maternal preeclampsia, a condition characterized by placental dysfunction. Given the placenta’s intermediary links to the maternal environment and fetal health outcomes, it is an emerging focus of evolutionary medicine, which seeks to understand how interactions between humans and the environment affect our biology and give rise to disease. The present review provides an overview of the evolutionary and developmental courses of the placenta as well as their implications on infant health.
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Kumar, Dhinesh, and Muthuprasad. "Study of Morphology of Placenta in Fifty Specimens." International Journal of Anatomy and Research 9, no. 2.3 (June 5, 2021): 8020–25. http://dx.doi.org/10.16965/ijar.2021.131.
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Introduction: The placenta is an important organ for keeping a pregnancy going and promoting normal foetal development. As a foetal organ, the placenta is subjected to the same stress and strain as the foetus. The growth of the foetus depends upon the location, functional capacity and integrity of the placental attachment. Aim: To study the morphology of the placenta in fifty placental specimens. Methods: The study was conducted in the Institute of Anatomy, Madurai Medical College, in collaboration with the Department of Obstetrics and Gynecology. A total of fifty placental specimens were collected and analyzed for shape, diameter, thickness, placenta weight, maternal and fetal cotyledons, and attachment of cord, vascular pattern, fetoplacental ratio and placental co-efficient. Results: In fifty placentae, 60% circular in shape; 38% oval in shape; 2% triangular in shape. The mean diameter is 17.7 cm. The diameter is increased in anaemia and decreased in prematurity. The average thickness is 1.993 cm. The thickness is increased in Diabetes mellitus and decreased in anaemia. The average number of maternal cotyledons is 17; increased in Diatebes mellitus and decreased in prematurity. The average number of fetal cotyledons is 59 and increased in Diabetes mellitus. The feto-maternal cotyledon ratio is 3.5:1. It is increased in prematurity and decreased in Diabetes mellitus. The average weight of the placenta is 471 grams. The placental weight is increased in Diabetes mellitus and decreased in prematurity. The fetoplacental weight ratio is 5.805 and is decreased in prematurity. The placental coefficient is 0.18 and is increased in prematurity. Conclusion: The examination of the placenta yields valuable information regarding the intra-uterine events and fetal outcomes. KEYWORDS: Placenta, Macroscopic Morphology, Pregnancy.
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Ursini, Gianluca, Giovanna Punzi, Benjamin W. Langworthy, Qiang Chen, Kai Xia, Emil A. Cornea, Barbara D. Goldman, et al. "Placental genomic risk scores and early neurodevelopmental outcomes." Proceedings of the National Academy of Sciences 118, no. 7 (February 8, 2021): e2019789118. http://dx.doi.org/10.1073/pnas.2019789118.
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Tracing the early paths leading to developmental disorders is critical for prevention. In previous work, we detected an interaction between genomic risk scores for schizophrenia (GRSs) and early-life complications (ELCs), so that the liability of the disorder explained by genomic risk was higher in the presence of a history of ELCs, compared with its absence. This interaction was specifically driven by loci harboring genes highly expressed in placentae from normal and complicated pregnancies [G. Ursini et al., Nat. Med. 24, 792–801 (2018)]. Here, we analyze whether fractionated genomic risk scores for schizophrenia and other developmental disorders and traits, based on placental gene-expression loci (PlacGRSs), are linked with early neurodevelopmental outcomes in individuals with a history of ELCs. We found that schizophrenia’s PlacGRSs are negatively associated with neonatal brain volume in singletons and offspring of multiple pregnancies and, in singletons, with cognitive development at 1 y and, less strongly, at 2 y, when cognitive scores become more sensitive to other factors. These negative associations are stronger in males, found only with GRSs fractionated by placental gene expression, and not found in PlacGRSs for other developmental disorders and traits. The relationship of PlacGRSs with brain volume persists as an anlage of placenta biology in adults with schizophrenia, again selectively in males. Higher placental genomic risk for schizophrenia, in the presence of ELCs and particularly in males, alters early brain growth and function, defining a potentially reversible neurodevelopmental path of risk that may be unique to schizophrenia.
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Siargkas, Antonios, Ioannis Tsakiridis, Georgios Michos, Anastasios Liberis, Sofoklis Stavros, Menelaos Kyriakakis, Ekaterini Domali, Apostolos Mamopoulos, and Themistoklis Dagklis. "Impact of Placental Grading on Pregnancy Outcomes: A Retrospective Cohort Study." Healthcare 13, no. 6 (March 10, 2025): 601. https://doi.org/10.3390/healthcare13060601.
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Background: Placental grading remains underutilized in clinical practice despite its potential prognostic value. This study aimed to elucidate the relationship between premature placental calcification (PPC) and relevant perinatal outcomes in a large cohort. Methods: We conducted a retrospective cohort study involving 3088 singleton pregnancies that underwent routine third-trimester ultrasound examinations (30+0 to 35+6 gestational weeks) at the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, between January 2018 and December 2023. Placental calcification was graded using the Grannum system, categorizing placentas into Grades 0–1 (control), Grade 2, and Grade 3. Primary outcomes assessed were small for gestational age neonates (SGA) and preeclampsia. Secondary outcomes included gestational hypertension, fetal growth restriction (FGR), stillbirth, gestational age at birth, and birthweight centile. Multiple logistic regression was employed to adjust for confounders, i.e., maternal age, BMI, smoking, conception via assisted reproductive technology, and uterine artery pulsatility index. Results: In total, 544 pregnancies (17.6%) had Grade 2 placentas, and 41 pregnancies (1.3%) had Grade 3 placentas. Compared to the control group, Grade 2 placentas were associated with increased odds of SGA (adjusted odds ratio [aOR] 1.80; 95% confidence intervals [CI]: 1.43–2.25) and FGR (aOR 1.81; 95% CI: 1.35–2.42). Grade 3 placentas showed even higher odds of SGA (aOR 3.09; 95% CI: 1.55–6.17) and FGR (aOR 3.26; 95% CI: 1.53–6.95). No significant associations were found between placental grading and preeclampsia or stillbirth. Additionally, PPC was linked to lower birthweight percentiles and earlier gestational age at birth. Conclusions: Premature placental calcification (before 36+0 weeks), particularly Grade 3, is significantly associated with adverse perinatal outcomes such as SGA and FGR. Incorporating placental grading into routine prenatal care may enhance risk stratification and guide clinical decision making beyond traditional assessment methods.
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Sobhani, Nasim C., Elyzabeth Avvad-Portari, Aline C. M. Nascimento, Heloisa N. Machado, Daniel S. S. Lobato, Jose Paulo Pereira, Mikaela S. Esquivel, et al. "Discordant Zika Virus Findings in Twin Pregnancies Complicated by Antenatal Zika Virus Exposure: A Prospective Cohort." Journal of Infectious Diseases 221, no. 11 (November 27, 2019): 1838–45. http://dx.doi.org/10.1093/infdis/jiz629.
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Abstract Background There are limited data on the natural history of antenatal Zika virus (ZIKV) exposure in twin pregnancies, especially regarding intertwin concordance of prenatal, placental, and infant outcomes. Methods This prospective cohort study included twin pregnancies referred to a single institution from September 2015 to June 2016 with maternal ZIKV. Polymerase chain reaction (PCR) testing of maternal, placental, and neonatal samples was performed. Prenatal ultrasounds were completed for each twin, and histomorphologic analysis was performed for each placenta. Abnormal neonatal outcome was defined as abnormal exam and/or abnormal imaging. Two- to three-year follow-up of infants included physical exams, neuroimaging, and Bayley-III developmental assessment. Results Among 244 pregnancies, 4 twin gestations without coinfection were identified. Zika virus infection occurred at 16–33 weeks gestation. Zika virus PCR testing revealed discordance between dichorionic twins, between placentas in a dichorionic pair, between portions of a monochorionic placenta, and between a neonate and its associated placenta. Of the 8 infants, 3 (38%) had an abnormal neonatal outcome. Of 6 infants with long-term follow-up, 3 (50%) have demonstrated ZIKV-related abnormalities. Conclusions Neonatal PCR testing, placental findings, and infant outcomes can be discordant between co-twins with antenatal ZIKV exposure. These findings demonstrate that each twin should be evaluated independently for vertical transmission.
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Cetin, I., F. Parisi, C. Berti, C. Mandò, and G. Desoye. "Placental fatty acid transport in maternal obesity." Journal of Developmental Origins of Health and Disease 3, no. 6 (June 14, 2012): 409–14. http://dx.doi.org/10.1017/s2040174412000414.
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Pregestational obesity is a significant risk factor for adverse pregnancy outcomes. Maternal obesity is associated with a specific proinflammatory, endocrine and metabolic phenotype that may lead to higher supply of nutrients to the feto-placental unit and to excessive fetal fat accumulation. In particular, obesity may influence placental fatty acid (FA) transport in several ways, leading to increased diffusion driving force across the placenta, and to altered placental development, size and exchange surface area. Animal models show that maternal obesity is associated with increased expression of specific FA carriers and inflammatory signaling molecules in placental cotyledonary tissue, resulting in enhanced lipid transfer across the placenta, dislipidemia, fat accumulation and possibly altered development in fetuses. Cell culture experiments confirmed that inflammatory molecules, adipokines and FA, all significantly altered in obesity, are important regulators of placental lipid exchange. Expression studies in placentas of obese–diabetic women found a significant increase in FA binding protein-4 expression and in cellular triglyceride content, resulting in increased triglyceride cord blood concentrations. The expression and activity of carriers involved in placental lipid transport are influenced by the endocrine, inflammatory and metabolic milieu of obesity, and further studies are needed to elucidate the strong association between maternal obesity and fetal overgrowth.
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Cuffe, James S. M., Zarqa Saif, Anthony V. Perkins, Karen M. Moritz, and Vicki L. Clifton. "Dexamethasone and sex regulate placental glucocorticoid receptor isoforms in mice." Journal of Endocrinology 234, no. 2 (August 2017): 89–100. http://dx.doi.org/10.1530/joe-17-0171.
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Maternal dexamethasone exposure in the mouse impairs placental development and programs adult disease in a sexually dimorphic manner. Glucocorticoids bind to different glucocorticoid receptor (GR) isoforms to regulate gene transcription and cellular signaling. We hypothesized that sexually dimorphic placental responses to glucocorticoids are due to differences in GR isoforms present in the placenta. Pregnant C57Bl6 mice were exposed to saline or dexamethasone from E12.5 until E14.5 (1 µg/kg/h) before the collection of placentae. Cytoplasmic and nuclear protein fractions were extracted from placentae of male and female fetuses for Western blot analysis of GR isoforms. Eight known isoforms of the GR were detected in the mouse placenta including the translational isoforms GRα-A, B, C and D1–3 and the splice variants GRA and GRP. The expression of GRA, GRP and each of the GRα isoforms were altered by dexamethasone in relation to fetal sex and cellular location. Placentae of female fetuses had higher GRα-A and GRP expression in the cytoplasm than males, and GRα-C was more highly expressed in the nucleus of females than that in males. Dexamethasone significantly increased the cytoplasmic expression of GRα-A, but reduced the expression of GRα-C in placentae of males. Dexamethasone increased the expression of the GRα-C-regulated genes Sgk1 and Bcl2l11, particularly in females. The cleaved caspase-3 staining in placental sections indicated GRα-C may mediate sex differences in dexamethasone-induced apoptosis. These findings may underlie the sex-specific placental adaptations that regulate different growth profiles in males and females and different risks for programmed disease outcomes in offspring.
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Li, Han, Hao Peng, Wei Hong, Yingying Wei, Haojun Tian, Xiaojie Huang, Linyan Jia, et al. "Human Placental Endothelial Cell and Trophoblast Heterogeneity and Differentiation Revealed by Single-Cell RNA Sequencing." Cells 12, no. 1 (December 25, 2022): 87. http://dx.doi.org/10.3390/cells12010087.
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Background: The placenta is an important organ for fetal and maternal health during pregnancy and impacts offspring health late in life. Defects in placental vasculature and trophoblast have been identified in several pregnancy complications. Thus, the detailed molecular profile and heterogeneity of endothelial cells and trophoblasts in placentas will aid us in better understanding placental behaviors and improving pregnancy outcomes. Methods: Single-cell RNA sequencing (scRNA-seq) was performed to profile the transcriptomics of human placental villous tissues from eleven patients with normal pregnancies in the first and second trimesters (6–16 weeks of gestation). Results: The transcriptomic landscape of 52,179 single cells was obtained, and the cells were classified as trophoblasts, fibroblasts, endothelial cells, erythroid cells, Hofbauer cells, and macrophages. Our analysis further revealed the three subtypes of placental endothelial cells, with distinct metabolic signatures and transcription factor regulatory networks. We also determined the transcriptomic features of the trophoblast subpopulations and characterized two distinct populations of progenitor cells in cytotrophoblasts, which were capable of differentiating to extravillous trophoblasts and syncytiotrophoblasts, respectively. Conclusions: Our study provided a high-resolution molecular profile of the human placenta between 6 and 16 weeks of gestation. Our data revealed the placental cell complexity and demonstrated the transcriptional networks and signaling involved in placental endothelial and trophoblast differentiation during early pregnancy, which will be a resource for future studies of the human placental development.
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Garmi, Gali, Noah Zafran, Marina Okopnik, Israel Gavish, Shabtai Romano, and Raed Salim. "Placental Pathological Findings following Adjusting Enoxaparin Dosage in Thrombophilic Women: Secondary Analysis of a Randomized Controlled Trial." Thrombosis and Haemostasis 119, no. 01 (December 31, 2018): 087–91. http://dx.doi.org/10.1055/s-0038-1676521.
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Objective Randomized trials showed no improvement in pregnancy outcomes with the use of low molecular weight heparin (LMWH) to prevent placenta-mediated pregnancy complications (PMPCs) among thrombophilic women. However, the effect of treatment on placental findings was not examined. We aimed to examine the occurrence of placental vascular lesions in thrombophilic women treated with LMWH dose adjusted according to anti-factor Xa compared with a fixed dose. Study Design This study was a secondary analysis of a randomized trial designed to examine whether LMWH dose adjusted according to anti-factor Xa levels compared with a fixed dose would reduce the risk of PMPC. Eligible women were randomly allocated in a 1:1 ratio to either a fixed dose of 40 mg daily LMWH (fixed dose group) or adjusted dose according to anti-factor Xa levels (adjusted dose group). Placentas were examined by the same perinatal pathologist who was blinded to group allocation. The primary outcome for this analysis was the incidence of maternal placental vascular lesions. Results During the study period, 88 placentas were examined; 41 and 47 from the fixed and adjusted dose groups, respectively. Demographics, obstetrics and types of thrombophilias were similar between the groups. Maternal placental vascular lesions were observed in 23 (56.1%) and 21 (44.68%) placentas (p = 0.28) and foetal placental vascular lesions in 2 (4.88%) and 1 (2.13%) placentas (p = 0.59) in the fixed and adjusted groups, respectively. Conclusion Adjusted dose of enoxaparin according to anti-factor Xa levels compared with a fixed dose did not affect placental vascular lesions in thrombophilic women.
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Hernandorena, Cintia, Juan Sebastián Garcia, Victoria Cavoti Sadonio, and Carlos Grandi. "Lesiones placentarias de embarazos de madre adolescente en una maternidad pública de la Argentina." Revista de la Facultad de Ciencias Médicas de Córdoba 69, no. 1 (March 27, 2012): 7–14. http://dx.doi.org/10.31053/1853.0605.v69.n1.21352.
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Introduction. In Argentina, 18.3% of all births are related to adolescent mothers. Adolescent pregnancy has been associated with an increase of adverse perinatal outcomes. Placental examination helps to identify etiology and predict recurrence of perinatal pathologies. The aim of this study was to describe placental weight and placental lesions and to estimate the risks of adolescent pregnancies compared with young adults mothers.Methods. We examined 50 placentas from adolescent mothers (<16 yrs, n = 18 and 17-19 yrs, n = 32) and 101 placentas from adults mothers between 20 and 29 years old attending the Sarda’ Maternity Hospital of Buenos Aires, Argentina. Conventional methods were used for macroscopic and histological examination.Results. No differences were found in placental weights. In half of examined placenta one or more lesions were present, predominantly in adolescents (p = 0.327). In < 16 ys placental lesions represented 77.78 % (14/18, 95% CI 54 – 91), in older teenagers 34.3% (11/32, 95% CI 20 – 51) (OR 2.26, 95% CI 1.32 – 3.38, p = 0.003), whereas in young adults figure was 41.5% (42/101, [95% CI 32 – 51]), a 1.87 (IC 95% 1.33 – 2.62, p = 0.004) and 0.83 (IC 95% 0.49 – 1.41, p = 0.469) crude risks of both adolescents’ groups compared with adults, respectively.Adjusted risk for placental lesions was four folds higher in adolescent at or below 16 years (p = 0.018). Conclusions. No differences were found in placental weights Younger teenagers (? 16 year age) have an increased risk for having placental lesions.
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Fried, Michal, Richard O. Muga, Ambrose O. Misore, and Patrick E. Duffy. "Malaria Elicits Type 1 Cytokines in the Human Placenta: IFN-γ and TNF-α Associated with Pregnancy Outcomes." Journal of Immunology 160, no. 5 (March 1, 1998): 2523–30. http://dx.doi.org/10.4049/jimmunol.160.5.2523.
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Abstract Pregnant women, especially primigravidas, are highly susceptible to malaria infection, resulting in maternal anemia and low birth weight infants. Because circulating parasitemia is rare in the newborn, the cause of poor fetal outcomes has been unclear. We measured cytokine concentrations in placentas collected from women delivering in urban hospitals in malaria-holoendemic or nonendemic areas of Kenya. Normal placentas displayed a bias toward type 2 cytokines; type 1 cytokines IFN-γ and IL-2 were absent in placentas not exposed to malaria but present in a large proportion of placentas from a holoendemic area. TNF-α and TGF-β concentrations were significantly higher, and IL-10 concentrations significantly lower, in placentas from the holoendemic area. Among primigravidas, placental TNF-α concentrations were significantly higher in the presence of severe maternal anemia, and both IFN-γ and TNF-α were significantly elevated when a low birth weight, rather than normal weight, infant was delivered. We conclude that maternal malaria decreases IL-10 concentrations and elicits IFN-γ, IL-2, and TNF-α in the placenta, shifting the balance toward type 1 cytokines. This is the first demonstration that these placental cytokine changes are associated with poor pregnancy outcomes in humans.
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Voropaeva, E. E., Yu V. Khaidukova, E. A. Kazachkova, E. L. Kazachkov, T. N. Shamaeva, A. A. Aliyeva, L. S. Ishchenko, A. Yu Holopova, and G. V. Sychugov. "Perinatal outcomes and morphological examination of placentas in pregnant women with critical lung lesions in new COVID-19 coronavirus infection." Ural Medical Journal 22, no. 2 (April 30, 2023): 109–21. http://dx.doi.org/10.52420/2071-5943-2023-22-2-109-121.
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Introduction The likelihood of adverse perinatal outcome in new coronavirus infection (NKI) COVID-19 increases with the volume of lung tissue damage and correlates with the severity of respiratory failure (DN). Nevertheless, perinatal outcomes and placenta structural changes in pregnant women with critical lung lesions during NKI COVID-19 have been insufficiently studied.The objective of this investigation was to determine perinatal outcomes and the nature of placental lesions in pregnant women with critical lung injury during novel COVID-19 coronavirus infection.Material and methods A prospective cohort comparative study was conducted, with subsequent retrospective analysis of perinatal outcomes and the results of histologic examination of the placentas in 53 pregnant women with COVID-19 NCI. Group 1 was composed of 25 women with NKI COVID-19 complicated by community-acquired pneumonia with critical lung injury (KT-4, 76% or more); Group 2 was composed of 28 pregnant women with NKI COVID-19 complicated by community-acquired pneumonia with moderate-to-severe lung injury (KT-2, 25-50%). Perinatal outcomes and the results of morphological examination of the placenta were analyzed using the provisions of the classification of placental injuries developed by the Amsterdam Placenta Workshop Group (2014).Results In the main group, there were no children born with signs of miscarriage, while in the comparison group there were 8.7% of such children. SARS-CoV-2 antigen was diagnosed in a nasopharyngeal swab immediately after birth in 1 (4.3%) live-born infant in group 2 by PCR. The child died in the postnatal period on the 33rd day of life. Antenatal fetal death in women of Group 1 was the result of marked maternal hypoxia and extremely early PP, in Group 2 - the consequence of placental lesions. A wide spectrum of placental damages, including maternal and fetal malperfusion, maternal and fetal COVID-19 complicated by critical lung injury and with moderate lung injury.Discussion The placentas of pregnant women delivered due to critical condition do not have pronounced inflammatory and distrophic disorders, being characterized by the phenomena of acute PU. On the contrary, the placentas of women who successfully completed treatment with COVID-19 NKI of moderate severity and safely delivered at late gestational age exhibit the full spectrum of inflammatory and hypoxic lesions, leading to subcompensated and decompensated PU.Conclusion Weakly pronounced dystrophic processes, lymphocytic infiltration of the decidual and fetal membranes, signs of partial maternal vascular malperfusion and fetal stromal-vascular lesions, and acute PU phenomena were recorded in the placentas of women with NCI COVID-19 and critical pulmonary lesions. The absence of marked inflammatory infiltration of villi and fetal membranes, dystrophic processes, intervillous thrombosis, and villous infarcts realized in decompensated PU in the placentas of these patients was due to the immediate delivery of pregnant women with critical pulmonary lesions in NCI COVID-19.
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VS, Bini, Anitha Gopal, and Bindhu KM. "SECOND TRIMESTER PLACENTAL LOCATION AS A PREDICTOR OF ADVERSE PREGNANCY OUTCOMES." National Journal of Physiology, Pharmacy and Pharmacology 14, no. 12 (2024): 2638. https://doi.org/10.5455/njppp.2024.v14.i12.23.
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Background : Placenta is an important connecting organ between mother and fetus. A lot of fetal and maternal problems are related with the placenta. It is the vital link between the mother and fetus for metabolic exchange, endocrine and other body functions. So it is critical for maternal and neonatal wellbeing. The blood supply of the placenta is not uniformly distributed. The site of the implantation and resultant location of placenta within the uterus are likely to be the important determinants of placental blood flow and therefore pregnancy success. Placental location has been implicated in preterm birth, in fetal mal-position and mal-presentation, IUGR, Low APGAR score and development of preeclampsia. Objectives: The objective of the study, is to find out whether there is any significant correlation between second trimester placental location with the following Fetal outcomes such as intra uterine growth restriction (IUGR), preterm birth, low APGAR at 1 Minute (ie <7) , NICU admission, abnormal presentation and maternal outcomes such as preeclampsia, abruption, ante partum hemorrhage due to placental praevia, post partum hemorrhage. Materials and Methods: Study Design: A prospective observational study conducted at Department of Obstetrics and Gynaecology, Government Medical College Hospital in Kerala for a period of 12 months after getting the approval of Institutional Ethic Committee (IEC)/ Institutional Review Board (IRB) of the Institution. Population for the study is antenatal women of age group 18 to 35years without any high risk factors. Sample size is calculated as 390 with criteria for inclusion and exclusion. Sampling procedure used is Simple Random Sampling (SRS). The main tools used for the study were case records, obstetric USG, clinical examination findings and lab reports. The location of placenta was identified by Ultrasound Sonography done between 18 and 24 weeks. Location of placenta was classified as fundal, unilateral and low for the study. The outcome variables selected for the study comes under two categories ie maternal outcomes and fetal outcomes. The maternal outcomes are preeclampsia, placental abruption, ante partum hemorrhage due to placental praevia and post partum hemorrhage and fetal outcomes are intra uterine growth restriction (IUGR), preterm birth, low APGAR at 1 minute (ie <7), NICU admission and abnormal presentation. Analysis: In chi square test we get a p value. If p value is less than 0.05 then we treat it as a significant association between the variables. If the p value is less than 0.01 then there is highly significant association between the variables in the study. Results : There is a significant relation between the location of the placenta in second trimester and the maternal outcomes such as preeclampsia, APH in placental praevia and fetal outcomes such as IUGR, low APGAR at 1 minute (ie <7), NICU admission. It is also found that there is no significant association between location of the placenta in second trimester and the maternal outcomes such as placental abruption, post partum hemorrhage and fetal outcomes such as preterm birth and abnormal presentation. Conclusion : With the help of ultra Sonography, a simple, non invasive, easy to perform, cost effective diagnostic method, the location of placenta can easily made out and thereby indentifying the above high risk cases such as IUGR, low APGAR at 1 minute (ie <7), preeclampsia and APH in placental praevia. By identifying such patients appropriate treatment can be initiated and regular follow-up can be done in advance.
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Madhupriya, B., Varun Byrappa, Pranup Roshan Quadras, and Amit Massand. "Histopathology of Placenta in Stillbirth." Journal of the Anatomical Society of India 74, no. 1 (January 2025): 12–18. https://doi.org/10.4103/jasi.jasi_18_24.
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Abstract Purpose: For the development and survival of the fetus, the placenta plays an important role before birth. Examination of the placenta can aid/tell us the sequence of events prebirth, which will aid in identifying the etiology of unfavorable outcomes such as stillbirth, preterm delivery, intrauterine growth retardation, and neurodevelopmental impairment. We attempt to study the histopathological features of the placenta in stillbirths and categorize the various factors of placental pathology contributing to the same. Materials and Methods: From 60 stillbirths, placentae with umbilical cord and membranes were studied for 18 months at Kempegowda Institute of Medical Sciences. Detailed histomorphology with clinical details was recorded. TULIP classification of stillbirth was used to categorize the placental pathology. Results: Women from 19 to 38 years (38 multigravida, 22 primigravidae) with the majority in the gestational age of 20–28 weeks formed the study group. Maternal comorbidities were associated in 80% of cases, the most common being hypertensive disorders of pregnancy. The major cause of stillbirth in our cohort was placental bed pathology (maternal vascular underperfusion – 41%) followed by parenchymal pathology (fetal thrombotic vasculopathy – 17%, massive perivillous fibrin deposition – 12%). Placental pathology was seen in 86% of mothers with recurrent fetal loss. Conclusion: Histomorphology of the placenta is an essential step in determining the cause of stillbirth, especially in recurrent conditions. This will aid in planning future pregnancies and tailoring appropriate treatment plans.
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Rosenfeld, Cheryl S. "Placental serotonin signaling, pregnancy outcomes, and regulation of fetal brain development†." Biology of Reproduction 102, no. 3 (November 11, 2019): 532–38. http://dx.doi.org/10.1093/biolre/ioz204.
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Abstract The placenta is a transient organ but essential for the survival of all mammalian species by allowing for the exchanges of gasses, nutrients, and waste between maternal and fetal placenta. In rodents and humans with a hemochorial placenta, fetal placenta cells are susceptible to pharmaceutical agents and other compounds, as they are bathed directly in maternal blood. The placenta of mice and humans produce high concentrations of serotonin (5-HT) that can induce autocrine and paracrine effects within this organ. Placental 5-HT is the primary source of this neurotransmitter for fetal brain development. Increasing number of pregnant women at risk of depression are being treated with selective serotonin-reuptake inhibitors (SSRIs) that bind to serotonin transporters (SERT), which prevents 5-HT binding and cellular internalization, allowing for accumulation of extracellular 5-HT available to bind to 5-HT(2A) receptor (5-HT(2A)R). In vitro and in vivo findings with SSRI or pharmacological blockage of the 5-HT(2A)R reveal disruptions of 5-HT signaling within the placenta can affect cell proliferation, division, and invasion. In SERT knockout mice, numerous apoptotic trophoblast cells are observed, as well as extensive pathological changes within the junctional zone. Collective data suggest a fine equilibrium in 5-HT signaling is essential for maintaining normal placental structure and function. Deficiencies in placental 5-HT may also result in neurobehavioral abnormalities. Evidence supporting 5-HT production and signaling within the placenta will be reviewed. We will consider whether placental hyposerotonemia or hyperserotonemia results in similar pathophysiological changes in the placenta and other organs. Lastly, open ended questions and future directions will be explored.
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McIntyre, James Alexander, Ian A. Jones, Alla Danilkovich, and C. Thomas Vangsness. "The Placenta: Applications in Orthopaedic Sports Medicine." American Journal of Sports Medicine 46, no. 1 (April 4, 2017): 234–47. http://dx.doi.org/10.1177/0363546517697682.
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Background: Placenta has a long history of use for treating burns and wounds. It is a rich source of collagen and other extracellular matrix proteins, tissue reparative growth factors, and stem cells, including mesenchymal stem cells (MSCs). Recent data show its therapeutic potential for orthopaedic sports medicine indications. Purpose: To provide orthopaedic surgeons with an anatomic description of the placenta, to characterize its cellular composition, and to review the literature reporting the use of placenta-derived cells and placental tissue allografts for orthopaedic sports medicine indications in animal models and in humans. Study Design: Systematic review. Methods: Using a total of 63 keyword combinations, the PubMed and MEDLINE databases were searched for published articles describing the use of placental cells and/or tissue for orthopaedic sports medicine indications. Information was collected on placental tissue type, indications, animal model, study design, treatment regimen, safety, and efficacy outcomes. Results were categorized by indication and subcategorized by animal model. Results: Outcomes for 29 animal studies and 6 human studies reporting the use of placenta-derived therapeutics were generally positive; however, the placental tissue source, clinical indication, and administration route were highly variable across these studies. Fourteen animal studies described the use of placental tissue for tendon injuries, 13 studies for osteoarthritis or articular cartilage injuries, 3 for ligament injuries, and 1 for synovitis. Both placenta-derived culture-expanded cells (epithelial cells or MSCs) and placental tissue allografts were used in animal studies. In all human studies, commercial placental allografts were used. Five of 6 human studies examined the treatment of foot and ankle pathological conditions, and 1 studied the treatment of knee osteoarthritis. Conclusion: A review of the small number of reported studies revealed a high degree of variability in placental cell types, placental tissue preparation, routes of administration, and treatment regimens, which prohibits making any definitive conclusions. Currently, the clinical use of placenta is limited to only commercial placental tissue allografts, as there are no placenta-derived biological drugs approved for the treatment of orthopaedic sports medicine conditions in the United States. However, this review shows that the application of placental cells or tissue allografts appears to be safe and has potential to improve outcomes for orthopaedic sports medicine indications.
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Rolfo, Alessandro, Stefano Cosma, Anna Maria Nuzzo, Chiara Salio, Laura Moretti, Marco Sassoè-Pognetto, Andrea Roberto Carosso, Fulvio Borella, Juan Carlos Cutrin, and Chiara Benedetto. "Increased Placental Anti-Oxidant Response in Asymptomatic and Symptomatic COVID-19 Third-Trimester Pregnancies." Biomedicines 10, no. 3 (March 9, 2022): 634. http://dx.doi.org/10.3390/biomedicines10030634.
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Despite Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) -induced Oxidative Stress (OxS) being well documented in different organs, the molecular pathways underlying placental OxS in late-pregnancy women with SARS-CoV-2 infection are poorly understood. Herein, we performed an observational study to determine whether placentae of women testing positive for SARS-CoV-2 during the third trimester of pregnancy showed redox-related alterations involving Catalase (CAT) and Superoxide Dismutase (SOD) antioxidant enzymes as well as placenta morphological anomalies relative to a cohort of healthy pregnant women. Next, we evaluated if placental redox-related alterations and mitochondria pathological changes were correlated with the presence of maternal symptoms. We observed ultrastructural alterations of placental mitochondria accompanied by increased levels of oxidative stress markers Thiobarbituric Acid Reactive Substances (TBARS) and Hypoxia Inducible Factor-1 α (HIF-1α) in SARS-CoV-2 women during the third trimester of pregnancy. Importantly, we found an increase in placental CAT and SOD antioxidant enzymes accompanied by physiological neonatal outcomes. Our findings strongly suggest a placenta-mediated OxS inhibition in response to SARS-CoV-2 infection, thus contrasting the cytotoxic profile caused by Coronavirus Disease 2019 (COVID-19).
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de Castro, Ana, Hendreé E. Jones, Rolley E. Johnson, Teresa R. Gray, Diaa M. Shakleya, and Marilyn A. Huestis. "Maternal Methadone Dose, Placental Methadone Concentrations, and Neonatal Outcomes." Clinical Chemistry 57, no. 3 (March 1, 2011): 449–58. http://dx.doi.org/10.1373/clinchem.2010.154864.
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BACKGROUND Few investigations have used placenta as an alternative matrix to detect in utero drug exposure, despite its availability at the time of birth and the large amount of sample. Methadone-maintained opioid-dependent pregnant women provide a unique opportunity to examine the placental disposition of methadone and metabolite [2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP)], to explore their correlations with maternal methadone dose and neonatal outcomes, and to test the ability to detect in utero exposure to illicit drugs. METHODS We calculated the correlations of placental methadone and EDDP concentrations and their correlations with maternal methadone doses and neonatal outcomes. Cocaine- and opiate-positive placenta results were compared with the results for meconium samples and for urine samples collected throughout gestation. RESULTS Positive correlations were found between placental methadone and EDDP concentrations (r = 0.685), and between methadone concentration and methadone dose at delivery (r = 0.542), mean daily dose (r = 0.554), mean third-trimester dose (r = 0.591), and cumulative daily dose (r = 0.639). The EDDP/methadone concentration ratio was negatively correlated with cumulative daily dose (r = −0.541) and positively correlated with peak neonatal abstinence syndrome (NAS) score (r = 0.513). Placental EDDP concentration was negatively correlated with newborn head circumference (r = −0.579). Cocaine and opiate use was detected in far fewer placenta samples than in thrice-weekly urine and meconium samples, a result suggesting a short detection window for placenta. CONCLUSIONS Quantitative methadone and EDDP measurement may predict NAS severity. The placenta reflects in utero drug exposure for a shorter time than meconium but may be useful when meconium is unavailable or if documentation of recent exposure is needed.
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Flowers, Amy E., Tania L. Gonzalez, Laura E. Eisman, Nikhil Joshi, Di Wu, Yizhou Zhang, Chintda Santiskulvong, et al. "Sex Differences in the Human Placenta MicroRNA Transcriptome." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A753. http://dx.doi.org/10.1210/jendso/bvab048.1531.
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Abstract Maternal and fetal pregnancy outcomes vary based on fetal sex likely due to differences in placental function, reflected by sex differences in RNA expression. RNA transcripts are subject to fine-tuning control by post-transcriptional regulation including miRNAs binding to target RNAs and altering gene expression. Here we identify sexually dimorphic miRNA expression throughout gestation in the human placenta. Next-generation sequencing was used to identify human placenta miRNA expression profiles in first and third trimester uncomplicated pregnancies using discarded tissue obtained after chorionic villous sampling (n=113) and placenta (n=47). Differential expression analysis and mRNA target analysis were also examined. Sequencing identified 2,503 unique mature miRNAs expressed in each trimester. Of these, 13 significantly sexually dimorphic (FDR<0.05) miRNAs were identified in the first trimester and 4 significantly sexually dimorphic miRNAs were identified in the third trimester, including one miRNA, hsa-miR-361-5p, expressed across gestation. All of these sexually dimorphic miRNAs were significantly upregulated in females compared to males. Pathways analysis with predicted targets suggests sex differences in cancer and inflammation-related pathways in the first trimester and inflammation and growth-related pathways in the third trimester. Differential expression analysis on sex-segregated data identified 613 miRNAs upregulated in female placentas and 636 miRNAs upregulated in male placentas across gestation (FDR<0.05). In conclusion, fetal sex affects placental miRNA expression profiles and differentially expressed miRNAs may affect relevant downstream pathways, which may account for differences in pregnancy outcomes due to fetal sex. This work provides an expression atlas to direct functional studies investigating placental sex differences.
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Mavedatnia, Dorsa, Jason Tran, Irina Oltean, Vid Bijelić, Felipe Moretti, Sarah Lawrence, and Dina El Demellawy. "Impact of Co-Existing Placental Pathologies in Pregnancies Complicated by Placental Abruption and Acute Neonatal Outcomes." Journal of Clinical Medicine 10, no. 23 (December 3, 2021): 5693. http://dx.doi.org/10.3390/jcm10235693.
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Placental abruption (PA) is a concern for maternal and neonatal morbidity. Adverse neonatal outcomes in the setting of PA include higher risk of prematurity. Placental pathologies include maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM), acute chorioamnionitis, and villitis of unknown etiology (VUE). We aimed to investigate how placental pathology contributes to acute neonatal outcome in PA. A retrospective cohort study of all placentas with PA were identified. Exposures were MVM, FVM, acute chorioamnionitis and VUE. The primary outcome was NICU admission and the secondary outcomes included adverse base deficit and Apgar scores, need for resuscitation, and small-for-gestational age. A total of 287 placentas were identified. There were 160 (59.9%) of placentas with PA alone vs 107 (40.1%) with PA and additional placental pathologies. Odds of NICU admission were more than two times higher in pregnancies with placental pathologies (OR = 2.37, 95% CI 1.28–4.52). These estimates were in large part mediated by prematurity and birthweight, indirect effect acting through prematurity was OR 1.79 (95% CI 1.12–2.75) and through birthweight OR 2.12 (95% CI 1.40–3.18). Odds of Apgar score ≤ 5 was more than four times higher among pregnancies with placental pathologies (OR = 4.56, 95% CI 1.28–21.26). Coexisting placental pathology may impact Apgar scores in pregnancies complicated by PA. This knowledge could be used by neonatal teams to mobilize resources in anticipation of the need for neonatal resuscitation.
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Gumina, Diane L., and Emily J. Su. "Mechanistic insights into the development of severe fetal growth restriction." Clinical Science 137, no. 8 (April 2023): 679–95. http://dx.doi.org/10.1042/cs20220284.
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Abstract Fetal growth restriction (FGR), which most commonly results from suboptimal placental function, substantially increases risks for adverse perinatal and long-term outcomes. The only “treatment” that exists is delivery, which averts stillbirth but does not improve outcomes in survivors. Furthermore, the potential long-term consequences of FGR to the fetus, including cardiometabolic disorders, predispose these individuals to developing FGR in their future pregnancies. This creates a multi-generational cascade of adverse effects stemming from a single dysfunctional placenta, and understanding the mechanisms underlying placental-mediated FGR is critically important if we are to improve outcomes and overall health. The mechanisms behind FGR remain unknown. However, placental insufficiency derived from maldevelopment of the placental vascular systems is the most common etiology. To highlight important mechanistic interactions within the placenta, we focus on placental vascular development in the setting of FGR. We delve into fetoplacental angiogenesis, a robust and ongoing process in normal pregnancies that is impaired in severe FGR. We review cellular models of FGR, with special attention to fetoplacental angiogenesis, and we highlight novel integrin-extracellular matrix interactions that regulate placental angiogenesis in severe FGR. In total, this review focuses on key developmental processes, with specific focus on the human placenta, an underexplored area of research.
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Choi-Klier, Joanna, Stephanie Masters, Danielle Lewis, Kaitlyn Taylor, and Everett F. Magann. "What Is the Significance of Placental Lakes in Pregnancy? A Historic Literature Review." Journal of Clinical Medicine 14, no. 4 (February 14, 2025): 1260. https://doi.org/10.3390/jcm14041260.
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Background/Objectives: The presence of placental lakes has been recognized on obstetric ultrasounds for many years, although their influence on pregnancy and perinatal outcomes remains uncertain. Most studies evaluating outcomes are small and many outcomes are conflicting. The question remains whether placental lakes affect pregnancy outcomes and, if so, how and under what circumstances? The purpose of this review was to determine the incidence, diagnosis, pathology, management, and pregnancy outcomes to determine the influence of an isolated lake versus the influence of a lake with the presence of other factors on pregnancy and perinatal outcomes. Methods: Electronic databases (PubMed, OVID, CINAHI, Embase, and Web of Science) were searched. The only limitation was the abstract/paper had to be in English. The search years were 1980–2023. The search terms included “placenta lake” AND “pregnancy outcomes”. Results: Of 323 abstracts identified, 26 full articles were selected as the basis of this review. A number of adverse outcomes have been reported with placenta lakes, including hypertensive disorders of pregnancy, fetal growth restriction, and intrauterine fetal demise. Other studies reported no adverse outcomes. A number of factors in addition to the placental lake, such as the size of the lake, number of lakes, and presence of a thick placenta, might increase the risk of adverse outcomes. Conclusions: Unfavorable pregnancy outcomes may be related to placental lakes, particularly if the lakes are multiple and large and the placenta is thick. Additional large studies are needed to determine if antenatal surveillance is helpful.
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Tanaka, Tanaka, Osato, Kusaka, Maegawa, Taniguchi, and Ikeda. "Evaluation of Maternal and Neonatal Outcomes of Assisted Reproduction Technology: A Retrospective Cohort Study." Medicina 56, no. 1 (January 15, 2020): 32. http://dx.doi.org/10.3390/medicina56010032.
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Background: To evaluate maternal and neonatal outcomes of assisted reproductive technology (ART). Materials and Methods: Pregnant women registered from 2015 through 2017 (n = 6994) at five perinatal centers that managed high-risk pregnancies in Mie, Japan, retrospectively. Rates of preterm birth (<37 gestational weeks), early onset preeclampsia (<34 gestational weeks), late onset preeclampsia (≥34 gestational weeks), low-lying placenta, placenta previa, placenta accreta, placental abruption, atonic bleeding, uterine rupture, and amniotic fluid embolism after ART were evaluated. ART was defined as in vitro fertilization and micro-fertilization. Fisher’s exact test, Mann–Whitney’s U test, and logistic regression analysis were used to analyze the data. Results: Rates of obstetrical complications including low-lying placenta, placenta previa, placenta accreta, and atonic bleeding were increased with ART compared to those with the control. Particularly, ART was associated with a significantly increased rate of placenta accreta (adjusted odds ratio: 7.35, 95% confidence interval (CI): 3.20–16.6) and significantly decreased rate of placental abruption (adjusted odds ratio: 0.24, 95% CI: 0.07–0.61). Conclusions: This study showed that ART may reduce placental abruption and increase placenta previa. There is a possibility that the placenta attaches deeper in the myometrium because of ART.
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Gerstenberg, Jacob, Sasmita Mishra, Martha Holtfreter, Joachim Richter, Saskia Dede Davi, Dearie Glory Okwu, Michael Ramharter, Johannes Mischlinger, and Benjamin T. Schleenvoigt. "Human Placental Schistosomiasis—A Systematic Review of the Literature." Pathogens 13, no. 6 (June 3, 2024): 470. http://dx.doi.org/10.3390/pathogens13060470.
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Background: Schistosome egg deposition in pregnant women may affect the placenta of infected mothers and cause placental schistosomiasis (PS). Histopathological examination of placental tissue is an inadequate detection method due to low sensitivity. So far, there has not been any systematic review on PS. Methods: We conducted a systematic literature search on PubMed, EMBASE, and Medline and included all publications that reported microscopically confirmed cases of PS, as well as the relevant secondary literature found in the citations of the primarily included publications. Results: Out of 113 abstracts screened we found a total of 8 publications describing PS with a total of 92 cases describing egg deposition of dead and/or viable eggs and worms of S. haematobium and S. mansoni in placental tissue. One cross-sectional study investigating the prevalence of PS and its association with adverse birth outcomes, found 22% of placentas to be infested using a maceration technique but only <1% using histologic examination. Additionally, no direct link to deleterious pregnancy outcomes could be shown. Conclusions: PS is a highly unattended and underdiagnosed condition in endemic populations, due to a lack of awareness as well as low sensitivity of histopathological examinations. However, PS may play an important role in mediating or reinforcing adverse birth outcomes (ABO) such as fetal growth restriction (FGR) in maternal schistosomiasis, possibly by placental inflammation.
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Kadam, Digvijay, Yamini Patil, R. P. Patange, Supriya Patil, Shiju Sebastian, and Ravindra Jarag. "Relationships between Ultrasonographic Placental Thickness in the Third Trimester and Foetal Outcomes." Research Journal of Pharmacy and Technology, February 20, 2024, 746–50. http://dx.doi.org/10.52711/0974-360x.2024.00116.
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Poor neonatal outcomes, including low birth weight (LBW), poor APGAR scores, more NICU hospitalizations, and a higher chance to develop Pre-Eclampsia, IUGR, and Oligo Hydramnios, are all linked to thin placental thickness. While both thin and thick placentae are connected to a greater prevalence of C-sections, thick placentae are linked with a greater possibility of developing GDM and an increase in NICU hospitalizations. Objective of this research was to investigate the association between placental thickness as measured by ultrasonography in the third trimester and foetal outcome, including the relationship between placental histopathology and placental thickness. investigate the link among placental thickness, foetal outcome, and placental histology. Most newborns had fibrinoid necrosis and calcifications. Babies with Macrosomia and IUGR, respectively, were more likely to develop Syncytial knots and thickening of the vessel wall. Patients with normal placenta thickness at 36 weeks' gestation experienced fewer difficulties than those with thin or thick placentas at the same time. The study emphasizes the value of evaluating placental thickness using ultrasound in the third trimester to detect high-risk pregnancies. The study also shows that aberrant foetal and neonatal events are linked to certain placental histological characteristics, like artery wall thickening and infarctions.
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Wang, Jian-Qing, Zhi-Juan Li, Hui Gao, Jie Sheng, Chun-Mei Liang, Ya-Bin Hu, Xun Xia, et al. "Gender associations between phthalate exposure and biomarkers of oxidative stress: A prospective cohort study." Toxicology and Industrial Health, April 8, 2024. http://dx.doi.org/10.1177/07482337241245453.
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Previous epidemiologic research has shown that phthalate exposure in pregnant women is related to adverse birth outcomes in a sex-specific manner. However, the biological mechanism of phthalate exposure that causes these birth outcomes remains poorly defined. In this research, we investigated the association between phthalate exposure and placental oxidative stress in a large population-based cohort study, aiming to initially explore the relationship between phthalate exposure and gene expression in placental oxidative stress in a sex-specific manner. Quantitative PCR was performed to measure the expression of placental inflammatory mRNAs (HO-1, HIF1α, and GRP78) in 2469 placentae. The multiple linear regression models were used to investigate the associations between mRNA and urinary phthalate monoesters. Phthalate metabolites monomethyl phthalate (MMP) and mono-n-butyl phthalate (MBP) were positively correlated with higher HIF1α expression in placentae of male fetuses ( p < .05). Mono-benzyl phthalate (MBzP) increased the expression of HO-1, HIF1α, and GRP78 in placentae of male fetuses, and mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) up-regulated the expression of HIF1α and GRP78. Additionally, mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP) was negatively correlated with HO-1, HIF1α, and GRP78 in placentae of female fetuses. Maternal phthalate exposure was associated with oxidative stress variations in placental tissues. The associations were closer in the placentas of male fetuses than in that of female ones. The placenta oxidative stress is worth further investigation as a potential mediator of maternal exposure-induced disease risk in children.