Clinical correlations of patterns of placental pathology in preterm pre-eclampsia

Salafia, Carolyn M.; Pezzullo, John C.; Ghidini, Alessandro; López-Zeno, JoséA.; Whittington, Sara

doi:10.1016/s0143-4004(98)90100-x

Cited by 92 publications

(23 citation statements)

References 22 publications

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“…An example of a normotensive, mature placenta is shown with little/no Flt/sFlt-1 staining (E, ×50). particularly those that are delivered preterm (less than 37 weeks' gestation), are usually small and show accelerated villous maturation [17]. This hypermaturity is characterized by the presence of syncytial knots, above and beyond what is normal for gestational age [11].…”

Section: Discussionmentioning

confidence: 99%

Placental expression of vascular endothelial growth factor receptor-1/soluble vascular endothelial growth factor receptor-1 correlates with severity of clinical preeclampsia and villous hypermaturity

et al. 2011

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Section: Discussionmentioning

confidence: 99%

Placental expression of vascular endothelial growth factor receptor-1/soluble vascular endothelial growth factor receptor-1 correlates with severity of clinical preeclampsia and villous hypermaturity

et al. 2011

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“…For example, in pre-eclampsia, spiral arteries remain 'untransformed' [10], remaining muscular due to the incomplete invasion of trophoblast, leading to high-resistance blood flow passing through these vessels and abnormal uteroplacental blood flow. Though ischaemic-type changes have been observed in the majority of severe preterm cases [8,11], there may be subjectively normal placental histological findings even in cases of clinically severe disease at or near term [12,13]. Features such as infarction, extensive perivillous fibrin deposition and chronic villitis are more frequent in SGA in some studies [14] but not others [15] and are well-reported in clinically normal pregnancies.…”

Section: Introductionmentioning

confidence: 99%

Frequency and clinical significance of placental histological lesions in an unselected population at or near term

et al. 2011

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Associations between specific placental histological abnormalities and obstetric outcomes are reported. However, most data are based either on high-risk cases or relate to case-control studies selected from those with abnormal placental histology findings, with the unavoidable biases that these approaches entail. This study reports the frequency of the several common, objective and predefined histological abnormalities of the placenta as identified by pathologists blinded to all clinical information. A total 1,153 women were recruited from an unselected population delivering at 34-43 weeks. Histological findings in common obstetric outcome groups were compared to those of the unselected population, and odds ratios and predictive values were calculated. Normal histological findings were present in 72.1% of pregnancies with normal outcomes and in 79.1%, 66.6%, 80%, and 74.8% of pregnancies affected by pre-eclampsia (PET), pregnancy-induced hypertension (PIH), gestational diabetes (GDM), and small for gestational age (SGA), respectively. Chronic placental underperfusion was seen more frequently in PIH (odds ratio (OR) 2) and SGA (OR 1.4), while villitis of unknown aetiology was observed more commonly in cases with PIH (OR 3.2). Fetal thrombotic vasculopathy was twice as common in cases with GDM whilst massive perivillous fibrin deposition was much more frequent in those with PET (OR 20.2) and SGA (OR 8.9). Chorangiomata were 13 times more common in pregnancies with PET. However, in all cases, positive predictive values were low, with the majority of cases with histological abnormalities being associated with normal outcome. At term, specific placental histological lesions are significantly more common in complicated pregnancies, but the clinical significance of such lesions in a specific case remains uncertain, since the majority will be identified from clinically uncomplicated normal pregnancies.

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“…(Brosens and Renaer 1972;Teasdale 1985;Sodhi et al 1990;Salafia et al 1995;Salafia et al 1998;Sekotory and Ahmed 2001;Sikkema et al 2002) Although not specific for preeclampsia, infarcts, when large, central or multiple, indicate significant uteroplacental disease (Fox 1997). We have noted anecdotally that the placenta may often demonstrate few diagnostic pathological features in cases delivered near term even in the presence of severe clinical disease according to the criteria for induced or operative delivery.…”

Section: Introductionmentioning

confidence: 99%

Term preeclampsia is associated with minimal histopathological placental features regardless of clinical severity

Sebire

Goldin

Regan

2005

Journal of Obstetrics and Gynaecology

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Preeclampsia (PET) is a serious complication of pregnancy, which is associated with uteroplacental disease and reduced uteroplacental perfusion. One of the histological features in placentas from pregnancies complicated by PET is infarction, representing focal severe uteroplacental ischaemia. This study examines the relationship between gestation at induced delivery and the prevalence of placental infarction using a placental pathology database to identify induced or operative deliveries on the basis of severe PET. The clinical and pathological findings were reviewed. Thirty-seven cases were identified, (4.9% of all placentas submitted). In 16 (43%), non-peripheral significant infarcts were identified histologically, including 13/20 (65%) requiring delivery before 34 weeks' compared to 3/17 (17%) requiring delivery > or = 34 weeks (z=2.9, P<0.01). Histological infarction is common in placentas from pregnancies complicated by severe PET but the prevalence is significantly greater in cases requiring delivery at earlier gestations, even when similar clinical indications for delivery are applied.

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Clinical correlations of patterns of placental pathology in preterm pre-eclampsia

Cited by 92 publications

References 22 publications

Placental expression of vascular endothelial growth factor receptor-1/soluble vascular endothelial growth factor receptor-1 correlates with severity of clinical preeclampsia and villous hypermaturity

Placental expression of vascular endothelial growth factor receptor-1/soluble vascular endothelial growth factor receptor-1 correlates with severity of clinical preeclampsia and villous hypermaturity

Frequency and clinical significance of placental histological lesions in an unselected population at or near term

Term preeclampsia is associated with minimal histopathological placental features regardless of clinical severity

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