DOCSLIB.ORG

Placental Findings and Effect of Prophylactic Hydrocortisone in Extremely Preterm Infants

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Placental Findings and Effect of Prophylactic Hydrocortisone in Extremely Preterm Infants Placental Findings and Effect of Alice Héneau, MD, a Fabien Guimiot, PD, PhD, b Damir Mohamed, MSc, c, d Aline Rideau Batista Novais, MD, PhD, a ProphylacticCorinne Alberti, MD, PhD, c, d Olivier Baud, HydrocortisoneMD, PhD, a, e for the PREMILOC Trial study group in Extremely Preterm Infants OBJECTIVES: abstract To investigate the relationship between histologic findings of the placenta and response to early postnatal hydrocortisone treatment used to prevent bronchopulmonary METHODS: dysplasia (BPD) in extremely preterm infants. In an exploratory analysis of the Early Low-Dose Hydrocortisone to Improve Survival Without Bronchopulmonary Dysplasia in Extremely Preterm Infants (PREMILOC) trial, detailed placental analyses were performed on the basis of standardized macroscopic and histologic examinations. Placental histology, categorized into 3 groups, was correlated RESULTS: to neonatal outcomes and response to hydrocortisone treatment. Of 523 randomly assigned patients, 457 placentas were analyzed. In total, 125 out of 457 (27%) placentas were classified as normal, 236 out of 457 (52%) placentas were classified as inflammatory, and 96 out of 457 (21%) placentas were classified as vascular. ’ Placental inflammation was associated with a significant, increased rate of BPD-freeP survival at 36 weeks postmenstrual age, independent of gestational age, treatment group, and sex (adjusted odds ratio: 1.72, 95% confidence interval [CI]: 1.05 to 2.82, = .03). Regarding the response to treatment, the strongest benefit of hydrocortisone Pcompared with placebo was found in infants born after placental vascular disease, with significantly more Ppatients extubated at day 10 (risk difference: 0.32, 95% CI: 0.08 to 0.56, = .004) and similar positive direction on survival without BPD (risk difference: 0.23, 95% CI: 0.00 to 0.46, = .06). Adjusted to gestationalP age and treatment groups, placental inflammation was associated with significantly fewer patent ductus arteriosus ligation (adjusted hazard ratio: 0.58, 95% CI: 0.36 to 0.95, = .03). Placental histology was not found to be associated CONCLUSIONS: with other adverse events related to preterm birth. With these findings, we confirm that early low-dose hydrocortisone confers benefits in extremely preterm infants overall and we suggest there is a higher treatment effect in those born after placental vascular disease. a b c WHAT’S KNOWN ON THIS SUBJECT: Placenta-mediated NICU, Department of Developmental Biology, and Unit of Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Robert Debré and University Paris Diderot, Sorbonne Paris-Cité, Paris, pregnancy complications with fetal consequences are France; dInserm U1123 and Centre d'Investigation Clinique-Épidémiologie Clinique 1426, Paris, France; and associated with bronchopulmonary dysplasia in extremely eDivision of Neonatology and PICU, University Hospitals Geneva, Geneva, Switzerland preterm infants. WHAT THIS STUDY ADDS: Placental inflammation was associated Dr Héneau conducted the data collection and the analyses and reviewed and revised the with an increased rate of bronchopulmonary dysplasia-free manuscript; Dr Guimiot conducted the placental analyses and reviewed and revised the survival at 36 weeks postmenstrual age. The strongest benefits manuscript; Mr Mohamed designed the analysis plan, conducted the statistical analyses, and ’ of early hydrocortisone on respiratory status were observed in participated in analyses interpretation; Dr Alberti coordinated and supervised the statistical extremely preterm infants born after placental vascular disease. methods and analyses and reviewed and revised the manuscript; Dr Rideau Batista Novais participated in analyses interpretation; Dr Baud conceptualized this study, participated in To cite: Héneau A, Guimiot F, Mohamed D, et al. Placental Findings and Effect of Prophylactic Hydrocortisone in Extremely Preterm Infants. Pediatrics. 2018;141(2):e20171788 Downloaded from www.aappublications.org/news by guest on September 26, 2021 PEDIATRICS Volume 141, number 2, February 2018:e20171788 ARTICLE After extremely preterm birth, reduction in the frequency of received placebo or hydrocortisone bronchopulmonary dysplasia surgical ligation for patent ductus hemisuccinate (Hydrocortisone (BPD) is a leading cause of neonatal arteriosus (PDA). Because the UPJOHN 100 mg for injection; SERB mortality and short- and long- antenatal period is crucial for lung Laboratories, Paris, France), 1 mg/kg term respiratory morbidities, and development and its subsequent per day divided into 2 doses per day is a strong risk factor for 1poor vulnerability to postnatal events, we for 7 days, followed by 0.5 mg/kg per neurocognitive outcome. BPD hypothesized that the magnitude of day for 3 days. The cumulative dose is characterized by a disrupted the hydrocortisone treatment effect used in the trial was 8.5 mg/kg. Placental Analysis and Histology alveolar and2, 3vascular development on BPD could be related to placental in the lungs that originated, at findings. least partly, in placenta-mediated In this study the 2 main aims were pregnancy complications leading to determine if detailed placental Four hundred and fifty-seven to extremely preterm delivery. histology was associated with placentas that were associated In several retrospective studies, different treatment effects on with infants enrolled in the researchers have pointed out a tight respiratory status and survival PREMILOC trial were prospectively relationship between fetal growth or without BPD in extremely preterm collected and analyzed from 386 placental vascular disease and infants, and whether it could pregnancies (including 317 single the subsequent development of 4, 5 be associated with any other and 69 multiple). All placentas were chronic lung disease in the infant. complications of extremely preterm analyzed on the basis of placental In a recent cohort study, placental delivery. histolopathology11, 12 as defined by diseases leading to fetal damage were METHODS Redline et al. Data collected were found to be associated with BPD6 reviewed by 2 investigators (A.H. and in extremely preterm infants. The Study Population F.G.) blinded to the treatment group placenta appears to play a key role and the clinical outcomes. Placental in prenatal lung development and, analysis was performed in 2 steps. therefore, in lung vulnerability to The PREMILOC study was a double- The first macroscopic examination several insults, including infections, blind, multicenter trial, in which was conducted and consisted oxidative stress, and chronic 523 extremely preterm infants were of a description of membranes, inflammation. randomly assigned to receive either measurement of the disrupted side, low-dose hydrocortisone or placebo measurement of the placenta, and There has been highly publicized during the first 10 postnatal days. the description of its shape. The controversy regarding postnatal All infants were inborn, delivered umbilical cord length, its insertion steroid use in the most immature before 27 completed weeks, and on the fetal surface, its appearance, infants, which has proved to be an enrolled by 24 hours after birth. and the number of vessels were also ’ unsolved challenge7 for neonatologists The primary outcome was survival analyzed. Fetal and maternal surfaces in preventing BPD. On the basis without BPD at 36 weeks PMA and were depicted. After sectioning of the concept of relative adrenal was analyzed in 521 infants. The trial the umbilical cord, the placenta 8 é insufficiency, postnatal steroid use was approved by the National Ethics was weighed and the placenta/ was revisited in a more physiologic Committee (Comit de Protection des fetus weights ratio was calculated. basis as a prophylactic replacement Personnes), the French National Drug Description of placental parenchyma 9 é é é treatment. The Early Low-Dose Safety Agency (Agence Nationale was performed on 1-cm sections. é Hydrocortisone to Improve Survival de S curit du M dicament et des For histology, several samples were Without Bronchopulmonary Produits de Sant , European Clinical collected as follows: 1 fragment Dysplasia in Extremely Preterm Trials Database number 2007- of umbilical cord at both fetal Infants (PREMILOC) study was 002041-20), and the French Data and placental sides, 1 fragment of ’ a multicenter, randomized Protection Authority (Commission membranes and amniotic epithelium, é controlled trial that tested the Nationale de l Informatique et 4 fragments of parenchyma in effect of low-dose hydrocortisone des Libert s). Written informed healthy areas, and all the fragments administered soon after birth to consent was obtained from parents in abnormal areas. All samples ’ µ improve survival without BPD at 36 of all eligible infants before random were then embedded in paraffin weeks postmenstrual age (PMA)10 assignment. The trial was registered and cut at 4 to 5 m thickness on in extremely preterm infants. at clinicaltrials.gov (NCT00623740) Superfrost plus slides. A second Demonstrated in this trial was a before the first patient was enrolled. histologic examination was then significant improvement in survival Study protocol10 has been previously performed13 according to standard without BPD and a significant reported. In brief, infants protocol. The placentas were Downloaded from www.aappublications.org/news by guest on September 26, 2021 2 HÉNEAU et al TABLE 1 Baseline Characteristics of the Population According to Placental Histology Placental
Load more

Recommended publications
  • Twin Transfusion Syndrome
    Obstetrica }i Ginecologia LXVI (2018) 129-133 Review article UNDERSTANDING THE PATHOPHYSIOLOGY OF THE TWIN-TO- TWIN TRANSFUSION SYNDROME N. Suciu1,2, A.Oncescu1, Andreea-Cătălina Fetecău1, L. Pop1, Oana Toader1,2 1Departament of Obstetrics and Gynecology, “Alessandrescu-Rusescu” National Institute for Mother and Child Care, Polizu Hospital, Bucharest. 2 Department of Obstetrics and Gynecology, ”Carol Davila” University of Medicine and Pharmacy, Bucharest Abstract Twin-to-twin transfusion syndrome (TTTS) also known as twin oligohydramnios-polyhydramnios sequence (TOPS) is considered to be one of the most frequent complications of monochorionic diamniotic pregnancies. The placenta lies at the core of the TTTS pathophysiology and during the past two decades, numerous studies have been carried out in order to help understand the transfusional mechanisms. The placental anastomoses, which are the primary mediators of transfusional imbalance are incapable of fully explaining the disease and also the negative impact it has on both the renal and cardiovascular systems. The current paper is aimed at providing an insight into the placental and fetal pathophysiology of the syndrome after reviewing the current articles published in the literature. Rezumat Sindromul transfuzor-transfuzat (TTTS), cunoscut si sub denumirea de secventa oligohidramnios- polihidramnios (TOPS) este considerat a fi una dintre cele mai frevvente si severe complicatii ce apar la sarcinile gemelare monocoriale, biamniotice. Placentatia jocă un rol substantial în fiziopatologia sindromului transfuzor- transfuzat si, în ultimii 20 de ani, numaroase studii au fost efectuate pentru a ajuta la întelegerea mecanismelor transfuzionale ce stau la baza acestui tip de sindrom. Anastomozele placentare, depistate la sarcinile gemelare cu TTTS si principalii mediatori răspunzători de dezechilibrul transfuzional sunt insuficienti pentru a putea explica aparitia sindromului precum si impactul negativ al acestuia asupra sistemelor renal si cardiovascular fetale.
    [Show full text]
  • Evaluation of Prenatal Adenoviral Vascular Endothelial Growth Factor Gene Therapy in the Growth-Restricted Sheep Fetus and Neonate
    Evaluation of Prenatal Adenoviral Vascular Endothelial Growth Factor Gene Therapy in the Growth-Restricted Sheep Fetus and Neonate David John Carr University College London 2013 A thesis submitted for the degree of Doctor of Philosophy 1 Declaration I, David Carr, confirm that the work presented in this thesis is my own. Where information has been derived from other sources, I confirm that this has been indicated in the thesis. 2 Abstract Background Fetal growth restriction (FGR) is associated with reduced uterine blood flow (UBF). In normal sheep pregnancies, adenovirus (Ad) mediated over-expression of vascular endothelial growth factor (VEGF) in the uterine arteries (UtA) increases UBF. It was hypothesised that enhancing UBF would improve fetal substrate delivery in an ovine paradigm of FGR characterised by reduced UBF from mid-gestation. Methods Singleton pregnancies were established using embryo transfer in adolescent ewes subsequently overnourished to generate FGR (n=81). Ewes were randomised mid-gestation to 11 receive bilateral UtA injections of 5x10 particles Ad.VEGF-A165 or inactive treatment (saline or 5x1011 particles Ad.LacZ, a control vector). Fetal growth/wellbeing were evaluated using serial ultrasound. Late-gestation study: UBF was monitored using indwelling flowprobes until necropsy at 0.9 gestation. Vasorelaxation, neovascularisation in perivascular adventitia and placental mRNA expression of angiogenic factors/receptors were examined. A group of control-fed ewes with normally-developing fetuses was included (n=12). Postnatal study: Pregnancies continued until spontaneous delivery near to term. Lambs were weighed and measured weekly and underwent metabolic challenge at 7 weeks, dual-energy X-ray absorptiometry at 11 weeks, and necropsy at 12 weeks postnatal age.
    [Show full text]
  • Preface Preface from the Editors
    Preface Preface from the Editors t is with both excitement and sadness that we present to etry came onto the stage, dramatically changing the newborn you the final issue of the UTMJ for the 2011-2012 aca- screen to include the identification of more than 50 metabol- Idemic year. Serving as your Editors-in-Chief this year has ic disorders.3 However, with the increasing ability to identify been an immense pleasure, and has allowed us the oppor- disorders comes the complex challenge of treating them, and tunity to carry on the many exciting endeavours and initia- the ensuing debate on the value of identifying a disorder if no tives associated with the UTMJ. For our final issue, we decided viable or definitive treatment currently exists.3 to focus on a topic that is widely popular, multifaceted and The topic of fetal treatment is another issue that often sometimes controversial: obstetrics and gynaecology. comes into the news headlines, with astonishing advances in The landscape of obstetrics and gynaecology is an ever- fetal therapy and fetal surgery. Familiar early fetal therapies changing one. For example, something as seemingly simple include simple procedures, such as the first transplacental as contraception has seen a continuous stream of changes and administration of glucorticoids to mature fetal lungs in situ- advancements over the years, which is evident in our Histori- ations of premature delivery in 1972.4 More advanced fetal cal Perspective article published by Foster in 1969. The prac- surgeries began in the 1980s, often credited
    [Show full text]
  • New Perspectives on the Late-Term Mare and Newborn Foal
    IN-DEPTH: PERINATOLOGY—END OF PREGNANCY THROUGH BEGINNING OF LIFE New Perspectives on the Late-Term Mare and Newborn Foal Wendy Vaala, VMD, Diplomate ACVIM Author’s address: Equine Technical Services, Intervet Inc., 29160 Intervet Lane, Millsboro, DE 19966; e-mail: [email protected]. © 2007 AAEP. 1. Introduction dotal observations and conclusions can be inferred, A successful perinatal program requires the col- because there is not a large enough number of clin- laborative efforts of those trained in reproduction ical cases with similar problems from which to and neonatology. In ambulatory situations, one draw significant conclusions. Until larger, multi- person must often specialize in both areas; addition- centric collaborative trials validate the usefulness of ally, that person must have the equipment and monitoring specific hormones or the efficacy of var- expertise available to manage obstetrical complica- ious therapies designed to manage and maintain tions and to provide neonatal resuscitation and complicated pregnancies, it is the author’s recom- nursing care. Periparturient complications during mendation that no one therapy or monitoring aid late pregnancy may include severe maternal illness should be relied on exclusively. Any mare receiv- or colic, reproductive tract disease, or fetal anoma- ing therapy to prolong an abnormal pregnancy lies. The most serious threats to uteroplacental should receive frequent assessment. That way, the health and foal survival are perinatal sepsis, hypox- clinician can promptly determine if silent or unde- ia/ischemia, and maturation disorders. The chal- tected fetal demise occurs without ensuing abortion lenge is to improve our ability to recognize mares or if parturition occurs without the customary warn- with jeopardized pregnancies at an earlier stage in ing signs.
    [Show full text]
  • Twin-To-Twin Transfusion Syndrome [1]
    Published on The Embryo Project Encyclopedia (https://embryo.asu.edu) Twin-to-Twin Transfusion Syndrome [1] By: DeRuiter, Corinne Keywords: Fetus [2] Congenital disorders [3] Human development [4] Twin-to-Twin Transfusion Syndrome (TTTS) is a rare placental disease that can occur at any time duringp regnancy [5] involving identical twins. TTTS occurs when there is an unequal distribution of placental blood vessels between fetuses, which leads to a disproportionate supply of blood delivered. This unequal allocation of blood leads to developmental problems in both fetuses that can range in severity depending on the type, direction, and number of interconnected blood vessels. TTTS only affects identical twin pregnancies during which the fetuses share ap lacenta [6] during development. The placenta [6] acts as an interface between the mother and twins during pregnancy [5], and is the organ that is responsible for supplying the developing fetuses with blood. Twins afflicted by TTTS have a higher mortality rate than twins without TTTS, especially if the syndrome occurs twenty-six weeks or earlier in pregnancy [5]. In describing TTTS, one of the developing fetuses is considered a donor twin and the other a recipient twin. TTTS occurs when the placenta [6] has fewer blood vessels that connect it to the donor twin than connect it to the recipient twin. The blood that would normally go to the donor twin is then diverted to the recipient twin, causing a reduction [7] in blood volume in the donor twin. This excess of blood in the recipient twin can strain the recipient twin’s heart and may ultimately lead to heart failure.
    [Show full text]
  • SARS-Cov-2 and Placenta: New Insights and Perspectives
    viruses Article SARS-CoV-2 and Placenta: New Insights and Perspectives Leonardo Resta 1 , Antonella Vimercati 2 , Gerardo Cazzato 1,* , Giulia Mazzia 1, Ettore Cicinelli 2, Anna Colagrande 1, Margherita Fanelli 3 , Sara Vincenza Scarcella 1, Oronzo Ceci 1 and Roberta Rossi 1 1 Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; [email protected] (L.R.); [email protected] (G.M.); [email protected] (A.C.); [email protected] (S.V.S.); [email protected] (O.C.); [email protected] (R.R.) 2 Department of Biomedical Sciences and Human Oncology, Gynecologic and Obstetrics Clinic, University of Bari “Aldo Moro”, 70124 Bari, Italy; [email protected] (A.V.); [email protected] (E.C.) 3 Medical Statistic, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; [email protected] * Correspondence: [email protected]; Tel.: +39-340-5203641 Abstract: The study of SARS-CoV-2 positive pregnant women is of some importance for gynecolo- gists, obstetricians, neonatologists and women themselves. In recent months, new works have tried to clarify what happens at the fetal–placental level in women positive for the virus, and different pathogenesis mechanisms have been proposed. Here, we present the results of a large series of placentas of Coronavirus disease (COVID) positive women, in a reference center for COVID-positive pregnancies, on which we conducted histological, immunohistochemical and electron microscopy investigations. A case–control study was conducted in order to highlight any histopathological alterations attributable to SARS-CoV-2.
    [Show full text]
  • Association Between Maternal Inflammatory Bowel Disease And
    Journal of Perinatology (2014) 34, 435–440 © 2014 Nature America, Inc. All rights reserved 0743-8346/14 www.nature.com/jp ORIGINAL ARTICLE Association between maternal inflammatory bowel disease and adverse perinatal outcomes D Getahun1,2, MJ Fassett3, GF Longstreth1, C Koebnick1, AM Langer-Gould1, D Strickland1 and SJ Jacobsen1 OBJECTIVE: To examine whether inflammatory bowel disease (IBD) is associated with ischemic/inflammatory conditions during pregnancy. STUDY DESIGN: A retrospective cohort study using the 2000 to 2012 Kaiser Permanente Southern California maternally-linked medical records (n = 395 781). The two major subtypes of IBD, ulcerative colitis and Crohn’s diseases were studied. Adjusted odds ratios (ORs) were used to quantify the associations. RESULT: A pregnancy complicated by IBD was associated with increased incidence of small-for-gestational age birth (OR = 1.46, 95% confidence interval (CI) = 1.14 to 1.88), spontaneous preterm birth (OR = 1.32, 95% CI = 1.00 to 1.76) and preterm premature rupture of membranes (OR = 1.95, 95% CI = 1.26 to 3.02). Further stratifying by IBD subtypes, only ulcerative colitis was significantly associated with increased incidence of ischemic placental disease, spontaneous preterm birth and preterm premature rupture of membranes. CONCLUSION: The findings underscore the potential impact of maternal IBD on adverse perinatal outcomes. Clinicians should be aware that the association between IBD and adverse perinatal outcome varies by IBD subtypes. Journal of Perinatology (2014) 34, 435–440; doi:10.1038/jp.2014.41; published online 20 March 2014 INTRODUCTION liver; these complications of CD tend to be more common with 15,16 Inflammatory bowel disease (IBD) is a generic term that refers colon involvement.
    [Show full text]
  • Placental Contribution to Obstetric Hemorrhage
    PLACENTAL CONTRIBUTION TO OBSTETRIC HEMORRHAGE Ware Branch, MD Medical Director of Women and Newborn Clinical Program for the Urban Central Region of Intermountain Healthcare Professor of Obstetrics and Gynecology, University of Utah, Salt Lake City Third Stage of Labor Sudden decrease in uterine size and area of implantation site Formation of retroplacental hematoma Uterine contraction Secondary clot formation Placental Contribution to Obstetric Hemorrhage • Placental abruption • Placenta previa • Placenta accreta (spectrum) Placental Contribution to Obstetric Hemorrhage • Uterine bleeding after 20 weeks complicates 5-10% of pregnancies; of these: – Abruption ~ 15% – Previa ~ 10% – Accreta ~? – Other (local / focal bleeding) Placental Contribution to Obstetric Hemorrhage Placental Abruption • Bleeding at the decidual-placental interface (maternal vessels in decidua basalis) à premature separation • Occurs in about 0.5-1% of pregnancies • Adverse outcomes: – Fetus/neonate: FGR, LBW, PTB, HIE, perinatal death – Mother: DIC, transfusion, hysterectomy, renal failure, death Placental Contribution to Obstetric Hemorrhage Placental Abruption • Estimated to be the cause of ~10% of preterm births and ~10% of perinatal deaths • Maternal mortality – In about about 1% of serious abruption cases – Attributable cause of 7 maternal deaths in UK, 2000-2005 Placental Contribution to Obstetric Hemorrhage Placental Abruption Risk Factors for Abruption Demographic or Historical Current Medical Behavioral •Prior abrupon •Hypertensive dise ase • Maternal age
    [Show full text]
  • Risk of Ischemic Placental Disease Is Increased Following in Vitro Fertilization with Oocyte Donation: a Retrospective Cohort Study
    Journal of Assisted Reproduction and Genetics (2019) 36:1917–1926 https://doi.org/10.1007/s10815-019-01545-3 ASSISTED REPRODUCTION TECHNOLOGIES Risk of ischemic placental disease is increased following in vitro fertilization with oocyte donation: a retrospective cohort study Anna M. Modest1,2 & Katherine M. Johnson1 & S. Ananth Karumanchi3,4 & Nina Resetkova5 & Brett C. Young1 & Matthew P. Fox2,6 & Lauren A. Wise2 & Michele R. Hacker1,7 Received: 23 May 2019 /Accepted: 23 July 2019 /Published online: 29 July 2019 # Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Purpose Assess the risk of ischemic placental disease (IPD) among in vitro fertilization (IVF; donor and autologous) pregnancies compared with non-IVF pregnancies. Methods This was a retrospective cohort study of deliveries from 2000 to 2015 at a tertiary hospital. The exposures, donor, and autologous IVF, were compared with non-IVF pregnancies and donor IVF pregnancies were also compared with autologous IVF pregnancies. The outcome was IPD (preeclampsia, placental abruption, small for gestational age (SGA), or intrauterine fetal demise due to placental insufficiency). We defined SGA as birthweight < 10th percentiles for gestational age and sex. A secondary analysis restricted SGA to < 3rd percentile. Results Of 69,084 deliveries in this cohort, 262 resulted from donor IVF and 3,501 from autologous IVF. Compared with non- IVF pregnancies, IPD was more common among donor IVF pregnancies (risk ratio (RR) = 2.9; 95% CI 2.5–3.4) and autologous IVF pregnancies (RR = 2.0; 95% CI 1.9–2.1), adjusted for age and parity. IVF pregnancies were more likely to be complicated by preeclampsia (donor RR = 3.8; 95% CI 2.8–5.0 and autologous RR = 2.2; 95% CI 2.0–2.5, adjusted for age, parity, and marital status), placental abruption (donor RR = 3.8; 95% CI 2.1–6.7 and autologous RR = 2.5; 95% CI 2.1–3.1, adjusted for age), and SGA (donor RR = 2.7; 95% CI 2.1–3.4 and autologous RR = 2.0; 95% CI 1.9–2.2, adjusted for age and parity).
    [Show full text]
  • Placental Function
    Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine 1066 Placental Function An Epidemiological and Magnetic Resonance Study SARA SOHLBERG ACTA UNIVERSITATIS UPSALIENSIS ISSN 1651-6206 ISBN 978-91-554-9142-0 UPPSALA urn:nbn:se:uu:diva-239294 2015 Dissertation presented at Uppsala University to be publicly examined in Auditorium Minus, Gustavianum, Akademigatan 3, Uppsala, Friday, 27 February 2015 at 09:00 for the degree of Doctor of Philosophy (Faculty of Medicine). The examination will be conducted in Swedish. Faculty examiner: Professor Karel Marsal (Lunds universitet). Abstract Sohlberg, S. 2015. Placental Function. An Epidemiological and Magnetic Resonance Study. Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine 1066. 72 pp. Uppsala: Acta Universitatis Upsaliensis. ISBN 978-91-554-9142-0. Placental function is central for normal pregnancy and in many of the major pregnancy disorders. We used magnetic resonance imaging techniques to investigate placental function in normal pregnancy, in early and late preeclampsia and in intrauterine growth restriction. We also investigated maternal body mass index and height, as risk factors for preeclampsia. A high body mass index and a short maternal stature increase the risk of preeclampsia, of all severities. The association seems especially strong between short stature and early preeclampsia, and a high body mass index and late preeclampsia. (Study I) Using diffusion-weighted magnetic resonance imaging, we found that the placental perfusion fraction decreases with increasing gestational age in normal pregnancy. Also, the placental perfusion fraction is smaller in early preeclampsia, and larger in late preeclampsia, compared with normal pregnancies. That these differences are in opposite directions, suggests that there are differences in the underlying pathophysiology of early and late preeclampsia.
    [Show full text]
  • Placental Abruption: Clinical Features and Diagnosis
    Official reprint from UpToDate® www.uptodate.com ©2017 UpToDate® Placental abruption: Clinical features and diagnosis Authors: Cande V Ananth, PhD, MPH, Wendy L Kinzler, MD Section Editor: Charles J Lockwood, MD, MHCM Deputy Editor: Vanessa A Barss, MD, FACOG All topics are updated as new evidence becomes available and our peer review process is complete. Literature review current through: May 2017. | This topic last updated: Feb 23, 2017. INTRODUCTION — Placental abruption (also referred to as abruptio placentae) is bleeding at the decidual-placental interface that causes partial or complete placental detachment prior to delivery of the fetus. The diagnosis is typically reserved for pregnancies over 20 weeks of gestation. The major clinical findings are vaginal bleeding and abdominal pain, often accompanied by hypertonic uterine contractions, uterine tenderness, and a nonreassuring fetal heart rate (FHR) pattern. Abruption is a significant cause of maternal and perinatal morbidity, and perinatal mortality. The perinatal mortality rate is approximately 20-fold higher in comparison to pregnancies without abruption (12 percent versus 0.6 percent, respectively) [1]. The majority of perinatal deaths (up to 77 percent) occur in utero; deaths in the postnatal period are primarily related to preterm delivery [1-4]. However, perinatal mortality associated with abruption appears to be decreasing [1]. INCIDENCE — Placental abruption complicates approximately 1 percent of pregnancies [5,6], with two-thirds classified as severe due to accompanying maternal, fetal, and neonatal morbidity [7]. The incidence appears to be increasing in the United States, Canada, and several Nordic countries [5], possibly due to increases in the prevalence of risk factors for the disorder and/or to changes in case ascertainment [8,9].
    [Show full text]
  • Stillbirth: Management and Prevention
    10/22/20 njm MANAGEMENT AND PREVENTION OF STILLBIRTH BACKGROUND -incidence approximately 1 in 150 pregnancies -recurrence approximately 3% (depends on underlying cause) -parents often have these 3 questions: -Why did this happen? -Could it happen again? -What do we do now? ETIOLOGY Most frequent causes: -fetal growth restriction -post dates (poorly dated pregnancy) -fetal aneuploidy (abnormal number of chromosomes) (Down syndrome and Turner Syndrome = most common) -lethal fetal anomalies/syndromes -hypertensive disease (principally due to unexpected abruption) -poorly controlled diabetes -extreme obesity, especially close to term (pathophysiology unclear) -thyroid disease (both hyper- and hypo-) -intrahepatic cholestasis of pregnancy -lupus erythematosus (especially with antiphospholipid syndrome or renal insufficiency) -fetal infections (cytomegalovirus, parvovirus, syphilis, etc.) -feto-maternal hemorrhage (especially after trauma) -nevertheless, up to a third of stillbirths are idiopathic, despite work up -cord accidents are actually an uncommon, but commonly ascribed, cause of stillbirths (excluding overt cord prolapse, velamentous insertion, entanglement of monoamnionic twins) -likewise, the inherited thrombophilias are no longer thought to be a significant cause of stillbirth IUFD WORK-UP A thorough work up can provide answers to the family and give insight to future clinical care. Fetal gross exam findings: The following gross findings appear to be good predictors of the time of fetal death: ●Brown or red discoloration of the umbilical cord or desquamation ≥1 cm suggests the fetus has been dead at least six hours before delivery. ●Desquamation of the face, back, abdomen suggests the fetus has been dead at least 12 hours before delivery. ●Desquamation ≥5 percent of the body or ≥2 body zones suggests the fetus has been dead at least 18 hours before delivery (body zones = scalp, face, neck, chest, back, arms, hand, leg, foot, scrotum).
    [Show full text]