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The great obstetric syndromes: The roots of disease
Published in Moshe Hod, Lois G. Jovanovic, Gian Carlo Di Renzo, Alberto de Leiva, Oded Langer, Textbook of Diabetes and Pregnancy, 2018
Rinat Gabbay-Benziv, Ahmet A. Baschat
Microscopically, a number of lesions have been found in increased frequency in placentas of diabetic women compared to controls. Villous fibrinoid necrosis, a condition where villous stroma is replaced by fibrinoid material, and villous immaturity with a decreased formation of terminal villi are observed. These changes may affect maternal–fetal nutrient delivery and gas exchange and accordingly may be precursors to otherwise unanticipated fetal complications such as stillbirth.26,27 Chorangiosis and vascular hyperplasia of the chorionic villi are defined as the occurrence of 10 or more villi with 10 or more capillaries in 10 or lower-power microscopic fields and may be a result of increased vascular recruitment that occurs with placental overgrowth. Infarction of 10% or more of the placenta and evidence of ischemia (Tenney–Parker changes) resulting in increased maturation of branching villi and increased numbers of fetal nucleated red blood cells as a marker of chronic fetal hypoxemia are also more commonly seen in the placentas of diabetic women.
The Role of Mesenchymal Stem Cells in the Functions and Pathologies of the Human Placenta
Published in Ornella Parolini, Antonietta Silini, Placenta, 2016
Gina Diamanta Kusuma, Padma Murthi, Bill Kalionis
Fetal and maternal vascular abnormalities include a large group of placental pathologies, such as fetal thrombotic vasculopathy; hypertrophic decidual vasculopathy, where the smooth muscle of the maternal decidual blood vessels is hypertrophic; excess blood vessels in the chorionic villi called chorangiosis; chorangioma; and placental infarctions, which are localized areas of tissue that are dead or dying after deprivation of the blood supply.
Chronic myeloid leukaemia in pregnancy: call for guidelines
Published in Journal of Obstetrics and Gynaecology, 2019
Pallavee P., Rupal Samal, Seetesh Ghose
We share our experience of two cases of pregnancy in CML patients treated with Imatinib and had two different outcomes. Both were in the chronic phase, of which, the first was a 25-year old primigravida diagnosed with CML 3 years prior, on Imatinib 600 mg OD. Though she had planned her pregnancy, she did report for preconceptional counselling and had continued Imatinib at the same dosage until 10 weeks of gestation. Later, she stopped Imatinib on her own due to hyperemesis gravidarum and restarted it at a reduced dose of 200 mg at around 16 weeks of gestation. Her first antenatal check up with us was at 24 weeks, when she was asymptomatic, with normal examination findings and a blood picture which showed Hb of 12.5% per gram, leukocytosis of 31,000 cells/cm and a platelet count of 3.5 lakhs/cm. Her anomaly scan was normal. Later, she presented with eclampsia at 26 weeks of gestation, for which termination of pregnancy was done. The foetus had no gross anomalies on inspection and a histopathology of the placenta revealed chorangiosis. The second case was a 29-year old G4A3 diagnosed with CML 6 years prior, who had two induced abortions while on Imatinib, following which she had a spontaneous abortion, all of these in the first trimester. The fourth was a planned pregnancy, and she discontinued Imatinib prior to her pregnancy and delivered a healthy neonate at 38 weeks of gestation.
Giant Hepatic Hemangioma and Placental Chorangiosis: A Unique Case of Stillbirth?
Published in Fetal and Pediatric Pathology, 2019
Michele Paudice, Leonardo Alett Peñuela, Flaminia Torielli, Bruno Spina, Valentino Remorgida, Francesca Buffelli, Ezio Fulcheri, Cesare Arioni, Valerio Gaetano Vellone
Hepatic hemangiomas (HH) are benign vascular tumors accounting for most of the fetal and neonatal hepatic tumors. In the literature, only a few cases of prenatally diagnosed HH have been reported. Focal HH is the most common type, whereas only two cases of multiple fetal HH have been described [1, 2]. The diagnosis of fetal HH is mainly based on prenatal imaging, including ultrasonography (US), color-Doppler imaging and MR scan. The prognosis of fetal HH ranges from asymptomatic to life threatening conditions, including fetal hydrops, cardiac failure, consumptive coagulopathy and tumor rupture [3]. The term chorangiosis refers to placental villus capillary hypervascularity. It is associated with placental malperfusion and long-standing fetal hypoxia. Altshuler [4] proposed the diagnostic criteria for this condition: the presence of a minimum of ten villi, each with ten or more vascular channels, in ten or more areas of three or more random placental areas when using ocular magnification (×10). Possible complications are cardiac failure, anemia and thrombocytopenia [5]. We report a stillbirth with acute congestive heart failure (CHF) and myocardial infarction with HH and placental chorangiosis.