Ischemic placental syndrome – prediction and new disease monitoring

Abstract

The last decade has seen an improved understanding of the cause of the development of pathologies such as gestational hypertension, preeclampsia, intrauterine growth restriction, intrauterine fetal death or placental abruption. Nowadays, we know that most conditions within this group share the same pathogenesis, the cause of which is placental ischemia. The following review is an attempt to propose a new method for prediction, diagnosis and--above all--appropriate monitoring of pregnant women and fetuses developing the ischemic placental syndrome with the use of tests that are new but yet widely available in clinical diagnosis. They are closely related to the condition's pathogenesis, therefore their elevated levels may predate clinical symptoms, and--most importantly--they correlate with syndrome aggravation and the occurrence of complications. Perhaps, the new look will allow us to improve perinatal results by reducing mortality and severe complications in pregnant women and fetal deaths resulting from sudden intrauterine fetal death or placental abruption.

Adverse maternal and neonatal outcomes among singleton pregnancies in women of very advanced maternal age: a retrospective cohort study

“…The primary outcome was a composite of preeclampsia, intrauterine growth retardation (IUGR), placental abruption and stillbirth, also known as ischemic placental diseases [22]. Placental ischemia is a consequence of impaired trophoblast invasion and too shallow spiral artery conversion that may develop preeclampsia, IUGR, placental abruption and part of stillbirth [23].…”

Uteroplacental vascular syndromes: Theories, hypotheses and controversies

“…In an unselected population the rate is 2% [7,8]. South African data just published is dramatically worse [4].…”

“…Intrauterine growth restriction (IUGR) depending on the definition -this being the most controversial. The term "Uteroplacental vascular syndromes" (UPVS's) is a one which has been previously been called the 'Great Obstetrical Syndromes' [1], maternal placental syndromes [2], placental syndromes [3] and ischemic placental syndrome [4]. Uteroplacental vascular syndromes better describes the true nature of the pathophysiology of the disease process.…”

“The First Thousand Days” Define a Fetal/Neonatal Neurology Program

“…Fetal growth restriction ( 64 ), altered amniotic fluid volumes ( 65 ), hydrops fetalis ( 66 ), and systemic non-cardiac anomalies ( 67 ) exemplify trimester-specific biomarkers associated with potential fetal brain injury. Disease pathways include collectively ischemic placental syndromes (IPS) ( 68 ), often superimposed on earlier placental inflammatory disorders resulting from MIA ( 41 ). Reduced placental size and/or dysfunction of the developing chorionic villous system compromise fetal nutrient/waste removal and deprive multiple neuroactive substances required for healthy fetal brain development ( 69 ).…”

“…Common disease pathways alter the developing placental vasculature, mediated by G × E interactions of leucocytes and macrophages beginning with trophoblastic development ( 87 , 88 ) during implantation. GOS are represented by the IPS ( 68 ) resulting in shallow and incomplete remodeling of spiral arteries ( Figures 5A,B ). Chronic asphyxial conditions from the GOS contribute to brain injuries later in the third trimester, during labor and delivery, as the GNNS and during childhood following postnatal illnesses that later further injure brain.…”