A new, clinically oriented, unifying and simple placental classification system

Turowski, G; Berge, L.N.; Helgadottir, L.B.; Jacobsen, E; Roald, Borghild

doi:10.1016/j.placenta.2012.10.002

Cited by 41 publications

(33 citation statements)

References 28 publications

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“…A recent review calls for a clinically oriented, unifying and simple placental pathology classification system; yet, more research is still needed to define international diagnostic criteria to describe placental morphology (56). Furthermore, future studies should clearly describe the methodology and definitions pathologists used to report placental abnormalities.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of placental pathology in maternal diabetes mellitus

et al. 2015

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During a pregnancy complicated by diabetes, the human placenta undergoes a number of functional and structural pathologic changes, such as increased placental weight and increased incidence of placental lesions including villous maturational defects and fibrinoid necrosis. The pathologic findings reported have differed among studies, potentially reflecting differences in type of diabetes, study methodology, or glycemic control of study participants. Alternatively, these discrepancies may represent different biologic adaptations to distinct metabolic diseases. In order to clarify these distinctions, we conducted a comprehensive review of English language citations in Pubmed and Embase using the keywords “diabetes”, “placenta”, AND “pathology”. Abstracts were reviewed for relevance then full-text articles were reviewed in order to extract a comprehensive summary of current pathological findings associated with pregestational and gestational diabetes mellitus, as well as an understanding of the impact of glycemic control on placental pathology. Placental abnormalities most consistently associated with maternal diabetes are an increased incidence of villous immaturity, increased measures of angiogenesis, and increased placental weight. The literature suggests that, despite similarities in placental abnormalities, differences in placental pathology may reflect differences in pathophysiology among different types of diabetes. Consequently, standardization of terminology used to define placental lesions is warranted. Moreover, further research is needed to investigate the impact of pathophysiology, glycemic control and clinical factors, such as infant sex, weight and race, on placental structure and function.

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Section: Discussionmentioning

confidence: 99%

A systematic review of placental pathology in maternal diabetes mellitus

et al. 2015

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“…According to the literature [11-19], nine parameters were analyzed, of which seven were related to tissue damage and two were related to hypoxic parenchymal compensation (Table 1). The seven parameters related to tissue damage were chronic villitis, fibrin deposition, calcification, syncytial knots, fetal thrombotic vasculopathy, distal villous hypoplasia, and delayed villous maturation.…”

Section: Methodsmentioning

confidence: 99%

Histological Analysis of Term Placentas from Hyperimmune Globulin-Treated and Untreated Mothers with Primary Cytomegalovirus Infection

Gabrielli¹,

Bonasoni²,

Foschini³

et al. 2018

Fetal Diagn Ther

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Background: The Congenital Human Cytomegalovirus Infection Prevention (CHIP) study, a randomized, blinded, placebo-controlled trial, demonstrated that the efficacy of hyperimmune globulin (HIG) was not different from that of placebo regarding transmission of cytomegalovirus (CMV) from mothers to newborns. Our aim was to analyze histologically HIG effects on placentas collected for the CHIP study. Materials and Methods: Virological and histological analyses were performed on 40 placentas from transmitter and nontransmitter HIG-treated and untreated mothers by assessing the number of CMV-positive cells, tissue viral load, tissue damage, and compensatory mechanisms. Results: The HIG and placebo groups showed no significant differences in the number of CMV-positive cells (median number in 10 fields at 10 high-power fields: 2.5 vs. 2, p = 0.969) and viral load (median load: 5 copies/5 ng vs. 10.5 copies/5 ng, p = 0.874). Regarding histological examination, the scores of parameters related to tissue damage and hypoxic parenchymal compensation were higher in transmitters except for chorangiosis, with statistically significant differences observed for chronic villitis (p = 0.007), calcification (p = 0.011), and the total score of tissue damage (p < 0.001). The HIG and placebo groups showed no significant differences for all tissue damage and compensation parameters and overall scores. Discussion: HIGs are not able to reduce placental viral load and histological damage, which was significantly associated only with infection.

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“…The literature on placental histologic findings is vast but mainly based on and developed for the examination of placentas sent for gross and histologic examination due to pregnancy-and birth-related complications, such as infection, intrauterine growth retardation, and fetal death. Several guidelines on practical handling of placentas are available in textbooks and articles, as are recommendations for reporting pathologic entities and specific subentities [8][9][10][11][12][13][14][15][16][17][18]. These are constantly being updated in the literature.…”

Section: Introductionmentioning

confidence: 99%

“…Placental evaluation is complicated by the fact that well-defined pathologic entities in some cases are causative, explaining a negative pregnancy outcome, while in other cases are incidental findings in uncomplicated pregnancies. Large studies of unselected series of placentas have been published [18][19][20][21], but only few papers have reported series of morphologic findings in normal term placentas [22,23]. In these publications, the criteria for reporting specific entities vary and are not always described in precise detail, making comparison between studies difficult.…”

Section: Introductionmentioning

confidence: 99%

Pathologic Evaluation of Normal and Perfused Term Placental Tissue

et al. 2014

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This study reports for the 1st time the incidence and interobserver variation of morphologic findings in a series of 34 term placentas from pregnancies with normal outcome used for perfusion studies. Histologic evaluation of placental tissue is challenging, especially when it comes to defining "normal tissue" versus "pathologic lesions." A scoring system for registration of abnormal morphologic findings was developed. Light microscopic examination was performed independently by 2 pathologists, and interobserver variation was analyzed. Findings in normal and perfused tissue were compared and selected findings were tested against success parameters from the perfusions. Finally, the criteria for frequent lesions with fair to poor interobserver variation in the nonperfused tissue were revised and reanalyzed. In the perfused tissue, the perfusion artefact "trophoblastic vacuolization," which is believed to represent dilated transtrophoblastic channels, was reproducible and significantly correlated to the perfusion marker "fetal leakage." In longer perfusions, microscopy of the perfused cotyledon revealed bacteria in the fetal vessels. This finding led to an adjustment in the perfusion protocol with addition of antibiotics to the medium. In the "normal" tissue, certain lesions were very frequent and showed only fair or poor interobserver agreement. Revised minimum criteria for these lesions were defined and found reproducible. This study has emphasized the value of pathologic examination as a supplement in placental perfusion models. Examination of the perfused cotyledon for trophoblastic vacuolization is recommended as an additional quality marker in perfusion models. The study also underlines the need for exact definitions of abnormality in frequent placental lesions.

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A new, clinically oriented, unifying and simple placental classification system

Cited by 41 publications

References 28 publications

A systematic review of placental pathology in maternal diabetes mellitus

A systematic review of placental pathology in maternal diabetes mellitus

Histological Analysis of Term Placentas from Hyperimmune Globulin-Treated and Untreated Mothers with Primary Cytomegalovirus Infection

Pathologic Evaluation of Normal and Perfused Term Placental Tissue

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