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Objective-To evaluate the effect of maternal cigarette smoking on placental histology in women with abruption.Study design-Data were derived from the New Jersey-Placental Abruption Study (NJ-PAS)-an ongoing, case-control study, conducted since August 2002 in two large hospitals in NJ. Abruption cases were identified based on a clinical diagnosis. Histological evaluations were performed by two perinatal pathologists who were blinded to the abruption status. Maternal smoking during pregnancy was determined based on patient's self report. Among abruption cases, histological findings were compared between smokers and non-smokers, and the association expressed as odds ratio (OR) with 95% confidence interval (CI). All analyses were adjusted for potential confounders.Results-A total of 189 abruption cases were available for analysis, of which 10.6% (n=20) were smokers. Intervillous thrombus was more common in women who smoked (20%) than in nonsmokers (3.0%) (OR 17.5, 95% CI 3.1, 99.4). However, placental infarcts were seen less frequently among smokers than non-smokers (10.0% vs 32.5%; OR 0.2, 95% CI 0.1, 0.8).Conclusion-These findings suggest that different pathologic mechanisms may be responsible for the histologic findings between smokers and non-smokers diagnosed with placental abruption. KeywordsPlacental abruption; smoking; villous fibrosis; intervillous thrombus; microinfarcts; trophoblast knotting Placental abruption complicates approximately 1% of all pregnancies, 1, 2 with an increase in its incidence over time. 3 This condition is associated with significant maternal morbidity and Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. The association of maternal smoking with placental abruption has been well documented with studies reporting relative risks of 1.4 to 2.5. 9-11 Cigarette use is associated with a 2.5 fold increase in severe abruption resulting in fetal death. 9 The risk of abruption increases with the number of cigarettes smoked per day, 11 with a threshold effect at approximately 10 cigarettes per day after which the risk remains constant. 12 NIH Public AccessStudies focusing on smoking-related placental abruption pathology are sparse. These studies allude to the mechanism of abruption in smokers that is initiated by decidual necrosis at the margin of the placenta. 13, 14 Maternal smoking has been shown to decrease placental blood flow. 15 This effect may be mediated through changes in production of vasoactive substances, such as prostacyclin and nitric oxide, 16 or endothelial cell damage. 17The sequence of events in the placentas of smokers leading t...

Fetal goiter is a rare complication of pregnancy, and may be the consequence of fetal hyperthyroidism or hypothyroidism. To our knowledge, this is the first report of three-dimensional (3D) sonography in the evaluation and treatment of fetal goiter.A 36-year-old woman in her fifth pregnancy presented for prenatal care at a gestational age of 13 weeks. Hyperthyroidism had been diagnosed 2 weeks previously during evaluation for palpitations and tachycardia. She was otherwise asymptomatic and her pregnancy had been otherwise uncomplicated. She had previously had a fullterm uncomplicated normal vaginal delivery, followed by three first-trimester spontaneous miscarriages. The physical examination was unremarkable. Her thyroidstimulating hormone (TSH) level was suppressed, and she had elevated free thyroxine levels. In addition, she had circulating thyroid-stimulating immunoglobin and thyroid-binding inhibitory immunoglobin.At 13 weeks she was started on 100 mg propylthiouracil (PTU) thrice daily. Targeted sonography at 23 weeks' gestation revealed a fetal goiter with neck extension. At 27 weeks' gestation 2D and 3D sonography and power Doppler angiography were performed (Figures 1-4) using a Voluson 730 (GE Medical Systems, Milwaukee, WI, USA) ultrasound machine. Because of the possibility that the goiter was the result of fetal hypothyroidism from transplacental transfer of PTU to the fetus, it was decided to reduce the PTU dose to 50 mg twice daily. Despite this reduction in the dose of PTU, the fetal goiter did not diminish in size. Consequently, cordocentesis was performed at 30 weeks' gestation and it was determined that the fetus was profoundly hypothyroid, with a TSH level of 23.61 mIU/mL (normal range, 0.35-5.5 mIU/mL). Intra-amniotic injection of 500 µg thyroxine was therefore performed immediately. Because the goiter only demonstrated modest diminution in size ( Figure 5) 2 weeks later, a further intra-amniotic injection of 250 µg thyroxine was administered. At 34 weeks' gestation, the goiter was still present, although it had diminished somewhat in size. Therefore another cordocentesis was performed, which revealed that the fetus was now euthyroid. By 35 weeks' gestation, the goiter was significantly smaller. The patient was delivered by Cesarean at 36 weeks' gestation because labor had started and the fetus was in a breech presentation.

SASP reduced rates of pre-term delivery and improved pregnancy outcomes for mice infected with 10(4) CFU E. coli. This suggests that SASP has the potential to play a role in strategies to prevent pre-term birth in women.