Possible Role of Trophoblast in Preeclampsia
Gérard Chaouat in The Immunology of the Fetus, 2020
Some knowledge of placental structure and development is necessary over and above that provided in preceding chapters, because we depend on it for “a true understanding of many aspects of placental pathology”.16 The information in Table 1 must, therefore, be interpreted with the following caveats in mind: The morphology of the placenta is in a state of continual flux.16Its appearances alter not only as gestation advances but depend on what area is examined.16The fetally derived tissue recognized at parturition as “the placenta” is only part of the maternofetal interaction. The interrelationship and interaction of fetal trophoblast with maternal decidua in the placental bed are of key importance.Our understanding is far from complete. New techniques for examining tissues are rightly constrained by the ethics of obtaining tissue from normal human pregnancies.
Pathologic abnormalities of placental structure and function in diabetes
Moshe Hod, Lois G. Jovanovic, Gian Carlo Di Renzo, Alberto de Leiva, Oded Langer in Textbook of Diabetes and Pregnancy, 2018
Placental pathology in pregnancies complicated by maternal diabetes varies based on physiological influences including the type of diabetes, degree of dysglycemia, and insulin use.11,21,27 Type 1 diabetes is associated with increased capillary volume and greater degrees of vascular dysfunction, including increased branching and nonbranching angiogenesis, likely the result of increased leakiness of fetal placental vessels.21,22 In addition, studies have shown that women with type 1 diabetes have a higher prevalence of placental dysmaturity while women with type 2 diabetes have a higher prevalence of placental infarcts.21 Compared to gestational diabetes, pregestational diabetes results in a greater number of histopathologic lesions, such as chorial edema and interstitial hemorrhage,33 while gestational diabetes has been associated with increased fibrinoid material, villous edema, hyperplasia, and thickening of the basement membrane.34
Hepatic tumors
Prem Puri in Newborn Surgery, 2017
Choriocarcinoma is a rapidly growing, hemorrhagic tumor of the trophoblastic tissues. The placenta is believed to be the site of origin, with subsequent hematogenous metastasis in the infant and/or mother. The liver is the most frequently involved site in infants. Choriocarcinoma in the neonatal period is a rare (approximately 1:40,000 pregnancies), life-threatening malignancy but one that is highly responsive to the appropriate early treatment when instituted.169 The disease is generally recognized late in the neonate with median age of symptomatology at 1 month. Cases have been documented and treated successfully, both in the presence and absence of maternal or placental disease.170–172 Bolze et al.173 confirmed a case of transplacental transmission through tumor genotyping, strengthening the theorized mechanism of hematogenous spread from mother to child. The absence of placental disease can be explained by the presence of even a microscopic focus of primary disease in the placenta missed on histopathology; a placental focus of choriocarcinoma is not always present in maternal disease either.
Evaluation of the relation between placental weight and placental weight to foetal weight ratio and the causes of stillbirth: a retrospective comparative study
Published in Journal of Obstetrics and Gynaecology, 2018
Norbert Pásztor, János Sikovanyecz, Attila Keresztúri, Zoltan Kozinszky, Gábor Németh
After the labour, both the foetus and the placenta were weighed at the delivery suite without umbilical cord and membranes. Autopsies and placental histopathological examinations were conducted by pathologists based on standard guidelines (Benirschke and Kaufmann 1995; Siebert 2007). The Tulip classification was applied to the present population; relevant categories for causes of death were determined as described earlier (Korteweg et al. 2006) (Table 1). Briefly, the Tulip classification system categorises foetal death by underlying causes and pathomechanisms on the basis of both clinical and pathological findings, with a relatively low percentage of unknown causes. Furthermore, Tulip classification allows good inter-rater agreement and was easy to use for the clinicians (Korteweg et al. 2006). Subcategories for placental pathology were demonstrated in detail. The pathology of placental bed was characterised by inadequate spiral artery remodelling and/or pathological signs in spiral arteries leading to uteroplacental vascular insufficiency. Placental pathology involves morphologic abnormalities, disorders of parenchyma and abnormal localisation of placenta. Umbilical cord complication comprises a constricting knot/loop around the neck, which could be recognised by histopathological evidence of foetal vascular obstruction. Manifestation of infection implied evidence of organ involvement with organism and/or diagnosing infectious findings in placental tissue. Other foetal or maternal pathological conditions leading to foetal death may be responsible for other causes (Korteweg et al. 2006).
Recurrence of Basal Plate Myofibers, with Further Consideration of Pathogenesis
Published in Fetal and Pediatric Pathology, 2019
Debra S. Heller, Rachel Wyand, Stewart Cramer
The placenta is the only tissue routinely submitted to pathology that had contributions from two separate human beings – the mother and her newborn; thus, placental pathology reports can also have implications for the future health of the mother (6). Placenta accreta can cause life-threatening postpartum hemorrhage, and its frequency has increased tenfold as the rate of Cesarean section has increased (9). This has caused increasing concern amongst clinicians, but it is not listed in the 1997 CAP guidelines for placental examination; at least partly because much of the important work in this area has been done after 1997. In 2001, Khong and Werger brought to the attention of general pathologists that basal plate myofibers (BPMF) can be found in the absence of clinical evidence of placenta accreta (10). Ernst and coworkers have suggested that BPMF are a risk factor for future placenta accreta (11,12). Most recently, it was reported that half the cases with major hemorrhage (>1500 cc) in the following pregnancy were in cases where the only evidence of placenta accreta was histologic (13). Both submitting more blocks, and adjunctive immunostaining for muscle markers can enhance detection of BPMF (6,10). In addition, it is only recently that the pathogenesis of pre-delivery basal plate damage in BPMF placentas has been seriously addressed (6,9,14).
Association of Placental Pathologic Findings with the Severity of Necrotizing Enterocolitis in Preterm infants – A Matched Case-Control Study
Published in Fetal and Pediatric Pathology, 2023
Parvesh Mohan Garg, Jaslyn L. Paschal, Md Abu Yusuf Ansari, Lauren Billington, Jennifer Ware, Kristin Adams, Youssef Al Hamda, Adebamike Oshunbade, Charles R. Rosenfeld, Imran N. Mir
In summary, using a standardized placental pathology classification, this single-center matched case-control study of predominantly African-American preterm infants with NEC showed that acute histologic chorioamnionitis with a fetal inflammatory response was associated with increased severity of NEC and the need for surgery. Our findings support the emerging theory that prenatal risk factors may contribute to NEC's increased risk and severity in preterm infants. Our results suggest that placental pathology findings may be valuable in shedding light on prenatal pathologic processes underlying the pathogenesis and severity of NEC in preterm infants. Finally, we speculate that the pro-inflammatory response seen in NEC could be explained by the further activation of an already primed inflammatory cascade and warrants further study. In the future, prospective multi-center studies, including additional clinical, maternal and laboratory predictors (e.g., inflammatory biomarkers), may help us better understand the mechanisms associated with the placental pathology and development of NEC and its severity.
Related Knowledge Centers
- Placenta
- Pre-Eclampsia
- Intrauterine Growth Restriction
- Placental Abruption
- Placenta Accreta Spectrum
- Placentitis
- Villitis of Unknown Etiology
- Vertically Transmitted Infection
- Circumvallate Placenta
- Placental Villous Immaturity