Delayed Villous Maturation of the Placenta: Quantitative Assessment in Different Cohorts

Treacy, Ann; Higgins, Mary; Kearney, John; McAuliffe, Fionnuala M.; Mooney, Eoghan E.

doi:10.2350/12-06-1218-oa.1

Cited by 30 publications

(19 citation statements)

References 20 publications

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“…The reduction in the number of terminal villi and vasculo-syncytial membranes present in the HLHS placenta and the observed structure is reminiscent of a placenta from earlier in the third trimester rather than one at term [39]. This is an interesting observation because the placenta is often hyper-mature in the context of FGR, suggesting novel mechanisms contribute to pathogenesis in this context, and because there are reports of brain immaturity of approximately 4 weeks in cases of HLHS [40], consistent with late gestation growth failure, suggesting prenatal or mid-gestation interventions may positively impact clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Hypoplastic left heart syndrome is associated with structural and vascular placental abnormalities and leptin dysregulation

et al. 2015

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Introduction Hypoplastic left heart syndrome (HLHS) is a severe cardiovascular malformation (CVM) associated with fetal growth abnormalities. Genetic and environmental factors have been identified that contribute to pathogenesis, but the role of the placenta is unknown. The purpose of this study was to systematically examine the placenta in HLHS with and without growth abnormalities. Methods HLHS term singleton births were identified from a larger cohort when placenta tissue was available. Clinical data were collected from maternal and neonatal medical records, including anthropometrics and placental pathology reports. Placental tissues from cases and controls were analyzed to assess parenchymal morphology, vascular architecture and leptin signaling. Results HLHS cases (n = 16) and gestational age-matched controls (n = 18) were analyzed. Among cases, the average birth weight was 2993 grams, including 31% that were small for gestational age. When compared with controls, gross pathology of HLHS cases demonstrated significantly reduced placental weight and increased fibrin deposition, while micropathology showed increased syncytial nuclear aggregates, decreased terminal villi, reduced vasculature and increased leptin expression in syncytiotrophoblast and endothelial cells. Discussion Placentas from pregnancies complicated by fetal HLHS are characterized by abnormal parenchymal morphology, suggesting immature structure may be due to vascular abnormalities. Increased leptin expression may indicate an attempt to compensate for these vascular abnormalities. Further investigation into the regulation of angiogenesis in the fetus and placenta may elucidate the causes of HLHS and associated growth abnormalities in some cases.

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Section: Discussionmentioning

confidence: 99%

Hypoplastic left heart syndrome is associated with structural and vascular placental abnormalities and leptin dysregulation

et al. 2015

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“…Villous trophoblast is hyper cellular with persistent cytotrophoblast . Immature intermediate/terminal villous ratio is increased . All or few criteria are of diagnostic value.…”

Section: Category Imentioning

confidence: 99%

Re‐view and view on maturation disorders in the placenta

Turowski

Vogel

2018

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Until delivery, the placenta plays an important mediator role between mother and fetus. This unit is affected by peristatic conditions, such as acute or chronic maternal diseases, malnutrition, drugs, and others. But also genetic factors and fetal malformations due to embryonic developmental disorders may contribute to macroscopically visible changes and functional disorders of the placenta. In a constantly ongoing progress of maturation, the placenta records and saves changes due to fetal distress partly as maturation disorders. Understanding of maturation disorders might, therefore, be an important contribution to a better understanding of influences on villous differentiation and might improve follow up and fetal outcome to reduce recurrence risk. However, an internationally unified classification system of maturation disorders does not exist. In this review, terminology, trials, and classifications of villous maturation disorders are summed up and compared, to pinpoint the need of agreement on an international unified and reproducible classification of maturation disorders.

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“…Integrating across the capillary surface and using Eq (11) gives the total oxygen transfer rate (labeled N flow as it corresponds to the flow-limited regime) to be…”

Section: Blood Flow and Oxygen Transfer In Real Geometries: Scaling Amentioning

confidence: 99%

“…First, there is thought to be an increased amount of fetal capillary dilation in pregnancies at high altitude, where conditions are hypoxic [6], evidenced by a reduced mean trophoblast thickness [7] and an increased percentage of villous volume occupied by fetal capillaries [8]. Second, a lack of terminal villi and vasculo-synyctial membranes, amongst other markers, characterizes a pathology known as delayed villous maturation, also known as defective villous maturation or distal villous immaturity [9][10][11][12][13][14]. There is an increased prevalence of delayed villous maturation in stillbirths where the autopsy findings were consistent with fetal hypoxia [10,15]; it is also associated with poor neurologic outcomes due to hypoxia [9,13].…”

Section: Introductionmentioning

confidence: 99%

Image-Based Modeling of Blood Flow and Oxygen Transfer in Feto-Placental Capillaries

et al. 2016

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During pregnancy, oxygen diffuses from maternal to fetal blood through villous trees in the placenta. In this paper, we simulate blood flow and oxygen transfer in feto-placental capillaries by converting three-dimensional representations of villous and capillary surfaces, reconstructed from confocal laser scanning microscopy, to finite-element meshes, and calculating values of vascular flow resistance and total oxygen transfer. The relationship between the total oxygen transfer rate and the pressure drop through the capillary is shown to be captured across a wide range of pressure drops by physical scaling laws and an upper bound on the oxygen transfer rate. A regression equation is introduced that can be used to estimate the oxygen transfer in a capillary using the vascular resistance. Two techniques for quantifying the effects of statistical variability, experimental uncertainty and pathological placental structure on the calculated properties are then introduced. First, scaling arguments are used to quantify the sensitivity of the model to uncertainties in the geometry and the parameters. Second, the effects of localized dilations in fetal capillaries are investigated using an idealized axisymmetric model, to quantify the possible effect of pathological placental structure on oxygen transfer. The model predicts how, for a fixed pressure drop through a capillary, oxygen transfer is maximized by an optimal width of the dilation. The results could explain the prevalence of fetal hypoxia in cases of delayed villous maturation, a pathology characterized by a lack of the vasculo-syncytial membranes often seen in conjunction with localized capillary dilations.

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Delayed Villous Maturation of the Placenta: Quantitative Assessment in Different Cohorts

Abstract: CitationDelayed villous maturation of the placenta: quantitative assessment in different cohorts., 16 (2)

Cited by 30 publications

References 20 publications

Hypoplastic left heart syndrome is associated with structural and vascular placental abnormalities and leptin dysregulation

Hypoplastic left heart syndrome is associated with structural and vascular placental abnormalities and leptin dysregulation

Re‐view and view on maturation disorders in the placenta

Image-Based Modeling of Blood Flow and Oxygen Transfer in Feto-Placental Capillaries

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