Occult fetomaternal hemorrhage in women with pathological placenta with respect to permeability

Abstract

Aim: Women with preeclampsia, placenta previa (PP), placental abruption (PA), and placental mesenchymal dysplasia (PMD) were suggested to have placental permeability dysfunction. This study was performed to determine whether occult fetomaternal hemorrhage (FMH) is common in women with such complications and in women with non-reassuring fetal status (NRFS).Methods: Forty-one antenatal and 39 postnatal blood samples were obtained from 46 women consisting of 11 with complications (5, 3, 2, and 1 with preeclampsia, PP, PA, and PMD, respectively) and 35 controls without such complications. To estimate amount of fetal red blood cells (RBC), flow cytometry was performed using the FCC system with two antibodies against fetal hemoglobin (HbF) and carbonic anhydrase and the β-γ system with two monoclonal antibodies against hemoglobin β-chain and hemoglobin γ-chain (Hb-γ). A diagnosis of FMH was made when the fraction size of the isolated cell population on scatter plots expressing HbF alone or Hb-γ alone accounted for ≥ 0.02% of the total cell population on scatter plots.Results: FMH was identified in five women, including one each with preeclampsia, PA, PP, PMD, and no complications. Thus, the prevalence rate of FMH was significantly higher in women with complications than in controls (36% [4/11] vs. 2.9% [1/35], respectively, P = 0.009). The FMH occurrence rate did not differ between women with and without NRFS (7.7% [1/13] vs. 12% [4/33], respectively, P = 1.000). Conclusions:The risk of fetal RBC trafficking into the maternal circulation may be increased in women complicated with preeclampsia, PA, PP, and PMD.

Placental mesenchymal dysplasia with a good outcome: A case report

“…And the prospective risk of stillbirth with PMD was significantly high at any GW of 24 or later with median GW of 31 . In addition, as one of the specific causes of IUFD with PMD, fetomaternal hemorrhage is suggested . And, four IUFD/stillbirth cases out of 27 PMD cases (14.8%) seemed consistent with the rate as the complication of PMD based on previous studies .…”

A rat model of placental inflammation explains the unexplained elevated maternal serum alpha‐fetoprotein associated with adverse pregnancy outcomes

“…Pre‐eclampsia, stillbirth, fetal growth restriction and preterm birth are currently considered as placenta‐mediated disorders . A number of studies revealed that placental barrier dysfunction might occur in these disorders . Furthermore, it was found in animal studies that LPS could compromise placental barrier integrity and affect its permeability .…”

“…9,21 A number of studies revealed that placental barrier dysfunction might occur in these disorders. [22][23][24] Furthermore, it was found in animal studies that LPS could compromise placental barrier integrity and affect its permeability. 25,26 It was also observed in the in vitro study that inflammatory cytokines could weaken the placental barrier through destruction of tight junctions at trophoblastic and endothelial cells.…”

First-trimester maternal serum alpha-fetoprotein is not a good predictor for adverse pregnancy outcomes: a retrospective study of 3325 cases

“…Preterm birth, preeclampsia and SGA are currently considered as "placenta-mediated" disorders [28][29][30]. A series of evidences indicated that increased placental permeability might occur in these disorders [31][32][33]. Therefore, we may infer that, starting from the end of the first trimester when the primitive placenta undergoes remodeling to form the definitive organ [34], the increase in placental permeability is a gradually developed process under certain pathological conditions.…”