placenta Archives - Page 2 of 4 - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 1999;21(9):499-504
DOI 10.1590/S0100-72031999000900002
Purpose: to evaluate the ultrasound characteristics of normal pregnancies, according to the placental maturity, local of insertion and thickness, fetal presentation and position during the second half of pregnancy. Methods: a descriptive study was perfomed, including at least 120 measures in each gestational age, in 2,868 normal pregnant women from Campinas, Brazil, studied through routine obstetric ultrasound examinations, with fetal biometry and placental evaluation, applying Grannum, Berkowitz, Hobbins (1979) criteria for placental maturity. Placental thickness was measured at the cord insertion site. Results: grade 0 placentas were more frequent up to 31 weeks and grade I after 32 weeks. Grade II did not appear until 32 weeks and grade III was more frequent after 36 weeks. The placental thickness significantly increased with gestational age and the most frequent placental locations were anterior and posterior. The cephalic presentation was the most frequent all gestational ages, with only 1% of breech presentation at term. The most frequent fetal position was fetal spine left side, followed by right side. Conclusions: the studied factors showed a similar distribution to that expected for normal populations and could be used as a standard for the Brazilian population.
Summary
Rev Bras Ginecol Obstet. 1999;21(9):499-504
DOI 10.1590/S0100-72031999000900002
Purpose: to evaluate the ultrasound characteristics of normal pregnancies, according to the placental maturity, local of insertion and thickness, fetal presentation and position during the second half of pregnancy. Methods: a descriptive study was perfomed, including at least 120 measures in each gestational age, in 2,868 normal pregnant women from Campinas, Brazil, studied through routine obstetric ultrasound examinations, with fetal biometry and placental evaluation, applying Grannum, Berkowitz, Hobbins (1979) criteria for placental maturity. Placental thickness was measured at the cord insertion site. Results: grade 0 placentas were more frequent up to 31 weeks and grade I after 32 weeks. Grade II did not appear until 32 weeks and grade III was more frequent after 36 weeks. The placental thickness significantly increased with gestational age and the most frequent placental locations were anterior and posterior. The cephalic presentation was the most frequent all gestational ages, with only 1% of breech presentation at term. The most frequent fetal position was fetal spine left side, followed by right side. Conclusions: the studied factors showed a similar distribution to that expected for normal populations and could be used as a standard for the Brazilian population.
Summary
Rev Bras Ginecol Obstet. 2004;26(10):807-812
DOI 10.1590/S0100-72032004001000008
PURPOSE: placental villitis has been correlated with perinatal infection, although a percentage of cases remains etiologically unknown. The present study was aimed at the systematic morphological study of placentas for imunohistochemical characterization of villitis and assessment of its possible correlation with maternal and fetal outcome. METHODS: a hundred and twenty-eight placentas were studied. Gross examination was performed and all collected fragments were analyzed microscopically by the hematoxylin-eosin method. Villits was classified according to the inflammatory degree in to mild, moderate and severe. The immunohistochemical study to identify infectious agents was performed using monoclonal antibodies against Toxoplasma gondii and Cytomegalovirus. For inflammatory cell phenotype identification monoclonal antibodies against CD68, CD57, CD3, and CD20 were used. Statistical analysis was performed with the variables: maternal age and fetal gestational age, fetal and placental weight, and fetal and maternal outcomes. To compare the two groups we used the Mann-Whitney test and for proportions we used the chi2 test. The differences in the mean values between the treatment groups were considered statistically significant when p<0.05 (5%). RESULTS: villitis was identified in 11.7% of the cases. In 40% of the cases the children were stillborn (p=0.003). One case showed positive staining for toxoplasmosis while the remaining cases were negative. Imunohistochemical staining showed CD68+ cells, PanT+ cells and negative CD57 and PanB cells. CONCLUSION: we concluded that the intensity of the inflammatory process in the placenta was correlated with the severity of the fetal disease. The inflammatory cells in the villitis focus were macrophages; however, we could not identify infectious agents correlated with the villitis.
Summary
Rev Bras Ginecol Obstet. 2004;26(10):807-812
DOI 10.1590/S0100-72032004001000008
PURPOSE: placental villitis has been correlated with perinatal infection, although a percentage of cases remains etiologically unknown. The present study was aimed at the systematic morphological study of placentas for imunohistochemical characterization of villitis and assessment of its possible correlation with maternal and fetal outcome. METHODS: a hundred and twenty-eight placentas were studied. Gross examination was performed and all collected fragments were analyzed microscopically by the hematoxylin-eosin method. Villits was classified according to the inflammatory degree in to mild, moderate and severe. The immunohistochemical study to identify infectious agents was performed using monoclonal antibodies against Toxoplasma gondii and Cytomegalovirus. For inflammatory cell phenotype identification monoclonal antibodies against CD68, CD57, CD3, and CD20 were used. Statistical analysis was performed with the variables: maternal age and fetal gestational age, fetal and placental weight, and fetal and maternal outcomes. To compare the two groups we used the Mann-Whitney test and for proportions we used the chi2 test. The differences in the mean values between the treatment groups were considered statistically significant when p<0.05 (5%). RESULTS: villitis was identified in 11.7% of the cases. In 40% of the cases the children were stillborn (p=0.003). One case showed positive staining for toxoplasmosis while the remaining cases were negative. Imunohistochemical staining showed CD68+ cells, PanT+ cells and negative CD57 and PanB cells. CONCLUSION: we concluded that the intensity of the inflammatory process in the placenta was correlated with the severity of the fetal disease. The inflammatory cells in the villitis focus were macrophages; however, we could not identify infectious agents correlated with the villitis.
Summary
Rev Bras Ginecol Obstet. 2003;25(7):501-505
DOI 10.1590/S0100-72032003000700006
PURPOSE: to identify Listeria monocytogenes (Lm) in human placentas by immunohistochemistry (IHC) and relate its presence to the histological alterations found on conventional examination, to the pregnancy trimester, age of pregnant women, cases of abortion and premature delivery, and to the occurrence of habitual abortion. METHODS: a retrospective study was carried out at the pathology service of a teaching hospital in the city of Porto Alegre in 2000. The paraffin blocks of 254 placentas, obtained from abortion, premature delivery and full-term birth, were analyzed by conventional histology using hematoxylin and eosin (HE) staining. The IHC assay consisted of a rabbit anti-listeria polyclonal antibody B65420R (Biodesign®) diluted 1:1000, in addition to the avidin-biotin-streptavidin complex; 148 placentas revealed inflammatory disorders, hemorrhage, necrosis and thrombosis. The c² test was used for statistical analysis. RESULTS: Listeria monocytogenes was detected in 33.78% of the placentas analyzed by IHC. Chorioamnionitis and villitis showed significant statistical difference in the positive placentas. Lm occurred in the 1st, 2nd and 3rd trimester of pregnancy. The age of pregnant women, the cases of abortion and/or premature births were not statistically different as to the presence or absence of Lm in the placentas. Habitual abortions occurred in patients with or without Lm in the placental tissue. CONCLUSION: Immunohistochemistry may be used to confirm the histopathological diagnosis of listeriosis in all trimesters of pregnancy.
Summary
Rev Bras Ginecol Obstet. 2003;25(7):501-505
DOI 10.1590/S0100-72032003000700006
PURPOSE: to identify Listeria monocytogenes (Lm) in human placentas by immunohistochemistry (IHC) and relate its presence to the histological alterations found on conventional examination, to the pregnancy trimester, age of pregnant women, cases of abortion and premature delivery, and to the occurrence of habitual abortion. METHODS: a retrospective study was carried out at the pathology service of a teaching hospital in the city of Porto Alegre in 2000. The paraffin blocks of 254 placentas, obtained from abortion, premature delivery and full-term birth, were analyzed by conventional histology using hematoxylin and eosin (HE) staining. The IHC assay consisted of a rabbit anti-listeria polyclonal antibody B65420R (Biodesign®) diluted 1:1000, in addition to the avidin-biotin-streptavidin complex; 148 placentas revealed inflammatory disorders, hemorrhage, necrosis and thrombosis. The c² test was used for statistical analysis. RESULTS: Listeria monocytogenes was detected in 33.78% of the placentas analyzed by IHC. Chorioamnionitis and villitis showed significant statistical difference in the positive placentas. Lm occurred in the 1st, 2nd and 3rd trimester of pregnancy. The age of pregnant women, the cases of abortion and/or premature births were not statistically different as to the presence or absence of Lm in the placentas. Habitual abortions occurred in patients with or without Lm in the placental tissue. CONCLUSION: Immunohistochemistry may be used to confirm the histopathological diagnosis of listeriosis in all trimesters of pregnancy.
Summary
Rev Bras Ginecol Obstet. 2000;22(7):401-411
DOI 10.1590/S0100-72032000000700002
Purpose: to analyze the relationship between White's classification and the histopathological, changes occurring in the placentas of diabetic pregnant women, performing a qualitative comparison of histopathological changes in the placentas of nondiabetic pregnant women with those in diabetic ones (classes A and A/B), clinical, short duration (classes B and C), and clinical with vasculopathy (classes D to FRH), studying the influence of the quality of glycemic control and of gestational age on placental changes in the three groups of diabetic pregnant women. Patients and methods: specimens of placentas were collected from all diabetic pregnant women seen between 1991 and 1996 in the Maternity Section of the Hospital das Clínicas, Faculdade de Medicina de Botucatu, stained using the hematoxylin-eosin technique, and submitted to a histopathological examination. The quality of glycemic control was analyzed by the glycemia average of gestation and classified as adequate or inadequate, with a limit of 120 mg/dl. Gestational age was individualized as term and preterm. Results: forty-two newborns (43.3%) were born at term and the remaining were preterm (56.7%). The prematurity rate was higher for women with clinical diabetes (classes B and C; D to FRH). Some histopathological alterations were observed only in placentas from diabetic pregnant women: cystoid degeneration, chorial edema, intima edema, dysmaturity, Hofbauer cell hyperplasia, villitis, ghost cells, two vessels in the umbilical cord, and endarteritis. Conclusions: histopathological changes in the placentas of pregnant women with gestational diabetes (classes A and A/B), clinical, short duration (classes B and C), and clinical with vasculopathy (classes D to FRH) were similar to those in the nondiabetic ones, and, therefore, were independent of White's clinical classification. The histopathological changes in the placentas of pregnant women with gestational diabetes (classes A and A and B), clinical, short duration (classes B and C), and clinical with vasculopathy (classes D to FRH) were not related to gestational age at birth and to the quality of glycemic control of the mother. The comparison between histopathological changes and the increased number of preterm newborns in clinical diabetes, class D to FRH, suggest early placental ageing in clinical diabetes patients.
Summary
Rev Bras Ginecol Obstet. 2000;22(7):401-411
DOI 10.1590/S0100-72032000000700002
Purpose: to analyze the relationship between White's classification and the histopathological, changes occurring in the placentas of diabetic pregnant women, performing a qualitative comparison of histopathological changes in the placentas of nondiabetic pregnant women with those in diabetic ones (classes A and A/B), clinical, short duration (classes B and C), and clinical with vasculopathy (classes D to FRH), studying the influence of the quality of glycemic control and of gestational age on placental changes in the three groups of diabetic pregnant women. Patients and methods: specimens of placentas were collected from all diabetic pregnant women seen between 1991 and 1996 in the Maternity Section of the Hospital das Clínicas, Faculdade de Medicina de Botucatu, stained using the hematoxylin-eosin technique, and submitted to a histopathological examination. The quality of glycemic control was analyzed by the glycemia average of gestation and classified as adequate or inadequate, with a limit of 120 mg/dl. Gestational age was individualized as term and preterm. Results: forty-two newborns (43.3%) were born at term and the remaining were preterm (56.7%). The prematurity rate was higher for women with clinical diabetes (classes B and C; D to FRH). Some histopathological alterations were observed only in placentas from diabetic pregnant women: cystoid degeneration, chorial edema, intima edema, dysmaturity, Hofbauer cell hyperplasia, villitis, ghost cells, two vessels in the umbilical cord, and endarteritis. Conclusions: histopathological changes in the placentas of pregnant women with gestational diabetes (classes A and A/B), clinical, short duration (classes B and C), and clinical with vasculopathy (classes D to FRH) were similar to those in the nondiabetic ones, and, therefore, were independent of White's clinical classification. The histopathological changes in the placentas of pregnant women with gestational diabetes (classes A and A and B), clinical, short duration (classes B and C), and clinical with vasculopathy (classes D to FRH) were not related to gestational age at birth and to the quality of glycemic control of the mother. The comparison between histopathological changes and the increased number of preterm newborns in clinical diabetes, class D to FRH, suggest early placental ageing in clinical diabetes patients.
Summary
Rev Bras Ginecol Obstet. 2000;22(8):511-517
DOI 10.1590/S0100-72032000000800007
Purpose: to demonstrate the types of fetal malformations in multiple pregnancy and their relation to chorionicity. Methods: one hundred and sixty-nine multiple pregnancies were evaluated. In all cases prenatal ultrasound examination was performed during antenatal care. Chorionicity was defined by: first trimester ultrasound evaluation (absence of lambda sign); presence of two separate placentas; different fetal sex; pathological placental examination. Results: twenty-four (14.2%) fetal malformations were observed, 22 in twin and 2 in triplet pregnancy. In the group with fetal malformations 13 were monochorionic, 4 dichorionic and in 5 the chorionicity was unknown. Some malformations were unique to twins (conjoined twins n = 5, acardiac twin n = 3) and others were nonunique to twins. The gestational age at delivery was lower in the group with fetal malformations compared to the group without fetal malformations. Conclusion: the majority of malformations occurred in the monochorionic pregnancies. In multiple pregnancies early determination of chorionicity is helpful to establish the prognosis and to plan the management of pregnancy.
Summary
Rev Bras Ginecol Obstet. 2000;22(8):511-517
DOI 10.1590/S0100-72032000000800007
Purpose: to demonstrate the types of fetal malformations in multiple pregnancy and their relation to chorionicity. Methods: one hundred and sixty-nine multiple pregnancies were evaluated. In all cases prenatal ultrasound examination was performed during antenatal care. Chorionicity was defined by: first trimester ultrasound evaluation (absence of lambda sign); presence of two separate placentas; different fetal sex; pathological placental examination. Results: twenty-four (14.2%) fetal malformations were observed, 22 in twin and 2 in triplet pregnancy. In the group with fetal malformations 13 were monochorionic, 4 dichorionic and in 5 the chorionicity was unknown. Some malformations were unique to twins (conjoined twins n = 5, acardiac twin n = 3) and others were nonunique to twins. The gestational age at delivery was lower in the group with fetal malformations compared to the group without fetal malformations. Conclusion: the majority of malformations occurred in the monochorionic pregnancies. In multiple pregnancies early determination of chorionicity is helpful to establish the prognosis and to plan the management of pregnancy.
Summary
Rev Bras Ginecol Obstet. 2001;23(7):431-438
DOI 10.1590/S0100-72032001000700004
Purpose: to evaluate the association between the presence of diastolic notch in the maternal uterine arteries, and the histopathological changes of the uteroplacental vessels. Methods: transversal study of 144 women with single pregnancy interrupted by cesarean section between 27 and 41 weeks. In this sample, 84 had pregnancies complicated by preeclampsia and the other 60 were normal. In this group, Doppler study of both uterine arteries and placental bed biopsy was performed. Results: of the total of 144 patients, 88 patients (61%) had a biopsy fragment that was considered representative of the placental bed. The diastolic notch was present in 40 patients (70%) of the total of cases with inadequate physiologic alterations and absent in 28 patients (90%) of the total of cases with physiologic alterations (p=0.0000). The Doppler study showed 70% sensitivity, 90% specificity, 44% positive predictive value and 97% negative predictive value. The association between bilateral diastolic notch of uterine arteries and acute atherosis in the placental bed was also significant (24 out of 25 cases -- p=0.000). The Doppler study showed 96% sensitivity, 70% specificity, 26% positive predictive value and 99% negative predictive value, while for arteriolosclerosis its results were 80% sensitivity, 55% specificity, 17% positive predictive value and 96% negative predictive value. Conclusions: the diastolic notch in the maternal uterine is a safe indicator of pathological vessel alteration in the placental bed. The adequate trophoblast migration into the myometrium, revealed by physiologic changes, results in the absence of bilateral diastolic notch of the maternal uterine arteries.
Summary
Rev Bras Ginecol Obstet. 2001;23(7):431-438
DOI 10.1590/S0100-72032001000700004
Purpose: to evaluate the association between the presence of diastolic notch in the maternal uterine arteries, and the histopathological changes of the uteroplacental vessels. Methods: transversal study of 144 women with single pregnancy interrupted by cesarean section between 27 and 41 weeks. In this sample, 84 had pregnancies complicated by preeclampsia and the other 60 were normal. In this group, Doppler study of both uterine arteries and placental bed biopsy was performed. Results: of the total of 144 patients, 88 patients (61%) had a biopsy fragment that was considered representative of the placental bed. The diastolic notch was present in 40 patients (70%) of the total of cases with inadequate physiologic alterations and absent in 28 patients (90%) of the total of cases with physiologic alterations (p=0.0000). The Doppler study showed 70% sensitivity, 90% specificity, 44% positive predictive value and 97% negative predictive value. The association between bilateral diastolic notch of uterine arteries and acute atherosis in the placental bed was also significant (24 out of 25 cases -- p=0.000). The Doppler study showed 96% sensitivity, 70% specificity, 26% positive predictive value and 99% negative predictive value, while for arteriolosclerosis its results were 80% sensitivity, 55% specificity, 17% positive predictive value and 96% negative predictive value. Conclusions: the diastolic notch in the maternal uterine is a safe indicator of pathological vessel alteration in the placental bed. The adequate trophoblast migration into the myometrium, revealed by physiologic changes, results in the absence of bilateral diastolic notch of the maternal uterine arteries.
Summary
Rev Bras Ginecol Obstet. 2001;23(7):417-422
DOI 10.1590/S0100-72032001000700002
Purpose: to investigate risk factors associated with accretion in placenta previa (PP) patients. Methods: this was a retrospective case-control study of all the records of patients who delivered between 1986-1998 at Maternidade Escola de Vila Nova Cachoeirinha (São Paulo) with a diagnosis of placenta previa. The groups with and without accretion were compared regarding age, parity, previous history of miscarriage, curettage and cesarean section, type of PP and predominant area of placental attachment. Possible associations between the dependent (accretion) and independent (maternal and placental characteristics) variables were evaluated using the chi² test, univariate and multivariate analyses. Results: reviewing 245 cases of PP, two risk factors were significantly associated with accretion: central placenta previa (odds ratio (OR): 2.93) and two or more previous cesarean sections(OR: 2.54). Based on these data, a predictive model was constructed, according to which a patient with central PP and two more previous cesarean sections has a 44.4% risk for accretion. Conclusions: results of the current study may help obstetricians in the classification of their patients with PP in different risk categories for accretion. This could be useful in preparing for possible delivery complications in those patients considered at a higher risk for accretion.
Summary
Rev Bras Ginecol Obstet. 2001;23(7):417-422
DOI 10.1590/S0100-72032001000700002
Purpose: to investigate risk factors associated with accretion in placenta previa (PP) patients. Methods: this was a retrospective case-control study of all the records of patients who delivered between 1986-1998 at Maternidade Escola de Vila Nova Cachoeirinha (São Paulo) with a diagnosis of placenta previa. The groups with and without accretion were compared regarding age, parity, previous history of miscarriage, curettage and cesarean section, type of PP and predominant area of placental attachment. Possible associations between the dependent (accretion) and independent (maternal and placental characteristics) variables were evaluated using the chi² test, univariate and multivariate analyses. Results: reviewing 245 cases of PP, two risk factors were significantly associated with accretion: central placenta previa (odds ratio (OR): 2.93) and two or more previous cesarean sections(OR: 2.54). Based on these data, a predictive model was constructed, according to which a patient with central PP and two more previous cesarean sections has a 44.4% risk for accretion. Conclusions: results of the current study may help obstetricians in the classification of their patients with PP in different risk categories for accretion. This could be useful in preparing for possible delivery complications in those patients considered at a higher risk for accretion.
Summary
Rev Bras Ginecol Obstet. 2002;24(10):212-216
DOI 10.1590/S0100-72032002001000006
PURPOSE: to compare two methodologies for the calculation of placental volume in normal term pregnancies: one according to the Archimedes principle and the other to the cylinder volume, to estimate the absolute placental densities. Also, to define the methodology which relates to the weight and to the newborn classification. METHOD: fifty placentas from normal term pregnancies were tested by the two methodologies to estimate the placental volume and absolute density: a) Archimedes principle, and b) the cylinder volume with two possible different heights. The absolute placental densities were calculated, respectively, by the quotient between the placenta weight, properly standardized, and the different estimated volumes. RESULTS: most of the pregnant women had more than one gestation, average age of 25.4 years, mean placental volume between 547.8 and 610 cm³ and mean density between 0.94 and 1.14 g/cm³, depending on the used methodology. CONCLUSIONS: the Archimedes principle was the most appropriate methodology to estimate the term placental volume, best correlating with the newborn weight, the placental index and the classification of newborn weight in relation to gestational age.
Summary
Rev Bras Ginecol Obstet. 2002;24(10):212-216
DOI 10.1590/S0100-72032002001000006
PURPOSE: to compare two methodologies for the calculation of placental volume in normal term pregnancies: one according to the Archimedes principle and the other to the cylinder volume, to estimate the absolute placental densities. Also, to define the methodology which relates to the weight and to the newborn classification. METHOD: fifty placentas from normal term pregnancies were tested by the two methodologies to estimate the placental volume and absolute density: a) Archimedes principle, and b) the cylinder volume with two possible different heights. The absolute placental densities were calculated, respectively, by the quotient between the placenta weight, properly standardized, and the different estimated volumes. RESULTS: most of the pregnant women had more than one gestation, average age of 25.4 years, mean placental volume between 547.8 and 610 cm³ and mean density between 0.94 and 1.14 g/cm³, depending on the used methodology. CONCLUSIONS: the Archimedes principle was the most appropriate methodology to estimate the term placental volume, best correlating with the newborn weight, the placental index and the classification of newborn weight in relation to gestational age.
