Placental pathologies on fetal MRI are associated with high impairment rates: a prospective long-term outcome study

Objective: Placental anomalies visualized at midgestation by MRI are shown to be related to pregnancy outcome. We performed a prospective cohort study to investigate the influence of placental pathologies diagnosed with fetal MRI on long-term neurodevelopmental outcome.

Methods: In our hospital-based, cross-sectional study, all fetal MRI examinations of pregnancies with vascular placental pathology (i.e. infarction with/without hemorrhage, subchorionic thrombi/hemorrhages, intervillous thrombi/hemorrhages or retroplacental hematoma) between 2003 and 2007 were included. The extent of the pathology was expressed as the percentage of abnormality related to the whole placental volume. Pathohistological reports were correlated to MRI findings. Infants were prospectively investigated using Bayley developmental scales at the age of 2–3.5 years. Impairment was categorized as a Bayley scale two SDs below normal (<85 points).

Results: There were 31 singletons and 25 offspring of multiple pregnancies included in the analyses. Impairment rates were 32.2% in singletons and 32.0% in multiple births. No correlation between neuro/motordevelopmental outcome at 2–3.5 years and the type, extent or gestational week at the time of diagnoses of placental vascular pathologies was found.

Conclusion: The long-term outcome of children with vascular placental pathologies on fetal MRI was associated with a high impairment rate after 2–3.5 years, both on motor- and neurodevelopmental Bayley scales. Neurological impairment did not correlate with the extent of placental involvement, intrauterine growth restriction, gestational age at birth or multiple state.     

Molecular actions of heparin and their implications in preventing pre‐eclampsia

Summary

Pre‐eclampsia, a hypertensive disorder of pregnancy, continues to be a significant cause of global maternal morbidity. Low‐dose aspirin remains the only standard‐of‐care prophylactic therapy for preventing pre‐eclampsia, but is limited in efficacy. Heparin and its derivatives may further enhance the efficacy of aspirin therapy to prevent pre‐eclampsia, but the mechanisms mediating this augmentative effect are not known. Although heparin is an anticoagulant agent, it also possesses many anticoagulant‐independent properties that may be relevant in the prevention of pre‐eclampsia, including effects on placental, vascular and inflammatory function. This review summarizes the non‐anticoagulant properties of heparin, and extrapolates how these actions may influence the trajectory of pre‐eclampsia pathogenesis as a means of pathway‐specific therapy.

     

改良式宫颈环扎术治疗前置胎盘子宫下段出血的临床研究

目的 探讨改良式宫颈环扎术治疗前置胎盘子宫下段出血的治疗效果.方法 选取2013年7月1日至2014年6月30日20例前置胎盘剖宫产术中子宫下段出血患者,采用改良式宫颈环扎术进行治疗(观察组),并与2012年7月1日至2013年6月30日20例未行改良式宫颈环扎术的前置胎盘剖宫产术中子宫下段出血患者(对照组)进行比较,比较术中出血量、输红细胞悬液量、手术时间.结果 观察组与对照组术中出血量分别为(517.50±388.41)mL、(842.50±533.68)mL,输红细胞悬液量(10.90±0.78)U、(2.60±1.35)U,手术时间(73.15±14.60)min、(95.10±10.95) min,两组比较差异均有统计学意义(P＜0.05),且两组均无明显并发症发生.结论 针对前置胎盘子宫下段出血的患者,实施改良式宫颈环扎术进行止血,能有效降低出血量,值得进一步研究.     

Oral cadmium exposure during rat pregnancy: assessment of transplacental micronutrient transport and steroidogenesis at term

Diet is the main source of cadmium (Cd) exposure. Gastrointestinal absorption increases during pregnancy. Cadmium accumulated in the placenta may interfere with nutrient transport to the foetus. Data on the potential of Cd to act as a steroid disruptor of pregnancy are limited. We evaluated the effects of oral Cd exposure during pregnancy on placental function in micronutrient transfer to the foetus and steroidogenesis in Wistar rats (regular 4‐day cyclers) that mated with unexposed males. Pregnant rats were randomly assigned to a Cd group exposed orally to 50 mg Cd l^–1 (CdCl₂xH₂O dissolved in demineralized water), ≈7.5 mg Cd kg^–1 a day, during 20 days of gestation and control (supplied with demineralized water). Non‐pregnant rats were treated under the same experimental conditions. On day 20, all of the rats were killed and samples were taken for element analyses (by electrothermal atomic absorption spectrometry). Progesterone and testosterone were measured in serum and placenta‐derived samples (by immunoenzymometric assay and/or enzyme‐linked immunosorbent assay). In the exposed rats, Cd increased in blood and organs, more in pregnant rats, and in placenta and foetus whereas zinc increased in liver. Iron decreased in maternal organs and in foetus, whereas zinc decreased in maternal kidney and placenta. Liver copper was lower and kidney copper higher in all pregnant vs. non‐pregnant rats. Steroids in serum and placenta did not change. In conclusion, oral Cd exposure during rat pregnancy does not affect progesterone and testosterone at term. Transplacental iron and zinc handover are disrupted, which may put at risk the maintenance of foetal nutrition and viability. Copyright © 2014 John Wiley & Sons, Ltd.     

Melatonin protects against oxidative mitochondrial damage induced in rat placenta by ischemia and reperfusion

We assessed the effects of melatonin, a powerful scavenger of oxygen free radicals, on ischemia/reperfusion-induced oxidative damage to mitochondria in the rat placenta. In Wistar rats at day 19 of pregnancy, feto-placental ischemia was induced by occluding both utero-ovarian arteries for 20 min. Reperfusion was achieved by releasing the occlusion and restoring circulation for 30 min. Melatonin solution or the vehicle alone was injected intraperitoneally at dose of 10 mg/kg 1 hr before occlusion. Sham-ischemic animals were treated with vehicle. Each group consisted of 10 pregnant rats. We measured placental mitochondrial respiratory control index (RCI; a marker of mitochondrial respiratory activity), the ratio of the added adenosine 5-diphosphate (ADP) concentration to consumption of oxygen during state 3 respiration (ADP/O), and the concentration of thiobarbituric acid reactive substances (TBARS) in each group. RCI and ADP/O were significantly decreased by ischemia/reperfusion, while TBARS were increased. Melatonin prevented these changes. These results indicate that exogenous melatonin protects against ischemia/reperfusion-induced oxidative damage to mitochondria in rat placenta. Melatonin could be useful in treating preeclampsia and possibly other clinical states involving excess free radical production, such as fetal growth restriction and fetal hypoxia.     

妊娠高血压综合征患者胎盘组织生存素的表达及意义

目的观察妊娠高血压综合征(妊高征)患者胎盘组织中生存素(surv iv in)的表达情况,探讨其在妊高征发病中的作用。方法采用免疫组化SP法检测正常及妊高征孕妇胎盘组织中surv iv in的表达,并采用计算机图像分析系统进行定量分析。结果surv iv in蛋白主要位于绒毛小叶的合体滋养细胞及细胞滋养细胞,也存在于羊膜绒毛层。妊高征组胎盘滋组织surv iv in的平均光密度值为0.324±0.033,且随病情加重而减少,较正常胎盘的0.390±0.042显著降低(P<0.05).结论胎盘组织中surv iv in的减少可能与妊高征的发生发展有关。     

三维能量多普勒超声产前诊断胎盘植入性疾病

目的 评价三维能量多普勒超声（3D-PDUS）产前诊断胎盘植入性疾病（PAS）的价值。方法 纳入116例经超声诊断为前置胎盘孕妇,采用二维超声观察胎盘及周边结构,以3D-PDUS测量相关血流参数。根据产后临床及病理诊断将孕妇分为PAS组（n=32）及无PAS组（n=84）;根据胎盘绒毛侵袭子宫肌层深度将PAS组分为粘连性胎盘（PA）亚组（n=12）及异常侵袭性胎盘（AIP）亚组（n=20）。比较组间及亚组间3D-PDUS参数的差异。绘制受试者工作特征（ROC）曲线,计算曲线下面积（AUC）,评价3D-PDUS参数诊断PAS的效能。采用Cochran Q检验比较3D-PDUS参数与二维超声诊断PAS效能的差异。结果 PAS组血管化指数（VI）、流量指数（FI）及血管流量指数（VFI）均显著高于无PAS组（P均<0.05）;AIP亚组VI及VFI均显著高于PA亚组（P均<0.05）;亚组间FI差异无统计学意义（P>0.05）。VI、FI及VFI诊断PAS的效能均较高,VI与VFI的敏感度、特异度及准确率均无明显统计学差异（P均>0.05）;FI与二维超声诊断效能差异无统计学意义（P均>0.05）;VI及VFI诊断效能明显高于FI及二维超声（P均<0.05）。结论 3D-PDUS定量检测胎盘及周边结构血流参数可用于产前诊断PAS。