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Collagen Diseases and Intrauterine Growth Retardation
Published in Asim Kurjak, John M. Beazley, Fetal Growth Retardation: Diagnosis and Treatment, 2020
Danniel Weinstein, Joseph G. Schenker
In spite of detailed clinical observation reported in hundreds of pregnant patients with collagen diseases (especially with SLE), very little information has been recorded on the placenta in these cases, with or without IUGR. In the two studies82,93 in which electron microscopy was performed on placentas of 11 normal and 13 SLE patients, it failed to disclose any increased expression of viral activity in the SLE patients over the normal. On the contrary, some investigations have found viral particles in human placentas from SLE patients.93,94 Grennan et al.48 performed immunological studies and found granular deposits of immunoglobulins and C3 in trophoblast basement membranes and nuclei, which may play a role in the poor fetal outcome. In complicated pregnancies, particularly with maternal hypertension or preeclampsia, uteroplacental vessels are altered by occlusive lesions, such as fibrinoid necrosis, inflammation, and infiltration of the vascular wall by large cells with lipid-laden foamy cytoplasm for which the term atherosis was coined.95,96 Although there is a current controversy on the clinical significance of these lesions, it is generally agreed that impairment of uteroplacental blood flow results in variable placental dysfunction, which may culminate in placental infarction, and, as a consequence, in prematurity, IUGR, and death.
Possible Role of Trophoblast in Preeclampsia
Published in Gérard Chaouat, The Immunology of the Fetus, 2020
Figure 2 shows the placenta (cut into 1-cm slices) of a woman with severe preeclampsia accompanied by marked retardation of fetal growth. The most evident feature is of multiple infarcts due to ischemia and necrosis of villi. These infarcts are solely due to impaired blood supply from the maternal circulation, and their incidence is directly related to the severity of the condition.1 However, placental infarction is neither specific to preeclampsia nor an invariable consequence of the syndrome.
Lupus Anticoagulants
Published in Hau C. Kwaan, Meyer M. Samama, Clinical Thrombosis, 2019
Most LAs are IgG inhibitors, but IgG and IgM15 anticoagulants have also been described. No thrombotic complications were found in those with the IgM immunoglobulin class. The high thrombogenic risk is related to the antiphospholipid antibody affecting multiple locations where membrane phospholipid is present. The antibody acting on the phospholipid on endothelial cell membranes would impair the endothelial cell functions, including the synthesis of prostacyclin, thrombomodulin, and activation of protein C,16 and the action on platelet phospholipids would increase thromboxane formation.17 The anticoagulant effect is due to the inhibition of the calcium-dependent binding of Factor X and prothrombin to phospholipid micelles.18,19 The thrombotic complications of pregnancy are believed to be due to thrombosis of the placental vessels resulting in placental infarction.13,14,20 Although the extent of infarction may not account for all the fetal deaths, the antiphospholipid antibody is believed to impair placental growth and nutrient transport, which leads to the detriment of the fetus.
Doppler ultrasound findings in symptomatic pregnant women diagnosed with COVID-19
Published in Journal of Obstetrics and Gynaecology, 2022
Selami Erdem, Mehmet Irfan Kulahcioglu
SARS-CoV-2 enters cells by interacting with the angiotensin-converting enzyme receptor, the expression of which is increased in the uterus and placenta (Malinowski et al. 2020; Dhaundiyal et al. 2021). Foetal and maternal vascular malperfusion characterised by decidual arteriopathy have been reported in pathologies of placentas from pregnant women with SARS-CoV-2 infection (Baergen and Heller 2020; Shanes et al. 2020). Placental infarction areas and impaired perfusion were found in the pathological examination of the placenta of a case with intrauterine growth restriction and severe oligohydramnios (Moltner et al. 2021). Similarly, thrombotic events were reported more frequently in inpatients treated for covid-19, and endothelial damage and vasculopathy were detected to be higher compared to influenza infection (Ackermann et al. 2020; Klok et al. 2020). In addition, a previous study reported that SARS-CoV-2 infection in pregnant women may cause complications, such as premature birth, intrauterine growth restriction and maternal death8. Therefore, ultrasound and Doppler evaluations are required in pregnant women with SARS-CoV-2 infection (Favre et al. 2020).
Delivery outcomes in women with morbid obesity, where induction of labour was planned to prevent post-term complications
Published in Journal of Obstetrics and Gynaecology, 2022
J. D. Kammies, L. De Waard, C. J. B. Muller, D. R. Hall
Of the 40 (34.2%) emergency CS’s, five babies had Apgar scores <7 at 5 min, while three had respiratory distress syndrome. There was one intrauterine foetal death at 40 weeks 6 d. At the 36-week antenatal visit, the umbilical artery Doppler velocimetry had been normal and the baby well-grown. The patient presented 3 d after cessation of foetal movements. Placental histology demonstrated placental infarction with maternal vascular malperfusion, evidenced by a growth-restricted baby weighing 2985 g, which plotted between the 3rd and 10th percentile on local charts (Lavin et al. 2019).
Immunohistochemical localization of heme oxygenase-1 and bilirubin/biopyrrin of heme metabolites as antioxidants in human placenta with preeclampsia
Published in Hypertension in Pregnancy, 2020
Michiko Miya, Aikou Okamoto, Takashi Nikaido, Rie Tachimoto-Kawaguchi, Tadao Tanaka
Although no significant difference was observed in the placental weights between the two groups (p = 0.08), the PE group tended to have lower values, and the p-quantile was significantly lower in the PE group than in the control group (p < 0.01). Placental infarction was observed in four PE cases.