The correlation of ultrasonic placental grading and fetal pulmonary maturation in five hundred sixty-three pregnancies

In a previous study, it was suggested that the presence of a grade III placenta correlates 100% with a mature lecithin/sphingomyelin (L/S) ratio and may replace amniocentesis in confirming fetal lung maturity. In this study that hypothesis was tested in 563 pregnancies. All patients underwent amniocentesis and simultaneously had placental grading. The correlations of placental grade with an L/S ration ≥2 were: grade 0, 17%; grade I, 68%; grade II, 91%; grade III, 93%. The correlations of placental grade with the presence of phosphatidylglycerol (PG) were: grade 0, 17; grade I, 41%; grade II, 79%; grade II, 75%. The false positive rates associated with grade III placenta were, therefore, 7% for mature L/S ratio and 25% for PG present; when combined with a biparietal diameter ≥9.0 cm, a grade III placenta incorrectly predicted lung maturity in 8.5%. We conclude that placental grading is not accurate enough to replace amniocentesis as the standard test of fetal pulmonary maturity.     

Ultrasonographically observed preterm grade III placenta and perinatal outcome

Ultrasound studies of placenta were conducted in 270 singleton normal pregnancies. Women were enrolled between 31 and 34 weeks of gestation and were followed up for the outcome of pregnancy. Women with grade III placental maturity comprised the study group (n = 64) and those with grade I placenta were enrolled as control group (n = 206). Another 100 normal women were enrolled to note the prevalence of grade III placenta at term. There was an increased incidence of intrauterine growth retardation (6.20%) and fetal distress (7.8%) in the study group compared with the control group (nil), which was statistically significant. The incidence of low birth weight was also higher (34.37%) in the study group compared with the control group (22.33%). Three women in the study group developed preeclampsia at subsequent follow up visit but none in control group (P less than 0.01). Prevalence rate of grade III placenta at term was 28%. In view of these findings preterm grade III placenta is found to be a sensitive predictor of poor perinatal outcome.     

Plasma Antithrombin III Levels in Pre-Eclampsia

In a prospective study plasma AT III was determined in 2423 samples obtained from 653 women during pregnancy and post partum. The women were allocated to groups, according to the highest diastolic blood pressure, in the third trimester. AT III levels were normal throughout pregnancy, during labour and after vaginal delivery, except in 57 women with pregnancy induced or aggravated hypertension. We present evidence that AT III depression in pre-eclampsia is caused by increased consumption. AT III levels correlate with maternal morbidity as revealed by hepatorenal damage. A weak but significant correlation of AT III and platelets with placental infarction was demonstrated. Proteinuria was the best predictor of fetal outcome. AT III plasma levels increased the number of correct predictions. Following vaginal delivery AT III plasma levels rapidly returned to normal values.     

Antithrombin III activity in normal and toxemic pregnancies.

From August 1989 to October 1990, 83 pregnant Chinese women were the subjects for measuring the levels of plasma functional antithrombin III (AT III) activity. The correlations of AT III activity with perinatal outcome and the changes in maternal hepatorenal function were analyzed. The population was divided into four groups: Group I (n = 30), normal pregnancies; Group II (n = 23), mild pre-eclampsia; Group III (n = 26), severe pre-eclampsia; and Group IV (n = 4), eclampsia. The results demonstrated that: 1) AT III activity decreased with the severity of toxemia (p < 0.001), 2) AT III activity correlated with the degree of perinatal outcome and maternal morbidity, and 3) reduction of AT III activity correlated with impairment of maternal hepatorenal function. In conclusion, plasma AT III activity is a valuable parameter in the evaluation of toxemia.     

Hemostatic variables as independent predictors for fetal growth retardation in preeclampsia

BACKGROUND: Preeclampsia is a major contributor to perinatal disease and fetal growth retardation (FGR). It has been suggested that increased intravascular coagulation, fibrin deposition in spiral arteries and hypoperfusion of the placenta are involved in these pregnancy complications. METHODS: Multiple variables of the hemostatic system and lipid metabolism, as well as clinical features, were entered into univariate and multivariate models in order to examine the association with preeclampsia and FGR. RESULTS: Two hundred women with preeclampsia and 97 normotensive pregnant women were examined. Plasma levels of the thrombin-antithrombin complex (TAT), tissue factor pathway inhibitor free antigen (TFPI-Fag), protein S free antigen, plasminogen activator inhibitor type-1 (PAI-1) activity and serum levels of triglycerides were significantly increased, whereas plasma levels of antithrombin (AT), fibrinogen, C4b-binding protein (C4b-BP), PAI-2 antigen and serum HDL-cholesterol levels were decreased in the presence of preeclampsia. In the multivariate regression analysis, high TFPI-Fag plasma levels were associated with the presence of preeclampsia. The presence of FGR was in the univariate analysis associated with decreased PAI-1 activity and lower concentrations of fibrin, fibrinogen, factor VII antigen and PAI-2 antigen, as well as with evidence of macroscopic placental infarction. In a multivariate regression model, low maternal weight, placental infarction and low PAI-2 levels were predictors for low birth weight. In a logistic regression model, with the presence or absence of FGR as the dependent variable, male sex of the infant, placental infarction, low PAI-1 activity and factor VII antigen or PAI-2 antigen levels were independent predictors. CONCLUSIONS: Our results are consistent with activated coagulation in the placental vessels in preeclampsia. A low concentration of PAI-2 antigen in plasma emerged as the most consistent risk factor for preeclampsia and FGR.     

The effect of pre-existing maternal obesity and diabetes on placental mitochondrial content and electron transport chain activity

Introduction

Mitochondria dysfunction has been extensively implicated in the progression of these metabolic disorders, their role in placental tissue of diabetic and/or obese pregnant women is yet to be investigated. The aim of this study was to determine the effect of pre-existing type 1 and type 2 diabetes mellitus (DM), and pre-existing maternal obesity on placental mitochondrial function as assessed by mitochondrial content, electron transport chain (ETC) complex activities and oxidative stress.

Methods

Human placenta was obtained at the time of term Caesarean section from (i) non-obese (n = 19) and obese (n = 23) normal glucose tolerant (NGT) pregnant women; (ii) women with type 1 DM (n = 14) and BMI-matched NGT women (n = 14); and (iii) women with type 2 DM (n = 11) and BMI-matched NGT women (n = 11). The following endpoints were assessed: placental mitochondrial content by citrate synthase activity and mitochondrial DNA (mtDNA content); mitochondrial respiratory chain activity (complexes I, II, II & III, III and IV), and mitochondrial ROS (as assessed by mitochondrial hydrogen peroxide (H₂O₂) levels).

Results

When compared to placenta from NGT non-obese women, there was significantly lower mitochondrial DNA (mtDNA) content and electron transport chain complex I activity, and significantly higher mitochondrial H₂O₂ levels in placenta from NGT obese women (P < 0.05). Placental tissue from type 1 DM women showed significant reductions in ETC complex I, II & III, and III activity and increased H₂O₂ levels when compared to BMI-matched NGT women (P < 0.05). Type 2 DM women only exhibited significantly reduced ETC complex II & III activity when compared to BMI-matched NGT women (P < 0.05).

Discussion and conclusions

Women with pre-existing obesity or diabetes have decreased placental mitochondrial respiratory chain enzyme activities which may have detrimental consequences on placental function and therefore fetal growth and development.     

To ignore or not to ignore placental calcifications on prenatal ultrasound: a systematic review and meta-analysis

Objective: The human placenta is known to calcify with advancing gestational age, and, in fact, the presence of significant calcifications is one of the components of grade III placenta, typical of late gestation. As such, the presence of significant placental calcifications often prompts obstetric providers to expedite delivery. This practice has been attributed, in part, to the presumed association between grade III placenta and adverse pregnancy outcomes. Such approach, however, can be the source of major anxiety and may lead to unnecessary induction of labor, with its associated predisposition to cesarean delivery as well as a myriad of maternal and neonatal morbidities. The objective of this study was to examine the association between grade III placental calcifications and pregnancy outcomes.

Materials and methods: A systematic review of the literature was performed for studies evaluating the association between grade III placenta and a number of pregnancy outcomes, including labor induction, fetal distress (abnormal fetal heart tracing), low Apgar score (less than 7 at 5?min), need for neonatal resuscitation, admission to the Neonatal Intensive Care Unit, perinatal death, meconium liquor, and low birth weight.

Results: There was a five-fold increase in risk of labor induction with the presence of grade III placenta (OR 5.41; 95% CI 2.98–9.82). There was no association between grade III placenta and the incidence of abnormal fetal heart tracing (OR 1.62; 95% CI 0.94–2.78), low Apgar score of less than 7 at 5?min (OR 1.68; 95% CI 0.84–3.36), need for neonatal resuscitation (OR 1.08; 95% CI 0.67–1.75), and admission to the Neonatal Intensive Care Unit (OR 0.90; 95% CI 0.21–3.74). In turn, the incidence of meconium liquor was higher in the setting of grade III placentae (OR 1.68; 95% CI 1.17–2.39). Similarly, a positive association between grade III placental calcifications and low birth weight (OR 1.63; 95% CI 1.19–2.22) and perinatal death (OR 7.41; 95% CI 4.94–11.09) was identified.

Conclusion: The study alerts us to a significant association between grade 3 placental calcifications and labor induction, although it demonstrates that these sonographic findings do not appear to predispose to fetal distress, low Apgar score, need for neonatal resuscitation, or admission to the NICU.     

The fetal biophysical profile in pregnancies with grade III placentas

The components of the fetal biophysical profile of pregnancies with grade III placentas and good outcome were retrospectively analyzed and compared to the fetal biophysical components of pregnancies with grade 0 to II placentas. The results of the present study suggest that the dynamic components of the fetal biophysical profile (nonstress test, fetal breathing movements, fetal movements, fetal tone) are not altered in the presence of a grade III placenta and good pregnancy outcome; however, a greater incidence of reduced amniotic fluid volume was found in the presence of grade III placenta. The clinical significance of grade III placenta is discussed.     

Antithrombin III levels in normotensive and hypertensive pregnancy

Antithrombin III (AT III) is the main physiological inhibitor of blood coagulation. In a prospective study, plasma AT III was determined in 653 women during pregnancy, using an automated amidolytic technique. A control value 8 weeks after delivery was obtained in 192 of the women. In women with pregnancy-induced or aggravated hypertension a significant decrease in AT III levels was observed compared with normotensive controls of the same period of gestation and compared with the patients' own control values 6-8 weeks after delivery. No AT III depression occurred in patients with chronic hypertension during pregnancy. Patients with pregnancy hypertension and proteinuria had lower AT III levels than those without proteinuria, whose AT III levels were also depressed. Lowest AT III levels were seen in 2 eclamptic patients and in patients with severe preeclampsia, whose pregnancies were terminated for fetal distress while the infants were still preterm. Monitoring At III levels is of value in preeclampsia.     

Changes in coagulability and fibrinolytic activity in the patients with ovarian hyperstimulation syndrome]

Ovarian hyperstimulation syndrome (OHSS) is occasionally seen following hMG-hCG treatment in combination with a GnRH agonist. Increased coagulability and decreased renal perfusion may be life threatening in some severe cases. In order to evaluate coagulo-fibrinolytic activity, several related factors in the general circulation were examined for approximately 2 weeks after admission in 11 patients with severe OHSS. The results are as follows. 1. Fibrinopeptide A (FPA) was increased during the initial stage of OHSS followed by a gradual decrease. However, the level remained slightly higher than normal for 2 weeks after the onset of severe OHSS. 2. Fibrinopeptide B beta 15-42 (FPB beta 15-42) showed grossly similar patterns to those of FPA. 3. D-dimer levels were constantly higher than normal from the initial to the late stages of OHSS. 4. Thrombin-Antithrombin III complex (TAT) was markedly increased on the days of admission followed by a gradual decrease during the following week. 5. Antithrombin III (ATIII), plasminogen and alpha 2 plasmin inhibitor (alpha 2PI) showed only minimal decreasing patterns throughout blood samplings. 6. Increases in FPA, FPB beta 15-42 and D-dimer were greater in the cases with severe hemoconcentrations. Our present data suggest that severe OHSS brings on hypercoagulability resulting in microthrombosis. In order to avoid development of coagulopathy, prophylactic treatment should be considered for patients with OHSS.     

Relation of placental prolactogen and E3 in the blood of pregnant women to placental grading by ultrasonography and its clinical significance

Serum HPL and E3 of normal pregnant women and some pathologic pregnancies were dynamically measured and the relationship between their levels and placental gradings were investigated. The peak values of HPL and E3 were found in 13.16 +/- 7.49 and 15.68 +/- 6.51 days before delivery. The serum concentrations of the two hormones in women with severe PIH syndrome, postdate pregnancy and intrauterine fetal growth retardation (IUGR) were lowered. E3 declined earlier than HPL Analysis of the HPL, E3 levels in comparison with placental grading showed that the decline of the two hormones was mainly found in patients with grade III placenta.     

Lipid peroxidation, antioxidant defense, status of trace metals and leptin levels in preeclampsia

OBJECTIVE: To investigate the changes in enzyme activities of erythrocyte superoxide dismutase (SOD), catalase, and placental glutathione peroxidase (GSH-Px), and analyze the levels of serum malondialdehyde (MDA), copper (Cu), zinc (Zn), selenium (Se), leptin and placental MDA and glutathione (GSH). STUDY DESIGN: Cross-sectional prospective study consisting of 32 preeclamptic (PE) pregnant, 25 non-pregnant (NP) women, 28 healthy pregnant (HP) women. Levels of lipid peroxides in serum and placenta, and activities of SOD, catalase in erythrocyte and placental GSH level, placental GSH-Px activity were measured by spectrophotometric methods. Serum levels of Cu, Zn, Se measured by atomic absorption spectrophotometry. Serum levels of leptin was measured by enzyme immunoassay by using the Cayman chemical kit. One-way analysis of variance and post hoc Tukey-HSD test and Pearson correlation test were used for the statistical analyses. RESULTS: Serum levels of MDA, Cu, Leptin were markedly higher (P < 0.001); and serum level of Se was markedly lower (P < 0.001) in PE women compared with HP women and NP women. Also, placental MDA level was higher (P < 0.001) and placental GSH-Px activity was lower in PE women compared with HP women. In preeclamptic women erythrocyte catalase activity was markedly increased (P < 0.001), while erythrocyte SOD activity was markedly decreased (P < 0.001) compared to HP women and NP women. Placental GSH level was decreased compared to HP women (P < 0.001). Serum level of Zn was markedly decreased compared to NP women (P < 0.001) but no significant difference was observed in PE pregnant when compared with HP women (P > 0.05). Placental MDA level in PE women had significant negative correlation with serum Se level (r = -0.353, P < 0.05). A negative correlation was found between erythrocyte catalase activity with birth weight (r = -0.528, P < 0.001). Also, there were a significant negative correlation between serum levels of Cu and Se in the preeclamptic women (r = -0.407, P < 0.05). CONCLUSION: Our data demonstrate that elevation of lipid peroxides together with impaired antioxidant defense mechanisms and status of trace metals and the presence of possible interrelationship and crosstalk between those parameters may be related at least partly to the pathogenesis of preeclampsia. Additionally, lipid peroxides and blood oxidative imbalance could be part of the cytotoxic mechanisms leading to endothelial cell injury.     

Effect of hormone substitution therapy on AT III in women in the climacteric]

Anti-thrombin III is the major inhibitor of intravasal coagulation. Patients with AT III activity less than 80% are at risk for thromboembolic complications. We have examined 224 women with climacteric symptoms (flush, urogenital complaints, osteoporosis) who received estrogen replacement therapy for one year. 105 women (group I) received conjugated estrogens at 0.626 mg. 52 women (group II) were given conjugated estrogens at 1.25 mg. 67 women (group III) were treated with transdermal estrogen replacement (TTS 50 mcg). AT III activity was measured before and one year after replacement therapy. No significant alterations of AT III activity were noted between the different modalities of application. This supports epidemiologic findings suggesting that no increase in the incidence of thromboembolic complications was seen in women who received estrogen replacement therapy over several years.     

Placental respiratory chain complex activities in high risk pregnancies

Objectives: Mitochondrial oxidative phosphorylation is the key energy source for placental functions and fetal growth. The purpose of this study was to investigate the function of placenta in high risk pregnancies by measuring mitochondrial respiratory chain complex (RCC) activities, and to evaluate the correlation between double test risk ratio and RCC activities.

Methods: The placenta samples were collected from 50 pregnant women. The controls consisted of 20 normal uncomplicated pregnancies and the study group (n?=?30) consisted of preeclampsia (PE), intrauterin growth restriction (IUGR), advanced maternal age (AMA), twins and preterm deliveries. Complexes I, II–III, IV and citrate synthase (CS) activities were measured by spectrophotometric assays.

Results: Complexes I, II–III and IV activities were significantly lower in the study group than the controls (p?p?Conclusions: Impaired placental mitochondria RCC functions can lead to adverse pregnancy outcomes. Pregnant women with high risk in double test should be monitored carefully in terms of PE, IUGR and preterm delivery.     

Oxidative damage to pre-eclamptic placenta: immunohistochemical expression of VEGF,nitrotyrosine residues and von Willebrand factor

Objective: To determine the relationship of biomarkers of placental damage by oxidative stress in pre-eclamptic placenta. Methods: A case-control study was performed on a population of 14 pregnant women with PE and 12 women with normal pregnancies. Immunohistochemical expressions of VEGF, vWF distribution, (Na + K)-ATPase activity, and abundance of nitrotyrosine residues, were assessed in the placental tissue. Results: Women with pre-eclampsia showed increased VEGF expression and abundance of nitrotyrosine residues in placental villous, and plasma vWF levels (p < 0.05), whereas placental (Na + K)-ATPase activity were significantly reduced. The syncytiotrophoblast and the maternal space of pre-eclamptic placenta showed diminished and increased vWF expression, respectively, but no significant differences in its expression were found in the placental endothelium and stroma (p < 0.05). Conclusions: It could be suggested that increased oxidative stress and VEGF contribute to enhance the impairment of placental perfusion by increasing peroxynitrite formation, product of the NO and superoxide reaction, thereby partly contributing to account for the pathophysiology of this disease. The presence of vWF in the maternal space and its diminished expression in syncytiotrophoblast of pre-eclamptic placenta also might have pathogenic implications.     

Ultrasonic evidence of placental calcification at 36 weeks' gestation: maternal and fetal outcomes

BACKGROUND: To determine the significance of an inappropriately mature placenta on ultrasound examination (Grannum classification), in a low-risk obstetric population. Scans were performed at 36 weeks' gestation. The study group comprised patients demonstrating a grade III placenta, and the control group comprised patients not demonstrating a grade III placenta. METHODS: A total of 1802 low-risk patients were scanned using serial directed real-time ultrasound at 36 weeks' gestation to determine placental maturity. RESULTS: The incidence of a grade III placenta at 36 weeks' gestation was 3.8% (68/1802). A grade III placenta was associated with young maternal age and cigarette smoking, p < 0.01. The incidence of proteinuric pregnancy-induced hypertension in the study and control groups was 7.4% (5/68) and 1.56% (27/1734), respectively, p < 0.01. The proportion of infants with a weight less than the 10th centile at birth in the study and control groups was 17.6% (12/68) and 5.6% (97/1734), respectively, p < 0.01. CONCLUSIONS: Ultrasound detection of a grade III placenta at 36 weeks' gestation in a low-risk population helps to identify the "at-risk" pregnancy. It helps to predict subsequent development of proteinuric pregnancy-induced hypertension and may help in identifying the growth-restricted baby.     

Factors associated with poorer childbirth outcomes in pregnant women diagnosed with placenta previa

ObjectivePlacenta previa is a health issue during pregnancy when the placenta wholly or partially covers the opening of the uterus. It can result in bleeding during pregnancy or after delivery, and preterm delivery. This study aimed to investigate the risk factors correlated with poorer childbirth outcomes of placenta previa.Materials and methodsBetween May 2019 and January 2021, pregnant women diagnosed with placenta previa in our hospital were enrolled. Outcomes were postpartum hemorrhage after childbirth, and lower Apgar score and preterm delivery of the neonate. Laboratory blood examination data preoperatively were collected from medical records.ResultsA total of 131 subjects were included, with a median age 31 years. Multivariate analysis showed that fibrinogen reduced risk for postpartum hemorrhage (adjusted odds ratio (aOR): 0.45, 95% confidence interval (CI): 0.26–0.79, p = 0.005). Homocysteine (aOR: 0.73, 95% CI: 0.54–0.99, p = 0.04) reduced the risk while D-dimer (aOR: 1.19, 95% CI: 1.02–1.37, p = 0.02) increased the risk for low Apgar score. Age (aOR: 0.86, 95% CI: 0.77–0.96, p = 0.005) decreased the risk but history of full-term pregnancy more than twice (aOR: 8.58, 95% CI: 2.32–31.71, p = 0.001) increased the risk for preterm delivery.ConclusionThe findings suggest that poorer childbirth outcomes in pregnant women with placenta previa are associated with young age, history of full-term pregnancy, and preoperative concentrations of low fibrinogen, low homocysteine and high D-dimer. This provides obstetricians adjunctive information for early screening of high-risk population and relevant treatment arrangement in advance.     

Increased Maternal Serum and Cord Blood Fibronectin Concentrations in Preeclampsia are Associated with Higher Placental Hyaluronic Acid and Hydroxyproline Content

Background. Total or cellular fibronectin (FN) determinations have been used to differentiate between normal and preeclamptic pregnants. The purpose of this study was to examine the relationship between maternal serum FN levels and the extracellular matrix molecule contents of placental tissue, such as FN, hyaluronic acid (HA) and hydroxyproline (HP) levels. Material and Methods. We obtained maternal blood samples and placental tissue samples from healthy (n = 17, controls) and preeclamptic pregnants (n = 29). We also obtained cord blood samples for FN and HA determination from the same patients. FN and HA concentrations in the placenta and maternal and cord blood were measured by and enzyme-linked immunosorbent assay and HP contents in the placenta were measured by a colorimetric assay. Results. FN levels in maternal serum, cord blood, and placenta were significantly higher in preeclamptics than in controls (p<0.001, p<0.001 and p<0.05, respectively). HA concentrations in the cord blood and placenta were found to be elevated in preeclamptics (p<0.05 and p<0.01). Preeclamptics had significantly higher placental HP levels than controls (p<0.001). Similar statistically significant results were obtained when the pregnant subjects classified as nulliparous and multiparous. There was no difference in ECM molecule levels between nulliporous and multiparous women in preeclamptic pregnant group. In regression analysis maternal serum FN levels were correlated with placental HA and HP levels (p<0.01 and p<0.01). There was a positive correlation between cord blood FN and both placental HP (p<001) and HA levels (p<0.01). FN levels in maternal serum, cord blood, and placenta were also negative correlated with fetal birth weight (p<0.01, p<0.05 and p<0.05, respectively). Conclusion. FN in maternal serum, cord blood, and placenta is increased with elevated placental HA and HP levels, probably reflecting placental basement membrane alterations during preeclampsia.     

妊娠肝内胆汁淤积症患者血硒及胎盘硒水平变化与胎盘组织学改变的关系

OBJECTIVE: To explore the effect of deficiency of blood selenium and placental selenium on the damage of histomorphology of the placentas in ICP. METHODS: We measured the selenium concentration by a catalytic polorographic method in blood and placenta and glutathione peroxidase (GSH-Px) activity by a 5,5'-dithionbis (2-nitrobenzoic acid) direct method in blood in 30 women with ICP (ICP group) and 30 normal pregnant women (control group). Furthermore, the features of the placentas (10 from control group and 10 from ICP group) pathologic changes were observed microscopically. RESULTS: (1) The selenium concentrations in blood (0.0389 +/- 0.0090) mg/L and placenta (0.3770 +/- 0.0964) mg/kg and the activity of GSH-Px (59.31 +/- 11.42) U in ICP group were found to be significantly lower than those in blood (0.0477 +/- 0.0094) mg/L and placenta (0.4554 +/- 0.0626) mg/kg and the activity of GSH-Px (68.48 +/- 10.47) U in control group, respectively (P < 0.002). (2) The activity of GSH-Px had a significant positive correlation with selenium concentration in blood in ICP group (r = 0.05498, P < 0.001) and in control group (r = 0.06234, P < 0.001). There was a positive correlation between blood and placental selenium concentrations in ICP group (r = 0.6473, P < 0.001). On the other hand, there was not correlation in women with normal pregnancies. (3) Placentas obtained from women with ICP had swelling and fibrinoid necrosis of villi, increasing number of syncytial sprouts, thickening of vasculo-syncytial membrane (VSM) and decreasing size of the intervillous space under light microscopy. Placentas from control group did not show the pathologic changes as mentioned above. CONCLUSIONS: As selenium constitutes the active part of GSH-Px, these results suggest that the placental selenium deficiency may lead to reduced placental GSH-Px activity and the antioxidative defence may have been defective which may be associated with the damage of histomorphology of the placentas in ICP.     

Placental abnormalities associated with isolated single umbilical artery in small-for-gestational-age births

BackgroundPrevious studies have shown that pregnancies complicated by placentas with an isolated single umbilical artery (iSUA) are at increased risk for small-for-gestational-age (SGA) births. The etiology of SGA in this population, however, remains unknown.ObjectiveThe primary objective of this study was to evaluate whether placental abnormalities in pregnancies with SGA births differ according to the presence of iSUA.Study designThis was an observational study of all women with pathologic examination of the placenta after delivering a non-anomalous, singleton SGA neonate between January 2009 and August 2015. SGA was defined as birthweight less than 10th percentile for gestational age. Women were categorized according to whether they had an iSUA or a three-vessel cord. The following placental pathologies were compared between the groups using bivariable and multivariable analyses: SGA placenta, maternal vascular malperfusion, high grade fetal vascular malperfusion, and chronic villitis.Results1833 women were included in the analysis: 34 with iSUA and 1799 with three-vessel cord. More than 85% of women in both groups had at least one placental abnormality. After adjusting for nulliparity and neonatal gender, the presence of iSUA was associated with increased odds of high grade fetal vascular malperfusion (adjusted odds ratio 2.8, 95% confidence interval 1.1–7.5) and decreased odds of maternal vascular malperfusion (adjusted odds ratio 0.2, 95% confidence interval 0.1–0.9). There was no significant association with other pathologic findings.ConclusionPathologic placental findings associated with SGA birth differed based on umbilical cord composition. The presence of iSUA in an SGA birth was associated with a higher odds of high grade fetal vascular malperfusion abnormalities and lower odds of maternal vascular malperfusion abnormalities, compared to SGA birth with a 3VC.