Outstanding clinical and research questions in complex twin and multiple pregnancy

Townsend, Rosemary; Khalil, Asma

doi:10.1002/pd.6067

Cited by 4 publications

(3 citation statements)

References 27 publications

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“…Зміни плацентарних структур відіграють важливу роль у розвитку настання передчасної пологової діяльності. Інформація, що одержана під час його дослідження, абсолютно необхідна для повноцінного висновку про причини, механізм близьких і віддалених наслідків патології вагітності [20][21][22][23][24][25].…”

Section: результати дослідження та їх обговоренняunclassified

Immunohistochemical features of expression of progesterone receptors of placental structures in premature birth

Tkalich

Poladych

2022

RHW

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The objective: to study the immunohistochemical features of placenta in women with premature birth in 28–33 weeks of pregnancy. Materials and methods. 120 pregnant women (the main group) who were hospitalized and delivered in the Kyiv Perinatal Center during 2018–2020 at a gestation period of 23–33 weeks were examined. The women of the main group were divided into two subgroups depending on the term of birth – the 1st group included patients who delivered at 23–28 weeks of pregnancy, the patients of the 2nd group had labors at 29–33 weeks. Placentas of women in the main group were examined using morphological (histological method – staining with hematoxylin and eosin and van Gieson) and immunohistochemical methods (indirect streptavidin-peroxidase method for determining the expression level of progesterone receptors – PR). Results. Premature maturation of chorionic villi was found in 40 % of placentas of women in the 1st group 1, in 20 % – blood circulation disorders and the presence of acute inflammatory infiltration in the fetal membranes, decidual and chorionic membranes, 10 % – pathological immaturity of the placenta according to the variant of chaotic sclerosed villi. During the immunohistochemical study of RP, an unexpressed reaction was found in the epithelium and stromal cells of stem, intermediate and terminal villi – 1 point; in fetal membranes and extravillous cytotrophoblast – 2 points; in the endothelium of vessels – 0–1 point. In the placentas of women in the 2nd group premature maturation of villi was found in 70 % of cases, pseudoinfarcts of villi which are embedded in fibrinoid occupying a significant area – 45 %, afunctional zones – 55 %, blood circulation disorders – 35 %, pathological immaturity placenta according to the variant of chaotic, sclerosed villi – 20 %, acute inflammatory infiltration in the fetal membranes – 15 %. Immunohistochemical analysis of the placental barrier revealed the highest expression of RP in the nuclei of decidual cell which belong to the maternal structure. It should be noted the presence of expression of progesterone receptors in stem villi, fibroblasts and nuclei of the vessel wall. Minimal or absent expression was determined in the nuclei of other villous structures and their vessels. Conclusions. It was established that the receptivity of progesterone has its own characteristics in placental structures depending on the gestation period, which is an important factor in the choice of management for the prevention and reduction of perinatal losses for this contingent of pregnant women.

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Section: результати дослідження та їх обговоренняunclassified

Immunohistochemical features of expression of progesterone receptors of placental structures in premature birth

Tkalich

Poladych

2022

RHW

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“…Перебіг БВ у результаті ДРТ відрізняється від одноплідної вагітності через часті випадки ускладнень, таких як анемія, прееклампсія, невиношування, порушення положення та розташування плода, дисфункція плаценти, затримка розвитку плода, нерівномірний ріст плода, відмінності в розмірах при народженні та вроджені аномалії розвитку плода [3]. За даними Associations of Reproducologistsу, у 72% жінок вагітність перебігає без ускладнень і приводить народження живих дітей, при цьому в 28-46% випадків БВ унаслідок застосування ДРТ закінчується передчасними пологами [1,11]. Частота мимовільних викиднів у терміні до 12 тижнів вагітності досягає 30-54%, із яких 75% мають обтяжений, не тільки акушерсько-гінекологічний, але й соматичний анамнез [4,5].…”

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Expression of progesterone receptors in multiple pregnancy

Poladich,

Kostenko

2023

UJHW

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Hormonal disorders, specifically progesterone insufficiency, constitute the primary cause of pregnancy loss. The role of progesterone insufficiency in the genesis of obstetric and gynecological losses is actively discussed worldwide. Progesterone and the quantity of its receptors play a crucial role in the maintenance and prolongation of pregnancy. The placenta, being the main site of progesterone synthesis, represents a significant source of information and serves as an essential diagnostic object. The obtained data during placental research are indispensable for understanding the etiopathogenic changes in pregnancy loss in the case of multiple pregnancies. Purpose - to analyze the immunohistochemical changes in the expression of progesterone receptors in placental structures of parturients with dichorionic diamniotic twins depending on the method of conception. Materials and methods. We conducted a clinical-statistical analysis of the course of pregnancy and childbirth in women with multiple pregnancies induced by assisted reproductive technologies (ART). To determine the expression of progesterone receptors, immunohistochemical research of placentas from women with dichorionic and diamniotic twins resulting from ART was carried out. Results.The study revealed that women with multiple pregnancies induced by ART had a complicated somatic and obstetric-gynecological history, which subsequently negatively influenced the outcomes and course of pregnancy. A complicated pregnancy not only affects the process of childbirth but also the timing of delivery, as premature births in multiple pregnancies occur twice as often as in singleton pregnancies. Immunohistochemical analysis of the placenta showed the highest quantity of progesterone receptors and their expression in the nuclei of decidual cells (50%) of the maternal structure of the placenta in women with dichorionic and diamniotic twins resulting from ART. Conclusions.The obtained data on the expression of progesterone receptors indicate an evident connection between structural interactions of the placenta and endometrium, which is a key component in the advisability of prescribing progesterone therapy for the prevention of obstetric and perinatal losses. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

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“…In an introductory commentary piece, Drs Townsend and Khalil highlight how gaps in our knowledge of twin pregnancies limit our ability to care optimally for these pregnancies, 8 and they present a research agenda, developed in collaboration with patients, to move forward. Important topics include prevention of preterm birth, prevention of maternal morbidity, and prevention of complications specific to monochorionic twins.…”

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confidence: 99%

Complex multiple pregnancies: what's new?

Mieghem

2021

Prenatal Diagnosis

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This issue of the journal is specifically dedicated to complicated multiple pregnancies and gathers some of the latest research in the field. The incidence of twins and higher order multiples has been rising over the past decades, partly due to an increased use assisted reproductive technologies (ART). The latter particularly leads to a higher incidence of monochorionic twins, which occur spontaneously in 0.4% of the total population but in about 2% of all pregnancies conceived after ART. 1 Monochorionic twins have much higher rates of complications than dichorionic twins due to their specific placental angioarchitecture which can lead to complications such as twin-twin transfusion syndrome (TTTS; in 10%-15% of cases), 2 selective growth restriction (sIUGR; in 15% of cases), 2 twin-anemia-polycythemia sequence (TAPS; in 4% of cases) 3 and twin-reversed-arterialperfusion syndrome (TRAP; in 1%-2%). 4 Thanks to close surveillance strategies, the detection rates of these anomalies have improved significantly 5 and this has allowed for the introduction of treatments such as fetoscopic laser ablation of placental anastomoses, 6 bipolar cord occlusion and radiofrequency ablation. 7

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Outstanding clinical and research questions in complex twin and multiple pregnancy

Cited by 4 publications

References 27 publications

Immunohistochemical features of expression of progesterone receptors of placental structures in premature birth

Immunohistochemical features of expression of progesterone receptors of placental structures in premature birth

Expression of progesterone receptors in multiple pregnancy

Complex multiple pregnancies: what's new?

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