Placental Pathology in COVID-19

Objectives To describe histopathologic findings in the placentas of women with coronavirus disease 2019 (COVID-19) during pregnancy. Methods Pregnant women with COVID-19 delivering between March 18, 2020, and May 5, 2020, were identified. Placentas were examined and compared to historical controls and women with placental evaluation for a history of melanoma. Results Sixteen placentas from patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were examined (15 with live birth in the third trimester, 1 delivered in the second trimester after intrauterine fetal demise). Compared to controls, third trimester placentas were significantly more likely to show at least one feature of maternal vascular malperfusion (MVM), particularly abnormal or injured maternal vessels, and intervillous thrombi. Rates of acute and chronic inflammation were not increased. The placenta from the patient with intrauterine fetal demise showed villous edema and a retroplacental hematoma. Conclusions Relative to controls, COVID-19 placentas show increased prevalence of decidual arteriopathy and other features of MVM, a pattern of placental injury reflecting abnormalities in oxygenation within the intervillous space associated with adverse perinatal outcomes. Only 1 COVID-19 patient was hypertensive despite the association of MVM with hypertensive disorders and preeclampsia. These changes may reflect a systemic inflammatory or hypercoagulable state influencing placental physiology.

Placental pathology in COVID-19

Objectives: To describe histopathologic findings in the placentas of women with COVID-19 during pregnancy. Methods: Pregnant women with COVID-19 delivering between March 18, 2020 and May 5, 2020 were identified. Placentas were examined and compared to historical controls and women with placental evaluation for a history of melanoma. Results: 16 placentas from patients with SARS-CoV-2 were examined (15 with live birth in the 3rd trimester 1 delivered in the 2nd trimester after intrauterine fetal demise). Compared to controls, third trimester placentas were significantly more likely to show at least one feature of maternal vascular malperfusion (MVM), including abnormal or injured maternal vessels, as well as delayed villous maturation, chorangiosis, and intervillous thrombi. Rates of acute and chronic inflammation were not increased. The placenta from the patient with intrauterine fetal demise showed villous edema and a retroplacental hematoma. Conclusions: Relative to controls, COVID-19 placentas show increased prevalence of features of maternal vascular malperfusion (MVM), a pattern of placental injury reflecting abnormalities in oxygenation within the intervillous space associated with adverse perinatal outcomes. Only 1 COVID-19 patient was hypertensive despite the association of MVM with hypertensive disorders and preeclampsia. These changes may reflect a systemic inflammatory or hypercoagulable state influencing placental physiology.

Monochorionic-diamniotic twin pregnancy complicated by twin reversed arterial perfusion sequence and retroplacental hematoma – a case report

Twin reversed arterial perfusion (TRAP) sequence is a rare and severe complication specific to monochorionic twin pregnancies, involving the presence of an acardiac twin and a structurally normal co-twin (pump twin). We report on the case of a33-year-old female with a biamniotic monochorionic twin pregnancy complicated with TRAP sequence and polyhydramnios. The patient underwent fetoscopic termination of the acardiac twin and at 34 gestational weeks (GW) was readmitted with aretroplacental hematoma. The patient gave birth through caesarean section to a living female fetus, weighing 1480 g. To the best of our knowledge, this is the first case reporting a twin pregnancy with TRAP sequence complicated with retroplacental hematoma.

Placental examination in nonmacerated stillbirth versus neonatal mortality

Aim: To retrospectively statistically compare clinical and placental phenotypes of nonmacerated fetuses and live-born perinatal deaths in 3rd trimester pregnancies. Methods: Twenty-five clinical and 47 placental phenotypes were statistically compared among 93 cases of nonmacerated (intrapartum, or recent antepartum death) 3rd trimester fetal deaths (Group 1), 118 3rd trimester neonatal deaths (Group 2) and 4285 cases without perinatal mortality (Group 3). Results: Sixteen clinical and placental phenotypes were statistically significantly different between Group 3 and the two groups of perinatal deaths, which included eight placental phenotypes of fetal vascular malperfusion and eight other placental phenotypes of various etiology (amnion nodosum, 2-vessel umbilical cord, villous edema, increased extracellular matrix of chorionic villi, erythroblasts in fetal blood and trophoblastic lesions of shallow placentation). Statistically significant differences between Groups 1 and 2 were scant (oligohydramnios, fetal malformations, cesarean sections, hypercoiled umbilical cord and amnion nodosum being more common in the latter, and retroplacental hematoma more common in the former). Conclusion: Placental examination in neonatal mortality shows thrombotic pathology related to umbilical cord compromise and features of shallow placental implantation that are similar to those in nonmacerated stillbirth; however, the features of placental abruption were more common in recent antepartum death, as were the features related to neonatal congenital malformations in neonatal deaths.

Acute complications of preeclampsia: prognosis and management at Pikine National Hospital in Dakar (Senegal)

ABSTRACTBackground: The objective of this study was to evaluate the prevalence of acute complications of preeclampsia in order to describe the epidemiological profile of the disease, to assess its prognosis and management.Methods: This was a retrospective study of patients admitted to the Pikine National Hospital from 1 January 2010 to 31 December 2013 (48 months) with severe complicated pre-eclampsia. Included in this study were patients admitted or diagnosed with severe complicated pre-eclampsia and having given birth in the structure or not.Results: The incidence of severe preeclampsia in childbirth varied from 9.7% to 11.5% during the four years of our study. Patients were largely paucigest (55.7% of cases) and paucipares (58.5% of cases). The mean age was 28.14 years with extremes of 14 and 47 years. More than half of the patients (57.7%) were between 21 and 34 years of age. They were mostly married (90.7%). Three-quarters of the patients (76.8%) had proteinuria with ≥ 3 cross-bands. Thrombocytopenia was found in 9.7% of patients, hepatic cytolysis in 12.1%, and elevation of serum creatinine in 13.8%. The level of transaminases was found to be greater than 2 in the normal range in 12.1%. Complicated forms were the most represented in our study. These were acute complications, with 715 cases, or 57.3% of the patients. They were either isolated (52.8%) or associated (4.5%). These included eclampsia (24.9%), followed by retroplacental hematoma (24.6%), fetal death in utero (23.7%), HELLP syndrome (3.4%). , Acute edema of the lungs (1.5%), and acute renal failure (1.4%). The lethality was 2.4%. The causes of maternal death were dominated by eclampsia (14 cases), DIC (3 cases) and OAP (2 cases). We counted 77.7% of live births and a stillbirth of 254.5 ‰.Conclusions: Pre-eclampsia is a serious complication of pregnancy. Its frequency is still high in sub-Saharan Africa. In the presence of signs of severity, maternal (vital and functional) and neonatal prognosis are inevitably involved. If management is based on fetal extraction, resuscitation measures are a guarantee of maternal survival.

Efficacy of the Kampo Medicine Xiong-Gui-Jiao-Ai-Tang, a Traditional Herbal Medicine, in the Treatment of Threatened Abortion in Early Pregnancy

This study was carried out to evaluate the clinical efficacy of Xiong-gui-jiao-ai-tang (Kyuki-kyogai-to), a traditional Chinese herbal medicine, in the treatment of threatened abortion in early pregnancy. We enrolled 72 women diagnosed with threatened abortion at Osaka Medical College Hospital and assigned them at random to the following two groups: a group of 36 women who received Xiong-gui-jiao-ai-tang at a dose of 7.5 g/day and another group of 36 women who received human chorionic gonadotropin (hCG)(control group). We found that in the Xiong-gui-jiao-ai-tang group (2.9 ± 3.5 days), the number of days required before hemostasis was reached in the uterus was significantly shorter than in the control group (10.8 ± 8.2 days, p < 0.0001). Furthermore, the number of days required for retroplacental hematoma in the vicinity of the gestational sac to disappear was significantly shorter in the Xiong-gui-jiao-ai-tang group (9.9 ± 7.1 days) than in the control group (23.2 ± 12.8 days) ( p < 0.0001). In retroplacental hematoma size, significant rates of reduction were obtained in both major and minor axis measurements at the 7th day of treatment for the Xiong-gui-jiao-ai-tang group compared to the control group (control vs Xiong-gui-jiao-ai-tang: major axis: 7.5 ± 3.8% vs 42.3 ± 10.5%; minor axis: 15.3 ± 16.8% vs 71.5 ± 48.2%)( p < 0.0001, each case). The results of this study demonstrated the beneficial effects of Xiong-gui-jiao-ai-tang in stabilizing early pregnancy. Xiong-gui-jiao-ai-tang can be expected to improve unstable early pregnancy with uterine bleeding and to prevent abortion.