A morphometric and histological study of placental malaria shows significant changes to villous architecture in both Plasmodium falciparum and Plasmodium vivax infection

Chaikitgosiyakul, Sethawud; Rijken, Marcus J.; Muehlenbachs, Atis; Lee, Sue J.; Chaisri, Urai; Viriyavejakul, Parnpen; Turner, Gareth D. H.; Pongponratn, Emsri; Nosten, François; McGready, Rose

doi:10.1186/1475-2875-13-4

Cited by 54 publications

(53 citation statements)

References 39 publications

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“…[43][44][45] It is conceivable that anemia may render the uterus and/or placenta particularly vulnerable to bleeding since they are highly vascular organs. Second, there is some evidence that the chronic hypoxic environment caused by anemia can upregulate or dysregulate placental vascularity, [46][47][48][49][50] which may increase the vulnerability of the placenta and uterus to vascular fragility and PPH. Third, anemia has been associated in some studies, 51,5253 with uterine atony (implicated in PPH 54,55 ), perhaps related to tissue iron deficiency.…”

Section: Discussionmentioning

confidence: 99%

Maternal death and postpartum hemorrhage in sub‐Saharan Africa – A pilot study in metropolitan Mozambique

Lancaster

Barnes

Correia

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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Background Maternal mortality in sub‐Saharan Africa is approximately 500 to 1000 per 100 000 births (vs. approximately 5‐20 in developed countries). Postpartum hemorrhage (PPH) is deemed responsible for 30% to 50% of the deaths. Objective To study PPH, risk factors, and mortality in metropolitan Mozambique to inform future studies and intervention strategies. Materials/Methods Retrospective cross‐sectional data extraction from all charts available to us (n = 495) recording deliveries between January and June 2018 at Maputo Central Hospital. Data included age, maternal survival, HIV status, parity, delivery mode, complications, vital signs, laboratory values, and maternal/fetal data. PPH was determined by charted diagnosis, interventions for hemorrhaging, placental abruption, transfusion, or blood loss. Autopsy reports from all deceased patients (n = 35) were examined. Results Median age was 29 years with 17% HIV prevalence. Risk factors for PPH (frequency, 12%) included parity (adjusted odds ratios (AORs) for 3+ versus nulliparity, 7.20 (95% confidence interval [CI], 2.46‐21.10), gestation length (AOR, 0.86; CI, 0.81‐0.92 per week), and body temperature (AOR, 1.10; CI, 1.04‐1.16 per 0.1°C). Maternal mortality was strongly associated with PPH (AOR, 5.22; 95% CI, 2.26‐12.08) and HIV (AOR, 11.66; 95% CI, 4.72‐28.78). Laboratory values (n = 241) were available from mothers experiencing complications (approximately 50%). Anemia (prevalence 54%) was a strong predictor of PPH with an inverse relationship between hemoglobin levels on admission (AOR, 0.62; 95% CI, 0.50‐0.77 per g/dL higher hemoglobin) and the probability of later suffering from PPH. Mothers who died following PPH had lower median hemoglobin (6.2 g/dL) than mothers who survived (9.2 g/dL). Protocols to estimate peripartum blood loss were not used; antifibrinolytics and/or cryoprecipitate were unavailable. Conclusion Postpartum hemorrhage is a serious problem even in metropolitan areas of sub‐Saharan Africa, and anemia influenced bleeding and death substantially. To address this problem, it is critical to raise awareness and region‐specific prevention and intervention protocols.

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Section: Discussionmentioning

confidence: 99%

Maternal death and postpartum hemorrhage in sub‐Saharan Africa – A pilot study in metropolitan Mozambique

Lancaster

Barnes

Correia

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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“…[9][10][11] Inflammation in the placenta has been linked to impaired transplacental transport of glucose 12 and amino acids, 13 and disruption of the insulin-like growth hormone axis. 14 Impaired nutrient transport across the placenta may be further exacerbated by altered placental angiogenesis 15 leading to changes in both the villous architecture 16 and surface area for nutrient exchange, as well as impaired uteroplacental blood flow. 15,17 These histologic and functional changes likely contribute to impaired fetal growth.…”

Section: Pathophysiology Of Malaria In Pregnancymentioning

confidence: 99%

An overview of malaria in pregnancy

Bauserman

Conroy

North

et al. 2019

Seminars in Perinatology

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One hundred twenty-five million pregnant women are at risk for contracting malaria, a preventable cause of maternal and infant morbidity and death. Malaria parasites contribute to adverse pregnancy and birth outcomes due to their preferential accumulation in placental intervillous spaces. Pregnant women are particularly vulnerable to malaria infections, and malaria infections during pregnancy put their fetuses at risk. Malaria in pregnancy is associated with anemia, stillbirth, low birth weight and maternal and fetal death. We review the challenges to diagnosing malaria in pregnancy, as well as strategies to prevent and treat malaria in pregnancy. Finally, we discuss the current gaps in knowledge and potential areas for continued research.

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“…iE sequestration leads to acute vascular modifications of placental villi, reducing the available surface for feto-placental exchanges. This decrease may be correlated with intra-uterine growth retardation [9, 10]. The blood flow modifications by the accumulation of iEs in the intervillous spaces originate ST hypoxia and angiogenesis deregulation.…”

Section: Introductionmentioning

confidence: 99%

Usefulness of a biomarker to identify placental dysfunction in the context of malaria

Gueneuc

Deloron

Bertin

2017

Malar J

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In most tropical areas, pregnant women are at increased risk of malaria, as a consequence of the massive sequestration of parasitized red blood cells in the placenta. The placenta plays a key role in embryonic and fetal development as well as in maternal-fetal exchanges, and pregnancy-associated malaria may alter selected placenta functions that lead to stillbirth and low birth weight. Although there are several tools (blood smear examination, RDT, PCR) to diagnose malaria infection during pregnancy, there is currently no test to assess placenta dysfunction in the framework of pregnancy-associated malaria. Pregnancy-associated malaria shares many features with preeclampsia, an extensively studied disease. Various biomarkers associated with placental dysfunction have been identified as associated with preeclampsia. Several of these are inflammatory markers that lack of specificity. A few seem more specific of placenta dysfunction, including s-endoglin and sFlt1, increased in the peripheral blood during preeclampsia. The predictive value of these biomarkers should be studied in the context of pregnancy-associated malaria to evaluate their usefulness in identifying placental dysfunction during malaria. These biomarkers should be considered to improve the diagnosis of placental dysfunction during malaria and pregnant women monitoring.

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A morphometric and histological study of placental malaria shows significant changes to villous architecture in both Plasmodium falciparum and Plasmodium vivax infection

Cited by 54 publications

References 39 publications

Maternal death and postpartum hemorrhage in sub‐Saharan Africa – A pilot study in metropolitan Mozambique

Maternal death and postpartum hemorrhage in sub‐Saharan Africa – A pilot study in metropolitan Mozambique

An overview of malaria in pregnancy

Usefulness of a biomarker to identify placental dysfunction in the context of malaria

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