Placenta growth factor: potential role in pregnancy

PROBLEM: In spite of the known requirement for adequate vascularity during placentation, little is known regarding the regulation of angiogenic growth factor production by trophoblast. Placenta growth factor (PIGF) is a recently discovered angiogenic growth factor whose expression is relatively limited to trophoblast. METHOD OF STUDY: Current literature of PIGF was reviewed, with emphasis on its expression, regulation, role in angiogenesis, and potential function(s) at the maternal-fetal interface. RESULTS: PIGF is abundantly expressed by trophoblast, which implies that it could act in a paracrine manner to modulate vascular development, stability, and/or function within the decidua and placental villi. In addition, expression of the PIGF receptor, fms-like tyrosine kinase (flt-1) receptor, on trophoblast raises the potential for an autocrine role of PIGF in regulating trophoblast growth and/or function. CONCLUSIONS: The potential for PIGF to influence both vascular endothelial cells and trophoblast suggests that aberrant trophoblast production of PIGF could compromise cellular function during gestation and contribute to the vascular and placental pathologies noted in many obstetric complications.     

Immunopathology of the implantation site utilizing monoclonal antibodies to natural killer cells in women with recurrent pregnancy losses

PROBLEM: Placental lesions of 71 women with documented recurrent spontaneous abortions of unknown etiology were evaluated using immunohistochemical staining. METHOD OF STUDY: Placental tissue blocks (less than 12 weeks gestation) from prior pregnancy losses were obtained, recut, and analyzed utilizing monoclonal antibody to identify the trophoblast (cytokeratin 8/18) and natural killer (NK) cells (CD57) at the implantation site. The following features were evaluated: trophoblast invasion pattern; syncytium formation; vasculitis and thromboembolism of decidual vessels; decidual inflammation; decidual necrosis; fibrin deposition at the decidual necrosis site; mononuclear-cell infiltration in villi and intervillous space; perivillous fibrin deposition; trophoblast morphology; and quantitation of CD57+ NK cells within the decidual tissue near the implantation site. Controls consisted of 20 healthy women with no history of recurrent pregnancy losses, who had their pregnancies electively terminated. RESULTS: Of the women studied, 29.6% demonstrated elevated CD57+ NK cells at the implantation site (P = 0.030), 54.1% had inadequate cytotrophoblast invasion depth (P = 0.000), 44.1% demonstrated inadequate syncytium formation (P = 0.004), and 33.9% presented thromboembolism in decidual vessels (P = 0.025). CONCLUSION: Some women with recurrent spontaneous abortions demonstrate abnormal placental lesions at the implantation site. Immunopathologic evaluation of the placental implantation site that terminated in a spontaneous abortion may reveal the immunopathogenesis of previous pregnancy losses.     

安替比林的体外人胎盘灌流

以安替比林为参照物,建立体外人胎盘灌流技术,采用局部胎盘小叶的开放及封闭灌流方法。开放灌充安替比林消除率与时间、母体循环中的浓度无显著相关性,只随流速比的增大而增大,二者之间有显著相关性（ｒ＝０９０６）。封闭灌流两个方向的灌流,供体面安替比林浓度逐渐降低,且都符合指数函数Ｃ（ｔ）＝Ｃｏ×ｅ－ｋｔ,受体面浓度逐渐升高。两个方面的清除率分别为０４１ｍｌ／ｍｉｎ,０５２ｍｌ／ｍｉｎ,两者间无显著差异,提取效率母体面到胎儿面方向略低（Ｐ＜００５）,分别是６８３％,２８９％。以上结果与相关资料一致,说明本室体外人胎盘灌流设备、技术均已完备,结果可靠。     

Establishment and characterization of a cytotrophoblast cell line from normal placenta of human origin

A cell line has been established from human placentae at thefirst trimester of normal pregnancy. The cell line was obtainedby culture of purified cytotrophoblast cells in serum-free mediumsupplemented with epidermal growth factor, insulin, dexamethasoneand 0.1% bovine serum albumin. The cells can be subculturedfor >30 passages in one to three splits. All the cells weremononuclear epithelial-like cells positive to cytokeratin 18,gonadotrophin-releasing . hormone (GnRH), neuropeptide Y, neurotensin,leucine-enkephalin, dopamine and 5-hydroxytryptamine inununo-cytochemicalstaining. The cells secreted GnRH, progesterone and oestradiol(in the presence of testosterone) but little human chorionicgonadotrophin and no -endorphin. The cell line showed humankaryotypes and had a population doubling time of 48 h in serum-freemedium. However, the cells would stop growing in the mediumcontaining fetal bovine serum. A normal cytotrophoblast cellline established in serum-free medium will be particularly usefulin the study of cytotrophoblast cell proliferation and differentiation.     

Basement membrane thickening in the placentae from diabetic women

A light microscopy study was carried out on 48 placentae. Seventeen placentae were obtained from non-diabetic mothers while the other 31 placentae were from both women with controlled diabetes and women who had an abnormality of the glucose tolerance test. All the women delivered at 38-40 weeks of gestation. Placentae from diabetic patients showed immaturity of the villi, hypertrophy of the capillaries and thickening of the basement membrane of the trophoblastic villi (3.2 +/- 0.35 microns) and the amniotic membrane (1.8 +/- 0.3 microns). Focal fibrinoid necrosis, an increase in the number of Hofbauer cells and dilatation of villi capillaries were also commonly observed in placentae from diabetic mothers, and the normal cuboidal cells lining the amniotic membrane tended to become tall columnar (17.6 +/- 6.3 microns) with distally located nuclei. Similar findings were observed in patients who had a potentially abnormal glucose tolerance test, which suggests the possibility of primary lesion in origin. Therefore, control of hyperglycemia may only partially prevent the development of placental abnormalities.     

Placental transfer of lead,mercury and cadmium in women living in a rural area

Summary The influence of the lead content of drinking water on the transplacental transfer of lead was investigated in 70 pregnant women living in a rural area of Belgium. The mothers were divided into 2 groups: group A: morning water lead below 50 g/liter; group B: morning water lead above this value. In group A, the mean lead content of water was 11.8 g/liter and in group B it amounted to 247.4 g/liter.The difference in the mean lead concentration between the two groups were for maternal blood: 3.2 g/100 ml, for umbilical cord blood: 3.3 g/100 ml, and for placenta: 3.6 g/100 g. These differences are statistically significant.There were significant correlations between water lead and lead concentration in blood (mother, newborn) or placenta. An increment of water lead concentration from 50 to 500 g/liter increases blood lead concentration in mother and in newborn by about 3 g/100 ml and in placenta by about 2.5 g/100 g (wet weight).     

胎盘早剥32例临床分析

目的 通过对胎盘早剥的临床分析，探讨早期诊断及治疗方法，以降低孕产妇和围产儿死亡率。方法 对我院200l—2002年元月收治的qd胎盘早剥32例进行顾性分析。结果 围产儿死亡19例，死亡率59．3％，其中胎死宫内者17例，新生儿死亡2例。孕产妇32例中1例并发DIC及凝血功能障碍，经及时刨救治愈。无孕产妇死亡。结论 胎盘早剥的早期诊断更应注重病史及诱因，B超已成为胎盘早剥的重要辅助诊断方法。适时终止妊娠可减少母子严重的并发症。     

产后出血的高危因素分析

目的　分析产后出血发生的相关危险因素 ,探讨预防和减少产后出血的措施。方法　对我院1 990年 1月～ 2 0 0 2年 1 2月间住院分娩的产妇出现产后出血的产妇 31 9例 ,对照 6 38例。通过多元Logistic回归分析评价各危险因素的相对危险性。结果　产后出血的发病率为 2 0 9%。相对独立的多个危险因素作用大小的顺位为 :胎盘粘连或植入、前置胎盘、多胎妊娠及胎儿体重≥ 4 0 0 0g、重度妊高征、流产次数≥ 2次、胎盘早剥 ;在阴道分娩的产妇中 ,作用相对独立的危险因素的顺位为胎盘粘连或植入、胎儿体重≥ 4 0 0 0g、妊高征、第三产程 >1 0min、流产次数≥ 2次。结论　避免产前非意愿妊娠以减少前置胎盘、胎盘粘连或植入 ;减少巨大儿、多胎的发生 ,有助于预防和减少产后出血     

The relationship of placenta previa and history of induced abortion.

OBJECTIVES: We evaluated the risk of placenta previa being associated with a history of induced abortion by different surgical procedures. METHODS: Cases (n=192) were women who had a singleton delivery complicated by placenta previa at a major obstetric care hospital in western Washington state between April 1, 1990 and December 31, 1992. Controls (n=622) were women with singleton deliveries not complicated by placenta previa or abruption. Odds ratios, determined by logistic regression, approximate the relative risks. RESULTS: Vacuum aspiration abortion was not associated with an increased risk of placenta previa (OR 0.9, 95% CI 0.6-1.5). However, the risk of placenta previa increased with the number of sharp curettage abortions (OR 2.9, 95% CI 1.0-8.5 for > or =3). CONCLUSIONS: Risk of placenta previa may be increased in a dose response fashion by multiple sharp curettage abortions. However, vacuum aspiration does not confer an increased risk, and may be a better alternative.     

DIAGNOSIS OF CONGENITAL CYTOMEGALOVIRUS INFECTION BY EXAMINATION OF PLACENTA: Application of Polymerase Chain Reaction and in Situ Hybridization

We examined the placentas of 12 patients in whom congenital cytomegalovirus CMV infection was suspected from serological and or pathological evaluation. Seven patients died including four intrauterine deaths and five survived. On histological examination, the characteristic inclusion bodies were detected in only three placentas, and villitis with plasma cell infiltration was seen in eight placentas. Immunohistochemistry using a specific antibody against CMV improved the sensitivity of CMV detection 10 cases were positive . With the polymerase chain reaction PCR following the extraction of DNA from formaldehyde-fixed placenta samples, CMV DNA was detected in seven cases. All 12 subjects were diagnosed with CMV infection by additional Southern blot analysis after the PCR. CMV DNA was also detected by an in situ hybridization method in all cases. With current molecular biological techniques the placenta can be reliably used for the diagnosis of congenital CMV infection.